1990 年至 2010 年荷兰安乐死立法前后末期医疗实践的趋势：一项重复的横断面调查。

Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey.

机构信息

VU University Medical Center, Department of Public and Occupational Health and EMGO Institute for Health and Care Research, VUmc Expertise Center for Palliative Care, Amsterdam, Netherlands.

出版信息

Lancet. 2012 Sep 8;380(9845):908-15. doi: 10.1016/S0140-6736(12)61034-4. Epub 2012 Jul 11.

DOI:10.1016/S0140-6736(12)61034-4

PMID:22789501

Abstract

BACKGROUND

In 2002, the euthanasia act came into effect in the Netherlands, which was followed by a slight decrease in the euthanasia frequency. We assessed frequency and characteristics of euthanasia, physician-assisted suicide, and other end-of-life practices in 2010, and assessed trends since 1990.

METHODS

In 1990, 1995, 2001, 2005, and 2010 we did nationwide studies of a stratified sample from the death registry of Statistics Netherlands, to which all deaths and causes were reported. We mailed questionnaires to physicians attending these deaths (2010: n=8496 deaths). All cases were weighted to adjust for the stratification procedure and for differences in response rates in relation to the age, sex, marital status, region of residence, and cause and place of death.

FINDINGS

In 2010, of all deaths in the Netherlands, 2·8% (95% CI 2·5-3·2; 475 of 6861) were the result of euthanasia. This rate is higher than the 1·7% (1·5-1·8; 294 of 9965) in 2005, but comparable with those in 2001 and 1995. Distribution of sex, age, and diagnosis was stable between 1990 and 2010. In 2010, 77% (3136 of 4050) of all cases of euthanasia or physician-assisted suicide were reported to a review committee (80% [1933 of 2425] in 2005). Ending of life without an explicit patient request in 2010 occurred less often (0·2%; 95% CI 0·1-0·3; 13 of 6861) than in 2005, 2001, 1995, and 1990 (0·8%; 0·6-1·1; 45 of 5197). Continuous deep sedation until death occurred more frequently in 2010 (12·3% [11·6-13·1; 789 of 6861]) than in 2005 (8·2% [7·8-8·6; 521 of 9965]). Of all deaths in 2010, 0·4% (0·3-0·6; 18 of 6861) were the result of the patient's decision to stop eating and drinking to end life; in half of these cases the patient had made a euthanasia request that was not granted.

INTERPRETATION

Our study provides insight in consequences of regulating euthanasia and physician-assisted suicide within the broader context of end-of-life practices. In the Netherlands the euthanasia law resulted in a relatively transparent practice. Although translating these results to other countries is not straightforward, they can inform the debate on legalisation of assisted dying in other countries.

FUNDING

The Netherlands Organization for Research and Development (ZonMw).

摘要

背景

2002 年，荷兰通过了安乐死法案，随后安乐死的频率略有下降。我们评估了 2010 年安乐死、协助自杀和其他临终关怀实践的频率和特征，并评估了自 1990 年以来的趋势。

方法

1990 年、1995 年、2001 年、2005 年和 2010 年，我们对荷兰统计局死亡登记处的分层样本进行了全国性研究，所有死亡和死因均在此报告。我们向参加这些死亡的医生邮寄了问卷（2010 年：n=8496 例死亡）。所有病例均经过加权处理，以调整分层程序以及与年龄、性别、婚姻状况、居住地、死因和死亡地点相关的应答率差异。

发现

2010 年，荷兰所有死亡中，有 2.8%（95%CI 2.5-3.2；6861 例中的 475 例）是安乐死的结果。这一比例高于 2005 年的 1.7%（9965 例中的 294 例），但与 2001 年和 1995 年相似。1990 年至 2010 年，性别、年龄和诊断的分布保持稳定。2010 年，所有安乐死或协助自杀病例中，有 77%（4050 例中的 3136 例）向审查委员会报告（2005 年为 80%[2425 例中的 1933 例]）。2010 年，没有明确患者请求的结束生命的情况比 2005 年、2001 年、1995 年和 1990 年（0.8%[5197 例中的 45 例]）更少见（0.2%[6861 例中的 13 例]）。2010 年，持续深度镇静直至死亡的情况更为常见（12.3%[6861 例中的 789 例]），高于 2005 年（8.2%[9965 例中的 521 例]）。2010 年，所有死亡中，有 0.4%（0.3-0.6；6861 例中的 18 例）是由于患者决定停止进食和饮水以结束生命；在这些病例中，有一半患者提出了未获批准的安乐死请求。