Dutch use of end-of-life sedation rises, prompting calls for closer oversight
Keeping dying patients asleep, known as palliative sedation, is being used more often in the Netherlands, with experts warning that hospitals do not systematically track the practice, creating limited national oversight, NOS reports.
The increase is visible in pharmacy data and clinical estimates. In 2015, 19.9 percent of deaths involved palliative sedation among patients receiving medication at home. By 2025, that share had risen to 28 percent. Because hospitals do not record the practice in a standardized way, the total number of cases nationwide is, however, unknown. One palliative care specialist told NOS that they estimate it is used in at least 40 percent of all deaths.
Palliative sedation is used for patients with a life expectancy of no more than two weeks. Doctors administer medication that lowers consciousness so patients do not experience the dying process and instead die in their sleep.
Specialists speaking to NOS say the trend should be investigated. Palliative care specialist Sabine Netters said such an "invasive" intervention should not become too easy to use and warned that rapid growth in any medical practice requires scrutiny.
The Royal Dutch Medical Association (KNMG) said palliative sedation, when applied carefully, is standard medical practice aimed at relieving suffering in the final phase of life and is fundamentally different from euthanasia, which involves strict legal reporting and review requirements. Euthanasia accounted for 6 percent of deaths last year in the Netherlands.
The practice is not systematically monitored in hospitals because it is considered part of normal medical care. Critics say this lack of oversight makes it difficult to assess whether it is being used appropriately or is increasingly being used as a default option.
A joint statement from the ministers of health and long-term care said they do not recognize claims that palliative sedation is being used too quickly but do acknowledge that it is being used more often. They attributed the increase to greater recognition of refractory symptoms—untreatable conditions that cause severe suffering—and to expectations among patients and relatives. They also said palliative sedation is increasingly viewed as a standard part of end-of-life care, though patients and families are not always clear about the medical conditions required for its use.
Doctors also note that pain relief is often possible in the final stage of life while keeping patients conscious, and they argue that this option should always be explicitly offered. Netters warned that under time pressure, clinicians may turn to sedation too quickly.
Community nurse Jennifer Bergkamp told NOS that care providers sometimes skip important steps in end-of-life discussions, arguing that more communication could reduce fear and help patients understand what a natural death involves.
