Family Practice Advance Access originally published online on October 15, 2009
Family Practice 2009 26(6):481-487; doi:10.1093/fampra/cmp069
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Telephone consultations on palliative sedation therapy and euthanasia in general practice in The Netherlands in 2003: a report from inside
a Department for Palliative Medicine, Integraal Kankercentrum Noord Oost, 9700 AH Groningen, The Netherlands
b University of Wales College of Medicine, Velindre Hospital Whitchurch Cardiff, UK
c Honorary Professor in Palliative Medicine
d Department of General Practice
e Department of Oncology, University Medical Centre Groningen, Groningen, The Netherlands
Correspondence to Florien van Heest, Zuidzijde 1, 7874 TD Odoornerveen, The Netherlands; E-mail: f.vanheest{at}ikno.nl
Received 18 October 2008; Revised 16 July 2009; Accepted 10 September 2009.
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Abstract |
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Background. GPs with a special interest and with specific training in palliative medicine (GP advisors) supported professional carers (mostly GPs) through a telephone advisory service. Each telephone call was formally documented on paper and subsequently evaluated.
Objective. Data from 2003 were analysed independently to reveal how often and in what way palliative sedation and euthanasia were discussed.
Methods. The telephone documentation forms and corresponding evaluation forms of two GP advisors were systematically analysed for problems relating to the role of sedation and/or euthanasia both quantitatively and qualitatively.
Results. In 87 (21%) of 415 analysed consultations, sedation and/or euthanasia were discussed either as the presenting question (sedation 26 times, euthanasia 37 times and both 10 times) or arising during discussion (sedation 11 times and euthanasia three times). Qualitative analysis revealed that GPs telephoned to explore therapeutic options and/or wanted specific information. Pressure on the GP (either internal or external) to relieve suffering (including shortening life by euthanasia) had often precipitated the call. On evaluation, 100% of the GPs reported that the advice received was of value in the patient's care.
Conclusion. GPs caring for patients dying at home encountered complex clinical dilemmas in end-of-life care (including palliative sedation therapy and euthanasia). They valued practical advice from, and open discussion with, GP advisors. The advice often helped the GP find solutions to the patient's problems that did not require deliberately foreshortening life.
Keywords. Consultation, general practice, sedation, terminal care, voluntary euthanasia.
van Heest FB, Finlay IG, Kramer JJE, Otter R and Meyboom-de Jong B. Telephone consultations on palliative sedation therapy and euthanasia in general practice in The Netherlands in 2003: a report from inside. Family Practice 2009; 26: 481–487.