End-of-life decisions and involvement of Physical and Rehabilitation Medicine Physicians in Europe

Abstract

Objective: As Physical and Rehabilitation Medicine physicians are experts in functional prognoses of disabling health conditions, the aim of this study was to gain insight into their involvement in end-of-life decisions in patients with neurological or terminal diseases in European countries.Design: Exploratory cross-sectional survey.Subjects: Delegates of the Union of European Medical Specialists, Physical and Rehabilitation Medicine Section.Methods: In July 2020, a self-constructed survey was sent to 82 delegates from 38 European countries, who were asked to answer from the point of view of their country. Topics included the legal status of end-of-life decisions and the involvement of Physical andRehabilitation Medicine physicians in these decisions.Results: Between July 2020 and December 2020, 32 delegates from 28 countries completed the survey (response rate country level of 74%). If legal frameworks allow for these specific end-of-life decisions, involvement of Physical and Rehabilitation Medicine physicians was reported in 2 of 3 countries in euthanasia cases, 10 of 17 countries in non-treatment decision cases, and 13 of 16 countries in cases of intensified symptom management by the administration of drugs using potentially life-shortening doses.Conclusion: Estimated involvement of Physical and Rehabilitation Medicine physicians in end-of-life decisions varied between European countries, even when legal frameworks allow for these decisions. LAY ABSTRACTEnd-of-life considerations may arise after severe disabling health conditions and lead to end-of-life decisions. As Physical and Rehabilitation Medicine physicians are experts in functional prognosis for patients with these health conditions, their expertise could be of value to consider in these decisions. Legal frameworks and attitudes towards end-of-life decisions differ between European countries. However, there is a lack of information on the involvement of Physical and Rehabilitation Medicine physicians in these decisions. Therefore, delegates of Physical and Rehabilitation Medicine physicians in European countries were surveyed on the legal status of end-of-life decisions and the involvement of Physical and Rehabilitation Medicine physicians. The responses of delegates from 28 countries suggested differences in involvement of Physical and Rehabilitation Medicine physicians in end-of-life decisions between European countries, even between countries with a legal status of these end-of-life decisions. In the light of the ageing population and a general tendency toward more liberal attitudes concerning end-of-life decisions in Europe, these findings could be of interest in order to optimize end-of-life care in the coming years.