the doctor's dilemma between patient autonomy and physician beneficence at the end of life. : I. Illustration of the problem by comparing Flemish and Dutch epidemiological data.

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Abstract

This first of twin papers comments the recently published large-scale epidemiological study of the incidence and characteristics of end-of-life decisions (ELD) in Flanders (Belgium), and compares it with previous Dutch studies using the same strictly anonymous death-certificate based methodology, the most reliable available so far. Yet, attention is drawn to some methodological constraints and limitations: 1) by concentrating on the last-taken ELD, the end-of life process tends to be reduced to an act; 2) the model used by the studies is intentionalistic, and the method retrospective, so that they deal with what physicians state to remember having done, and with what intention, but not directly with what they objectively did, and with what consequences; 3) the patient variables (situation, information status, needs, wishes) remain largely unstudied. Such limitations can be remedied only in future prospective studies.
The studies show inverse proportional incidences of euthanasia and life- ending without explicit patient request in the Netherlands and Flanders: Dutch patients exercise more autonomy, and Flemish patient receive more paternalistic beneficence. These studies constitute empirical evidence for the competitiveness of these values in medical practice at the end of life. They lead up to the novel concept of the patient-physician information contract, a proposal for the reconciliation of conflicting values, which is described in the twin paper.
Original languageDutch
Pages (from-to)64-73
Number of pages10
JournalEthiek & Maatschappij
Volume4
Publication statusPublished - 2001

Bibliographical note

Ethiek en Maatschappij 4: 64-73; 2001

Keywords

  • Doctor-patient communication
  • End-of-Life Care
  • Covenant

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