Decisions about medical treatment in the last phase of life : Withholding and withdrawing medication and other interventions

Continuation of potentially inappropriate interventions at the end of life seems common practice. The causes of this practice have rarely been studied and the perspectives of patients, their relatives and caregivers are not known.
Eric Geijteman’s thesis aims to provide insight into the practice of withholding and withdrawing medical interventions in the last phase of life. The thesis includes data from repetitive nationwide studies on end-of-life decision making practices, retrospective chart review studies, questionnaire studies, an interview study, and a Delphi study. In addition, two case reports and a letter to the editor are included.
The first part of the thesis focuses on current end-of-life practices. It shows that patients with a limited life expectancy are often exposed to potentially futile and even harmful medical interventions.
In part two, we explore the perspectives of patients, their relatives and physicians regarding potentially inappropriate medications in the last phase of life. The results in this part underline that limited awareness among physicians seems to be an important factor to explain why many patients use one or more potentially inappropriate medications in the last months before their expected death. Low priority and uncertainty about the consequences are other important causes.
In the third part, possible solutions for improvement of medical care at the end of life are described. It reveals that there is a great need of research into the consequences of deprescribing medication at the end of life. Such deprescribing studies require research methods in which participants in the control group are not aware of the trial intervention. Another solution to improve medical care is to increase physicians’ acknowledge that in the last phase of a patient’s life providing less or no interventions aimed at prolonging life is the best option.