Forgoing of end of life treatment varies in European countries

The frequency of withholding or withdrawing life-prolonging treatment at the end of a patient’s life varied greatly among six European countries, according to an article in the February 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

“Modern medicine provides unprecedented opportunities in diagnostics and treatment to save and sustain life,” according to background information in the article. However, in certain situations at the end of a patient’s life, physicians may refrain from using all possible treatments to prolong life.

Georg Bosshard, M.D., M.A.E., from the University of Zurich, Switzerland, and colleagues studied different types of treatment withheld or withdrawn from patients in six European countries between June 2001 and February 2002. Physicians were sent questionnaires about their decision-making process of the patients’ treatment. They were asked whether or not they withheld or withdrew medical treatment and if so, what kind of treatment.

The researchers found marked differences in the occurrence of end-of-life nontreatment decisions in the participating countries. Decisions not to treat were reported for 41 percent of deaths in Switzerland, 30 percent in the Netherlands, 27 percent in Belgium, 23 percent in Denmark, 22 percent in Sweden, and 6 percent in Italy. Medication was the treatment most frequently forgone in all of the countries studied except Italy, making up 54 percent of treatments forgone in Denmark, 48 percent in Switzerland, 42 percent in Belgium, 38 percent in the Netherlands, 37 percent in Sweden. Forgoing hydration or nutrition treatment was also common, occurring in 22 percent of the cases studied.

“In all of the participating countries, life-prolonging treatment is withheld or withdrawn at the end of life,” the authors write. “Low-technology interventions, such as medication or hydration or nutrition, are most frequently forgone. In older patients and outside the hospital, physicians prefer not to initiate life-prolonging treatment at all rather than stop it later.”