ABSTRACT
OBJECTIVES: To determine the frequencies and types of limitation of medical treatment performed by physician members of the German Society for Palliative Medicine and to analyse the findings with respect to clinical and ethical aspects of end-of-life practices. DESIGN: Cross-sectional postal survey. SETTING: Data collection via the secretary of the German Society for Palliative Medicine using the German language version of the EURELD survey instrument. SUBJECTS: All 1645 physician members of the German Society for Palliative Medicine. Main outcome measures Types and frequencies of limitation of treatment and possible determinants. RESULTS: 901 physicians participated in the study (response rate 55.8%). Participants reported limitation of treatment in 69.1% of cases. These decisions most often affected artificial nutrition (19%), chemotherapy (14%), antibiotics (11%) and medication other than antibiotics (11%). In the majority of eligible cases, physicians estimated the life-shortening effect of limitation of treatment to be <7 days. However, estimations differ depending on the medical measures in question. Bivariate statistical analysis indicated that withholding of treatment was performed significantly more frequently for patients aged ≥65 years (p=0.019). In addition, there were significant associations between the incidence of limitation of treatment and the different diseases reported by respondents as the underlying cause of death. CONCLUSION: The findings of this study provide information on the current state of an ethically and clinically challenging aspect of clinical practice and can serve as a starting point for further interdisciplinary research on normative and empirical aspects of treatment decision-making at the end of life.
Subject(s)
Decision Making/ethics , Palliative Care/ethics , Patient Selection/ethics , Physicians/psychology , Terminal Care/ethics , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cross-Sectional Studies , Female , Germany , Humans , Infant , Male , Middle Aged , Physicians/ethics , Surveys and Questionnaires , Young AdultABSTRACT
OBJECTIVES: To elicit types and frequencies of end-of-life practices by physician members of the German Society for Palliative Medicine. To analyse associations between characteristics of physicians and patients and end-of-life practices with intended hastening of death. DESIGN: Cross-sectional postal survey. MAIN OUTCOME MEASURES: Types and frequencies of end-of-life practices with foreseeable or intended hastening of patients' death. Association between end-of-life practices with hastening of death and predefined characteristics of physicians and patients. RESULTS: Nine hundred and one physicians participated in the study (response rate: 55.8%). There was alleviation of symptoms in 78.1% and limitation of medical treatment with possible life shortening in 69.1% of cases. In 10 cases medication had been administered by the physician (N = 9) or the patient (N = 1) with the intention to hasten death. Patients' best interest and avoidance of possible harm to the patient were reported as reasons for non-involvement of competent patients in decision making. Physicians with added qualification in palliative medicine significantly less frequently reported end-of-life practices with intended hastening of death (p = 0.003). CONCLUSION: Physician members of the German Society for Palliative Medicine perform a broad spectrum of end-of-life practices including intended hastening of death. The findings on patients' non-involvement in decision making warrant further empirical-ethical analysis.
