US and Dutch views differ on sedation at end of life

By Sarah Guy, medwireNews Reporter

Physicians from the USA and the Netherlands differ in their views on sedation at the end of life, with the Dutch justifying it by stating that it does not hasten death, and the Americans indicating that although it might hasten death, this is justifiable if it is not the primary intention, show study findings.

The researchers observed that physicians also differ in their communication about sedation at the end of life, with Dutch respondents reporting they initiate open discussions with their patients to allow for planning, while American respondents are less likely to do so.

Judith Rietjens (Erasmus Medical Center, Rotterdam, the Netherlands) and colleagues' study took in the views of 18 physicians from areas of the USA where physician-assisted suicide is legal, and 18 from the Netherlands, where a national palliative sedation guideline was established in 2006 and a 2002 law permits physician-assisted suicide and euthanasia under certain conditions.

While Dutch physicians described the use of sedation at the end of life as "palliative sedation" - mirroring the term used in their national guidelines - US respondents were less consistent in their definitions, including: "use of sedatives," "excessive sedation," and "terminal sedation."

Almost all physicians stated that use of sedation at the end of life was with the intention of making the patient comfortable. However, where the difference between sedation and euthanasia became unclear, respondents referred to intention to differentiate the two concepts.

"When I think of physician-assisted suicide, that's the intention. The intention is to end life. I think about terminal sedation or even some of the IV narcotics that we use. The goal is to make them more comfortable, not to cause them to pass," said one US physician.

By contrast, Dutch physicians' were more likely to respond: "The patients die because of their underlying disease not because of palliative sedation."

Dutch physicians discussed palliative sedation more openly and frequently than their US counterparts, explaining that patients are then able to make up their own minds about future treatment, and know that there is a choice.

Some US physicians reported discussing sedation more often with patients' family members, suggesting that patients are not always in a position to be able to have a conversation about it, and that such a discussion is not a formality but dependent on the individual hospital.

"Our data point to the need for more awareness and discussion about the role of sedation in relieving suffering for patients nearing death, including the role of guidelines," conclude the researchers in the Journal of Medical Ethics.

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