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Study signals Dutch switch to drugs from euthanasia

Terminally-ill patients in the Netherlands increasingly receive drugs to render them unconscious until death, according to a study that suggests people are substituting deep sedation for legal euthanasia.

The researchers found that 1,800 people – 7.1 percent of all deaths in the Netherlands in 2005 – were drugged into so-called continuous deep sedation shortly before dying. This compares with 5.6 percent of cases in 2001.

At the same time, the use of euthanasia fell from 2.6 percent of all deaths to 1.7 percent, representing a decrease of 1,200 cases, the researchers reported in the British Medical Journal on Friday.

“The increased use of continuous deep sedation for patients nearing death in the Netherlands and the limited use of palliative consultation suggests that this practice is increasingly considered as part of a regular medical practice,” Judith Rietjens of Erasmus University Medical Centre in Rotterdam and colleagues wrote.

In 2001, the Netherlands became the first country to legalise adult euthanasia, a move condemned by the Roman Catholic Church. It has since been adopted by Belgium, and other European states are investigating allowing it.

While euthanasia is regulated by law and carries strict conditions, deep sedation is considered part of regular medical practice and typically used in the last few weeks in life, Rietjens said.

“The practice of sedating medicines is used in other countries not just the Netherlands,” she said. “It is used in the last phase of life for people with symptoms that can’t be treated.”

The researchers looked at more than 6,500 deaths across the Netherlands in 2005 and found that about one in ten people who received continuous deep sedation had previously requested euthanasia or assisted suicide, but been rejected.

The people most likely to request deep sedation were those with terminal cancer treated by a family doctor, a group also likely to choose euthanasia – suggesting patients may be swapping one practice for another, Rietjens added.

Further research is needed to learn why people are turning to sedation and whether factors such as increasing media attention or religious views are playing a role, she said.

“The findings really indicate the increase in continuous deep sedation is partly related to a decrease in euthanasia,” she said. “There may be some sort of substitution taking place.”

Ira Byock, Director of Palliative Medicine at Dartmouth Medical School in New Hampshire in the United States, noted in a commentary there was some concern continuous deep sedation could enable doctors to evade requirements for euthanasia.

He called for further research into deep sedation that incorporates the views of patients and families, health care professionals as well as experts in law and ethics.