Open Access Open Badges Research article

Physicians' experiences with end-of-life decision-making: Survey in 6 European countries and Australia

Rurik Löfmark1*, Tore Nilstun2, Colleen Cartwright3, Susanne Fischer4, Agnes van der Heide5, Freddy Mortier6, Michael Norup7, Lorenzo Simonato8, Bregje D Onwuteaka-Philipsen9 and the EURELD Consortium

Author Affiliations

1 Centre for Bioethics at Karolinska Institutet and Uppsala Universitet, LIME, SE-171 77 Stockholm, Sweden

2 Department of Medical Ethics, BMC C 13, Lund University, S-211 84 Lund, Sweden

3 Southern Cross University, Hogbin Drive, Coffs Harbour NSW 2450 Australia

4 Center for Health Sciences, School of Health Professions Zurich University of Applied Sciences, P.O. Box, CH-8401 Winterthur, Switzerland

5 Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands

6 Ghent University, Ghent Bioethics Centre, Blandijnberg 2, 9000, Ghent, Belgium

7 Unit of Medical Philosophy Department of Health Services Research, Institute of Public Health University of Copenhagen, Øster Farimagsgade 5, PO Box 2099, DK 1014 Denmark

8 Department of Environmental Medicine and Public Health, University of Padova, Via Loredan 19, 35131 Padova, Italy

9 Vrije Universiteit Medical Centre, Department of Public and Occupational Health and EMGO Institute, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands

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BMC Medicine 2008, 6:4  doi:10.1186/1741-7015-6-4

Published: 12 February 2008



In this study we investigated (a) to what extent physicians have experience with performing a range of end-of-life decisions (ELDs), (b) if they have no experience with performing an ELD, would they be willing to do so under certain conditions and (c) which background characteristics are associated with having experience with/or being willing to make such ELDs.


An anonymous questionnaire was sent to 16,486 physicians from specialities in which death is common: Australia, Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland.


The response rate differed between countries (39–68%). The experience of foregoing life-sustaining treatment ranged between 37% and 86%: intensifying the alleviation of pain or other symptoms while taking into account possible hastening of death between 57% and 95%, and experience with deep sedation until death between 12% and 46%. Receiving a request for hastening death differed between 34% and 71%, and intentionally hastening death on the explicit request of a patient between 1% and 56%.


There are differences between countries in experiences with ELDs, in willingness to perform ELDs and in receiving requests for euthanasia or physician-assisted suicide. Foregoing treatment and intensifying alleviation of pain and symptoms are practiced and accepted by most physicians in all countries. Physicians with training in palliative care are more inclined to perform ELDs, as are those who attend to higher numbers of terminal patients. Thus, this seems not to be only a matter of opportunity, but also a matter of attitude.