End‐of‐life decisions in Australian medical practice

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Abstract
Objective: To estimate the proportion of medical end‐of‐life decisions in Australia, describe the characteristics of such decisions and compare these data with medical end‐of‐life decisions in the Netherlands, where euthanasia is openly practised. Design: Postal survey, conducted between May and July 1996, using a self‐administered questionnaire based on the questionnaire used to determine medical end‐of‐life decisions in the Netherlands in 1995. Participants: A random sample of active medical practitioners from all Australian States and Territories selected from medical disciplines in which there were opportunities to be the attending doctor at non‐acute patient deaths, and hence to make medical end‐of‐life decisions. Main outcome measure: Proportion of Australian deaths that involved a medical end‐of‐life decision, using ratio‐to‐size estimation based on the sampled doctors' responses to the questionnaire. The response rate was 64%. Results: The proportion of all Australian deaths that involved a medical end‐of‐life decision were: euthanasia, 1.8% (including physician‐assisted suicide, 0.1%); ending of patient's life without patient's concurrent explicit request, 3.5%; withholding or withdrawing of potentially life‐prolonging treatment, 28.6%; alleviation of pain with opioids in doses large enough that there was a probable life‐shortening effect, 30.9%. In 30% of all Australian deaths, a medical end‐of‐life decision was made with the explicit intention of ending the patient's life, of which 4% were in response to a direct request from the patient. Overall, Australia had a higher rate of intentional ending of life without the patient's request than the Netherlands. Conclusions: Australian law has not prevented doctors from practising euthanasia or making medical end‐of‐life decisions explicitly intended to hasten the patient's death without the patient's request.