Intentionally hastening death by withholding or withdrawing treatment

Purpose: This study aims to provide empirical data on physicians' intentions in withholding and withdrawing treatment, and to discuss possible implications for the ethical debate. Basic procedures: The data presented come from EURELD, a large research project designed to investigate medical end-of-life decisions in six European countries. A continuous random sample of death certificates formed the basis for contacting doctors who had attended the deceased; the doctors were asked to complete, strictly anonymously, mail questionnaires on the decisions taken at the end of their patients' lives. Main findings: In the six countries studied, physicians reported they had the explicit intention of hastening the end of life in 45% of all treatments that were withheld/withdrawn. The highest numbers of cases with an underlying intention of hastening the end of life were found in Switzerland and Sweden (52% and 51%, respectively); the lowest figures came from Denmark and Belgium (36% and 38%). Middle-ranking countries were Italy (42%) and the Netherlands (45%). Overall, dialysis and respiration were comparatively more often forgone with the explicit intent to hasten the end of life (57% and 54%, respectively), whereas a particularly low percentage of cases with such an explicit intention was found for oncotherapy (34%). Principal conclusions: In almost every second case, a medical decision to withhold or withdraw treatment is taken with the explicit intention of hastening the end of the patient's life. No clear association can be found between the intent to hasten the end of life and features of the treatment forgone that can be determined objectively, such as the likelihood and extent of a life-shortening effect, the immediacy of death, or the expected burden of any potential life-sustaining measure. The findings of the study challenge the usefulness of doctors' intentions with regard to hastening the end of life as criteria for moral judgements on decisions to withhold or withdraw medical treatment.

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