Euthanasia and other end of life decisions and care provided in final three months of life: nationwide retrospective study in Belgium

doi:10.1136/bmj.b2772

Published 30 July 2009, doi:10.1136/bmj.b2772
Cite this as: BMJ 2009;339:b2772

Research

Euthanasia and other end of life decisions and care provided in final three months of life: nationwide retrospective study in Belgium

Lieve Van den Block, professor of communication and education in general practice, and postdoctoral researcher¹^,2, Reginald Deschepper, anthropologist and professor of critical care¹^,6, Johan Bilsen, professor of public health¹^,4, Nathalie Bossuyt, researcher³, Viviane Van Casteren, senior researcher³, Luc Deliens, professor of public health and palliative care¹^,5

¹ Vrije Universiteit Brussel, End-of-Life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium, ² Vrije Universiteit Brussel, Department of General Practice, 1090 Brussels, Belgium , ³ Scientific Institute of Public Health, Department of Epidemiology, 1040 Brussels, Belgium , ⁴ Vrije Universiteit Brussel, Department of Public Health, 1090 Brussels, Belgium , ⁵ Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, 1007 MB Amsterdam, Netherlands , ⁶ Vrije Universiteit Brussel, Department of Critical Care, 1090 Brussels, Belgium

Correspondence to: L Van den Block lvdblock{at}vub.ac.be

Objective To explore the relation between the care providedin the final three months of life and the prevalence and typesof end of life decisions in Belgium.

Design Two year nationwide retrospective study, 2005-6 (SENTI-MELCstudy).

Setting Data collection via the sentinel network of generalpractitioners, an epidemiological surveillance system representativeof all general practitioners in Belgium.

Subjects 1690 non-sudden deaths in practices of the sentinelgeneral practitioners.

Main outcome measures Non-sudden deaths of patients (aged >1year) reported each week. Reported care provided in the finalthree months of life and the end of life decisions made. Multivariableregression analysis controlled for age, sex, cause, and placeof death.

Results Use of specialist multidisciplinary palliative careservices was associated with intensified alleviation of symptoms(odds ratio 2.1, 95% confidence interval 1.6 to 2.6), continuousdeep sedation forgoing food/fluid (2.9, 1.7 to 4.9), and thetotal of decisions explicitly intended to shorten life (1.5,1.1 to 2.1) but not with euthanasia or physician assisted suicidein particular. To a large extent receiving spiritual care wasassociated with higher frequencies of euthanasia or physicianassisted suicide than receiving little spiritual care (18.5,2.0 to 172.7).

Conclusions End of life decisions that shorten life, includingeuthanasia or physician assisted suicide, are not related toa lower use of palliative care in Belgium and often occur withinthe context of multidisciplinary care.

© Block et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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