End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.
Department of Internal Medicine, Ghent University, Ghent, Belgium.
Eur J Epidemiol. 2018 Jul;33(7):689-693. doi: 10.1007/s10654-018-0397-5. Epub 2018 Apr 21.
Death certificates are the main source of information on the incidence of the direct and underlying causes of death, but may be unsuitable for monitoring the practice of medical assistance in dying, e.g. euthanasia, due to possible underreporting. This study examines the accuracy of certification of euthanasia.
Mortality follow-back survey using a random sample of death certificates (N = 6871). For all cases identified as euthanasia we checked whether euthanasia was reported as a cause of death on the death certificate. We used multivariable logistic regression analysis to evaluate whether reporting varied according to patient and decision-making characteristics.
Through the death certificates, 0.7% of all deaths were identified as euthanasia, compared with 4.6% through the mortality follow-back survey. Only 16.2% of the cases identified from the survey were reported on the death certificate. Euthanasia was more likely to be reported on the death certificate where death was from cancer (14% covered), neurological diseases (22%) and stroke (28%) than from cardiovascular disease (7%). Even when the recommended drugs were used or the physician self-labelled the end-of-life decision as euthanasia, euthanasia was only reported on the death certificate in 24% of cases.
Death certificates substantially underestimate the frequency of euthanasia as a cause of death in Belgium. Mortality follow-back studies are essential complementary instruments to examine and monitor the practice of euthanasia more accurately. Death certificate forms may need to be modified and clear guidelines provided to physicians about recording euthanasia to ensure more accurate certification.
死亡证明是直接和根本死因发病情况的主要信息来源，但由于可能存在漏报，其可能并不适合监测安乐死（例如安乐死）的实施情况。本研究旨在检验安乐死认证的准确性。
采用随机抽取死亡证明的死亡率回溯调查（N=6871）。对于所有被认定为安乐死的案例，我们均核查了死亡证明是否将安乐死列为死因。我们采用多变量逻辑回归分析来评估报告情况是否因患者和决策特征而异。
通过死亡证明，我们识别出 0.7%的死亡为安乐死，而通过死亡率回溯调查则识别出 4.6%的安乐死。调查中识别出的案例中仅有 16.2%在死亡证明上有报告。在死亡证明上报告安乐死的情况中，癌症（14%涵盖）、神经疾病（22%）和中风（28%）所致死亡比心血管疾病（7%）所致死亡更有可能报告安乐死。即使使用了推荐的药物或医生将临终决策自我标记为安乐死，在调查中也仅有 24%的案例在死亡证明上报告了安乐死。
死亡证明大大低估了比利时安乐死作为死因的频率。死亡率回溯调查是更准确地检查和监测安乐死实施情况的重要补充手段。可能需要修改死亡证明表格，并为医生提供关于记录安乐死的明确指导方针，以确保更准确的认证。
