The European Journal of Public Health Advance Access published online on September 27, 2008
The European Journal of Public Health, doi:10.1093/eurpub/ckn084
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A comparison of physicians’ end-of-life decision making for non-western migrants and Dutch natives in the Netherlands
Hilde M. Buiting1,*, Judith A.C. Rietjens1, Bregje D. Onwuteaka-Philipsen2, Paul J. van der Maas1, Johannes J. M. van Delden3 and Agnes van der Heide1
1 Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
2 Department of Public and Occupational Health and Institute for Research in Extramural Medicine, Vrije Universiteit Medical Center, The Netherlands
3 Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
Correspondence: Hilde Buiting, Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands, tel: +31 10 7044269, fax: +31 10 7038474, e-mail: h.buiting{at}erasmusmc.nl
Received April 11, 2008 , accepted August 14, 2008
Background: Non-western migrants have a different cultural background that influences their attitudes towards healthcare. As the first wave of this relatively young group is growing older, we investigated, for the first time, whether end-of-life decision-making practices for non-western migrants differ from Dutch natives. Methods: In 2005, we sent questionnaires to physicians who attended deaths identified from the central death registry of Statistics Netherlands (n = 9651; non-western migrants: n = 627, total response: 78%). We performed multivariate logistic regression analyses adjusted for age, sex and cause of death. Results: Of all deaths of non-western origin, 54% were non-sudden, whereas 67% of all deaths with a Dutch origin were non-sudden (P = 0.00). A relatively large number of non-suddenly deceased persons of non-western origin had died under the age of 65 (53%) as compared to Dutch natives (15%). Euthanasia was performed in 2.4% of all non-suddenly deceased persons in the non-western migrant group as compared to 2.7% in the native Dutch group (adjusted odds ratio = 0.82, P = 0.63). Alleviation of symptoms with a potential life-shortening effect was somewhat lower for non-western migrants (30% vs. 38%; adjusted odds ratio = 0.78, P = 0.07). Physicians decided to forgo potentially life-prolonging treatment in comparable rates (26% vs. 23%; adjusted odds ratio = 1.1, P = 0.73). Yet, the type of treatments forgone and underlying reasons differed. Conclusion: Euthanasia was not less common among non-suddenly deceased non-western migrants as compared to Dutch natives. However, intensive symptom alleviation was used less frequently and forgoing potentially life-prolonging treatment involved different characteristics. These findings suggest that cultural factors may affect end-of-life decision making.
Keywords: culture, decision-making, end-of-life, ethnicity, migrant