About 10 per cent of all deaths in the Netherlands in 2001 were due to terminal sedation — drugging patients and stopping all food and water — according to a report in the Annals of Internal Medicine. In most cases, the primary intention of the doctor was to alleviate symptoms of pain or distress, but in 17% the doctor explicitly intended to bring about the death of the patient. In many of these cases, death was not imminent. The lead author, Professor Paul van der Maas, of Erasmus University Medical Centre, said that ensuring that a dying patient remains asleep until death has become established medical practice in the Netherlands.

Under Dutch legislation patients can also choose euthanasia, but they usually feel that terminal sedation is more natural. The researchers found that doctor discuss whether terminal sedation should be administered with the patients’ relatives but not always with the patients themselves, who often are no longer able to communicate. They also found it “remarkable” that GPs were much less likely to consult other doctors or caregivers. Doctors rarely consulted specialists in palliative care from other institutions or pain management teams.