In Netherlands, Dutch doctors do decide, including whether to withhold or withdraw treatment in a substantial proportion of elderly patients. End of life decisions are not made by patients or their families.
Why? It is not ageism, according to a survey in the Journal of Medical Ethics. It may be financial, since long-term care is paid for by the government, but survey respondents say they deny treatment out of respect for patients. Most commonly that means denying simple food and fluids.
The authors looked at a sample of deaths, stratified according to whether end of life decisions were likely or not, between August and November 2010 in The Netherlands. All doctors who certified a death were sent a questionnaire about end of life decision-making. In all, questionnaires were completed for 6600 patients, one in three of whom was aged between 65 and 79, and four out of 10 of whom were aged 80 and above. The most common reasons doctors gave for denying or withdrawing treatment included their belief there was no chance of improvement (72%) and the futility of prolonging treatment (62%). They were also around twice as likely to mention loss of dignity and respect for the patient's wishes for those aged 80+.
In more than half of cases (56%) there was no discussion about end of life decisions with the patient. Around one in three doctors (35%) judged that their decision had not shortened life; around one in four (27%) said that it had shortened life by up to a week.
The oldest patients were significantly more likely to be women and unmarried.
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