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Limitation of treatment at the end of life: an empirical-ethical analysis regarding the practices of physician members of the German Society for Palliative Medicine
  1. Jan Schildmann1,
  2. Julia Hoetzel1,
  3. Anne Baumann1,
  4. Christof Mueller-Busch2,
  5. Jochen Vollmann1
  1. 1Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany
  2. 2German Society for Palliative Medicine; University Witten/Herdecke, Germany
  1. Correspondence to Dr Jan Schildmann, Institut für Medizinische Ethik und Geschichte der Medizin and History of Medicine, Ruhr-Universitaet Bochum, Malakowturm-Markstraße 258a, D-44799 Bochum, Germany; jan.schildmann{at}


Objectives To determine the frequencies and types of limitation of medical treatment performed by physician members of the German Society for Palliative Medicine and to analyse the findings with respect to clinical and ethical aspects of end-of-life practices.

Design Cross-sectional postal survey.

Setting Data collection via the secretary of the German Society for Palliative Medicine using the German language version of the EURELD survey instrument.

Subjects All 1645 physician members of the German Society for Palliative Medicine.

Main outcome measures Types and frequencies of limitation of treatment and possible determinants.

Results 901 physicians participated in the study (response rate 55.8%). Participants reported limitation of treatment in 69.1% of cases. These decisions most often affected artificial nutrition (19%), chemotherapy (14%), antibiotics (11%) and medication other than antibiotics (11%). In the majority of eligible cases, physicians estimated the life-shortening effect of limitation of treatment to be <7 days. However, estimations differ depending on the medical measures in question. Bivariate statistical analysis indicated that withholding of treatment was performed significantly more frequently for patients aged ≥65 years (p=0.019). In addition, there were significant associations between the incidence of limitation of treatment and the different diseases reported by respondents as the underlying cause of death.

Conclusion The findings of this study provide information on the current state of an ethically and clinically challenging aspect of clinical practice and can serve as a starting point for further interdisciplinary research on normative and empirical aspects of treatment decision-making at the end of life.

  • Codes of/position statements on professional ethics
  • care of the dying patient
  • prolongation of life and Euthanasia

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  • JS and JH contributed equally to this paper.

  • Funding JH was funded by a start up grant of the Ruhr University Bochum (“Programm zur Anschubfinanzierung des wissenschaftlichen Nachwuchs”). JS and AB form part of the NWR-Junior Research Group “Medical Ethics at the End of Life: Norm and Empiricism” at the Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum which is funded by the Ministry for Innovation, Science, Research and Technology of the German state of North Rhine-Westphalia.

  • Competing interests CM-B (past president) and JS are members of the German Society for Palliative Medicine.

  • Ethics approval This study was conducted with the approval of the Research Ethics Committee of the Medical Faculty of the Ruhr-University Bochum.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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