Sedation in the Netherlands: A consequence of the growth in palliative care or akin to euthanasia?

Objectives. - Through the particular example of the Netherlands, this article discusses the influence of the rise of palliative care on the practice of sedation in terminal phase. Method. - We researched the data from articles relating to the development of palliative care in the Netherlands and the results of the Dutch national end-of-life studies published in 2001 and 2005. Results and discussion. - In the Netherlands, between 2001 and 2005, palliative care grows significantly, all the while sedation is used more frequently in terminal phase. This leads to the following two questions: is the increase in sedation use in terminal phase a consequence of the growth in palliative care? Is the increasing extent to which sedation is used in terminal phase leaning towards slow euthanasia? Conclusion. - The increase in use of sedation in terminal phase in the Netherlands cannot be said to be positively correlated with the development of palliative care in the country. Palliative care's aim towards the end-of-life is indeed rather to try and avoid situations where sedation is needed. It is important to insist on its use on a strictly exceptional basis in terminal phase. Unless the patient experiences severe refractory symptoms that he/she considers unbearable, sedation should be considered as injudicious. (C) 2012 Elsevier Masson SAS. All rights reserved.