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Study highlights increasing use of
continuous deep sedation in the Netherlands
Newswise — The use of continuous deep sedation for patients nearing
death in the Netherlands is increasing,
while cases of euthanasia have declined,
according to a study published on bmj.com
today.
Although the exact cause of this trend is unclear, there are
indications that continuous deep sedation
may in some cases be being used as a
substitute for euthanasia.
Patients nearing death often experience distressing symptoms and
sedating drugs can be used as an option of
last resort. Sedation can be used
intermittently or continuously until death,
and the depth of sedation can vary from a
lowered state of consciousness to
unconsciousness.
The most extreme use of sedation is continuous deep sedation until
death, but there is a lack of large scale
research on its use.
In 2001, a large study in six European countries showed that
continuous deep sedation was used in up to
8.5% of all deaths, among patients with
cancer and other diseases, and provided in
as well as outside hospital.
In 2005, researchers repeated this study using a random sample of
over 6,500 deaths that occurred in the
Netherlands between August and November
2005. Physicians were surveyed about their
medical decisions for the non-sudden deaths.
The use of continuous deep sedation increased from 5.6% of deaths
in 2001 to 7.1% in 2005 (an increase of 1800
cases). The increase occurred mostly in
patients with cancer who were treated by a
general practitioner. In contrast, the use
of euthanasia decreased from 2.6% of all
deaths in 2001 to 1.7% of all deaths in 2005
(a decrease of 1200 cases).
In about four out of five of cases, sedation was induced by
benzodiazepines, and in 94% patients were
sedated for less than one week until death.
Only 9% of physicians consulted a palliative
expert.
About one in ten patients who received continuous deep sedation had
previously requested euthanasia or assisted
suicide but it had not been granted.
Possible explanations for these trends include increased knowledge
and media attention about continuous deep
sedation, say the authors. Their findings
suggest that continuous deep sedation is
increasingly considered part of regular
medical practice in the Netherlands.
They call for future research to focus on the underlying reasons
for the use of continuous deep sedation.
This study provides some insight into end of life management of
patients with intractable suffering, say
researchers in an accompanying editorial.
They believe that further research must incorporate the
perspectives of patients and families, as
well as professionals from health care,
spiritual care, social services, law and
ethics. And they call for informed public
debate about ethical and effective ways to
alleviate persistent suffering at the end of
life.
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