用于安乐死的药物：1998-2013 年在比利时弗兰德斯进行的一项基于人群的死亡率随访研究。

Drugs Used for Euthanasia: A Repeated Population-Based Mortality Follow-Back Study in Flanders, Belgium, 1998-2013.

机构信息

End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.

出版信息

J Pain Symptom Manage. 2018 Oct;56(4):551-559. doi: 10.1016/j.jpainsymman.2018.06.015.

DOI:10.1016/j.jpainsymman.2018.06.015

PMID:30009965

Abstract

CONTEXT

According to guideline recommendations, barbiturates and neuromuscular relaxants are the recommended drugs for euthanasia.

OBJECTIVES

To describe changes over time in drugs used to perform euthanasia and differences in case characteristics according to the drugs used.

METHODS

Repeated population-based mortality follow-back study among physicians attending a large representative sample of deaths in 1998, 2007, and 2013 in Flanders, Belgium.

RESULTS

In 1998, we identified 25 euthanasia cases (1.2% of all deaths), 142 cases in 2007 (2.0% of all deaths), and 349 cases in 2013 (4.6% of all deaths). Use of recommended drugs to perform euthanasia increased from 11.9% of euthanasia cases in 1998 to 55.3% in 2007 and 66.8% in 2013 (P < 0.001). In 2013, cases with recommended drugs compared with nonrecommended drugs more often involved requests expressed both orally and in writing (86.8%/14.1%; P < 0.001), consultation with colleague physicians (93.8%/69.1%; P < 0.001), and administration in the presence of another physician (98.3%/54.3%; P < 0.001), and were more often self-labeled by physicians as euthanasia (95.5%/0.9%; P < 0.001) and reported to the euthanasia review committee (92.3%/3.8%; P < 0.001). Between 2007 and 2013, physicians consistently labeled cases in which nonrecommended drugs were used as palliative sedation (72.8%/78.4%; P = 0.791) or alleviation of pain and symptoms (13.2%/15.0%; P > 0.999).

CONCLUSION

Physicians in Flanders are increasingly using the recommended drugs for euthanasia. This suggests that guidelines and training regarding the conduct and pharmacological aspects of euthanasia may have had important effects on the practice of euthanasia. However, the declining but persisting use of nonrecommended drugs requires further attention.

摘要

背景

根据指南建议，巴比妥类药物和神经肌肉松弛剂是实施安乐死的推荐药物。

目的

描述实施安乐死药物的使用随时间的变化，并根据所使用药物的不同，描述病例特征的差异。

方法

在比利时佛兰德地区，对参加了 1998 年、2007 年和 2013 年大规模代表性死亡研究的医生进行了一项基于人群的死亡后随访的重复研究。

结果

1998 年，我们发现 25 例安乐死病例（占所有死亡人数的 1.2%），2007 年 142 例（占所有死亡人数的 2.0%），2013 年 349 例（占所有死亡人数的 4.6%）。实施安乐死时使用推荐药物的比例从 1998 年的 11.9%上升到 2007 年的 55.3%和 2013 年的 66.8%（P<0.001）。2013 年，与未推荐药物相比，使用推荐药物的病例更常涉及口头和书面表达的请求（86.8%/14.1%；P<0.001）、与同事医生咨询（93.8%/69.1%；P<0.001）以及在另一名医生在场的情况下给药（98.3%/54.3%；P<0.001），且医生自我诊断为安乐死的比例更高（95.5%/0.9%；P<0.001），并向安乐死审查委员会报告（92.3%/3.8%；P<0.001）。在 2007 年至 2013 年期间，医生一直将未推荐药物用于姑息性镇静（72.8%/78.4%；P=0.791）或缓解疼痛和症状（13.2%/15.0%；P>0.999）的病例标记为姑息性镇静。