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

doi:10.1136/bmj.39504.531505.25

BMJ, doi: 10.1136/bmj.39504.531505.25, (Published 14 March 2008)

Research

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

Judith Rietjens, postdoctoral researcher¹, Johannes van Delden, professor of medical ethics², Bregje Onwuteaka-Philipsen, associate professor³, Hilde Buiting, junior researcher¹, Paul van der Maas, professor of public health¹, Agnes van der Heide, associate professor¹

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

Correspondence to: J Rietjens j.rietjens{at}erasmusmc.nl

Objectives To study the practice of continuous deep sedationin 2005 in the Netherlands and compare it with findings from2001.

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

Setting Nationwide physician study in the Netherlands.

Participants Reporting physicians received a questionnaire aboutthe 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 to7.1% (6.5% to 7.6%) in 2005, mostly in patients treated by generalpractitioners and in those with cancer (in 2005, 47% of sedatedpatients had cancer v 33% in 2001). In 83% of cases sedationwas induced by benzodiazepines, and in 94% patients were sedatedfor periods of less than one week until death. Nine per centof those who received continuous deep sedation had previouslyrequested euthanasia but their requests were not granted. Nineper cent of the physicians had consulted a palliative expert.

Conclusions The increased use of continuous deep sedation forpatients nearing death in the Netherlands and the limited useof palliative consultation suggests that this practice is increasinglyconsidered as part of regular medical practice.

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Rietjens, J., Buiting, H., Pasman, H., van der Maas, P., van Delden, J., van der Heide, A (2009). Deciding about continuous deep sedation: physicians' perspectives: A focus group study. Palliat Med 23: 410-417 [Abstract]
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