CardiovascularLegalised Euthanasia Is Not Detrimental To Palliative Care
Assisted dying laws do not mean that fewer people use palliative care, according to a study published on bmj.com today.
The research also shows that receiving spiritual care in the final three months of life was associated with higher frequencies of euthanasia or physician assisted suicide than receiving little or no spiritual care.
Dr Lieve Van den Block and colleagues from the End-of-Life Care Research Group in Brussels, found that far from opposing each other, life shortening and palliative care complemented one another and often worked in unison.
Previous studies have already revealed that death is often preceded by medical end of life decisions that had a life shortening effect, for example, the use of lethal drugs, continuous sedation or intensifying drugs to alleviate symptoms that also had the effect of hastening death. However, this is the first large scale study exploring the relationship between end of life decisions and end of life care.
Van den Block investigated almost 2,000 non-sudden deaths that took place in Belgium from 2005 to 2006. Belgium is particularly suited to this study because it has well developed integrated palliative care provision as well as legalised euthanasia.
In the study, 32% of patients were 85 or older, 50% were male and cancer was the cause of death for 43% of cases. Assisted dying, intensified prescribing and continuous deep sedation without food/fluid administration were more commonly decided on for patients with cancer.
The authors found that the use of specialist multidisciplinary palliative care in Belgium was often associated with medical decisions to shorten life and that end of life decisions and palliative care do not contradict but worked together.
The concern that euthanasia or physician assisted suicide might be disproportionately chosen by or for patients who do not access palliative care services is not supported in Belgium.
Whether these results would be mirrored in other countries needs to be studied, say the authors, but results will depend on individual legal situations, palliative care systems and medical practice. However, Van den Block argues that studies from Oregon (where physician assisted suicide is permitted) "showed that most patients receiving physician assisted suicide were enrolled in hospice care and that the legalisation of physician assisted suicide has resulted in more hospice referrals and training of physicians in palliative care."
In the accompanying editorial, Dr Ira Byock, a Director of Palliative Medicine in the USA, says that while Van den Block"s research provides "a valuable contribution to understanding the context of dying in Belgium," he is concerned about some of the conclusions being extrapolated from the study.
Byock says the data show that assisted dying is rarely performed in Belgium and "it would be a mistake to suggest that these findings dispel concerns about euthanasia or that they support including euthanasia within palliative care."
Link to Research
Link to Editorial
British Medical Journal