End-of-life decisions in the UK involving medical practitioners

Abstract

This study estimates the frequency of different medical end-of-life decisions (ELDs) made in the United Kingdom (UK) in 2007–2008, comparing these with 2004. Postal survey was carried out with 8857 medical practitioners, of whom 3733 (42%) practitioners replied, with 2869 having attended a person who died in the previous year. The proportion of UK deaths involving (1) voluntary euthanasia (0.21%; CI: 0–0.52), (2) physician-assisted suicide (0.00%) and (3) ending of life without an explicit request from the patient (0.30%; CI: 0–0.60) is low. Better questions about ELDs showed both non-treatment decisions (21.8%; CI: 19.0–24.5) and double effect measures (17.1%; CI: 14.6–19.6) to be much less common than suggested in earlier estimates, rarely involving intent to end life or being judged to have shortened life by more than a day. Continuous deep sedation (16.5%; CI: 14.3–18.7) is relatively common in UK medical practice, particularly in hospitals, home care settings and with younger patients. Further findings about the distribution of ELDs across subgroups are also reported. Survey research in this area requires careful control over question wording if valid estimates and comparisons of the prevalence of ELDs are to be made. The high rate of sedation compared with other countries may be a cause for concern.