van der Heide Agnes, Onwuteaka-Philipsen Bregje D, Rurup Mette L, Buiting Hilde M, van Delden Johannes J M, Hanssen-de Wolf Johanna E, Janssen Anke G J M, Pasman H Roeline W, Rietjens Judith A C, Prins Cornelis J M, Deerenberg Ingeborg M, Gevers Joseph K M, van der Maas Paul J, van der Wal Gerrit
Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands.
N Engl J Med. 2007 May 10;356(19):1957-65. doi: 10.1056/NEJMsa071143.
In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and other end-of-life practices.
We mailed questionnaires to physicians attending 6860 deaths that were identified from death certificates. The response rate was 77.8%.
In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001. In 73.9% of all cases of euthanasia or assisted suicide in 2005, life was ended with the use of neuromuscular relaxants or barbiturates; opioids were used in 16.2% of cases. In 2005, 80.2% of all cases of euthanasia or assisted suicide were reported. Physicians were most likely to report their end-of-life practices if they considered them to be an act of euthanasia or assisted suicide, which was rarely true when opioids were used.
The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation.
2002年，荷兰一项关于应患有无法忍受痛苦的患者请求由医生协助结束生命的法案生效。2005年，我们对安乐死、医生协助自杀及其他临终医疗行为进行了一项随访研究。
我们向从死亡证明中识别出的6860例死亡病例的主治医生邮寄了调查问卷。回复率为77.8%。
2005年，在荷兰所有死亡病例中，1.7%是安乐死所致，0.1%是医生协助自杀所致。这些比例显著低于2001年，2001年所有死亡病例中有2.6%是安乐死所致，0.2%是协助自杀所致。在所有死亡病例中，0.4%是在没有患者明确请求的情况下结束生命所致。2005年，7.1%的所有死亡病例采用了持续深度镇静并可能加速死亡，较2001年的5.6%显著增加。在2005年所有安乐死或协助自杀病例中，73.9%是使用神经肌肉阻滞剂或巴比妥类药物结束生命；16.2%的病例使用了阿片类药物。2005年，所有安乐死或协助自杀病例中有80.2%被报告。如果医生认为其临终医疗行为是安乐死或协助自杀行为，他们最有可能报告，而使用阿片类药物时很少如此。
荷兰安乐死法案实施后，安乐死和医生协助自杀的发生率略有下降。这种下降可能是由于其他临终护理干预措施（如姑息性镇静）的应用增加所致。
