End-ot-lite decisions in Dutch medical practice

In the end, death comes to us all. This reality has not changed during centuries of attempting to unravel the mysteries of life and death. Even today, death is the most unescapable event in each human life. Life and time before death, however, have altered considerably. At least two changes are responsible for this. The first is that, over the past hundred and fifty years, man has succeeded in changing his condition in such a way that, in the well developed countries, average life expectancy has doubled. The strongly reduced perinatal and infant mortality have caused death to disappear almost completely from daily life in the Netherlands. A second Important development is of much more recent date, basically dating only from after World War Ii: the development of modern medicine. Medical practice today is increasingly able to assist in curing the sick, in making life bearable for the sick and extending life for a shorter or longer period of time. In other words: death still comes to everyone, but the time at which this happens isoften partly determined by decisions whether to stop or to continue treatment. Obviously, this does not hold for all deaths. People still die from accidents or from acute fatal diseases such as acute myocardial infarction. In all non-sudden deaths, however, patient and physician are involved in a shorter or longer disease process. A considerable difference compared with the situation existing over one hundred years ago, when In some municipalities more than half of all deceased had no physician's assistance during their preceding disease. Now that medicine can offer so much in terms of prolonging life and relieving suffering, the physician's task at the end of life is expanding. In the past, this task primarily Involved the provision of terminal care. Increasingly, decision-making by the physician is among the medical responsibilities at the end of life