Study highlights increasing use of continuous deep sedation in the Netherlands

Mar 21, 2008

The use of continuous deep sedation for patients nearing death in the Netherlands is increasing, while cases of euthanasia have declined, according to a study published on bmj.com today.

Although the exact cause of this trend is unclear, there are indications that continuous deep sedation may in some cases be being used as a substitute for euthanasia.

Patients nearing death often experience distressing symptoms and sedating drugs can be used as an option of last resort. Sedation can be used intermittently or continuously until death, and the depth of sedation can vary from a lowered state of consciousness to unconsciousness.

The most extreme use of sedation is continuous deep sedation until death, but there is a lack of large scale research on its use.

In 2001, a large study in six European countries showed that continuous deep sedation was used in up to 8.5% of all deaths, among patients with cancer and other diseases, and provided in as well as outside hospital.

In 2005, researchers repeated this study using a random sample of over 6,500 deaths that occurred in the Netherlands between August and November 2005. Physicians were surveyed about their medical decisions for the non-sudden deaths.

The use of continuous deep sedation increased from 5.6% of deaths in 2001 to 7.1% in 2005 (an increase of 1800 cases). The increase occurred mostly in patients with cancer who were treated by a general practitioner. In contrast, the use of euthanasia decreased from 2.6% of all deaths in 2001 to 1.7% of all deaths in 2005 (a decrease of 1200 cases).

In about four out of five of cases, sedation was induced by benzodiazepines, and in 94% patients were sedated for less than one week until death. Only 9% of physicians consulted a palliative expert.

About one in ten patients who received continuous deep sedation had previously requested euthanasia or assisted suicide but it had not been granted.

Possible explanations for these trends include increased knowledge and media attention about continuous deep sedation, say the authors. Their findings suggest that continuous deep sedation is increasingly considered part of regular medical practice in the Netherlands.

They call for future research to focus on the underlying reasons for the use of continuous deep sedation.

This study provides some insight into end of life management of patients with intractable suffering, say researchers in an accompanying editorial.

They believe that further research must incorporate the perspectives of patients and families, as well as professionals from health care, spiritual care, social services, law and ethics. And they call for informed public debate about ethical and effective ways to alleviate persistent suffering at the end of life.

Source: British Medical Journal

Explore further: Key element of CPR missing from guidelines

add to favorites email to friend print save as pdf

Related Stories

Docs optimistic, but Giffords in for long recovery

Jan 10, 2011

(AP) -- Recovering from a gunshot wound to the head depends on the bullet's path, and while doctors are optimistic about Rep. Gabrielle Giffords' odds, it can take weeks to months to tell the damage.

Early mobilization of patients in ICU improves outcomes

May 18, 2009

Aside from the obvious and immediate health problems that patients undergoing mechanical ventilation face, those who recover often do so with profound loss of strength and mobility that can impair their daily functioning ...

Recommended for you

Exploring 3-D printing to make organs for transplants

5 hours ago

Printing whole new organs for transplants sounds like something out of a sci-fi movie, but the real-life budding technology could one day make actual kidneys, livers, hearts and other organs for patients ...

High frequency of potential entrapment gaps in hospital beds

7 hours ago

A survey of beds within a large teaching hospital in Ireland has shown than many of them did not comply with dimensional standards put in place to minimise the risk of entrapment. The report, published online in the journal ...

Key element of CPR missing from guidelines

Jul 29, 2014

Removing the head tilt/chin lift component of rescue breaths from the latest cardiopulmonary resuscitation (CPR) guidelines could be a mistake, according to Queen's University professor Anthony Ho.

Burnout impacts transplant surgeons (w/ Video)

Jul 28, 2014

Despite saving thousands of lives yearly, nearly half of organ transplant surgeons report a low sense of personal accomplishment and 40% feel emotionally exhausted, according to a new national study on transplant surgeon ...

User comments : 0