Estimating the potential life-shortening effect of continuous sedation until death: a comparison between two approaches.

Bruinsma SM, Rietjens JA, Swart SJ, Perez RS, van Delden JJ, van der Heide A.

J Med Ethics. 2013 Jul 11. 

Source

Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.

Abstract

CONTEXT:

In some cases, physicians estimate that continuous sedation until death may have a life-shortening effect. The accuracy of these estimations can be questioned.

AIM:

The aim of this study is to compare two approaches to estimate the potential life-shortening effect of continuous sedation until death.

METHODS:

In 2008, 370 Dutch physicians filled out a questionnaire and reported on their last patient who received continuous sedation until death. The potential life-shortening effect of continuous sedation was estimated through a direct approach (question: Did continuous sedation, according to your estimation, hasten the patient's death? If yes: by how much time?) and an indirect approach (estimated life expectancy minus duration of sedation). The intrarater agreement between both approaches was determined with a weighted κ.

RESULTS:

According to the direct approach, sedation might have had a life-shortening effect in 51% of the cases and according to the indirect approach in 84%. The intrarater agreement between both approaches was fair (weighted κ=0.38). In 10% of all cases, the direct approach yielded higher estimates of the extent to which life had been shortened; in 58% of the cases, the indirect approach yielded higher estimates.

CONCLUSIONS:

The results show a discrepancy between different approaches to estimate the potential life-shortening effect of continuous sedation until death.