Volume 327, Number 7408 of the British Medical Journal (26 July 2003) provided a series of articles exploring the question, “What is a good death?” One article examines the effects of euthanasia on the bereaved family and friends, another provides a trend analysis of twenty five years of requests for euthanasia and physician assisted suicide in the Netherlands. Articles of interest are summarised below.
(a) A systematic review of physicians’ survival predictions in terminally ill cancer patients
Paul Glare and colleagues conducted a systematic review and meta-analysis of eight studies that assessed the accuracy of doctors’ survival predictions. Four studies were from the United Kingdom, three were from Italy, and one was from the United States. The review found that doctors often overestimate the survival of terminally ill cancer patients. Doctors’ predictions were correct to within a week in only 25% of cases and out by more than four weeks in a similar number. Doctors consistently overestimated the duration of survival in seven of the eight studies. Predictions were more accurate closer to death. The authors warned that clinicians caring for patients with terminal cancer need to be aware of their tendency to overestimate survival, as it may affect patients’ prospects for achieving a good death.
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Also in Issue 327 of the BMJ Tony Walter examines ‘Historical and Cultural Variants on the Good Death’ and ‘Patients’ voices are needed in debates on euthanasia’ proposes that legalising euthanasia is premature when research evidence from the perspectives of those who desire euthanasia is limited. The authors of the latter article (which was informed by discussion with the European Association of Palliative Care) write that priority must be given to doctors acquiring the skills for providing good end of life care.