WITHDRAWAL OR WITHHOLDING OF TREATMENT AT THE END OF LIFE - RESULTS OF A NATIONWIDE STUDY

Background: Decisions to withhold or withdraw treatment (nontreatment decisions) become increasingly important because they have to be made more frequently and more explicitly. This nationwide study provides in formation on the occurrence and background of these nontreatment decis ions. Methods: Three studies were undertaken: interviews with 405 phys icians, 5197 answered questionnaires concerning deceased persons, and information about 2257 deaths collected by a prospective study. Result s: Of all deaths, 30% appeared to be sudden and unexpected. In 39% of all nonsudden deaths, a nontreatment decision was made. This percentag e varied by specialty (28% to 55%). Nontreatment decisions were made m ore often in older female patients. The decisions were made at the exp licit request of the patient (19%), after discussion with the patient or after a previous wish (22%), or without any involvement of the pati ent (59%). Of this last group, 87% of patients were not competent at t he time of the decision. In 24% of cases of nontreatment, life was sho rtened by at least a week. Of all physicians interviewed, 56% had chan ged their attitude since the beginning of their practice, most of them toward more nontreatment decisions at the end of life. Conclusions: N ontreatment decisions are made frequently in medical practice. Most of ten the physician has to weigh medical and nonmedical burdens and bene fits. For this to be done properly, the patient should be involved whe never possible. Other requirements are optimal palliative treatment, b etter prognostic knowledge, consultation of other specialists, and the absence of defensive motives.