De praktijk van terminale sedatie in Nederland

Objective. To describe the practice of terminal sedation in the Netherlands. Design. Descriptive. Methods. A sample group of physicians (n = 4I0: response 85%) were asked how often they had used terminal sedation in 2000 and 200I. This was defined as the administration of drugs to keep the patient deeply sedated or in coma until death, without artificial nutrition or hydration. Where applicable, they were asked about the decision-making process they had used in their most recent case. Results. Fifty-two per cent of the physicians had implemented terminal sedation. Based on the numbers given by the physicians interviewed, it was estimated that terminal sedation is carried out in I0% of all deaths in the Netherlands: 5.5% by a specialist, 2.5% by a general practitioner and 2.0% by a nursing-home physician. Of their 211 most recent cases terminal sedation was aimed at alleviating pain in 5I%, agitation in 38%, and dyspnoea in 38%. Terminal sedation was implemented with the explicit intention of hastening death in I7% of the cases. The decision to start deep sedation was discussed with the patient in 59% of cases and the decision to forgo artificial nutrition or hydration in 34%. Conclusions. In the care provided to patients in the last phase of life, terminal sedation is a practice which is relatively frequently applied to alleviate severe symptoms.