Legalized Euthanasia Not Linked to Reduced Use of Palliative Care

Last Updated: 2009-07-30 19:01:26 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The results of a study in Belgium suggest that legalized euthanasia and other measures that can shorten life are not significantly associated with lower use of palliative care.

In the study, life-shortening decisions in general were linked to the use of multidisciplinary palliative care services, but euthanasia and physician-assisted suicide in particular were not, Dr. Lieve Van den Block, from Vrije Universiteit Brussel, and co-researchers comment in the July 31st Online First issue of BMJ.

"The concern that euthanasia or physician-assisted suicide might be disproportionately chosen by or for patients who do not assess palliative care services is not supported," the researchers conclude.

The findings stem from a 2-year nationwide retrospective study (SENTI-MELC) conducted between 2005 and 2006. Included were 1690 non-sudden deaths that occurred in practices of general practitioners.

Although the use of palliative care services was not tied to euthanasia or physician-assisted suicide, it was linked with continuous deep sedation forgoing food/fluid (OR 2.9), intensified alleviation of symptoms (OR 2.1), and to "the total of decisions explicitly intended to shorten life" (OR 1.5).

Spiritual care, by contrast, was associated with higher rates of euthanasia and physician-associated suicide. The receipt of spiritual care increased the odds of these life-ending measures by 18.5-fold.

"Life shortening end of life decisions often occur within the context of multidisciplinary care in Belgium," the authors write, "and they often coexist with a palliative care philosophy."

In an accompanying editorial, Dr. Ira Byock, from the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, comments that "the findings are a valuable contribution to understanding the context of dying in Belgium," but adds that the authors" conclusions may not be accurate.

Noting that the data show that assisted dying is seldom performed in Belgium, "it would be a mistake to suggest that these findings dispel concerns about euthanasia or that they support including euthanasia within palliative care."

Source:

BMJ 2009.


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