Institutional members access full text with Ovid®

Share this article on:

Sex-based Differences in End-of-Life Decision Making in Flanders, Belgium

Smets, Tinne MA, PhD*; Rietjens, Judith A. PhD*,†; Chambaere, Kenneth PhD*; Coene, Gily PhD; Deschepper, Reginald PhD*; Pasman, H. Roeline PhD§; Deliens, Luc PhD*,§

doi: 10.1097/MLR.0b013e3182551747
Original Articles

Background: Sex-related differences in end-of-life decisions (EOLD) are underresearched and unexplored.

Objectives: To investigate whether there are (1) differences in demographic and/or clinical characteristics between male and female decedents; (2) differences between men and women in the prevalence of EOLD with a possible or certain life-shortening effect; (3) differences in EOL decision making between men and women.

Methods: In 2007, we performed a postmortem survey in Flanders, Belgium among physicians certifying a large representative sample (n=6927) of death certificates. Response rate was 58.4%.

Results: Of patients with nonsudden death, women more often die in a care home than men (31.4% vs. 18.2%) who more often die at home (24.1% vs. 17.9%). Men tend to die more often from cancer than women (45.4% vs. 32.1%). Decisions to withhold or withdraw potentially life-prolonging treatment are more often made in women (28.0% vs. 22.8%, P=0.003); euthanasia and pain and symptoms treatment [alleviation of pain and symptoms (APS)] occur more often in men (3.6% vs. 2.1% euthanasia, P=0.023; 41.8% vs. 36.9% APS, P=0.012). These differences disappear after controlling for confounders. Bivariate associations were found between sex and EOL decision making. Some of them remained after controlling for confounders.

Conclusions: It is not the patient’s sex in itself that determines the likelihood of an EOLD, but the different clinical profiles of men and women at the end of life. Although sex is not a determining factor in the prevalence of EOLD, it influences the decision-making process, indicating that there may be a difference in the way that male and female patients participate in EOL decision making.

*End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussel, Belgium

Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands

Centre for Gender and Diversity, Vrije Universiteit Brussel, Brussel, Belgium

§Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands

Supported by the Institute for the Promotion of Innovation by Science and Technology, Flanders Belgian Federal Science Policy Office (BELSPO).

The authors declare no conflict of interest.

Reprints: Tinne Smets, MA, PhD, End-of-Life Care Research Group, Faculty of Medicine and Pharmacy, Laarbeeklaan 103, 1090 Brussels, Belgium. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.