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Medical end-of-life practices in Swiss cultural regions: a death certificate study
BACKGROUND: End-of-life decisions remain controversial. Switzerland, with three main languages shared with surrounding countries and legal suicide assistance, allows exploration of the effects of cultural differences on end-of-life practices within the same legal framework. METHODS: We conducted a d...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5909244/ https://www.ncbi.nlm.nih.gov/pubmed/29673342 http://dx.doi.org/10.1186/s12916-018-1043-5 |
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author | Hurst, Samia A. Zellweger, Ueli Bosshard, Georg Bopp, Matthias |
author_facet | Hurst, Samia A. Zellweger, Ueli Bosshard, Georg Bopp, Matthias |
author_sort | Hurst, Samia A. |
collection | PubMed |
description | BACKGROUND: End-of-life decisions remain controversial. Switzerland, with three main languages shared with surrounding countries and legal suicide assistance, allows exploration of the effects of cultural differences on end-of-life practices within the same legal framework. METHODS: We conducted a death certificate study on a nationwide continuous random sample of Swiss residents. Using an internationally standardized tool, we sent 4998, 2965, and 1000 anonymous questionnaires to certifying physicians in the German-, French-, and Italian-speaking regions. RESULTS: The response rates were 63.5%, 51.9%, and 61.7% in the German-, French-, and Italian-speaking regions, respectively. Non-sudden, expected deaths were preceded by medical end-of-life decisions (MELDs) more frequently in the German- than in the French- or Italian-speaking region (82.3% vs. 75.0% and 74.0%, respectively), mainly due to forgoing life-prolonging treatment (70.0%, 59.8%, 57.4%). Prevalence of assisted suicide was similar in the German- and French-speaking regions (1.6%, 1.2%), with no cases reported in the Italian-speaking region. Patient involvement was smaller in the Italian- than in the French- and German-speaking regions (16.0%, 31.2%, 35.6%). Continuous deep sedation was more frequent in the Italian- than in the French- and German-speaking regions (34.4%, 26.9%, 24.5%), and was combined with MELDs in most cases. CONCLUSION: We found differences in MELD prevalence similar to those found between European countries. On an international level, MELDs are comparably frequent in all regions of Switzerland, in line with the greater role given to patient autonomy. Our findings show how cultural contexts and legislation can interact in shaping the prevalence of MELDs. |
format | Online Article Text |
id | pubmed-5909244 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-59092442018-04-30 Medical end-of-life practices in Swiss cultural regions: a death certificate study Hurst, Samia A. Zellweger, Ueli Bosshard, Georg Bopp, Matthias BMC Med Research Article BACKGROUND: End-of-life decisions remain controversial. Switzerland, with three main languages shared with surrounding countries and legal suicide assistance, allows exploration of the effects of cultural differences on end-of-life practices within the same legal framework. METHODS: We conducted a death certificate study on a nationwide continuous random sample of Swiss residents. Using an internationally standardized tool, we sent 4998, 2965, and 1000 anonymous questionnaires to certifying physicians in the German-, French-, and Italian-speaking regions. RESULTS: The response rates were 63.5%, 51.9%, and 61.7% in the German-, French-, and Italian-speaking regions, respectively. Non-sudden, expected deaths were preceded by medical end-of-life decisions (MELDs) more frequently in the German- than in the French- or Italian-speaking region (82.3% vs. 75.0% and 74.0%, respectively), mainly due to forgoing life-prolonging treatment (70.0%, 59.8%, 57.4%). Prevalence of assisted suicide was similar in the German- and French-speaking regions (1.6%, 1.2%), with no cases reported in the Italian-speaking region. Patient involvement was smaller in the Italian- than in the French- and German-speaking regions (16.0%, 31.2%, 35.6%). Continuous deep sedation was more frequent in the Italian- than in the French- and German-speaking regions (34.4%, 26.9%, 24.5%), and was combined with MELDs in most cases. CONCLUSION: We found differences in MELD prevalence similar to those found between European countries. On an international level, MELDs are comparably frequent in all regions of Switzerland, in line with the greater role given to patient autonomy. Our findings show how cultural contexts and legislation can interact in shaping the prevalence of MELDs. BioMed Central 2018-04-20 /pmc/articles/PMC5909244/ /pubmed/29673342 http://dx.doi.org/10.1186/s12916-018-1043-5 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Hurst, Samia A. Zellweger, Ueli Bosshard, Georg Bopp, Matthias Medical end-of-life practices in Swiss cultural regions: a death certificate study |
title | Medical end-of-life practices in Swiss cultural regions: a death certificate study |
title_full | Medical end-of-life practices in Swiss cultural regions: a death certificate study |
title_fullStr | Medical end-of-life practices in Swiss cultural regions: a death certificate study |
title_full_unstemmed | Medical end-of-life practices in Swiss cultural regions: a death certificate study |
title_short | Medical end-of-life practices in Swiss cultural regions: a death certificate study |
title_sort | medical end-of-life practices in swiss cultural regions: a death certificate study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5909244/ https://www.ncbi.nlm.nih.gov/pubmed/29673342 http://dx.doi.org/10.1186/s12916-018-1043-5 |
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