A poll, made in 2002 in six European countries (Belgium, Denmark, Italy, Netherlands, Suede and Suisse) studied near-death medical practices1. Today, while death occurs most of the time in institution, after a long-term disease, what is the practice of health professionals, who have to, more and more often, make medical decisions to shorten their patient life?
Hasten death 1 to 2 times out of 3
According to this study, a medical decision could hasten death in one to two non-sudden deaths out of three. This decision concerns the establishment of pain treatments, the decision to not establish or interrupt a treatment, even the administration of a substance with the explicit intention to hasten death. According to physician declarations, if this last practice represents 0.1% of deaths in Italy, it concerns 1.8% of them in Belgium and 3.4% in Netherlands, even before these two countries have legalised euthanasia.
Intention to cause death
Except in Italy, 15 to 30% of decisions are made with the explicit intention to cause patient death.
The patient or its family members and the other caregivers are not always involved in this decision. In most of the cases, lethal drugs are administrated without explicit request from the patient. Among the deaths assisted by a physician, 49% in Belgium are not subject to discussions with the patient, generally unconscious, or with the family in 30% of cases in Suede.
Treatment and / or feeding?
In this study, among the decisions of no treatment, stopping the drugs is associated to stopping feeding and hydration, which maintains the confusion between disproportionate care stopping and basic care due to any people, whatever their state.
1. La fin de vie en Europe : le point sur les pratiques médicales, Bulletin mensuel de l’INED, janvier 2007.