Deliens L, Mortier F, Bilsen J, Cosyns M, Vander Stichele R, Vanoverloop J, Ingels K, Bernheim J
Service de Sociologie Médicale, Vrije Universiteit Brussel.
Rev Med Liege. 2001 Jun;56(6):443-52.
The study presented here is the first replica of the Dutch death certificate study on end of life decisions (ELDs). The main objective was to assess the incidence of euthanasia (the administration of drugs with the explicit intention to shorten the patient's life at the explicit request of the patient), physician assisted suicide (PAS), and other ELDs in medical practice in Belgium (Flanders).
A 20% random sample of 3,999 deaths was selected from all death certificates between January 1 and April 30, 1998. The physicians who signed the death certificates received one mail questionnaire per death case.
The response rate of the physicians was 52%. The results were corrected for the non response bias, and extrapolated to estimated annual incidences after seasonal adjustment for causes of death. It was estimated that 1.3% (1.0-1.6%, CI: 95) of all deaths resulted from euthanasia or PAS. In 3.2% (2.7-3.8%, CI: 95) of all cases, the physician ended the patient's life with lethal drugs 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 18.5% (17.3-19.7%, CI: 95) of cases and nontreatment decisions in 16.4% (15.3-17.5%, CI: 95) of cases, of which 5.8% (5.1-6.5%, CI: 95) with the explicit intention of ending the patient's life.
ELDs are prominent in medical practice in Belgium (Flanders). The incidence of deaths preceded by an ELD is similar to the Netherlands, but greater than in Australia. However, in Belgium (Flanders) the incidence of ending of patient's life without the patient's explicit request (3.2%, 2.7-3.8% CI: 95) is similar to Australia (3.5%, 2.7-4.3% CI: 95), but significantly higher than in the Netherlands (0.7%, 0.5-0.9% CI: 95).
本文所呈现的研究是对荷兰临终决策（ELD）死亡证明研究的首次复刻。主要目的是评估比利时（弗拉芒地区）医疗实践中安乐死（应患者明确请求给药以明确意图缩短患者生命）、医生协助自杀（PAS）及其他临终决策的发生率。
从1998年1月1日至4月30日期间的所有死亡证明中随机抽取20%（共3999例死亡）作为样本。为每份死亡病例向签署死亡证明的医生发送一份邮寄问卷。
医生的回复率为52%。对结果进行了无应答偏差校正，并在对死亡原因进行季节调整后外推至估计的年发生率。据估计，所有死亡中有1.3%（1.0 - 1.6%，95%置信区间）是由安乐死或医生协助自杀导致的。在所有病例的3.2%（2.7 - 3.8%，95%置信区间）中，医生在未得到患者明确请求的情况下使用致命药物结束了患者生命。在18.5%（17.3 - 19.7%，95%置信区间）的病例中，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16.4%（15.3 - 17.5%，95%置信区间）的病例中存在不进行治疗的决策，其中5.8%（5.1 - 6.5%，95%置信区间）明确意图是结束患者生命。
临终决策在比利时（弗拉芒地区）的医疗实践中很突出。由临终决策导致死亡的发生率与荷兰相似，但高于澳大利亚。然而，在比利时（弗拉芒地区），在未得到患者明确请求的情况下结束患者生命的发生率（3.2%，2.7 - 3.8%，95%置信区间）与澳大利亚（3.5%，2.7 - 4.3%，95%置信区间）相似，但显著高于荷兰（0.7%，0.5 - 0.9%，95%置信区间）。
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