While there will always be competing opinions on how to end someone's life with dignity, protecting the elderly from rash decisions during end-of-life care has always been a top priority in the medical community. Even if the data shows that physicians are withholding or withdrawing treatment from older patients more often than younger ones, doctors attest it's not a case of ageism.
A new study found that forgoing treatment occurs more frequently in elderly patients than it does with younger ones. Researchers took a stratified sampling of all deaths occurring between August and November 2010 in the Netherlands. They then sent a questionnaire on end-of-life decision-making to every doctor who certified a death in the study's sample, which was 6,600 patients. The report's findings were published in the Journal of Medical Ethics, the official journal of the Institute of Medical Ethics.
Researchers found that treatment was withdrawn or withheld in 37% of the cases sampled. Additionally, the data showed that doctors were more likely to hold back treatment from patients if they were part of an older age group. Survey respondents admitted to withholding treatment from 42% of patients who were 80 years of age or older; 36% of patients between the ages of 65 and 79; and 25% of patients between 16 and 64 years old. The study revealed that artificial hydration/nutrition, medication and antibiotics were the three types of treatment most frequently withheld or withdrawn from patients.
"Most important reasons physicians in our study gave for the decision to withhold a treatment was that they thought that there was no chance of improvement for the patient and/or that they thought providing the treatment could cause futile prolongation of the patient's life," said Dr. H. Roeline Pasman, senior researcher at the VU University medical center and one of the co-authors of the paper. "Also expected suffering when starting treatment was a mentioned reason in 28% of the patients."
In more than half of these cases (56%), the doctor did not discuss the decision to forgo treatment with the patient. This is mainly because 93% of these patients were not capable of assessing their own situation and making a decision. The majority of them were unconscious (66%) and others had dementia (31%). The decision was discussed with a patient's family 44% of the time.
"In the Netherlands the guiding principle is that treatment decisions are discussed with the patient, or if the patient is not competent, their family, and when a patient refuses treatment this has to be respected according to the Medical Treatment Agreement Act," Pasman said. "In addition, a physician is not obliged to follow the patient's wish for wanting treatment; physicians have their own professional responsibility and can forgo treatment that is futile."
Physicians did not believe their decision to forgo treatment impacted patients negatively. Around 35% believed it had not shortened life. Another 27% said that it had shortened life by up to a week. Overall, however, 81% thought life had been shortened by one week at the most.
"This shows that the physicians thought that the patient was already in the really last phase of life and seem not to want to intervene in the normal dying process," she said.
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