"Euthanasia": a survey by the Swiss Association for Palliative Care

Since the Swiss Association for Palliative Care (SAPC) considers itself an important partner in the national debate on euthanasia, the Board decided to conduct a survey among its members. An anonymous questionnaire was sent to the 726 members of the SAPC, consisting of multiple choice questions on positions that might be adopted in different hypothetical scenarios and one open question about the rationale for the answers. The response rate achieved with one mailing was 55.6%. The proportions of the respondents who were opposed to different forms of euthanasia were, in ascending order: 56% opposed to physician-assisted suicide (PAS); 69% to direct active euthanasia (DAE); 75% to DAE for psychiatric patients; 84% to delegation of DAE in the case of incompetent patients; and 90% to life-terminating acts without explicit requests (LAWER). Almost 10% of the members reported personal experiences with PAS and different forms of DAE. The main decisional bases drawn on for the answers were ethical values and the clinical or personal experience of the respondents; however, the same categories of arguments were used both by those opposing and by those favouring DAE. There are important variations among the members of the SAPC in the debate on euthanasia. Individual autonomy seems to be an important underlying concept for the different positions; the categories of arguments cited by opponents and supporters of DAE did not differ.

The intention to hasten death: a survey of attitudes and practices of surgeons in Australia

OBJECTIVE

To determine attitudes among surgeons in Australia to assisted death, and the proportion of surgeons who have intentionally hastened death with or without an explicit request.

DESIGN

Anonymous, cross-sectional, mail-out survey between August and November 1999

PARTICIPANTS

683 out of 992 eligible general surgeons (68.9% response rate).

MAIN OUTCOME MEASURES

Proportion of respondents answering affirmatively to questions about administering excessive doses of medication with an intention to hasten death.

RESULTS

247 respondents (36.2%; 95% CI, 32.6%-39.9%) reported that, for the purpose of relieving a patient's suffering, they have given drugs in doses that they perceived to be greater than those required to relieve symptoms with the intention of hastening death. More than half of these (139 respondents; 20.4% of all respondents; 95% CI, 17.4%-23.6%) reported that they had never received an unambiguous request for a lethal dose of medication. Of all respondents, only 36 (5.3%; 95% CI, 2.9%-6.1%) reported that they had given a bolus lethal injection, or had provided the means to commit suicide, in response to an unambiguous request.

CONCLUSIONS

More than a third of surgeons surveyed reported giving drugs with an intention to hasten death, often in the absence of an explicit request. However, in many instances, this may involve the use of an infusion of analgesics or sedatives, and such actions may be difficult to distinguish from accepted palliative care, except on the basis of the doctor's self-reported intention. Legal and moral distinctions based solely on a doctor's intention are problematic.

An expanded typology of suicide, assisted suicide, and euthanasia

The present article proposes an expanded typology of suicide, assisted suicide, and euthanasia in doctor-patient relations. Three dimensions are distinguished: the active-passive nature of the act, the degree of doctor involvement, and the reaction of the doctor to the patient's wishes. Thirteen distinct categories emerge, each of which may be active or passive. Among these categories are: solitary suicide, disapproved suicide, observed suicide, assisted suicide, voluntary euthanasia, non-voluntary euthanasia, and involuntary euthanasia. Within the observed suicide, assisted suicide, and voluntary euthanasia categories, the patient's wish to die can either be discussed, accepted, or encouraged. This article provides clinical examples of many of these categories and discusses their legal status and implications.

The regulation of euthanasia and related medical procedures that shorten life in the Netherlands

The Dutch political discussion concerning euthanasia has concentrated on whether there are situations in which euthanasia should be legalised and how these should be defined. An equally important question has been largely ignored: under what conditions is legal regulation of euthanasia likely to be effective?

Looked at from this perspective of effective control, the available empirical data lead to a rather different interpretation and to rather different concerns from those that so far have played a role in the political discussion. Euthanasia does not seem to deserve the attention that has been lavished on it. Neither in terms of its frequency nor in terms of the procedural safeguards with which it is surrounded does it seem to pose a substantial problem of control.

On the other hand, other medical procedures which, like euthanasia, intentionally shorten a patient's life surely warrant more attention than they have received. These other procedures are much more frequent than euthanasia and, because they are deemed ‘normal medical practice’, are attended by more limited procedural safeguards. Furthermore, because a given procedure can often be constructed either as ‘euthanasia’ or as one of the related procedures, effective regulation of euthanasia in isolation from the others is not possible.

Given an encompassing regulation of all medical procedures that shorten life, control can best be entrusted, at least in the first instance, to the medical profession itself and the substantive norms that govern euthanasia can perhaps largely be left to the patient and his or her family and doctor.