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Continuous Deep Sedation Until Death-a Swiss Death Certificate Study.

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The number of patients receiving continuous deep sedation until death has quadrupled, with this trend linked to evolving end-of-life medical practices rather than patient characteristics. This shift impacts where and why patients undergo sedation.

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deep sedationgeneral internal medicineprimary caresymptom alleviationwithholding treatment

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Area of Science:

  • Medical Ethics
  • Palliative Care
  • End-of-Life Care

Background:

  • The incidence of continuous deep sedation until death has significantly increased over the past decade, with unclear underlying reasons.
  • This trend necessitates an investigation into patient demographics, clinical factors, and end-of-life decisions associated with sedation.

Purpose of the Study:

  • To identify the socio-demographic and clinical profiles of patients undergoing continuous deep sedation.
  • To examine concurrent medical end-of-life decisions, including potentially life-shortening interventions, in sedated patients.

Main Methods:

  • A cross-sectional study utilizing death certificates from German-speaking Switzerland in 2001 and 2013.
  • Involved a random sample of death certificates for non-sudden, expected deaths, supplemented by anonymous physician surveys on end-of-life practices.

Main Results:

  • The proportion of patients continuously deeply sedated until death rose from 6.7% in 2001 to 24.5% in 2013.
  • Sedation was more prevalent in younger patients (<65 years) and those dying in hospitals or specialized palliative care units.
  • A strong association was found between continuous deep sedation and foregoing life-prolonging treatments combined with symptom alleviation (OR 6.8).

Conclusions:

  • Continuous deep sedation in Swiss clinical practice predominantly occurs outside specialized palliative care settings.
  • The observed increase in sedation is primarily attributed to shifts in medical end-of-life practices, not changes in patient clinical profiles.