The increase was mostly among patients with cancer treated by general practitioners. During the same period, the use of euthanasia dropped from 2.6 percent of deaths to 1.7 percent, a decrease of 1,200 cases, the report found.
"Of the physicians who used continuous deep sedation, 15 percent used morphine and no benzodiazepines and 91 percent did not consult a palliative-care expert," Rietjens said.
Among patients who opted for continuous deep sedation, 94 percent had less than a week to live. For 47 percent of the patients, continuous deep sedation was started in the last 24 hours before they died. In addition, about one in 10 of these patients had requested euthanasia, but their request had not been approved, the researchers reported.
The findings were published Friday in the online edition of the British Medical Journal.
Dr. Ira Byock is an end-of-life-care expert and director of palliative medicine at Dartmouth Medical School, who co-authored an accompanying editorial in the journal. He said he's not sure why there's been an increase in the use of continuous deep sedation in the Netherlands, and he questions whether other methods of controlling pain and discomfort shouldn't be used instead.
"We don't know if continuous deep sedation is being used as a substitute for euthanasia or whether it is indicative of better care for people who would otherwise die in distress," Byock said.
If deep sedation is being used as a substitute for euthanasia, then there are troubling clinical and ethical implications, Byock said. "We want to know if deep sedation is being used to avoid the procedural safeguards for euthanasia or whether it is being used appropriately to address symptoms such as pain or breathlessness that would otherwise be uncontrolled," he said.
In the United States, where euthanasia is not legal, deep sedation is used as a last resort when pain or discomfort is no longer controllable by other methods, Byock said. The decision to use deep sedation is also made in consultation with the patient or the family, he added.
"Even in the United States, there is concern that these practices [deep sedation] not be used too readily as a substitute for the meticulous, painstaking treatment of people's physical distress," Byock said. "There is no distress you're going to have that I cannot alleviate with medications, but we don't want that to be a substitute for good, comprehensive medical care."
More information
For more on end-of-life care, visit the National Hospice and Palliative Care Organization.
