Legalised euthanasia "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.