A comparison of physicians' end-of-life decision making for non-western migrants and Dutch natives in the Netherlands
Background: Non-western migrants have a different cultural background that influences their attitudes towards healthcare. As the first wave of this relatively young group is growing older, we investigated, for the first time, whether end-of-life decision-making practices for non-western migrants differ from Dutch natives. Methods: In 2005, we sent questionnaires to physicians who attended deaths identified from the central death registry of Statistics Netherlands (n = 9651; non-western migrants: n = 627, total response: 78%). We performed multivariate logistic regression analyses adjusted for age, sex and cause of death. Results: Of all deaths of non-western origin, 54% were non-sudden, whereas 67% of all deaths with a Dutch origin were non-sudden (P = 0.00). A relatively large number of non-suddenly deceased persons of non-western origin had died under the age of 65 (53%) as compared to Dutch natives (15%). Euthanasia was performed in 2.4% of all non-suddenly deceased persons in the non-western migrant group as compared to 2.7% in the native Dutch group (adjusted odds ratio = 0.82, P = 0.63). Alleviation of symptoms with a potential life-shortening effect was somewhat lower for non-western migrants (30% vs. 38%; adjusted odds ratio = 0.78, P = 0.07). Physicians decided to forgo potentially life-prolonging treatment in comparable rates (26% vs. 23%; adjusted odds ratio = 1.1, P = 0.73). Yet, the type of treatments forgone and underlying reasons differed. Conclusion: Euthanasia was not less common among non-suddenly deceased non-western migrants as compared to Dutch natives. However, intensive symptom alleviation was used less frequently and forgoing potentially life-prolonging treatment involved different characteristics. These findings suggest that cultural factors may affect end-of-life decision making.
|Keywords||Culture, Decision-making, End-of-life, Ethnicity, Migrant|
|Persistent URL||dx.doi.org/10.1093/eurpub/ckn084, hdl.handle.net/1765/30221|
|Note||Free full text at PubMed|
Buiting, H.M., Rietjens, J.A.C., Onwuteaka-Philipsen, B.D., van der Maas, P.J., van Delden, J.J.M., & van der Heide, A.. (2008). A comparison of physicians' end-of-life decision making for non-western migrants and Dutch natives in the Netherlands. European Journal of Public Health, 18(6), 681–687. doi:10.1093/eurpub/ckn084