Article Figures & Tables
Tables
- Table 1: Characteristics of physicians and patients involved in life-ending acts without explicit patient request
Characteristic No. (%)
n = 66Physician specialty Family physician 33 (50.0) Specialist 33 (50.0) Patient age, yr 1–64 10 (15.2) 65–79 28 (42.4) ≥ 80 28 (42.4) Patient sex Male 34 (51.5) Female 32 (48.5) Patient cause of death (as listed on death certificate) Cancer 41 (62.1) Cardiovascular disease
(including cerebrovascular accident)10 (15.2) Respiratory disease 5 (7.6) Neurological disease 3 (4.5) Other disease 7 (10.6) Patient place of death Home 22 (33.3) Hospital 32 (48.5) Nursing home 11 (16.7) Other 1 (1.5) Term No. (%)
n = 66Symptom treatment 13 (19.7) Palliative sedation 45 (68.2) Compassionate life-ending 4 (6.1) Euthanasia 0 (0.0) Other 4 (6.1) Drugs and doses used† Intensified alleviation of pain and other symptoms, No. (%)
n = 1249Life-ending act without explicit patient request,
No. (%)
n = 66Euthanasia or assisted suicide, No. (%)
n = 142Drugs n = 1199 n = 65 n = 139 Opioids 1139 (95.0) 61 (93.8) 56 (40.3) As the only drug 703 (58.6) 29 (44.6) 22 (15.8) With benzodiazepines 284 (23.7) 17 (26.2) 20 (14.4) With drugs other than benzodiazepines 78 (6.5) 8 (12.3) 3 (2.1) With benzodiazepines and other drugs 74 (6.2) 7 (10.8) 11 (7.9) No opioids 60 (5.0) 4 (6.1) 83 (59.7) χ2 p value 0.2 < 0.001 Reported OME opioid doses used in last 24h‡, mg n = 821 n = 37 n = 44 1–119 307 (37.4) 14 (37.8) 6 (13.6) 120–239 267 (32.5) 10 (27.0) 10 (22.7) 240–479 179 (21.8) 10 (27.0) 21 (47.7) ≥ 480 68 (8.3) 3 (8.1) 7 (15.9) χ2 p value 0.9 0.04 Note: OME = oral morphine equivalent. *Administration of drugs for the treatment and management of pain or other symptoms, taking into account a potential life-shortening effect. †Cases with missing values were excluded from the analysis. ‡Conversion rates were obtained from handbooks and review publications with equianalgesic tables. (14)– (17)
- Table 4: Classification of life-ending acts without explicit patient request according to drugs and doses used and expressed wish for life ending*
Drug(s) used Administration schedule Expressed wish to end life No expressed wish to end life Total Explicit Implicit Patient
incapablePatient
capableOpioid dose no higher than necessary for symptom control, with or without low-dose benzodiazepines Stable dose over final 3 d 1 1 7 2 11 Gradual increase in opioids over final 3 d 1 2 8 2 13 Strong increase in opioids on final day 2 3 5 Opioid doses or sedatives not normally used as part of mainstream palliative care Opioid doses exceeding symptom requirements, but either stable or gradually increasing, with or without low-dose benzodiazepines 3 1 4 Opioid doses exceeding symptom requirements and strongly rising on last day, with or without low-dose benzodiazepines 3 2 6 11 Strong sedatives (barbiturates, propofol or high-dose benzodiazepines) 3 7 9 1 20 Unspecified doses of opioids, benzodiazepines or both 1 1 2 Total 10 13 37 6 66 *Reported by the physicians themselves: drugs, doses, opioid course in final 3 days, and whether opioid doses were higher than necessary to relieve symptoms. Judgments of low-dose v. high-dose benzodiazepines were made by the authors: Low-dose benzodiazepines: lorazepam ≤ 2.5 mg; diazepam ≤ 20 mg or no dose indicated; midazolam ≤ 2 mg High-dose benzodiazepines: lorazepam > 2.5 mg; midazolam > 2 mg or no dose indicated.