END-OF-LIFE DECISIONS IN AUSTRALIAN MEDICAL-PRACTICE

Objective: To estimate the proportion of medical end-of-life decisions in Australia, describe the characteristics of such decisions and comp are these data with medical end-of-life decisions in the Netherlands, where euthanasia is openly practised. Design: Postal survey, conducted between May and July 1996, using a self-administered questionnaire ba sed on the questionnaire used to determine medical end-of-life decisio ns in the Netherlands in 1995. Participants: A random sample of active medical practitioners from all Australian States and Territories sele cted from medical disciplines in which there were opportunities to be the attending doctor at non-acute patient deaths, and hence to make me dical end-of-life decisions. Main outcome measure: Proportion of Austr alian deaths that involved a medical end-of-life decision, using ratio -to-size estimation based on the sampled doctors' responses to the que stionnaire. The response rate was 64%. Results: The proportion of all Australian deaths that involved a medical end-of-life decision were: e uthanasia, 1.8% (including physician-assisted suicide, 0.1%); ending o f patient's life without patient's concurrent explicit request, 3.5%; withholding or withdrawing of potentially life-prolonging treatment, 2 8.6%; alleviation of pain with opioids in doses large enough that ther e was a probable life-shortening effect, 30.9%. In 30% of all Australi an deaths, a medical end-of-life decision was made with the explicit i ntention of ending the patient's life, of which 4% were in response to a direct request from the patient. Overall, Australia had a higher ra te of intentional ending of life without the patient's request than th e Netherlands. Conclusions: Australian law has not prevented doctors f rom practising euthanasia or making medical end-of-life decisions expl icitly intended to hasten the patient's death without the patient's re quest.