Quick Search:

uzh logo
Browse by:
bullet
bullet
bullet
bullet

Zurich Open Repository and Archive

Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-18725

Bosshard, G; Nilstun, T; Bilsen, J; Norup, M; Miccinesi, G; van Delden, J J M; Faisst, Karin; van der Heide, A (2005). Forgoing treatment at the end of life in 6 European countries. Archives of Internal Medicine, 165(4):401-407.

[img] PDF - Registered users only
1MB

View at publisher

Abstract

BACKGROUND: Modern medicine provides unprecedented opportunities in diagnostics and treatment. However, in some situations at the end of a patient's life, many physicians refrain from using all possible measures to prolong life. We studied the incidence of different types of treatment withheld or withdrawn in 6 European countries and analyzed the main background characteristics. METHODS: Between June 2001 and February 2002, samples were obtained from deaths reported to registries in Belgium, Denmark, Italy, the Netherlands, Sweden, and Switzerland. The reporting physician was then sent a questionnaire about the medical decision-making process that preceded the patient's death. RESULTS: The incidence of nontreatment decisions, whether or not combined with other end-of-life decisions, varied widely from 6% of all deaths studied in Italy to 41% in Switzerland. Most frequently forgone in every country were hydration or nutrition and medication, together representing between 62% (Belgium) and 71% (Italy) of all treatments withheld or withdrawn. Forgoing treatment estimated to prolong life for more than 1 month was more common in the Netherlands (10%), Belgium (9%), and Switzerland (8%) than in Denmark (5%), Italy (3%), and Sweden (2%). Relevant determinants of treatment being withheld rather than withdrawn were older age (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.31-1.79), death outside the hospital (death in hospital: OR, 0.80; 95% CI, 0.68-0.93), and greater life-shortening effect (OR, 1.75; 95% CI, 1.27-2.39). CONCLUSIONS: In all of the participating countries, life-prolonging treatment is withheld or withdrawn at the end of life. Frequencies vary greatly among countries. Low-technology interventions, such as medication or hydration or nutrition, are most frequently forgone. In older patients and outside the hospital, physicians prefer not to initiate life-prolonging treatment at all rather than stop it later.

Citations

50 citations in Web of Science®
57 citations in Scopus®
Google Scholar™

Altmetrics

Downloads

2 downloads since deposited on 03 Jun 2009
0 downloads since 12 months

Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemology, Biostatistics and Prevention Institute (EBPI)
DDC:610 Medicine & health
Date:2005
Deposited On:03 Jun 2009 11:13
Last Modified:27 Nov 2013 20:45
Publisher:American Medical Association
ISSN:0003-9926
Publisher DOI:10.1001/archinte.165.4.401
Official URL:http://archinte.ama-assn.org/cgi/content/full/165/4/401
PubMed ID:15738368

Users (please log in): suggest update or correction for this item

Repository Staff Only: item control page