These differences may be partially explained by the different study designs; the legislation has also changed between these studies and ours. It is not easy to compare study findings with those conducted elsewhere, even where similar survey protocols are used (retrospective survey of certifying physicians, with a representative sample of deaths). The definition we used for sudden deaths and the wording and approach for questions about end-of-life medical decisions were different to those used in EURELD type studies. In particular, we chose a two-step approach: a question
on a treatment/decision (withholding, withdrawing a treatment, intensifying the alleviation of pain); and, for each decision made, its possible or certain effect Inhibitors,research,lifescience,medical on hastening death as Inhibitors,research,lifescience,medical well as the intention of hastening death, is investigated. According to Seale [29] who compared the two wordings for UK, the two-step approach
gives a lower percentage of end-of-life decisions compared to the approach where the potential effect of hastening death is included in the question of treatment. As a result, end-of-life Inhibitors,research,lifescience,medical decisions could not be classified in an identical manner as Eureld, although we tried to get as close as possible. If we had replaced our definition of “sudden death” (deaths declared by physician as “sudden and unexpected” and for which they cannot provide any information about the patient’s end of life) with the EURELD definition, the percentage of sudden deaths would have more than doubled (from 16.9 to 39.3%). This change of definition of sudden deaths till reduces Inhibitors,research,lifescience,medical more the proportion of medical decisions without any intention regarding deaths than the one that possibly or certainly hastened deaths. Compared with the 2001 Eureld survey results [4] and more recent results in Belgium [30] and the Netherlands [31], and taking the definitions of medical decisions closest to those used in these surveys, Inhibitors,research,lifescience,medical the proportion of sudden deaths in the French data (39%) is higher than that of all other countries (29-34%). The percentage of deaths for which a decision was made that possibly
or certainly hastened death (40%), is around the average observed in the other European countries. It is much higher than in Italy, (29% in 2001), but well below the levels in Switzerland, where assisted suicide is legal (51% in 2001), and in the Netherlands (57% in 2010) and Belgium (48% GSK-3 in 2007), two countries where euthanasia has been legalised. In France, intensification of treatment to alleviate pain and/or symptoms is close to the level observed in Belgium in 2007, but slightly higher than in most EURELD countries. However, levels of withholding or withdrawal of treatment are similar to those observed in more recent surveys in Belgium and the Netherlands. France ranks among the countries with a low percentage of physician-assisted dying by administration of a drug to deliberately hasten death.
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