Deliens L, Mortier F, Bilsen J, Cosyns M, Vander Stichele R, Vanoverloop J, Ingels K
Department of Medical Sociology and Health Sciences, Free University of Brussels, Belgium.
Lancet. 2000 Nov 25;356(9244):1806-11. doi: 10.1016/s0140-6736(00)03233-5.
Our study is a repeat of the Dutch death-certificate study on end-of-life decisions (ELDs). The main objective was to estimate the frequency of euthanasia (the administration of lethal drugs with the explicit intention of shortening the patient's life at the patient's explicit request), physician-assisted suicide (PAS), and other ELDs in medical practice in Flanders, Belgium.
A 20% random sample of 3999 deaths was selected from all deaths recorded between Jan 1 and April 30, 1998. The physicians who signed the corresponding death certificates received one questionnaire by post per death.
The physicians' response rate was 1355 (52%). 1925 deaths were described. The results were corrected for non-response bias, and extrapolated to estimated annual rates after seasonal adjustment for death causes, and we estimate that 705 (1.3%, 95% CI 1.0-1.6) deaths resulted from euthanasia or PAS. In 1796 (3.2%, 2.7-3.8) cases, lethal drugs were given without the explicit request of the patient. Alleviation of pain and symptoms with opioids in doses with a potential life-shortening effect preceded death in 10,416 (18.5%, 17.3-19.7) cases and non-treatment decisions in 9218 (16.4%, 15.3-17.5) cases, of which 3261 (5.8%, 5.1-6.5) with the explicit intention of ending the patient's life.
ELDs are prominent in medical practice in Flanders. The frequency of deaths preceded by an ELD is similar to that in the Netherlands, but lower than that in Australia. However, in Flanders the rate of administration of lethal drugs to patients without their explicit request is similar to Australia, and significantly higher than that in the Netherlands.
我们的研究是对荷兰临终决定（ELDs）死亡证明研究的重复。主要目的是估计比利时弗拉芒地区医疗实践中安乐死（应患者明确要求给予致命药物以明确缩短患者生命）、医生协助自杀（PAS）及其他临终决定的发生率。
从1998年1月1日至4月30日记录的所有死亡病例中随机抽取20%（3999例死亡）作为样本。为每例死亡向签署相应死亡证明的医生邮寄一份问卷。
医生的回复率为1355例（52%）。共描述了1925例死亡。对无回复偏倚进行了校正，并在对死因进行季节性调整后外推至估计的年发生率，我们估计705例（1.3%，95%可信区间1.0 - 1.6）死亡是由安乐死或医生协助自杀导致的。在1796例（3.2%，2.7 - 3.8）病例中，在未得到患者明确要求的情况下给予了致命药物。在10416例（18.5%，17.3 - 19.7）病例中，在死亡前使用了具有潜在缩短生命作用剂量的阿片类药物来缓解疼痛和症状，在9218例（16.4%，15.3 - 17.5）病例中做出了不进行治疗的决定，其中3261例（5.8%，5.1 - 6.5）明确意图是结束患者生命。
临终决定在弗拉芒地区的医疗实践中很突出。由临终决定导致的死亡发生率与荷兰相似，但低于澳大利亚。然而，在弗拉芒地区，在未得到患者明确要求的情况下向患者给予致命药物的比例与澳大利亚相似，且显著高于荷兰。
