Bosshard G, Faisst K, Fischer S, Minder R, Zellweger U, Tschopp A, Gutzwiller F, Bär W
Institut für Rechtsmedizin der Universität Zürich, Zürich.
Dtsch Med Wochenschr. 2005 Dec 16;130(50):2887-92. doi: 10.1055/s-2005-923321.
There have not been any comprehensive data from German-speaking countries on the medical practice of withholding or withdrawing treatment at the end of life. This study from the German-speaking part of Switzerland provides the first in-depth analysis in this field. This study is based on data from this region and is a contribution to a large empirical research project on medical end-of-life decisions in 6 European countries (EURELD).
Continuous random samples (n = 4991) were taken from all deaths in the German-speaking part of Switzerland that had been reported to the Swiss Federal Office of Statistics between June and October 2001. Doctors who had been attending the deceased person were asked to complete mailed questionnaires, their replies being kept strictly anonymous.
The response rate was 67 %. Medications were withheld or withdrawn in 48 % of all treatments forgone: among these, antibiotics accounted for 17 %. Other potentially life-sustaining medical measures forgone included artificial hydration (12 %), surgery (7 %), artificial feeding (6 %), chemotherapy (6 %), diagnostic tests (4 %), hospital admissions (3 %), renal dialysis (2 %), blood product infusions (2 %), intubation (2 %), ventilation (2 %), resuscitation (2 %), and radiotherapy (1 %). 43 % of all treatments were forgone in patients who died in hospital, 42 % in nursing homes, and 15 % at home. In almost three-quarters (73 %) of the treatments forgone, a primary-care doctor had ordered the treatment to be withheld or withdrawn. On average, forgoing treatment led to a life-shortening effect of more than one month in 8 % of all cases. The proportion was higher for renal dialysis (25 %), blood products infusion (18 %), and diagnostic tests (16 %).
Forgoing life-sustaining medical treatment comprises a wide range of decisions taken in many different clinical settings. In most cases the likely lifespan is only slightly shortened.
来自德语国家的关于临终时停止或撤销治疗的医疗实践，尚无任何全面数据。这项来自瑞士德语区的研究首次对该领域进行了深入分析。本研究基于该地区的数据，是对一项关于欧洲6个国家临终医疗决策的大型实证研究项目（EURELD）的贡献。
从2001年6月至10月间向瑞士联邦统计局报告的瑞士德语区所有死亡病例中连续随机抽取样本（n = 4991）。要求照料死者的医生填写邮寄的问卷，他们的回复严格保密。
回复率为67%。在所有放弃的治疗中，48%的治疗被停止或撤销用药：其中抗生素占17%。其他被放弃的可能维持生命的医疗措施包括人工补液（12%）、手术（7%）、人工喂养（6%）、化疗（6%）、诊断检查（4%）、住院（3%）、肾透析（2%）、输血（2%）、插管（2%）、通气（2%）、复苏（2%）以及放疗（1%）。43%的治疗在医院死亡的患者中被放弃，42%在养老院，15%在家中。在几乎四分之三（73%）被放弃的治疗中，由初级保健医生下令停止或撤销治疗。平均而言，在所有病例中，8%的放弃治疗导致生命缩短超过一个月。肾透析（25%）、输血（18%）和诊断检查（16%）的这一比例更高。
放弃维持生命的医疗治疗包含在许多不同临床环境中做出的广泛决策。在大多数情况下，可能的寿命仅略有缩短。
