Astrid M. Vrakking

CL Sprung

Erwin J. O. Kompanje

JA Rietjens

Jan Bakker

JJ Georges

JL Vincent

English

PubMed

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Comment on “Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: the ETHICATT study” by Sprung et al.

Intensive Care Med (2007) 33:747
DOI 10.1007/s00134-007-0570-x C O R R E S P O N D E N C E
Astrid M. Vrakking
Erwin J. O. Kompanje
Jan Bakker
Comment on “Attitudes
of European physicians, nurses,
patients, and families
regarding end-of-life decisions:
the ETHICATT study”
by Sprung et al.
Accepted: 29 January 2007
Published online: 2 March 2007
© Springer-Verlag 2007
An author’s reply to this comment is
available at: http://dx.doi.org/10.1007/
s00134-007-0571-9
Sir, We read with interest the paper
by Sprung et al. on attitudes of Euro-
pean physicians, nurses, patients,
and families regarding end-of-life
decisions [1]. The study compares
preferences for end-of-life decisions
between the above-mentioned groups
from six European countries with dif-
ferent societal backgrounds. We agree
with the authors that it is remarkable
that one-third to half of the respond-
ent groups wanted active euthanasia
for pain, both when they would be
diagnosed with a terminal illness and
when they would be permanently
unconscious; however, we question
the interpretation of the answers
for the second scenario, as in the
questionnaire, active euthanasia was
defined as the hastening of death at
the patient’s explicit request. In our
opinion, this scenario is theoretical,
since an unconscious patient cannot
explicitly request euthanasia. In such
a situation, alleviation of pain, with-
out the intention of hastening death,
is a much more plausible scenario.
In all participating countries, the
law does not allow hastening of
death without the patient’s explicit
request.
In addition, the numbers probably
represent an underestimation of the
respondents’ desire for euthanasia,
as studies have shown that pain is
not the only reason for a eutha-
nasia request [2, 3]. In these studies,
euthanasia requests were typically
related to patients’ sense of suffering
without improvement and loss of
dignity. Rietjens et al. showed that
in 36% of the patients that received
euthanasia, pain was the main reason
for their request [2].
Regrettably, a multivariate lo-
gistic regression analysis was only
presented for value of life vs quality
of life, and the desire to go into the
ICU. Especially for the euthanasia
scenario, it would be interesting to
compare countries, as it is known that
marked differences between countries
exist [4, 5].
References
1. Sprung CL, Carmel S, Sjokvist P,
Baras M, Cohen SL, Maia P,
Beishuizen A, Nalos D, Novak I,
Svantesson M, Benbenishty J, Hender-
son B (2006) Attitudes of European
physicians, nurses, patients, and fam-
ilies regarding end-of-life decisions:
the ETHICATT study. Intensive Care
Med DOI 10.1007/s00134-006-0405-1.
[Epub ahead of print]
2. Rietjens JA, van Delden JJ, van
der Heide A, Vrakking AM,
Onwuteaka-Philipsen BD, van der
Maas PJ, van der Wal G (2006)
Terminal sedation and euthanasia:
a comparison of clinical practices.
Arch Intern Med 166:749–753
3. Georges JJ, Onwuteaka-Philipsen BD,
van der Heide A, van der Wal G, van
der Maas PJ (2006) Requests to forgo
potentially life-prolonging treatment
and to hasten death in terminally ill
cancer patients: a prospective study.
J Pain Symptom Manage 31:100–110
4. Sprung CL, Cohen SL, Sjokvist P,
Baras M, Bulow HH, Hovilehto S,
Ledoux D, Lippert A, Maia P,
Phelan D, Schobersberger W,
Wennberg E, Woodcock T (2003)
End-of-life practices in European
intensive care units: the Ethicus Study.
J Am Med Assoc 290:790–797
5. Vincent JL (1999) Foregoing life
support in western European intensive
care units: the results of an ethical ques-
tionnaire. Crit Care Med 27:1626–1633
A. M. Vrakking () · E. J. O. Kompanje ·
J. Bakker
University Medical Center, Department of
Intensive Care, Room H324, Erasmus MC,
P.O. Box 2040, 3000 CA Rotterdam,
The Netherlands
e-mail: a.vrakking@erasmusmc.nl
Tel.: +31-10-4635755
Fax: +31-10-4632874


Vrakking, AM

Kompanje, Erwin

Bakker, Jan

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Comment on “Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: the ETHICATT study” by Sprung et al.

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