BMJ  2008;336:810-813 (12 April), doi:10.1136/bmj.39504.531505.25 (published 14 March 2008)

Research

Continuous deep sedation for patients nearing death in the Netherlands: descriptive study

¹ Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands, ² Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands, ³ Department of Public and Occupational Health, Institute for Research in Extramural Medicine, VU University Medical Centre, 1081 BT Amsterdam, Netherlands

Objectives To study the practice of continuous deep sedation in 2005 in the Netherlands and compare it with findings from 2001.

Design Questionnaire study about random samples of deaths reported to a central death registry in 2005 and 2001.

Setting Nationwide physician study in the Netherlands.

Participants Reporting physicians received a questionnaire about the medical decisions that preceded the patient’s death; 78% (n=6860) responded in 2005 and 74% (n=5617) in 2001.

Main outcome measures Characteristics of continuous deep sedation (attending physician, types of patients, drugs used, duration, estimated effect on shortening life, palliative consultation). Requests for euthanasia.

Results The use of continuous deep sedation increased from 5.6% (95% confidence interval 5.0% to 6.2%) of deaths in 2001 to 7.1% (6.5% to 7.6%) in 2005, mostly in patients treated by general practitioners and in those with cancer (in 2005, 47% of sedated patients had cancer v 33% in 2001). In 83% of cases sedation was induced by benzodiazepines, and in 94% patients were sedated for periods of less than one week until death. Nine per cent of those who received continuous deep sedation had previously requested euthanasia but their requests were not granted. Nine per cent of the physicians had consulted a palliative expert.

Conclusions The increased use of continuous deep sedation for patients nearing death in the Netherlands and the limited use of palliative consultation suggests that this practice is increasingly considered as part of regular medical practice.

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