National survey of end-of-life decisions made by UK medical practitioners.

Abstract

This study estimates the frequency of different end-of-life decisions (ELDs) in medical practice in the UK, compares these with other countries and assesses doctors' views on the adequacy of current UK law. Postal survey of 857 UK medical practitioners using a questionnaire used in other countries. The proportion of UK deaths involving an ELD were: 1) voluntary euthanasia 0.16% (0-0.36), 2) physician-assisted suicide 0.00%, 3) ending of life without an explicit request from patient 0.33% (0-0.76), 4) alleviation of symptoms with possibly life shortening effect 32.8% (28.1-37.6), 5) non-treatment decisions 30.3% (26.0-34.6). ELDs 1 and 2 were significantly less frequent than in the Netherlands and Australia; ELD 2 was also less frequent than Switzerland. ELD 3 was less frequent than in Belgium and Australia. Comparison of UK and New Zealand general practitioners showed lower rates of ELDs 4 and 5 in the UK. ELD 5 was more common than in most other European countries. A few doctors attending deaths felt UK law had inhibited or interfered with their preferred management of patients (4.6% (3.1-6.1%) of doctors) or that a new law would have facilitated better management (2.6% (1.4-3.8%) of doctors). The lower relative rate of ELDs involving doctor-assisted dying in the UK, and the relatively high rate of non-treatment decisions, suggests a culture of medical decision making informed by a palliative care philosophy.