Abstract
BackgroundEnd-of-life policies are hotly debated in many countries, with international evidence frequently used to support or oppose legal reforms. Existing reviews are limited by their focus on specific practices or selected jurisdictions. The objective is to review international time trends in end-of-life practices.MethodsWe conducted a systematic review of empirical studies on medical end-of-life practices, including treatment withdrawal, the use of drugs for symptom management, and the intentional use of lethal drugs. A search strategy was conducted in MEDLINE, EMBASE, Web of Science, Sociological s, PAIS International, Worldwide Political Science s, International Bibliography of the Social Sciences and CINAHL. We included studies that described physicians’ actual practices and estimated annual frequency at the jurisdictional level. End-of-life practice frequencies were analyzed for variations over time, using logit regression.ResultsAmong 8183 references, 39 jurisdiction-wide surveys conducted between 1990 and 2010 were identified. Of those, 22 surveys used sufficiently similar research methods to allow further statistical analysis. Significant differences were found across surveys in the frequency of treatment withdrawal, use of opiates or sedatives and the intentional use of lethal drugs (X2 > 1000, p < 0.001 for all). Regression analyses showed increased use of opiates and sedatives over time (p < 0.001), which could reflect more intense symptom management at the end of life, or increase in these drugs to intentionally cause patients’ death.ConclusionThe use of opiates and sedatives appears to have significantly increased over time between 1990 and 2010. Better distinction between practices with different legal status is required to properly interpret the policy significance of these changes. Research on the effects of public policies should take a comprehensive look at trends in end-of-life practice patterns and their associations with policy changes.
Highlights
End-of-life policies are hotly debated in many countries, with international evidence frequently used to support or oppose legal reforms
A scoping review highlighted the need to take a comprehensive look at international end-of-life practice variations, because existing reviews tended to focus on specific practices or selected countries [6]
Trends in patterns of “euthanasia” and “assisted suicide” are most frequently discussed, with less attention being put on treatment withdrawal and the use of drugs for symptom management [7,8,9,10,11]
Summary
End-of-life policies are hotly debated in many countries, with international evidence frequently used to support or oppose legal reforms. Trends in patterns of “euthanasia” and “assisted suicide” are most frequently discussed, with less attention being put on treatment withdrawal and the use of drugs for symptom management [7,8,9,10,11]. This could be problematic as it limits the ability to study the effects of public policies on the full range of end-of-life practices.
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