Doctors' Reports of Terminal Sedation without Hydration or Nutrition for Patients Nearing Death in the Netherlands

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The summary below is from the full report titled "Physician Reports of Terminal Sedation without Hydration or Nutrition for Patients Nearing Death in the Netherlands." It is in the 3 August 2004 issue of Annals of Internal Medicine (volume 141, pages 178-185). The authors are J.A.C. Rietjens, A. van der Heide, A.M. Vrakking, B.D. Onwuteaka-Philipsen, P.J. van der Maas, and G. van der Wal.

What is the problem and what is known about it so far?

When terminally ill patients are nearing death, the focus of care often changes from prolonging life to trying to make patients comfortable. As patients near death, they often have symptoms such as pain, shortness of breath, agitation, and anxiety. They also often become unable to eat and drink on their own. Sometimes, the only way to feed and hydrate such patients is through tubes placed in their veins or in their stomachs. Some patients and families prefer to stop nutrition and hydration rather than resort to these measures. Administration of sedating medications while stopping nutrition and hydration is called terminal sedation. Terminal sedation is an option for care of patients who are nearing death. Sedation relieves symptoms. Stopping hydration and nutrition may speed the time to death. Much controversy exists over the ethics of this practice in the United States. However, little is known about physicians' experience with terminal sedation.

Why did the researchers do this particular study?

To describe the practice of terminal sedation in the Netherlands.

Who was studied?

410 Dutch doctors who worked in hospitals, general practice offices, or nursing homes.

How was the study done?

During face-to-face interviews, the researchers asked the doctors whether they had ever used terminal sedation. If the doctor had used it, the researchers asked about the doctor's most recent case.

What did the researchers find?

Of 410 doctors in the Netherlands who completed the survey, just over half had ever used terminal sedation. Common reasons for using terminal sedation were the relief of pain, agitation, or shortness of breath. The doctors reported using terminal sedation primarily to hasten death in only 17% of reported cases.

What were the limitations of the study?

Because attitudes and practices regarding terminal sedation vary geographically and culturally, it is unclear whether these results are generalizable to countries other than the Netherlands.

What are the implications of the study?

A substantial proportion of Dutch doctors working in hospital, general practice, or nursing home settings have used terminal sedation. Doctors who used it reported that the main objective was to decrease symptoms. Speeding the time to death was the doctor's primary goal in a small number of reported cases.