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Labelling of end-of-life decisions by physicians

Jef Deyaert (UGent) , Kenneth Chambaere (UGent) , Joachim Cohen (UGent) , Marc Roelands (UGent) and Luc Deliens (UGent)
(2014) JOURNAL OF MEDICAL ETHICS. 40(7). p.505-507
Author
Organization
Abstract
Objectives: Potentially life-shortening medical end-of-life practices (end-of-life decisions (ELDs)) remain subject to conceptual vagueness. This study evaluates how physicians label these practices by examining which of their own practices (described according to the precise act, the intention, the presence of an explicit patient request and the self-estimated degree of life shortening) they label as euthanasia or sedation. Methods: We conducted a large stratified random sample of death certificates from 2007 (N=6927). The physicians named on the death certificate were approached by means of a postal questionnaire asking about ELDs made in each case and asked to choose the most appropriate label to describe the ELD. Response rate was 58.4%. Results: In the vast majority of practices labelled as euthanasia, the self-reported actions of the physicians corresponded with the definition in the Belgian euthanasia legislation; practices labelled as palliative or terminal sedation lack clear correspondence with definitions of sedation as presented in existing guidelines. In these cases, an explicit life-shortening intention by means of drug administration was present in 21.6%, life shortening was estimated at more than 24 h in 51% and an explicit patient request was absent in 79.7%. Discussion: Our results suggest that, unlike euthanasia, the concept of palliative or terminal sedation covers a broad range of practices in the minds of physicians. This ambiguity can be a barrier to appropriate sedation practice and indicates a need for better knowledge of the practice of palliative sedation by physicians.
Keywords
PALLIATIVE SEDATION, MEDICAL-PRACTICE, EUTHANASIA, FLANDERS, BELGIUM, DEATH, TRENDS

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Citation

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MLA
Deyaert, Jef, et al. “Labelling of End-of-Life Decisions by Physicians.” JOURNAL OF MEDICAL ETHICS, vol. 40, no. 7, 2014, pp. 505–07, doi:10.1136/medethics-2013-101854.
APA
Deyaert, J., Chambaere, K., Cohen, J., Roelands, M., & Deliens, L. (2014). Labelling of end-of-life decisions by physicians. JOURNAL OF MEDICAL ETHICS, 40(7), 505–507. https://doi.org/10.1136/medethics-2013-101854
Chicago author-date
Deyaert, Jef, Kenneth Chambaere, Joachim Cohen, Marc Roelands, and Luc Deliens. 2014. “Labelling of End-of-Life Decisions by Physicians.” JOURNAL OF MEDICAL ETHICS 40 (7): 505–7. https://doi.org/10.1136/medethics-2013-101854.
Chicago author-date (all authors)
Deyaert, Jef, Kenneth Chambaere, Joachim Cohen, Marc Roelands, and Luc Deliens. 2014. “Labelling of End-of-Life Decisions by Physicians.” JOURNAL OF MEDICAL ETHICS 40 (7): 505–507. doi:10.1136/medethics-2013-101854.
Vancouver
1.
Deyaert J, Chambaere K, Cohen J, Roelands M, Deliens L. Labelling of end-of-life decisions by physicians. JOURNAL OF MEDICAL ETHICS. 2014;40(7):505–7.
IEEE
[1]
J. Deyaert, K. Chambaere, J. Cohen, M. Roelands, and L. Deliens, “Labelling of end-of-life decisions by physicians,” JOURNAL OF MEDICAL ETHICS, vol. 40, no. 7, pp. 505–507, 2014.
@article{5805036,
  abstract     = {{Objectives: Potentially life-shortening medical end-of-life practices (end-of-life decisions (ELDs)) remain subject to conceptual vagueness. This study evaluates how physicians label these practices by examining which of their own practices (described according to the precise act, the intention, the presence of an explicit patient request and the self-estimated degree of life shortening) they label as euthanasia or sedation. 
Methods: We conducted a large stratified random sample of death certificates from 2007 (N=6927). The physicians named on the death certificate were approached by means of a postal questionnaire asking about ELDs made in each case and asked to choose the most appropriate label to describe the ELD. Response rate was 58.4%. 
Results: In the vast majority of practices labelled as euthanasia, the self-reported actions of the physicians corresponded with the definition in the Belgian euthanasia legislation; practices labelled as palliative or terminal sedation lack clear correspondence with definitions of sedation as presented in existing guidelines. In these cases, an explicit life-shortening intention by means of drug administration was present in 21.6%, life shortening was estimated at more than 24 h in 51% and an explicit patient request was absent in 79.7%. 
Discussion: Our results suggest that, unlike euthanasia, the concept of palliative or terminal sedation covers a broad range of practices in the minds of physicians. This ambiguity can be a barrier to appropriate sedation practice and indicates a need for better knowledge of the practice of palliative sedation by physicians.}},
  author       = {{Deyaert, Jef and Chambaere, Kenneth and Cohen, Joachim and Roelands, Marc and Deliens, Luc}},
  issn         = {{0306-6800}},
  journal      = {{JOURNAL OF MEDICAL ETHICS}},
  keywords     = {{PALLIATIVE SEDATION,MEDICAL-PRACTICE,EUTHANASIA,FLANDERS,BELGIUM,DEATH,TRENDS}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{505--507}},
  title        = {{Labelling of end-of-life decisions by physicians}},
  url          = {{http://doi.org/10.1136/medethics-2013-101854}},
  volume       = {{40}},
  year         = {{2014}},
}

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