The acceptability among lay persons and health professionals of actively ending the lives of damaged newborns

Romanian Lay People’s and Health Professionals’ Views about the Acceptability of Physician-Assisted Suicide

The conditions under which Physician-Assisted-Suicide (PAS) would be considered as acceptable among Romanians were examined. In July 2015-May 2016, 212 lay people and 52 health professionals judged the acceptability of PAS in 36 realistic vignettes composed of all combinations of four factors: the patient’s age, the level of incurability of the illness, the type of suffering, and the patient’s request for PAS. A majority of lay people (51%) and health professionals (85%) were opposed to PAS, quite irrespective of conditions. The most important factors determining acceptability were, for 36% of lay people, request for PAS and, for 18%, advanced age.  

Mapping French people's views regarding posthumous reproduction

OBJECTIVE

The study mapped French people's views regarding the acceptability of posthumous reproduction.

BACKGROUND

Posthumous reproduction - the use of a deceased person's gametes for procreative purposes -is a controversial procedure because it involves a series of ethical issues, namely the surviving partner's rights to procreation, the emotional feelings and financial interests of other family members, and the government's interest in maintaining orderly inheritance rules.

METHODS

A convenience sample of participants aged 19-68 (104 lay people, 47 health professionals and 15 lawyers) were presented with 48 realistic stories that were composed according to a four-factor within-subject design: marital status (married for about 10 years with children, married for about three years without children, and cohabiting for three years without children) × attitude of the deceased's parents (favourable vs. unfavourable to posthumous procreation) × time elapsed since the partner's death (three months vs. nine months) × deceased's wishes (written consent, oral consent given in front of credible witnesses, unknown wishes, and unfavourable attitude).

RESULTS

Through cluster analysis, four qualitatively different positions were found. They were called Never Acceptable (35% of the sample, mostly health professionals, lawyers and regular attendees to the church or temple), Tolerable in a Few Cases (28%), Depends on Deceased's Wishes (22%, mostly lay people) and Quite Acceptable (16%, mostly lay people).

CONCLUSIONS

About half of French lay people view the current legislation regarding posthumous assisted reproduction in a country such as the UK as more appropriate than the French legislation.

Determinants of Public Attitudes towards Euthanasia in Adults and Physician-Assisted Death in Neonates in Austria: A National Survey

Background

Euthanasia remains a controversial topic in both public discourses and legislation. Although some determinants of acceptance of euthanasia and physician-assisted death have been identified in previous studies, there is still a shortage of information whether different forms of euthanasia are supported by the same or different sub-populations and whether authoritarian personality dispositions are linked to attitudes towards euthanasia.

Methods

A large, representative face-to-face survey was conducted in Austria in 2014 (n = 1,971). Respondents faced three scenarios of euthanasia and one of physician assisted death differing regarding the level of specificity, voluntariness and subject, requiring either approval or rejection: (1) abstract description of euthanasia, (2) abstract description of physician-assisted suicide, (3) the case of euthanasia of a terminally-ill 79-year old cancer patient, and (4) the case of non-voluntary, physician assisted death of a severely disabled or ill neonate. A number of potential determinants for rejection ordered in three categories (socio-demographic, personal experience, orientations) including authoritarianism were tested via multiple logistic regression analyses.

Results

Rejection was highest in the case of the neonate (69%) and lowest for the case of the older cancer patient (35%). A consistent negative impact of religiosity on the acceptance across all scenarios and differential effects for socio-economic status, area of residence, religious confession, liberalism, and authoritarianism were found. Individuals with a stronger authoritarian personality disposition were more likely to reject physician-assisted suicide for adults but at the same time also more likely to approve of physician-assisted death of a disabled neonate.

Conclusion

Euthanasia in adults was supported by a partially different sub-population than assisted death of disabled neonates.

Attitudes among the general Austrian population towards neonatal euthanasia: a survey

Background

The Groningen Protocol aims at providing guidance in end-of-life decision-making for severely impaired newborns. Since its publication in 2005 many bioethicists and health care professionals have written articles in response. However, only very little is known about the opinion among the general population on this subject. The aim of this study was to present the general attitude towards neonatal euthanasia (NE) among the Austrian population and the factors associated with the respondents’ opinion.

Methods

A cross-sectional study was conducted among the general Austrian population. Computer-assisted telephone interviews were performed with 1,000 interviewees aged 16 years and older. Binary logistic regression was performed in order to determine factors that are independently associated with the respondents’ opinion about neonatal euthanasia.

Results

While 63.6% of the participants rejected the idea of neonatal euthanasia for severely impaired newborns, 36.4% opted either in favor or were undecided. Regression analysis has shown the respondents’ educational level (p = 0.005) and experience in the care of terminally ill persons (p = 0.001) to be factors that are positively associated with the rejection of neonatal euthanasia, whereas a higher age was associated with a lower degree of rejection (p = 0.021).

Conclusions

We found that the majority of the Austrian population rejects the idea of neonatal euthanasia for severely impaired newborns. However, given the increasing levels of rejection of NE among the younger generations and among people with a higher educational level, it cannot be precluded that the rejection rate might in future increase even further, rather than decrease.

The acceptability among young Hindus and Muslims of actively ending the lives of newborns with genetic defects

AIM

To explore the views in non-Western cultures about ending the lives of damaged newborns.

METHOD

254 university students from India and 150 from Kuwait rated the acceptability of ending the lives of newborns with genetic defects in 54 vignettes consisting of all combinations of four factors: gestational age (term or 7 months); severity of genetic defect (trisomy 21 alone, trisomy 21 with serious morphological abnormalities or trisomy 13 with impending death); the parents' attitude about prolonging care (unknown, in favour or opposed); and the procedure used (withholding treatment, withdrawing it or injecting a lethal substance).

RESULTS

Four clusters were identified by cluster analysis and subjected to analysis of variance. Cluster I, labelled 'Never Acceptable', included 4% of the Indians and 59% of the Kuwaitis. Cluster II, 'No Firm Opinion', had little variation in rating from one scenario to the next; it included 38% of the Indians and 18% of the Kuwaitis. In Cluster III, 'Parents' Attitude+Severity+Procedure', all three factors affected the ratings; it was composed of 18% of the Indians and 16% of the Kuwaitis. Cluster IV was called 'Severity+Parents' Attitude' because these had the strongest impact; it was composed of 40% of the Indians and 7% of the Kuwaitis.

CONCLUSIONS

In accordance with the teachings of Islam versus Hinduism, Kuwaiti students were more likely to oppose ending a newborn's life under all conditions, Indian students more likely to favour it and to judge its acceptability in light of the different circumstances.

The acceptability of ending a patient's life: a France-Portugal-Spain comparison

The views of French, Portuguese, and Spanish people on end-of-life decisions were compared. Two hundred seventy-seven adults from Barcelona, Oporto, and Toulouse judged the acceptability of life-ending procedures in 42 scenarios composed of all combinations of 3 factors: the patient's age (30 or 80 years), the patient's life expectancy (days, weeks, or months), and the type of procedure (suicide, suicide assisted by the physician, euthanasia by the physician at the request of a suffering patient, euthanasia of a comatose patient at the family's request, euthanasia of a comatose patient as stipulated in the patient's advance directives, euthanasia of a comatose patient without advance directions and without a request from the family, or euthanasia of a suffering patient without a request from the patient). In all 3 countries, the type of procedure had the major effect. The 4 procedures implemented by the patient or at the patient's request were, on average, considered acceptable. The 2 procedures not implemented at the patient's request were considered unacceptable. Euthanasia of a comatose patient at the request of the family was judged mildly acceptable. The attitudes of the people in Toulouse, Oporto, and Barcelona concerning the acceptability of ending a patient's life have now largely converged, although Spanish participants were statistically significantly more accepting than French and Portuguese participants.

Lay people's and health professionals' views about breaking bad news to children

BACKGROUND

Bad health news is difficult to communicate, especially when parents must give bad news to their children.

METHODS

We had 170 lay persons, 33 nurses and six physicians in Toulouse, France, judge the appropriateness of the parents' behaviour in 64 scenarios of parents dealing with this problem. The scenarios were composed according to a four within-subject orthogonal design: child's age (4, 6, 8 or 10), severity of disease (lethal or worrisome but curable), child's concern or not about his illness and parents' decision about communicating the news (tell nothing, minimize, tell the truth or ask the physician to tell the truth).

RESULTS

Cluster analysis revealed four clusters, labelled 'Always Tell the Truth' (33%, including a majority of doctors and nurses), 'Tell Nothing or Minimize' (16%, with an older average age), 'Tell the Truth Except in Cases of Incurable Illness' (22%) and 'Depends on Child's Characteristics' (29%).

CONCLUSIONS

Physicians in training and in practice need to be aware that lay people--and likely parents as well--have diverse and complex opinions about when and how parents should give bad health news to their children.