Continuous sedation until death with or without the intention to hasten death-a nationwide study in nursing homes in flanders, Belgium

摘要

Objectives: Continuous sedation until death (CSD), the removal of consciousness of an incurably ill patient until death, has become a controversial practice. Some consider CSD a palliative treatment, whereas others claim that CSD is frequently used with the intention to hasten death. In nursing homes in Flanders, the rate of CSD has tripled over the past decade, whereas legal euthanasia remains a rare practice. This study wants to investigate to what extent CSD is used to hasten death (CSD+) and to identify possible associated factors. Design: Nationwide cross-sectional retrospective survey, conducted in2012. Setting: Nursing homes in Flanders, Belgium. Participants: Coordinating and advisory physicians of all nursing homes in Flanders (n=660). Measurements: Physician reports of their most recent patient treated with CSD. Results: The response rate was 57.3%, and 159 of the 378 responding physicians reported a case of CSD (42.1%). According to the reported intentions involved, 62.2% of these cases were considered CSD- cases (no life-shortening pursued), whereas 37.8% were labeled CSD+ (life-shortening pursued). Physician factors such as experience in end-of-life care, palliative care training, training in sedation, or knowledge of sedation guidelines did not affect the outcome distribution (CSD- or CSD+). In CSD+, the patient has a longer life expectancy, is more competent, is clearly longing for death, and requests for euthanasia more frequently. Conclusions: In nursing homes in Flanders, CSD is frequently used to hasten the patient's death. In some cases, CSD can even be considered a substitute for legal euthanasia.