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Abstract
Background
The purpose of this study is to examine the frequency of decisions to forgo -withhold or withdraw- artificial nutrition or hydration (ANH) at the end of life in Belgium and to describe background characteristics of the patients and the decision making process.
Methods
Postal questionnaires regarding end-of-life decisions (including ANH) were mailed to physicians certifying a large representative sample (n=6927) of Belgian death certificates in 2007.
Results
Response rate was 58.4%. A decision to forgo ANH occurred in 6.6% of all deaths (4.2% withheld, 3.0% withdrawn). Being female, dying in a care home or hospital, and suffering from nervous system diseases (including dementia) or malignancies were the most important patient-related factors positively associated with a decision to forgo ANH. Physicians indicated that the decision to forgo ANH had had some life-shortening effect in 77% of cases, and estimated this effect at one week or more in 21%. Forgoing ANH was requested by the patient in 10%. Not consulting with the patient was mostly due to incompetence (coma or dementia). The family and other caregivers were mostly involved in the decision making.
Conclusion
An important proportion of deaths in Belgium are preceded by a decision to forgo ANH. These are ethically challenging decisions for all involved as nourishment epitomizes the basic care for a person in need and ANH decisions impact on patients' longevity. The finding that only 10% of patients themselves requested ANH to be forgone means that the family and care team are mostly burdened with these decisions. Though physicians in Belgium are legally entitled to withhold or withdraw any clinically 'pointless' treatment on their own accord, the gravity of ANH decisions calls for a model of shared decision making, preferably with the patient. Developing a protocol for timely discussion (particularly in institutional end-of-life care settings) may help to ensure such a decision model.
The purpose of this study is to examine the frequency of decisions to forgo -withhold or withdraw- artificial nutrition or hydration (ANH) at the end of life in Belgium and to describe background characteristics of the patients and the decision making process.
Methods
Postal questionnaires regarding end-of-life decisions (including ANH) were mailed to physicians certifying a large representative sample (n=6927) of Belgian death certificates in 2007.
Results
Response rate was 58.4%. A decision to forgo ANH occurred in 6.6% of all deaths (4.2% withheld, 3.0% withdrawn). Being female, dying in a care home or hospital, and suffering from nervous system diseases (including dementia) or malignancies were the most important patient-related factors positively associated with a decision to forgo ANH. Physicians indicated that the decision to forgo ANH had had some life-shortening effect in 77% of cases, and estimated this effect at one week or more in 21%. Forgoing ANH was requested by the patient in 10%. Not consulting with the patient was mostly due to incompetence (coma or dementia). The family and other caregivers were mostly involved in the decision making.
Conclusion
An important proportion of deaths in Belgium are preceded by a decision to forgo ANH. These are ethically challenging decisions for all involved as nourishment epitomizes the basic care for a person in need and ANH decisions impact on patients' longevity. The finding that only 10% of patients themselves requested ANH to be forgone means that the family and care team are mostly burdened with these decisions. Though physicians in Belgium are legally entitled to withhold or withdraw any clinically 'pointless' treatment on their own accord, the gravity of ANH decisions calls for a model of shared decision making, preferably with the patient. Developing a protocol for timely discussion (particularly in institutional end-of-life care settings) may help to ensure such a decision model.
| Original language | English |
|---|---|
| Pages (from-to) | 5 |
| Number of pages | 1 |
| Journal | Eur J Pall Care |
| Issue number | EAPC abstract book |
| Publication status | Published - 1 Jul 2013 |
| Event | Unknown - Duration: 1 Jul 2013 → … |
Keywords
- end-of-life care
Fingerprint
Dive into the research topics of 'Forgoing artificial nutrition or hydration (ANH) at the end of life in Belgium'. Together they form a unique fingerprint.Projects
- 1 Finished
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IWT323: Monitoring the quality of end-of-life care in Flanders (MELC-study)
Leemans, K., Deliens, L., Bilsen, J., Cohen, J., Van den Block, L., Meeussen, K., Chambaere, K., Smets, T., Houttekier, D., Pousset, G. & Van Wesemael, Y.
1/09/06 → 31/08/10
Project: Fundamental