Groenewoud J H, van der Heide A, Kester J G, de Graaff C L, van der Wal G, van der Maas P J
Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
Arch Intern Med. 2000 Feb 14;160(3):357-63. doi: 10.1001/archinte.160.3.357.
Decisions to withhold or withdraw life-prolonging treatment in terminally ill patients are common in some areas of medical practice. Information about the frequency and background of these decisions is generally limited to specific clinical settings. This article describes the practice of withholding or withdrawing life-prolonging treatment in the Netherlands.
Questionnaires were sent to the attending physicians of a stratified sample of 6060 of all 43002 cases of death in the Netherlands from August 1 through November 30, 1995. The questions concerned the treatments foregone, the patient characteristics, and the decision-making process. The response rate was 77%.
A nontreatment decision was made in 30% (95% confidence interval, 28%-31%) of all deaths in the Netherlands in 1995; this is an increase compared with 28% (95% confidence interval, 26%-29%) in 1990; in 20% of all deaths, this decision was the most important end-of-life decision. Artificial nutrition or hydration and antibiotics were the treatments most frequently foregone, each accounting for 25% of cases in which a nontreatment decision was made. Nursing-home physicians withheld or withdrew treatment more often than clinical specialists or general practitioners in 52%, 35%, and 17% of all deaths they were involved with, respectively. Of the patients in whom a nontreatment decision was the most important end-of-life decision, 26% were competent; of those, 93% were involved in the decision making. In 17% of patients, the nontreatment decision was made without being discussed with the patient or the patient's relatives and without knowledge of the patient's wishes. Life was shortened by an estimated 24 hours or less in 42% and 1 month or more in 8% of patients.
Decisions to forego life-prolonging treatment are frequently made end-of-life decisions in the Netherlands and may be increasing. Most of these decisions do not involve high-technology treatments, and the consequences, in terms of shortening of life, are relatively small.
在某些医疗实践领域，决定对绝症患者停止或撤销延长生命的治疗是很常见的。关于这些决定的频率和背景信息通常仅限于特定的临床环境。本文描述了荷兰停止或撤销延长生命治疗的做法。
向1995年8月1日至11月30日荷兰43002例死亡病例中分层抽样的6060例患者的主治医生发送问卷。问题涉及放弃的治疗、患者特征和决策过程。回复率为77%。
1995年荷兰所有死亡病例中有30%（95%置信区间，28%-31%）做出了不进行治疗的决定；与1990年的28%（95%置信区间，26%-29%）相比有所增加；在所有死亡病例的20%中，这一决定是最重要的临终决定。人工营养或补液以及抗生素是最常被放弃的治疗，在做出不进行治疗决定的病例中各占25%。养老院医生在其参与的所有死亡病例中，分别有52%、35%和17%的情况比临床专科医生或全科医生更频繁地停止或撤销治疗。在不进行治疗的决定是最重要的临终决定的患者中，26%具有行为能力；其中93%参与了决策。在17%的患者中，不进行治疗的决定是在未与患者或其亲属讨论且不了解患者意愿的情况下做出的。估计有42%的患者生命缩短了24小时或更少，8%的患者生命缩短了1个月或更长时间。
在荷兰，放弃延长生命治疗的决定是常见且可能在增加的临终决定。这些决定大多不涉及高科技治疗，就缩短生命而言，后果相对较小。
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