National survey of end-of-life decisions made by UK medical practitioners

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Abstract
Background: This study estimates the frequency of different end-of-life decisions (ELDs) in medical practice in the UK, compares these with other countries and assesses doctors’ views on the adequacy of current UK law. Method: Postal survey of 857 UK medical practitioners using a questionnaire used in other countries. Findings: The proportion of UK deaths involving an ELD were: 1) voluntary euthanasia 0.16% (0-0.36), 2) physician-assisted suicide 0.00%, 3) ending of life without an explicit request from patient 0.33% (0-0.76), 4) alleviation of symptoms with possibly life shortening effect 32.8% (28.1-37.6), 5) non-treatment decisions 30.3% (26.0-34.6). ELDs 1 and 2 were significantly less frequent than in the Netherlands and Australia; ELD 2 was also less frequent than Switzerland. ELD 3 was less frequent than in Belgium and Australia. Comparison of UK and New Zealand general practitioners showed lower rates of ELDs 4 and 5 in the UK. ELD 5 was more common than in most other European countries. A few doctors attending deaths felt UK law had inhibited or interfered with their preferred management of patients (4.6% (3.1-6.1%) of doctors) or that a new law would have facilitated better management (2.6% (1.4-3.8%) of doctors). Interpretation: The lower relative rate of ELDs involving doctor-assisted dying in the UK, and the relatively high rate of non-treatment decisions, suggests a culture of medical decision making informed by a palliative care philosophy.