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: Experts call for higher exam pass marks to close performance gap between international and UK medical graduates

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

What are the chances that your dad isn't your dad?

Apr 16, 2014

How confident are you that the man you call dad is really your biological father? If you believe some of the most commonly-quoted figures, you could be forgiven for not being very confident at all. But how ...

New technology that is revealing the science of chewing

Apr 15, 2014

CSIRO's 3D mastication modelling, demonstrated for the first time in Melbourne today, is starting to provide researchers with new understanding of how to reduce salt, sugar and fat in food products, as well ...

After skin cancer, removable model replaces real ear

Apr 11, 2014

(HealthDay)—During his 10-year struggle with basal cell carcinoma, Henry Fiorentini emerged minus his right ear, and minus the hearing that goes with it. The good news: Today, the 56-year-old IT programmer ...

User comments : 0

More news stories

Diagnosing and treating autism

April is National Autism Awareness Month. The Child Development Clinic at Children's Hospital of Richmond at VCU (CHoR) provides comprehensive assessment for pediatric patients with developmental delays or disabilities, including ...

Male monkey filmed caring for dying mate (w/ Video)

(Phys.org) —The incident was captured by Dr Bruna Bezerra and colleagues in the Atlantic Forest in the Northeast of Brazil.  Dr Bezerra is a Research Associate at the University of Bristol and a Professor ...

'Exotic' material is like a switch when super thin

(Phys.org) —Ever-shrinking electronic devices could get down to atomic dimensions with the help of transition metal oxides, a class of materials that seems to have it all: superconductivity, magnetoresistance ...