Overbeek Anouk, van de Wetering Veerle E, van Delden Johannes J M, Mevis Paul A M, Onwuteaka-Philipsen Bregje D, Postma Liselotte, Rietjens Judith A C, van der Heide Agnes
Department of Criminal Law, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
Ann Palliat Med. 2021 Mar;10(3):3554-3562. doi: 10.21037/apm-20-453. Epub 2020 Jul 21.
At the end of patients' lives, physicians sometimes provide medication with the explicit intention to hasten death. Physicians' assessment of such acts varies. We studied which characteristics are associated with physicians' classification of these acts.
This study concerns a secondary analysis of a nationwide study on the practice of medical decision-making at the end of life. In 2015, attending physicians of a sample of deceased people (n=9,351) received a questionnaire about end-of-life care and decision-making. The response rate was 78%. We studied 851 cases in which physicians reported that the patient had died as a result of medication they had provided with the explicit intention to hasten death. Chi-square tests and logistic regression analyses were performed.
If medication had been provided with the explicit intention to hasten death at the explicit request of the patient, physicians considered "euthanasia", "assisted suicide" or "ending of life" the most appropriate term for their course of action in 82% of all cases, while 17% of physicians chose the term "palliative or terminal sedation". Physicians' classification of their act as "euthanasia", "assisted suicide" or "ending of life" was less likely when patients had a short (1-7 days) or very short (max. 24 hours) life expectancy. Furthermore, such classification was less likely when their act had involved the use of other medication than muscle relaxants. The limited number of cases in which patients had been provided with medication without an explicit patient request were never classified as "euthanasia", "assisted suicide" or "ending of life".
Physicians rarely classify the provision of medication with the explicit intention of hastening death as "euthanasia", "assisted suicide" or "ending of life" when patients are in the dying phase and when they provide other medication than muscle relaxants. In these cases, acts are mostly classified as "palliative or terminal sedation". This suggests that the legal distinction between euthanasia and palliative care may not always be clear in clinical practice.
在患者生命末期，医生有时会出于加速死亡的明确意图而提供药物。医生对这类行为的评估各不相同。我们研究了哪些特征与医生对这些行为的分类有关。
本研究涉及对一项关于临终医疗决策实践的全国性研究的二次分析。2015年，对一部分已故患者（n = 9351）的主治医生进行了关于临终护理和决策的问卷调查。回复率为78%。我们研究了851例医生报告患者因他们出于加速死亡的明确意图而提供的药物导致死亡的案例。进行了卡方检验和逻辑回归分析。
如果是应患者明确要求出于加速死亡的明确意图而提供药物，在所有案例中，82%的医生认为“安乐死”“协助自杀”或“结束生命”是对其行为过程最合适的术语，而17%的医生选择“姑息性或终末期镇静”这一术语。当患者预期寿命较短（1 - 7天）或非常短（最长24小时）时，医生将其行为归类为“安乐死”“协助自杀”或“结束生命”的可能性较小。此外，当行为涉及使用除肌肉松弛剂之外的其他药物时，这种分类的可能性也较小。在没有患者明确要求而给患者提供药物的案例数量有限，这些案例从未被归类为“安乐死”“协助自杀”或“结束生命”。
当患者处于濒死阶段且医生提供的是除肌肉松弛剂之外的其他药物时，医生很少将出于加速死亡的明确意图而提供药物的行为归类为“安乐死”“协助自杀”或“结束生命”。在这些情况下，行为大多被归类为“姑息性或终末期镇静”。这表明在临床实践中，安乐死和姑息治疗之间的法律区别可能并不总是清晰的。
