Characteristics and Public Availability of Results of Clinical Trials on Rare Diseases Registered at Clinicaltrials.gov

same period from 0.3% to 1.1% (P < .001). Euthanasia and ending of life without the patient’s explicit request also increased, but the number of studied cases of the 2 categories was small, at 8 and 15 cases in 2001, and at 11 and 25 cases in 2013, respectively, and the increases, from 0.2% to 0.3% for euthanasia and from 0.5% to 0.8% for ending of life without the patient’s explicit request, were not significant. The greatest increase was in the use of continuous deep sedation until death, which rose from 4.7% of all deaths in 2001 to 17.5% in 2013 (P < .001). Sedation was combined with forgoing life-prolonging treatment, alleviation of pain and symptoms, or physician-assisted death in 62%, 28%, and 3% of cases, respectively. Discussion | In Switzerland in 2013, more than 4 of 5 nonsudden deaths, corresponding to 58.7% of all deaths, were preceded by at least 1 specific end-of-life practice in 2013 compared with 52.0% in 2001. Similar increases in medical end-of-life practices were reported in the Netherlands, from 43.8% in 2001 to 57.8% in 2010, and in Belgium, from 38.4% in 2001 to 47.8% in 2013. 2,3 Forgoing life-prolonging treatment and intensified alleviation of pain and symptoms constitute the vast majority of medical end-of-life practices. In Switzerland, an increase in the percentage of deaths in which life-prolonging treatment was forgone predominated among medical end-of-life practices. This trend contrasts with the situation in the Netherlands, where forgoing life-prolonging treatment decreased slightly, from 20.2% in 2001 to 18.2% in 2010, and intensified alleviation of symptoms increased from 20.1% in 2001 to 36.4% in