A Comparison of Clinical Practices

Background: An important issue in the debate about terminal sedation is the extent to which it differs from euthanasia. We studied clinical differences and similarities between both practices in the Netherlands. Methods: Personal interviews were held with a nationwide stratified sample of 410 physicians (response rate, 85%)aboutthemostrecentcasesinwhichtheyusedterminal sedation, defined as administering drugs to keep the patient continuously in deep sedation or coma until death without giving artificial nutrition or hydration (n=211), or performed euthanasia, defined as administering a lethal drug at the request of a patient with the explicit intention to hasten death (n=123). We compared characteristics of the patients, the decisionmaking process, and medical care of both practices. Results:Terminal sedation and euthanasia both mostly concerned patients with cancer. Patients receiving terminal sedation were more often anxious (37%) and confused(24%)thanpatientsreceivingeuthanasia(15%and 2%, respectively). Euthanasia requests were typically related to loss of dignity and a sense of suffering without improving, whereas requesting terminal sedation was more often related to severe pain. Physicians applying terminalsedationestimatedthatthepatient’slifehadbeen shortened by more than 1 week in 27% of cases, compared with 73% in euthanasia cases. Conclusions:Terminalsedationandeuthanasiabothare often applied to address severe suffering in terminally ill patients. However, terminal sedation is typically used to addressseverephysicalandpsychologicalsufferingindyingpatients,whereasperceivedlossofdignityduringthe last phase of life is a major problem for patients requesting euthanasia. Arch Intern Med. 2006;166:749-753