A comparison of physicians end-of-life decision making for non-western migrants and Dutch natives in the Netherlands

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.