Continuous sedation until death in nursing homes in Flanders, Belgium: Palliative sedation or slow euthanasia?

Sam Rys, Johan Bilsen, European Public Health Association (Redacteur)

Onderzoeksoutput: Meeting abstract (Journal)

Samenvatting

Background
Continuous Sedation until Death (CSD), the removal of consciousness of an incurably ill patient until death, has become a controversial topic of medical-ethical debate. Some describe CSD as 'palliative sedation' (PS); a treatment with the aim of relieving suffering, not shortening the patient's life. Others claim that CSD is frequently misused to perform 'slow euthanasia' (SE); the administration of sedation with the intention to hasten death gradually. Given the increasing rate of CSD in nursing homes in Flanders (Belgium), and the significant low rate of legal euthanasia, this study wants to examine to what extent CSD amounts to either PS or SE, as well as the characteristics associated with these different practices.
Methods
A questionnaire was sent to all coordinating and advisory physicians of nursing homes in Flanders (n=660). The questionnaire contained questions on the patient these physicians had most recently treated with CSD.
Results
The response rate was 57.3%. A case of CSD was reported by 159 physicians (42.1%). According to the reported intentions involved, 62.2% of these cases can be considered as PS (no life-shortening intentions reported), while 37.8% of the cases can be characterized as SE (life-shortening intentions reported). Factors such as palliative care training, education on CSD, or knowledge of sedation guidelines did not affect the outcome distribution (PS or SE). In SE, the patient has a longer life expectancy, is more competent, is clearly longing for death, and requests for euthanasia more frequently. Physicians preferred SE over legal euthanasia: to avoid the legal procedure, because they or the patient preferred sedation, or because legal euthanasia was not allowed by the nursing home's policy.
Conclusions
CSD is frequently used as a substitute for legal euthanasia in nursing homes in Flanders. This raises a serious public health issue; as such cases are not subject to any societal control -unlike legal euthanasia. Our findings do not support the role of education on CSD (or palliative care in general) in preventing the abuse of CSD.

Main messages
- Slow euthanasia is a common practice in nursing homes in Flanders
- Palliative care education or sedation guidelines have no impact on the prevention of slow euthanasia.
Originele taal-2English
Pagina's (van-tot)187-188
Aantal pagina's2
TijdschriftEuropean Journal of Public Health
Volume23
StatusPublished - 2013
EvenementUnknown -
Duur: 1 jan 2013 → …

Bibliografische nota

European Public Health Association

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