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Tuesday, January 22, 2013

There is more to end-of-life practices than euthanasia — Authors' reply

The Lancet
Volume 381, Issue 9862, Pages 202-203

Bregje Onwuteaka-Philipsen, Arianne Brinkman-Stoppelenburg, Hans van Delden, Anges van der Heide

We agree with Jan Schildmann and Eva Schildmann that the debate on end-of-life practices should not be limited to euthanasia. We also agree that increased attention to palliative care does not necessarily result in good quality end-of-life care. Our study gives an insight into end-of-life decision making and end-of-life acts, but not into the quality of end-of-life care. Additionally, what good quality end-of-life care consists of is not that straightforward. This is certainly true for palliative sedation. Although there is an increasing body of published studies on this subject, there are controversies on terminology and ethical acceptability of the practice. Guidelines are a way to try to overcome this and to improve quality of care. Yet there are many different guidelines—eg, at the institutional level and in different countries—and the premises of national guidelines can be the subject of debate. In our opinion, the role of empirical studies such as ours is to underpin the ongoing debate with information about what occurs in practice.

We declare that we have no conflicts of interest.

doi:10.1016/S0140-6736(13)60087-2