Expressed wishes and incidence of euthanasia in advanced lung cancer patients

Abstract

This study explores expressed wishes and requests for euthanasia (i.e. administration of lethal drugs at the explicit request of the patient), and incidence of end-of-life decisions with possible life-shortening effects (ELDs) in advanced lung cancer patients in Flanders, Belgium.We performed a prospective, longitudinal, observational study of a consecutive sample of advanced lung cancer patients and selected those who died within 18 months of diagnosis. Immediately after death, the pulmonologist/oncologist and general practitioner (GP) of the patient filled in a questionnaire. Information was available for 105 out of 115 deaths.According to the specialist or GP, one in five patients had expressed a wish for euthanasia; and three in four of these had made an explicit and repeated request. One in two of these received euthanasia. Of the patients who had expressed a wish for euthanasia but had not made an explicit and repeated request, none received euthanasia. Patients with a palliative treatment goal at inclusion were more likely to receive euthanasia. Death was preceded by an ELD in 62.9% of patients.To conclude, advanced lung cancer patients who expressed a euthanasia wish were often determined. Euthanasia was performed significantly more among patients whose treatment goal after diagnosis was exclusively palliative.

Euthanasia: from ethical debate to clinical reality

“…In lung cancer, a recent North American survey showed that physician referral to palliative care is negatively influenced by the perception that it can alarm patients and relatives while the belief in longer time to approach complex issues by the palliative care specialist is associated with more referral [15]. PARDON et al [4] also underline a different perception of the euthanasia request by the specialist or the general practitioner. The perception of euthanasia and palliative care among the population is evolving and will certainly influence medical practice in the future, as suggested by the growing importance of advance directives or anticipated declaration among the Belgian population, 25,000 advance directives being officially reported to the authorities.…”

“…In this issue of the European Respiratory Journal, PARDON et al [4] report the first study specifically dealing with euthanasia requests and practice in lung cancer patients. This prospective study was based on questionnaires sent to pulmonologists, oncologists and general practitioners immediately after the death of their patient.…”

“…PARDON et al [4] emphasise that of a 14% rate of repeated requests for euthanasia, half were not performed, principally because the physician in charge of the patients during the terminal phase is not the one who received the request and was not aware of it. Conversely, a lower rate of requests for euthanasia, 2.1%, was reported in palliative units in France [12].…”

“…The present study [4] was performed in Flanders and, as such, included Dutch Belgian representatives. This is of importance when generalising the results of the survey to other countries, taking into account that the practice of euthanasia is officially restricted to countries where it is registered in the legal code, such as Belgium or the Netherlands.…”

“…The study by PARDON et al [4] is the first disease-specific study on euthanasia and end-of-life decisions. The authors demonstrate that euthanasia is not an exception and is part of the end-of-life decision process in lung cancer in one of the few European countries, including Belgium and the Netherlands, where euthanasia is legally accepted under certain conditions.…”