Dutch doctors choose sedation rather than euthanasia
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《英国医生杂志》
Dutch doctors are sedating many terminally ill patients until death, in some cases without artificial feeding or hydration. Researchers estimate that terminal sedation occurred in about 10% of the total 14 000 deaths in 2001 (Annals of Internal Medicine 2004;141:178-85).
As sedation is considered normal medical treatment, doctors are not legally obliged to report their actions as they must in euthanasia. But terminal sedation is now seen as an alternative to euthanasia for many patients.
In most cases, the doctors?first aim was to alleviate symptoms, but in 17% of cases was an explicit intention to hasten death.
The study was funded by the Dutch government and led by Paul van der Maas, professor at the public health department of the Erasmus University Medical Centre, Rotterdam; Judith Rietjens, health researcher at the public health department of the Erasmus University Medical Centre; and Gerrit van der Wal, professor of social medicine at Amsterdam Free University Medical Centre.
The study looked specifically at terminal sedation in detail, analysing data from last year抯 national study into medical decisions at the end of life. That study included interviews with 410 doctors from a range of specialties. More than half had practised terminal sedation (defined as " the administration of drugs to keep the patient in deep sedation or coma until death without giving artificial nutrition or hydration").
In the most recent 211 cases, doctors intended to alleviate severe pain in half, reduce agitation in slightly more than a third, and help shortness of breath in slightly more than a third. Nearly 80% of patients who received sedation were aged 65 years or more, and more than half had cancer. The researchers estimated that sedation had shortened patients?lives by less than a week.
Doctors almost always discussed treatment with relatives but not always with patients, who were often no longer able to communicate. In a third of cases, patients themselves requested deep sedation.
Euthanasia, in which drugs are given to specifically end the patient抯 life, was discussed with the patient in more than a third of cases but rejected. One reason patients preferred terminal sedation was because they considered it to be less disturbing to the natural process of dying.
Professor Van der Maas said that ensuring that a dying patient remains asleep until death—mostly by giving benzodiazepines or combining these with morphine—had more or less become established medical practice. For some patients who were "suffering unbearably" it was a "relevant alternative" to euthanasia. He emphasised that the primary intention in most cases was alleviating symptoms not shortening life.
Last year the Netherlands?attorney general, Joan De Wijkerslooth, called for the legal controls on euthanasia to be extended to cover terminal sedation. The Dutch Medical Association, however, instead emphasised the need for clear professional guidelines to define terminal sedation and how doctors should act. It argued the involvement of the legal profession in a normal medical practice was a frightening prospect.(Utrecht Tony Sheldon)
As sedation is considered normal medical treatment, doctors are not legally obliged to report their actions as they must in euthanasia. But terminal sedation is now seen as an alternative to euthanasia for many patients.
In most cases, the doctors?first aim was to alleviate symptoms, but in 17% of cases was an explicit intention to hasten death.
The study was funded by the Dutch government and led by Paul van der Maas, professor at the public health department of the Erasmus University Medical Centre, Rotterdam; Judith Rietjens, health researcher at the public health department of the Erasmus University Medical Centre; and Gerrit van der Wal, professor of social medicine at Amsterdam Free University Medical Centre.
The study looked specifically at terminal sedation in detail, analysing data from last year抯 national study into medical decisions at the end of life. That study included interviews with 410 doctors from a range of specialties. More than half had practised terminal sedation (defined as " the administration of drugs to keep the patient in deep sedation or coma until death without giving artificial nutrition or hydration").
In the most recent 211 cases, doctors intended to alleviate severe pain in half, reduce agitation in slightly more than a third, and help shortness of breath in slightly more than a third. Nearly 80% of patients who received sedation were aged 65 years or more, and more than half had cancer. The researchers estimated that sedation had shortened patients?lives by less than a week.
Doctors almost always discussed treatment with relatives but not always with patients, who were often no longer able to communicate. In a third of cases, patients themselves requested deep sedation.
Euthanasia, in which drugs are given to specifically end the patient抯 life, was discussed with the patient in more than a third of cases but rejected. One reason patients preferred terminal sedation was because they considered it to be less disturbing to the natural process of dying.
Professor Van der Maas said that ensuring that a dying patient remains asleep until death—mostly by giving benzodiazepines or combining these with morphine—had more or less become established medical practice. For some patients who were "suffering unbearably" it was a "relevant alternative" to euthanasia. He emphasised that the primary intention in most cases was alleviating symptoms not shortening life.
Last year the Netherlands?attorney general, Joan De Wijkerslooth, called for the legal controls on euthanasia to be extended to cover terminal sedation. The Dutch Medical Association, however, instead emphasised the need for clear professional guidelines to define terminal sedation and how doctors should act. It argued the involvement of the legal profession in a normal medical practice was a frightening prospect.(Utrecht Tony Sheldon)