End-of-life practices in palliative care: a cross sectional survey of physician members of the German Society for Palliative Medicine.

ABSTRACT

OBJECTIVES: To elicit types and frequencies of end-of-life practices by physician members of the German Society for Palliative Medicine. To analyse associations between characteristics of physicians and patients and end-of-life practices with intended hastening of death. DESIGN: Cross-sectional postal survey. MAIN OUTCOME MEASURES: Types and frequencies of end-of-life practices with foreseeable or intended hastening of patients' death. Association between end-of-life practices with hastening of death and predefined characteristics of physicians and patients. RESULTS: Nine hundred and one physicians participated in the study (response rate 55.8%). There was alleviation of symptoms in 78.1% and limitation of medical treatment with possible life shortening in 69.1% of cases. In 10 cases medication had been administered by the physician (N = 9) or the patient (N = 1) with the intention to hasten death. Patients' best interest and avoidance of possible harm to the patient were reported as reasons for non-involvement of competent patients in decision making. Physicians with added qualification in palliative medicine significantly less frequently reported end-of-life practices with intended hastening of death (p = 0.003). CONCLUSION: Physician members of the German Society for Palliative Medicine perform a broad spectrum of end-of-life practices including intended hastening of death. The findings on patients' non-involvement in decision making warrant further empirical-ethical analysis.