Physicians' experiences with end-of-life decision-making: Survey in 6 European countries and Australia

An anonymous questionnaire was sent to 16,486 physicians from specialities in which death is common: Australia, Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland.The response rate differed between countries (39–68%). The experience of foregoing life-sustaining treatment ranged between 37% and 86%: intensifying the alleviation of pain or other symptoms while taking into account possible hastening of death between 57% and 95%, and experience with deep sedation until death between 12% and 46%. Receiving a request for hastening death differed between 34% and 71%, and intentionally hastening death on the explicit request of a patient between 1% and 56%.There are differences between countries in experiences with ELDs, in willingness to perform ELDs and in receiving requests for euthanasia or physician-assisted suicide. Foregoing treatment and intensifying alleviation of pain and symptoms are practiced and accepted by most physicians in all countries. Physicians with training in palliative care are more inclined to perform ELDs, as are those who attend to higher numbers of terminal patients. Thus, this seems not to be only a matter of opportunity, but also a matter of attitude.Postponing death is not always a self-evident goal of medicine. Other goals have also to guide medical decision-making at the end of life, such as improving the quality of life of patients and their families through the prevention and relief of suffering, even if this might hasten death [1]. End-of-life decisions (ELDs) include decisions about withholding or withdrawing potentially life-prolonging treatment and about alleviation of pain or other symptoms with a possible life-shortening effect. In some countries it is also permissible to make decisions about euthanasia or physician-assisted suicide (EAS), defined as the administration, prescription or supply of drugs to end life at the patient's explicit request.ELDs occur throughout the world, albeit at different rates for different ac