Chabot Boudewijn E, Goedhart Arnold
Oosterhoutlaan 7, 2012 RA Haarlem, Netherlands.
Soc Sci Med. 2009 May;68(10):1745-51. doi: 10.1016/j.socscimed.2009.03.005. Epub 2009 Apr 15.
Physicians may hasten death by medical decisions to end life (MDEL) that have been extensively researched. However, outside the medical domain, some individuals hasten their death by Voluntary Refusal of Food and Fluid while receiving some palliative care (VRFF) or by Independently taking Lethal Medication attended by a Confidant (ILMC). Both dying trajectories are more or less under the control of the individuals themselves. No survey data are available on how often these self-directed deaths occur in the Dutch population. We have isolated VRFF and ILMC from other dying trajectories in a population-based study employing after-death interviews with relatives, friends or nurses. Members of a research database that is representative of the Dutch population (n=31,516) were asked whether they had been a confidant in someone's decision to hasten death by VRFF or ILMC. In this sample, 144 deaths that conformed to our definitions were reported by proxies. We have computed an annual frequency of 2.1% VRFF deaths and of 1.1% ILMC deaths. The annual frequencies of VRFF and ILMC appear to be roughly the same as the yearly frequency of physician-assisted dying (1.8%). In seventy percent of those who had died by VRFF or ILMC, a diagnosis of cancer or a serious illness was reported by the informant. The proxies retrospectively described the self-directed hastening of death by both methods as a dignified death in about 75% of deaths. Both VRFF and ILMC require strenuous efforts and reflect a strong desire to control the process of dying. End-of-life research has shown that some control over the time of death is an important aspect of a 'good death' in western countries. We therefore presume that these self-directed methods for hastening death in consultation with proxies occur in other countries as well.
医生可能会通过已被广泛研究的结束生命的医疗决策（MDEL）来加速死亡。然而，在医疗领域之外，一些人在接受一些姑息治疗时通过自愿拒绝食物和液体（VRFF）或在有密友陪伴下独立服用致命药物（ILMC）来加速死亡。这两种死亡轨迹或多或少都在个人自身的控制之下。目前尚无关于荷兰人口中这些自我导向死亡发生频率的调查数据。在一项基于人群的研究中，我们通过对亲属、朋友或护士进行死后访谈，将VRFF和ILMC与其他死亡轨迹区分开来。我们询问了一个代表荷兰人口的研究数据库（n = 31,516）的成员，他们是否曾是某人通过VRFF或ILMC加速死亡决策的密友。在这个样本中，代理人报告了144例符合我们定义的死亡案例。我们计算出VRFF死亡的年发生率为2.1%，ILMC死亡的年发生率为1.1%。VRFF和ILMC的年发生率似乎与医生协助死亡的年发生率大致相同（1.8%）。在那些通过VRFF或ILMC死亡的人中，70%的人被 informant 报告患有癌症或重病。代理人回顾性地将这两种方法导致的自我导向的加速死亡描述为在大约75%的死亡案例中是有尊严的死亡。VRFF和ILMC都需要付出巨大努力，并且反映了对控制死亡过程的强烈愿望。临终研究表明，在西方国家，对死亡时间的一定控制是“善终”的一个重要方面。因此，我们推测，在与代理人协商后，这些自我导向的加速死亡方法在其他国家也会出现。
