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To the Editor: Dr Sprung and colleagues¹ stated that "active shortening of the dying process" was rare in their sample and affected only 2% of patients who died after life-sustaining treatment was withheld or withdrawn.

A recent European survey,² on the other hand, has indicated that 40% of ICU physicians admitted that they sometimes administered drugs to hasten death. Likewise, physicians at neonatal ICUs in 2 European countries admitted with significant frequency (in France, 73% of respondents; in the Netherlands, 47%) that they had decided to administer drugs with the purpose of ending the patient's life.³ In Italy, a survey found that the deliberate use of lethal doses of drugs was admitted by about 4% of ICU physicians and was considered ethically acceptable by about 16%.⁴

Although prospective studies cannot be compared with questionnaire-based surveys, overall these results imply that this practice in not as uncommon as Sprung et al . . . [Full Text of this Article]

Alberto Giannini, MD
Department of Anaesthesia and Intensive Care
Istituti Clinici di Perfezionamento
Milan, Italy

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