1
|
Sousa A, Marina S, Ricou M. Spiritual Beliefs and Hastened Death: A Study on Medical Students. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:384-408. [PMID: 32722991 DOI: 10.1177/0030222820944101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study focuses on the impact of common spiritual beliefs regarding metaphysical questions in agreeability with the practice of hastened death. A sample of 497 Portuguese medical students was collected. Differences between genders and religions, predictors for agreeability with hastened death and the association between spiritual beliefs and opinion towards hastened death cases were assessed. Respondents were mostly favourable to the practice of hastened death. Formal religious affiliation and higher levels of religiosity significantly associated with lesser agreeability with hastened death. Statistically significant association was found between every hastened death scenario and multiple of the spiritual beliefs used. A number of spiritual beliefs were predictors of agreeability. We discuss the implications of religion and spirituality in agreeability with hastened death. Further research is required to better understand the true weight of spirituality in one's opinion towards this ethical dilemma.
Collapse
Affiliation(s)
| | - Sílvia Marina
- Faculty of Medicine, University of Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Miguel Ricou
- Faculty of Medicine, University of Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| |
Collapse
|
2
|
Bužgová R, Kozáková R, Bar M, Škutová M, Ressner P, Bártová P. The Attitudes of Progressive Neurological Disease Patients and Their Family Members to End of Life Care: A Cross-Sectional Study. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:4-22. [PMID: 32571138 DOI: 10.1177/0030222820936922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The objective was to identify the attitudes of progressive neurological disease (PND) patients and their family members regarding end-of-life care, and their worries about dying. The sample included 327 participants. The Attitudes of Patients with PND to End-of-Life Care questionnaire was used to collect the data. Statistically significant differences in the assessment of attitudes towards end-of-life care between patients and family members were identified (p < 0.001). Family members more frequently favored patients being kept alive at any cost; patients more commonly wished to have their end of life under control. Respondents most frequently deferred to doctors when it came to decisions on treatment to keep patients alive. However, both patients and family members wanted patients to be able to decide on their treatment by leaving a written record of their previously stated wishes. The demands of patients and their families regarding end-of-life care should be documented in individual care plans.
Collapse
Affiliation(s)
- Radka Bužgová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Radka Kozáková
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Michal Bar
- Neurology Clinic, University Hospital Ostrava, Ostrava, Czech Republic
| | - Monika Škutová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Neurology Clinic, University Hospital Ostrava, Ostrava, Czech Republic
| | - Pavel Ressner
- Neurology Clinic, University Hospital Ostrava, Ostrava, Czech Republic
| | - Petra Bártová
- Neurology Clinic, University Hospital Ostrava, Ostrava, Czech Republic
| |
Collapse
|
3
|
Oncology healthcare professionals’ perceptions, explanatory models, and moral views on suicidality. Support Care Cancer 2019; 27:4723-4732. [DOI: 10.1007/s00520-019-04789-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/28/2019] [Indexed: 12/26/2022]
|
4
|
Yun YH, Kim KN, Sim JA, Yoo SH, Kim M, Kim YA, Kang BD, Shim HJ, Song EK, Kang JH, Kwon JH, Lee JL, Nam EM, Maeng CH, Kang EJ, Do YR, Choi YS, Jung KH. Comparison of attitudes towards five end-of-life care interventions (active pain control, withdrawal of futile life-sustaining treatment, passive euthanasia, active euthanasia and physician-assisted suicide): a multicentred cross-sectional survey of Korean patients with cancer, their family caregivers, physicians and the general Korean population. BMJ Open 2018; 8:e020519. [PMID: 30206075 PMCID: PMC6144336 DOI: 10.1136/bmjopen-2017-020519] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study determined attitudes of four groups-Korean patients with cancer, their family caregivers, physicians and the general Korean population-towards five critical end-of-life (EOL) interventions-active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide. DESIGN AND SETTING We enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a 'good death' with critical interventions at EoL care. RESULTS All participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling 'life was meaningful' (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing 'freedom from pain' negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, 'not being a burden to the family' was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89). CONCLUSION Groups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.
Collapse
Affiliation(s)
- Young Ho Yun
- Department of Biomedical Science, College of Medicine, Seoul National University, Seoul, Korea
- Department of Biomedical Informatics, College of Medicine, Seoul National University, Seoul, Korea
| | - Kyoung-Nam Kim
- Public Health Medical Service, Seoul National University Hospital, Seoul, Korea
| | - Jin-Ah Sim
- Department of Biomedical Science, College of Medicine, Seoul National University, Seoul, Korea
| | - Shin Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ae Kim
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Beo Deul Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun-Jeong Shim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, School of Medicine, Chonbuk National University, Jeonju, Korea
| | - Eun-Kee Song
- Division of Hematology/Oncology, Chonbuk National University Medical School, Jeonju, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Postgraduate Medical School, Gyeongsang National University, Jinju, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jung Lim Lee
- Department of Hemato-oncology, Daegu Fatima Hospital, Daegu, Korea
| | - Eun Mi Nam
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Chi Hoon Maeng
- Department of Medical Oncology and Hematology, Kyung Hee University Hospital, Seoul, Korea
| | - Eun Joo Kang
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Rok Do
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yoon Seok Choi
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Otte IC, Jung C, Elger B, Bally K. "We need to talk!" Barriers to GPs' communication about the option of physician-assisted suicide and their ethical implications: results from a qualitative study. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2017; 20:249-256. [PMID: 27785588 PMCID: PMC5487738 DOI: 10.1007/s11019-016-9744-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
GPs usually care for their patients for an extended period of time, therefore, requests to not only discontinue a patient's treatment but to assist a patient in a suicide are likely to create intensely stressful situations for physicians. However, in order to ensure the best patient care possible, the competent communication about the option of physician assisted suicide (PAS) as well as the assessment of the origin and sincerity of the request are very important. This is especially true, since patients' requests for PAS can also be an indicator for unmet needs or concerns. Twenty-three qualitative semi-structured interviews were conducted to in-depth explore this multifaceted, complex topic while enabling GPs to express possible difficulties when being asked for assistance. The analysis of the gathered data shows three main themes why GPs may find it difficult to professionally communicate about PAS: concerns for their own psychological well-being, conflicting personal values or their understanding of their professional role. In the discussion part of this paper we re-assess these different themes in order to ethically discuss and analyse how potential barriers to professional communication concerning PAS could be overcome.
Collapse
Affiliation(s)
- Ina C Otte
- Institute for Biomedical Ethics, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland.
- Institute of Primary Health Care, University of Basel, Klingelbergstr. 61, 4056, Basel, Switzerland.
| | - Corinna Jung
- Institute of Primary Health Care, University of Basel, Klingelbergstr. 61, 4056, Basel, Switzerland
| | - Bernice Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland
| | - Klaus Bally
- Institute of Primary Health Care, University of Basel, Klingelbergstr. 61, 4056, Basel, Switzerland
| |
Collapse
|
6
|
Sheahan L. Exploring the interface between 'physician-assisted death' and palliative care: cross-sectional data from Australasian palliative care specialists. Intern Med J 2017; 46:443-51. [PMID: 26762669 DOI: 10.1111/imj.13009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 12/10/2015] [Accepted: 12/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Legalisation of physician-assisted dying (PAD) remains a highly contested issue. In the Australasian context, the opinion and perspective of palliative care specialists have not been captured empirically, and are required to inform better the debate around this issue, moving forward. AIM To identify current attitudes and experiences of palliative care specialists in Australasia regarding requests for physician-assisted suicide and voluntary euthanasia, and to capture the opinion of palliative care specialists on the legalisation of these practices in the Australasian context. METHOD An anonymous, cross-sectional, online survey of Australasian specialists in palliative care, addressing the following six areas: (i) demographics; (ii) frequency of requests, and response given; (iii) understanding of the term 'voluntary euthanasia'; (iv) opinion regarding legalisation of physician-assisted suicide and voluntary euthanasia in Australasia, and willingness to participate if legal; (v) identification of the most important values guiding this opinion; and (vi) anticipated impact that legalisation of assisted death would have on palliative care practice. RESULTS Important findings include: (i) palliative care specialists are largely opposed to the legalisation of PAD; (ii) the proportional titration of opioids is not understood by any palliative care specialist studied to be 'voluntary euthanasia'; and (iii) there is a wide variation in frequency of requests, and one-third of palliative care specialists express discomfort in dealing with requests for assisted suicide or euthanasia. CONCLUSION Key areas for future research at the interface between PAD and best practice end-of-life care are identified, including exploration into why palliative care specialists are largely opposed to PAD, and consideration of the impact 'the opioid misconception' may have on the literature informing this debate.
Collapse
Affiliation(s)
- L Sheahan
- St George and Calvary Hospitals, Sydney, New South Wales, Australia.,Centre for Values Ethics and the Law in Medicine, University of Sydney, Sydney, New South Wales, Australia.,Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada.,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
7
|
Danyliv A, O'Neill C. Attitudes towards legalising physician provided euthanasia in Britain: The role of religion over time. Soc Sci Med 2015; 128:52-6. [DOI: 10.1016/j.socscimed.2014.12.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
8
|
A comparison of the willingness of resident and attending physicians to comply with the requests of patients at the end of life. J Gen Intern Med 2014; 29:1048-54. [PMID: 24647724 PMCID: PMC4061369 DOI: 10.1007/s11606-014-2830-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 11/07/2013] [Accepted: 03/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Little is known about the differences between physicians in training and post training in their willingness to comply with patient requests at the end of life. OBJECTIVE To compare the attitudes of attendings and residents regarding a range of patient requests at the end of life DESIGN Written, cross-sectional survey PARTICIPANTS The cohort included 191 attendings randomly selected across the state of Connecticut and 240 residents from 2 university-affiliated Internal Medicine programs. MAIN MEASURES We surveyed attendings and residents about their willingness to honor the requests of the same decisionally capable elderly patient in five scenarios involving different requests regarding end-of-life treatment. RESULTS While a large majority of both attendings and residents were willing to comply with each of the requests to withhold intubation (100 % and 94 %, respectively), to extubate (92 % and 77 %), and to give increasingly higher doses of narcotics (94 % and 71 %), a significantly larger proportion of attendings versus residents was willing to comply with each of these requests. Small proportions of attendings and residents were willing to prescribe a lethal amount of sleeping pills (3 % and 5 %, respectively) and to give a lethal injection in its current illegal state (1 % and 4 %). A significantly larger proportion of residents (32 %) compared to attendings (19 %) was willing to give a lethal injection if legal. Adjusting for sociodemographic factors, attending status was independently associated with willingness to extubate [adjusted odds ratio (AOR) = 3.0, 95 % CI = 1.6-5.7] and to give a lethal injection if legal (AOR = 0.5, 95 % CI = 0.3-0.8). The proportion of physicians willing to extubate increased across years since graduation, with the greatest differences occurring across the residency years (69 % to 86 %). CONCLUSIONS AND RELEVANCE Clinical experience was an important determinant of physicians' willingness to perform multiple patient requests at the end of life, with substantial changes in attitudes occurring during residency training. More research is needed to determine whether dedicated clinical exposure for physicians in training influences attitudes.
Collapse
|
9
|
Hughes R, Huby M. The construction and interpretation of vignettes in social research. ACTA ACUST UNITED AC 2012. [DOI: 10.1921/17466105.11.1.36] [Citation(s) in RCA: 213] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
10
|
Yun YH, Han KH, Park S, Park BW, Cho CH, Kim S, Lee DH, Lee SN, Lee ES, Kang JH, Kim SY, Lee JL, Heo DS, Lee CG, Lim YK, Kim SY, Choi JS, Jeong HS, Chun M. Attitudes of cancer patients, family caregivers, oncologists and members of the general public toward critical interventions at the end of life of terminally ill patients. CMAJ 2011; 183:E673-9. [PMID: 21624907 DOI: 10.1503/cmaj.110020] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Whereas most studies have focused on euthanasia and physician-assisted suicide, few have dealt comprehensively with other critical interventions administered at the end of life. We surveyed cancer patients, family caregivers, oncologists and members of the general public to determine their attitudes toward such interventions. METHODS We administered a questionnaire to four groups about their attitudes toward five end-of-life interventions--withdrawal of futile life-sustaining treatment, active pain control, withholding of life-sustaining measures, active euthanasia and physician-assisted suicide. We performed multivariable analyses to compare attitudes and to identify sociodemographic characteristics associated with the attitudes. RESULTS A total of 3840 individuals--1242 cancer patients, 1289 family caregivers and 303 oncologists from 17 hospitals, as well as 1006 members of the general Korean population--participated in the survey. A large majority in each of the groups supported withdrawal of futile life-sustaining treatment (87.1%-94.0%) and use of active pain control (89.0%-98.4%). A smaller majority (60.8%-76.0%) supported withholding of life-sustaining treatment. About 50% of those in the patient and general population groups supported active euthanasia or physician-assisted suicide, as compared with less than 40% of the family caregivers and less than 10% of the oncologists. Higher income was significantly associated with approval of the withdrawal of futile life-sustaining treatment and the practice of active pain control. Older age, male sex and having no religion were significantly associated with approval of withholding of life-sustaining measures. Older age, male sex, having no religion and lower education level were significantly associated with approval of active euthanasia and physician-assisted suicide. INTERPRETATION Although the various participant groups shared the same attitude toward futile and ameliorative end-of-life care (the withdrawal of futile life-sustaining treatment and the use of active pain control), oncologists had a more negative attitude than those in the other groups toward the active ending of life (euthanasia and physician-assisted suicide).
Collapse
Affiliation(s)
- Young Ho Yun
- Cancer Management Branch, Research Institute, National Cancer Center, Goyang, Korea.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Weiss GL, Lupkin LN. First-year college students' attitudes about end-of-life decision-making. OMEGA-JOURNAL OF DEATH AND DYING 2010; 60:143-63. [PMID: 20222234 DOI: 10.2190/om.60.2.c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study analyzes attitudes about treatment of the terminally ill among a group of first-year undergraduate students--a cohort that was in high school when intense publicity and extensive political and judicial involvement in the Terri Schiavo case occurred. Data for the study were collected by structured personal interviews with 201 randomly selected, first-year students in the first half of fall semester, 2005. Students clearly make distinctions in the propriety of active euthanasia, passive euthanasia, and physician-assisted death. Presented with a situation of a terminally ill patient in considerable pain, 65.1% of the students supported or strongly supported withdrawal of life-sustaining technology (passive euthanasia), 34.3% supported the physician providing the means of death to the patient (physician-assisted death), and 28.3% supported the physician actually administering a lethal injection (active euthanasia). A review of the literature of correlates of euthanasia attitudes in a variety of samples produced five potential types of influences: 1) general philosophical and religious beliefs; 2) fears about one's own death and dying process; 3) amount of information about and exposure to the issue of euthanasia; 4) characteristics of the community in which one lives; and 5) certain personal background characteristics. These categorical types produced 19 specific variables that were potentially related to euthanasia attitudes. The strongest predictor of attitudes varied among the three types of euthanasia, but political party affiliation had the most overall influence. Students self-identifying as Democrats were more likely than those self-identifying as Republicans to support euthanasia.
Collapse
Affiliation(s)
- Gregory L Weiss
- Dept. of Sociology, Roanoke College, Salem, Virginia 24153, USA.
| | | |
Collapse
|
12
|
Confusion between euthanasia and other end-of-life decisions: influences on public opinion poll results. Canadian Journal of Public Health 2007. [PMID: 17626391 DOI: 10.1007/bf03403719] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Public opinion polls indicate that a majority of Canadians are in favour of euthanasia. However, there have been many criticisms of the validity of these findings. The objective of this study was to assess public opinion towards euthanasia while controlling for possible threats to validity indicated in the literature review. METHODS A telephone public opinion poll was conducted in 2002 with a representative sample of the general population of Quebec (n = 991; response rate = 49.8%). Respondents were asked about their support for euthanasia and treatment withdrawal and, for comparison, were asked a previously used question on euthanasia (Gallup) which has been criticized for methodological problems. Respondents were also asked to distinguish between euthanasia and other end-of-life decisions in hypothetical scenarios. RESULTS Eleven percent more people supported euthanasia with the Gallup question than the question developed in this study. Support for euthanasia (69.6%) was less prevalent than for treatment withdrawal (85.8%). Respondents who failed to distinguish between euthanasia and treatment withdrawal or withholding treatment in hypothetical scenarios were more likely to support euthanasia in public opinion poll questions. Furthermore, there is a significant relationship between opinions about the acceptability of euthanasia and inaccurate knowledge of the nature of euthanasia. INTERPRETATION Public opinion polls on euthanasia must be interpreted in the light of the wording of the question. Education of the population concerning euthanasia and other end-of-life decisions may be considered to be an important prerequisite to engage in public debate concerning the legalization of euthanasia.
Collapse
|
13
|
Cartwright C, Onwuteaka-Philipsen BD, Williams G, Faisst K, Mortier F, Nilstun T, Norup M, van der Heide A, Miccinesi G. Physician discussions with terminally ill patients: a cross-national comparison. Palliat Med 2007; 21:295-303. [PMID: 17656406 DOI: 10.1177/0269216307079063] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A major issue in the care of terminally ill patients is communication and information provision. This paper reports the extent to which physicians in Australia, Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland discuss topics relevant to end of life care with terminally ill patients and their relatives (without first informing the patient), and possible associations between physician-specific characteristics and such discussions. Response rates to the postal survey ranged from 39% to 68% (n =10139). Physicians in most of the countries except Italy ;in principle, always' discuss issues related to terminal illness with their patients but not with patients' relatives without first informing the patient, unless the relatives ask. Cross-national differences remained strong after controlling for physician characteristics. The majority of physicians appeared to support the principle of patient-centred care to terminally ill patients, consistent with palliative care philosophy and with the law and/or professional guidelines in most of the countries studied.
Collapse
Affiliation(s)
- Colleen Cartwright
- Aged Services Learning & Research Collaboration, Southern Cross University, Coffs Harbour, NSW, Australia.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Georges JJ, Onwuteaka-Philipsen BD, van der Heide A, van der Wal G, van der Maas PJ. Physicians' opinions on palliative care and euthanasia in the Netherlands. J Palliat Med 2007; 9:1137-44. [PMID: 17040152 DOI: 10.1089/jpm.2006.9.1137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND In recent decades significant developments in end-of-life care have taken place in The Netherlands. There has been more attention for palliative care and alongside the practice of euthanasia has been regulated. OBJECTIVE The aim of this paper is to describe the opinions of physicians with regard to the relationship between palliative care and euthanasia, and determinants of these opinions. DESIGN Cross-sectional. SETTING/SUBJECTS Representative samples of physicians (n = 410), relatives of patients who died after euthanasia and physician-assisted suicide (EAS; n = 87), and members of the Euthanasia Review Committees (ERCs; n = 35). MEASUREMENTS Structured interviews with physicians and relatives of patients, and a written questionnaire for the members of the ERCs. RESULTS Approximately half of the physicians disagreed and one third agreed with statements describing the quality of palliative care in The Netherlands as suboptimal and describing the expertise of physicians with regard to palliative care as insufficient. Almost two thirds of the physicians disagreed with the suggestion that adequate treatment of pain and terminal care make euthanasia redundant. Having a religious belief, being a nursing home physician or a clinical specialist, never having performed euthanasia, and not wanting to perform euthanasia were related to the belief that adequate treatment of pain and terminal care could make euthanasia redundant. CONCLUSION The study results indicate that most physicians in The Netherlands are not convinced that palliative care can always alleviate all suffering at the end of life and believe that euthanasia could be appropriate in some cases.
Collapse
Affiliation(s)
- Jean-Jacques Georges
- Department of Public and Occupational Health, VU Medich Centrum, Institute for Research in Extramural Medicine, Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
15
|
Ulrich CM, Ratcliffe SJ. Hypothetical Vignettes in Empirical Bioethics Research. EMPIRICAL METHODS FOR BIOETHICS: A PRIMER 2007. [DOI: 10.1016/s1479-3709(07)11008-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
16
|
Miller M, Azrael D, Hemenway D. Belief in the inevitability of suicide: results from a national survey. Suicide Life Threat Behav 2006; 36:1-11. [PMID: 16676620 DOI: 10.1521/suli.2006.36.1.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To examine public opinion regarding the effectiveness of means restriction as an approach to preventing suicide we asked a national sample of 2,770 respondents a hypothetical question about what effect a suicide barrier might have had on the ultimate fate of the more than 1,000 people who have jumped to their death from the Golden Gate Bridge. Thirty-four percent of respondents believed that every single jumper would have found another way to complete suicide and an additional 40% believed that "most" would have completed suicide using other means. The strongest predictors of belief in complete substitution were firearm ownership and cigarette smoking. Belief in the inevitability of suicide may be a political impediment to adopting potentially effective suicide prevention efforts.
Collapse
Affiliation(s)
- Matthew Miller
- Harvard School of Public Health, Rm. #305 Kresge Building, 677 Huntington Avenue, Boston, MA 02115, USA.
| | | | | |
Collapse
|
17
|
Rietjens JAC, van der Heide A, Onwuteaka-Philipsen BD, van der Maas PJ, van der Wal G. A comparison of attitudes towards end-of-life decisions: survey among the Dutch general public and physicians. Soc Sci Med 2005; 61:1723-32. [PMID: 16029774 DOI: 10.1016/j.socscimed.2005.03.024] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2004] [Accepted: 03/14/2005] [Indexed: 11/26/2022]
Abstract
In The Netherlands, there has been a continuing public debate about the acceptability and regulatory system for medical decision-making concerning the end of life. We studied attitudes of the Dutch general public towards different types of end-of-life decisions in various situations and compared them to attitudes of physicians. Questionnaires were mailed to 1777 members of the Dutch general public (response: 78%). A total of 391 Dutch physicians, including general practitioners, nursing home physicians and clinical specialists, were interviewed in person (response: 81%). In both the survey and physician interviews, questions were asked about attitudes towards active ending of life, terminal sedation, and increasing morphine with premature death as a likely consequence, using hypothetical cases of different patients. By logistic regression analysis, the differences between public and physicians' attitudes were assessed, as well as the associations between attitudes of the general public and their personal characteristics. Acceptance of active ending of life at the request of a terminally ill cancer patient was higher among the general public (85%) than among physicians (64%). For physicians, acceptance decreased to 36% for an incompetent adult, 11% for a patient without a serious disease, and 6% for a patient with dementia. For the general public, these percentages were 63%, 37%, and 62%, respectively. Between both groups, no differences were found in acceptance of terminal sedation and increasing morphine. For the general public, determinants of support for active ending of life were being non-religious, lower education, and having a single household. Acknowledging the observed differences in appreciation of end-of-life decision-making between the general public and physicians is important in doctor-patient communication and in public debate and policymaking. Continued monitoring of practices and informing the general public and policymakers about the clinical and ethical consequences of different types of end-of-life decisions is important.
Collapse
Affiliation(s)
- Judith A C Rietjens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
18
|
Camps Herrero C, Gavilá Gregori J, Garde Noguera J, Caballero Díaz C, Iranzo González-Cruz V, Juárez Marroquí A, Safont Aguilera MJ, Blasco Cordellat A, Berrocal Jaime A, Sanz de Bremond MG. [Euthanasia in patients with cancer and the continuous-care providers]. Clin Transl Oncol 2005; 7:278-84. [PMID: 16185589 DOI: 10.1007/bf02710266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
During the clinical evolution of patients with cancer there are many occasions, or phases of the disease, when there are no specific treatments and, as such, we need to provide maximum comfort following appropriate symptom control; in this stage it is fundamental to respect personal autonomy together with the option to reject futile treatment. With appropriate control of symptoms it is possible to reach the stage where the majority of the patients do not continue to suffer. Continuous-care providers for cancer patients are those who are responsible for providing help to resolve these situations. In palliative medicine there are highly-efficacious procedures to the help in these last hours. Sedation is applied when it is impossible to control symptoms by other means. With appropriate Carer cover, it is not necessary to introduce laws on assisted suicide and/or active voluntary euthanasia, neither because of the magnitude of demand, nor because of the difficulties in achieving appropriate control of symptoms.
Collapse
Affiliation(s)
- Carlos Camps Herrero
- Servicio de Oncología Médica, Consorcio Hospital General Universitario de Valencia, España.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Johansen S, Hølen JC, Kaasa S, Loge HJ, Materstvedt LJ. Attitudes towards, and wishes for, euthanasia in advanced cancer patients at a palliative medicine unit. Palliat Med 2005; 19:454-60. [PMID: 16218157 DOI: 10.1191/0269216305pm1048oa] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Most studies on attitudes towards euthanasia and physician-assisted suicide (PAS) have been conducted in healthy populations. The aim of this study is to explore and describe attitudes towards, and wishes for, euthanasia/PAS in cancer patients with short life expectancy. METHOD Semi-structured interviews with 18 cancer patients with a life expectancy of less than nine months. All patients were recruited from an inpatient palliative medicine unit. RESULTS Patients holding a positive attitude towards euthanasia/PAS do not necessarily want euthanasia/PAS for themselves. Wishes are different from requests for euthanasia/PAS. Fear of future pain and a painful death were the main reasons given for a possible wish for euthanasia/PAS. Worries about minimal quality of life and lack of hope also contributed to such thoughts. Wishes for euthanasia/PAS were hypothetical; they were future oriented and with a prerequisite that intense pain, lack of quality of life and/or hope had to be present. Additionally, wishes were fluctuating and ambivalent. CONCLUSION The wish to die in these patients does not seem to be constant. Rather, this wish is more appropriately seen as an ambivalent and fluctuating mental 'solution' for the future. Health care providers should be aware of this when responding to utterances regarding euthanasia/PAS.
Collapse
Affiliation(s)
- Sissel Johansen
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | | | | | | |
Collapse
|
20
|
Mystakidou K, Rosenfeld B, Parpa E, Tsilika E, Katsouda E, Galanos A, Vlahos L. The schedule of attitudes toward hastened death: Validation analysis
in terminally ill cancer patients. Palliat Support Care 2005; 2:395-402. [PMID: 16594402 DOI: 10.1017/s1478951504040520] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: The faithful translation of the English version of
the Schedule of Attitudes toward Hastened Death (SAHD) into Greek and its
validation as an assessment tool in terminally ill cancer patients
receiving palliative treatment.Methods: 120 terminally ill cancer patients attending a
Palliative Care Unit, at the University of Athens, Greece, between June
2003 and November 2003 for palliative treatment.Results: SAHD would be a useful instrument for measuring
desire for hastened death with valid psychometric properties in a Greek
cancer population. The SAHD demonstrated high reliability. Desire for
hastened death was significantly associated with Hospital Anxiety and
Depression Scale (HAD) depression (r = 0.607, p <
0.0005) and substantially correlated with HAD anxiety (r = 0.502,
p < 0.0005). “Pain intensity” had a moderate
correlation with SAHD scores (r = 0.28, p = 0.01) and
SAHD scores correlated significantly with “pain interference in
mood” (r = 0.38, p = 0.01) and in “enjoyment
of life” (r = 0.34, p = 0.03). SAHD correlation
with quality of life was statistically significant (r =
−0.38, p < 0.01) as was health status (r =
−0.36, p < 0.01). Patients with a Poor Performance
Status (from Eastern Cooperative Oncology Group scale) correlated
significantly with high scores in SAHD (p = 0.038). Factor
analysis supported the unidimentionality of the measurement.Significance of results: SAHD could be a useful and valid
instrument for measuring desire for hastened death in Greek terminally ill
cancer patients.
Collapse
Affiliation(s)
- Kyriaki Mystakidou
- Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, 27 Korinthias Str., 115 26 Athens, Greece.
| | | | | | | | | | | | | |
Collapse
|
21
|
Mystakidou K, Parpa E, Katsouda E, Galanos A, Vlahos L. Pain and Desire for Hastened Death in Terminally Ill Cancer Patients. Cancer Nurs 2005; 28:318-24. [PMID: 16046896 DOI: 10.1097/00002820-200507000-00014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to assess the relationship between pain and the desire for hastened death in terminally ill cancer patients. The participants were 120 terminally ill cancer patients under palliative treatment from June 2003 to November 2004. Patients completed a pain assessment tool, the Greek Brief Pain Inventory (G-BPI), and a self-report measure of the desire for hastened death, the Greek Schedule of Attitudes Toward Hastened Death (G-SAHD). Moderate but statistically significant associations were found between some of the severity and interference items of G-BPI and G-SAHD; more specifically, between G-SAHD and G-BPI3, "worst pain in the last 24 hours" (r = 0.279, P = .002); G-SAHD and G-BPI4, "least pain in the last 24 hours" (r = 0.253, P = .005); and G-SAHD and G-BPI5, "average pain in the last 24 hours" (r = 0.283, P = .002). A stronger association was revealed between G-SAHD and G-BPI8, "relief provided by pain treatment and medications in the last 24 hours" (r = -0.326, P = .000). Multiple regression analyses including the enter model and the forward model were conducted. According to the enter model, the strongest predictors of hastened death were items G-BPI6, "current pain"; G-BPI8, "relief provided by pain treatment and medications in the last 24 hours"; G-BPI9i, "interference of pain in general activity"; and G-BPI9iii, "interference of pain in walking." According to the forward model, significant predictors of the desire for death were items G-BPI5, "average pain in the last 24 hours"; G-BPI6, "current pain"; G-BPI9i, "interference of pain in general activity"; and G-BPI9ii, "interference of pain in mood," all of which were statistically significant (P = .000-.042). Pain appeared to have a statistically significant relationship with the desire for hastened death. Effective treatment by healthcare professionals should be provided to reduce pain and cancer-related symptoms as well as the desire for hastened death.
Collapse
Affiliation(s)
- Kyriaki Mystakidou
- Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, Greece.
| | | | | | | | | |
Collapse
|
22
|
Miccinesi G, Fischer S, Paci E, Onwuteaka-Philipsen BD, Cartwright C, van der Heide A, Nilstun T, Norup M, Mortier F. Physicians’ attitudes towards end-of-life decisions: a comparison between seven countries. Soc Sci Med 2005; 60:1961-74. [PMID: 15743647 DOI: 10.1016/j.socscimed.2004.08.061] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Accepted: 08/25/2004] [Indexed: 10/26/2022]
Abstract
In the context of an European collaborative research project (EURELD), a study on attitudes towards medical end-of-life decisions was conducted among physicians in Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland. Australia also joined the consortium. A written questionnaire with structured questions was sent to practising physicians from specialties frequently involved in the care of dying patients. 10,139 questionnaires were studied. Response rate was equal to or larger than 50% in all countries except Italy (39%). Apart from general agreement with respect to the alleviation of pain and symptoms with possible life-shortening effect, there was large variation in support--between and within countries--for medical decision that may result in the hastening of death. A principal component factor analysis found that 58% of the variance of the responses is explained by four factors. 'Country' explained the largest part of the variation of the standardized factor scores.
Collapse
Affiliation(s)
- Guido Miccinesi
- Center for Study and Prevention of Cancer, Epidemiology Unit, Via S.Salvi 12, Florence, 50135 Firenze, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Affiliation(s)
- Chris Feudtner
- Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| |
Collapse
|
24
|
Dickinson GE, Clark D, Winslow M, Marples R. US physicians' attitudes concerning euthanasia and physician-assisted death: A systematic literature review. ACTA ACUST UNITED AC 2005. [DOI: 10.1080/13576270500030982] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
25
|
Mystakidou K, Parpa E, Katsouda E, Galanos A, Vlahos L. Influence of pain and quality of life on desire for hastened death in patients with advanced cancer. Int J Palliat Nurs 2004; 10:476-83. [PMID: 15577706 DOI: 10.12968/ijpn.2004.10.10.16211] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE to assess the relationship between quality of life, pain and desire for hastened death in advanced cancer patients. METHODS 120 Greek patients with advanced cancer were interviewed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 version 3.0 (EORTC QLQ-C30), the Greek Brief Pain Inventory (G-BPI), the Greek Hospital Anxiety and Depression Scale (G-HADS) and the Greek Schedule of Attitudes toward Hastened Death (G-SAHD). RESULTS statistically significant associations were found between total G-SAHD scores and scores for the worst level of pain in the previous 24 hours (G-BP13) (r = 0.279, P = 0.002), and between total G-SAHD scores and scores for the level of pain relief obtained in the last 24 hours (G-BP18) (r = -0.326, P = 0.0005). The strongest correlations were found between G-SADH and emotional functioning (r = 0.569, P<0.0001) and global quality of life (r = -0.331, P<0.0001) from EORTC QLQ-C30. In multivariate analyses, emotional functioning, social functioning, financial impact, and the interference of pain in general activity and mood were significant predictors of G-SAHD (all P<0.0001). CONCLUSION quality of life and pain appeared to have a statistically significant relationship with desire for hastened death. Adequate palliative care should alleviate pain and the desire for hastened death, improving quality of life.
Collapse
Affiliation(s)
- Kyriaki Mystakidou
- Areteion Hospital, School of Medicine, University of Athens, 27 Korinthias Str, 115 26 Athens, Greece.
| | | | | | | | | |
Collapse
|
26
|
Mitchell K, Glynn Owens R. Judgments of laypersons and general practitioners on justifiability and legality of providing assistance to die to a terminally ill patient: a view from New Zealand. PATIENT EDUCATION AND COUNSELING 2004; 54:15-20. [PMID: 15210255 DOI: 10.1016/s0738-3991(03)00167-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2001] [Revised: 03/15/2003] [Accepted: 04/27/2003] [Indexed: 05/24/2023]
Abstract
As part of a larger study, four decisions related to a vignette scenario of the elective death of a terminally ill patient suffering intractable pain are examined (doctor supplying information and drugs, assisting patient to take the drugs, or administering a lethal injection). Judgments on justifiability and legality of actions were obtained from laypersons and general practitioners (GPs) in Auckland, New Zealand. The results show that over 72% of laypersons and over 30% of GPs judged all four actions justified. Despite illegality a significant number of laypersons and some doctors were unsure of the legal status of actions. The current law in New Zealand prohibiting physician-assisted death may not reflect judgments by the majority of laypersons or 30% of general practitioners on the justifiability of elective death options for a terminally ill patient with intractable pain. Judgments on justifiability may be related to confusion over the legality of actions.
Collapse
Affiliation(s)
- Kay Mitchell
- Department of Psychology, University of Auckland, Tamaki Campus, Private Bag 92019, Auckland, New Zealand.
| | | |
Collapse
|
27
|
Yabroff KR, Mandelblatt JS, Ingham J. The quality of medical care at the end-of-life in the USA: existing barriers and examples of process and outcome measures. Palliat Med 2004; 18:202-16. [PMID: 15198133 DOI: 10.1191/0269216304pm880oa] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
CONTEXT Cancer is a leading cause of morbidity and mortality in the USA and despite many recent advances in detection and treatment, over half a million cancer patients in this country will die from their disease each year. OBJECTIVE Using cancer as a prototype, we provide a conceptual framework to identify and review barriers to optimal end-of-life care and propose examples of linked process and outcome measures that could be used to evaluate whether standards of optimal end-of-life care are being achieved. METHODS We propose a conceptual model of end-of-life care and use this model to review the published literature to identify the key goals of optimal end-of-life care and summarize existing barriers to optimal end-of-life care. We then provide examples of process and outcome measures linked to the goals of optimal end-of-life care and domains within the conceptual framework. RESULTS Within all components of care at the end-of-life--societal attitudes, health care system(s), providers, and patients and their families--there are significant barriers to the quality of care. Some of the most critical barriers to optimal care at the end-of-life in the USA are limited availability, and coverage of, co-ordinated service delivery; poor provider communication and diagnostic skills; limited opportunities for training in palliative care; patient fears and attitudes towards the sick role, and a lack of, or inadequate health insurance. Proposed patient, provider, and system level measures of the quality of care were guided by goals of optimal end-of-life care, and focus on communication about prognosis and risks and benefits of treatment, development of clear and informed treatment goals, delivery of services consistent with treatment goals, and promotion of quality of life. CONCLUSIONS At present, there are substantial societal, health care system, provider, and patient barriers to obtaining optimal cancer care at the end-of-life. Ongoing discussions about appropriate measures of the quality of end-of-life care are gaining momentum, however. The proposed process and outcome measures for assessing optimal end-of-life care use cancer as a prototype, but are broadly applicable to other patient populations with life-threatening disease.
Collapse
Affiliation(s)
- K Robin Yabroff
- Cancer Control Program, Department of Human Oncology, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC, USA.
| | | | | |
Collapse
|
28
|
Hart LG, Norris TE, Lishner DM. Attitudes of family physicians in Washington state toward physician-assisted suicide. J Rural Health 2003; 19:461-9. [PMID: 14526504 DOI: 10.1111/j.1748-0361.2003.tb00583.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT The topic of physician-assisted suicide is difficult and controversial. With recent laws allowing physicians to assist in a terminally ill patient's suicide under certain circumstances, the debate concerning the appropriate and ethical role for physicians has intensified. PURPOSE This paper utilizes data from a 1997 survey of family physicians (FPs) in Washington State to test two hypotheses: (1) older respondents will indicate greater opposition to physician-assisted suicide than their younger colleagues, and (2) male and rural physicians will have more negative attitudes toward physician-assisted suicide than their female and urban counterparts. METHODS A questionnaire administered to all active FPs obtained a 68% response rate, with 1074 respondents found to be eligible in this study. A ZIP code system based on generalist Health Service Areas was used to designate those practicing in rural versus urban areas. FINDINGS One-fourth of the respondents overall indicated support for physician-assisted suicide. When asked whether this practice should be legalized, 39% said yes, 44% said no, and 18% indicated that they did not know. Fifty-eight percent of the study sample reported that they would not include physician-assisted suicide in their practices even if it were legal. Responses disaggregated by age-groups closely paralleled the group overall. There was a significant pattern of opposition on the part of rural male respondents compared to urban female respondents. Even among those reporting support for physician-assisted suicide, many expressed reluctance about including it in their practices. CONCLUSIONS These findings highlight the systematic differences in FP attitudes toward one aspect of health care by gender, rural-urban practice location, and other factors.
Collapse
Affiliation(s)
- L Gary Hart
- Department of Family Medicine, University of Washington, Box 354696, Seattle, WA 98195-4696, USA.
| | | | | |
Collapse
|
29
|
Pacheco J, Hershberger PJ, Markert RJ, Kumar G. A longitudinal study of attitudes toward physician-assisted suicide and euthanasia among patients with noncurable malignancy. Am J Hosp Palliat Care 2003; 20:99-104. [PMID: 12693641 DOI: 10.1177/104990910302000207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This longitudinal study investigated whether attitudes toward physician-assisted suicide (PAS) and euthanasia (E) are stable among patients with noncurable malignancy, and whether depression and various coping strategies were related to such attitudes. Thirty patients with noncurable malignancies completed questionnaires measuring attitudes toward PAS and E, depression, and coping. Three months later, and subsequently at six-month intervals, repeated measures were obtained from 24 patients. There was a trend for patients to become less supportive of legalizing PAS and E from the initial to last attitude measurement. Depression was unrelated to attitude change. There were significant changes on two coping dimensions: use of social support for emotional reasons and use of religious resources. Our findings should be considered in clinical, legislative, and ethical debates.
Collapse
Affiliation(s)
- Jaime Pacheco
- Dayton VA Medical Center and Department of Medicine, Wright State University School of Medicine, Dayton, Ohio, USA
| | | | | | | |
Collapse
|
30
|
Suarez-Almazor ME, Newman C, Hanson J, Bruera E. Attitudes of terminally ill cancer patients about euthanasia and assisted suicide: predominance of psychosocial determinants and beliefs over symptom distress and subsequent survival. J Clin Oncol 2002; 20:2134-41. [PMID: 11956275 DOI: 10.1200/jco.2002.08.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although euthanasia and physician-assisted suicide (PAS) are controversial issues, the views of those most affected, terminal patients, are seldom explored. Our objective was to assess whether the attitudes about euthanasia/PAS of terminally ill cancer patients were determined by their symptomatic distress. PATIENTS AND METHODS We conducted a survey of 100 patients with terminal cancer. Statements related to the legalization of euthanasia/PAS were scored using Likert scales. We also asked patients how often they had considered ending their lives. Their responses were analyzed in relation to disease characteristics, including an assessment of symptomatic severity, sociodemographic features, general beliefs about the suffering of cancer patients, and survival. RESULTS Most patients (69%) supported euthanasia or PAS for one or more situations. The association between these attitudes and symptoms was weak, consistent in univariate analysis only for shortness of breath. No significant associations were observed with pain, nausea, well-being, loss of appetite, depression, or subsequent survival. Agreement with euthanasia was significantly related to male sex, lack of religious beliefs, and general beliefs about the suffering of cancer patients and their families. In multivariate analysis, the only characteristics that remained statistically associated with support were the strength of religious beliefs and the perception that patients with cancer are a heavy burden on their families. Frequency of suicidal ideation was associated with poor well-being, depression, anxiety, and shortness of breath, but not with other somatic symptoms such as pain, nausea, and loss of appetite. CONCLUSION Symptom intensity had limited impact on the attitudes about euthanasia of terminally ill cancer patients. Our findings suggest that patient views are primarily determined by psychosocial traits and beliefs, as opposed to disease severity or symptomatic distress.
Collapse
Affiliation(s)
- Maria E Suarez-Almazor
- Department of Medicine, Baylor College of Medicine, Houston Center for Utilization Studies and Quality of Care, Veterans Affairs Medical Center, Houston, TX 77030, USA.
| | | | | | | |
Collapse
|
31
|
Materstvedt LJ, Kaasa S. Euthanasia and physician-assisted suicide in Scandinavia--with a conceptual suggestion regarding international research in relation to the phenomena. Palliat Med 2002; 16:17-32. [PMID: 11963448 DOI: 10.1191/0269216302pm470oa] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article analyses and compares recent research on Scandinavian physicians' attitudes towards, as well as their practice of, euthanasia and physician-assisted suicide. The studies discussed are quite dissimilar in their design, resulting in considerable difficulties as far as comparability is concerned. Such difficulties are common in these fields of research. As an intended contribution to the amendment of future research, we suggest what we take to be detailed and precise definitions of the terms euthanasia and physician-assisted suicide for use internationally. Our definitions, or interpretations, basically draw on the Dutch experience and understanding of these terms. The Dutch approach implies that acts of abstention from life-prolonging treatment, i.e., withholding and withdrawing treatment, and pain and symptom treatment that theoretically could shorten life (including terminal sedation) are to be considered 'normal medical practice'. Furthermore, death is seen as having natural causes in all of these acts. That, however, is not the case with euthanasia and physician-assisted suicide. When a physician performs either of these acts, he or she is required to state 'unnatural death' in the patient's death certificate. Our conceptual suggestions do not address the ethical status of the various medical decisions that are made with regard to the death of patients; our aim is conceptual clarity only. As far as euthanasia and physician-assisted suicide in Scandinavia is concerned, even though comparisons prove difficult, we do think some observations may be made: physicians from Norway, Denmark and Sweden display differences in both attitude and practice concerning these phenomena. Norwegian physicians are most restrictive with regard to attitude. Danish and Swedish physicians display a more liberal attitude, the latter being the most liberal. These findings did not fit the physicians' practice. Danish physicians have performed euthanasia and physician-assisted suicide more often than Norwegian physicians. Swedish physicians, even though they are the most liberal when it comes to attitude, appear never to have performed euthanasia and very seldom physician-assisted suicide.
Collapse
Affiliation(s)
- L J Materstvedt
- Unit for Applied Clinical Research, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim N-7489, Norway.
| | | |
Collapse
|
32
|
Landon BE, Reschovsky J, Reed M, Blumenthal D. Personal, organizational, and market level influences on physicians' practice patterns: results of a national survey of primary care physicians. Med Care 2001; 39:889-905. [PMID: 11468507 DOI: 10.1097/00005650-200108000-00014] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND One of the principal tenets of managed care is that physicians' clinical decisions can be influenced both to improve the quality and consistency of care and to decrease health care expenditures. Medical decision making, however, remains a complex phenomenon and the most important determinants of physicians' approaches to clinical decision making remain poorly understood. OBJECTIVES To determine how clinical decisions are associated with individual characteristics, practice setting and organizational characteristics, attributes of the patient population under care, and the market environment. RESEARCH DESIGN Cross-sectional, nationally representative survey of patient-care physicians. SUBJECTS Primary care physicians who provide direct patient care at least 20 hours per week. MEASURES Proportion of physicians who would order a referral, diagnostic test, or treatment for 5 clinical scenarios thought to be representative of discretionary medical decisions. RESULTS Responses were received from 4,825 primary care physicians who cared for adult patients (Response Rate 65%). The distribution of results for each of the five clinical scenarios demonstrates significant variability both within and between physicians. No evidence was seen of a consistent practice style across the vignettes (eg, "aggressive" or "conservative"). The organizational setting of practice was the most consistent predictor of behavior across all the clinical scenarios, with the exception of back pain, which was minimally related to any of the environmental factors. When compared to physicians in solo practice, physicians in all other practice settings were less likely to order a test or referral or pursue treatment. Practice involvement with managed care and measures of financial influences and administrative strategies associated with managed care were minimally and inconsistently associated with reported physician behaviors. CONCLUSIONS The ability of managed care to improve the quality and consistency of care while also controlling the costs of care depends on its ability to influence medical decisions. Our findings generally demonstrate that managed care has a weak influence on discretionary medical decisions and that the influence of managed care pales in comparison to personal and practice setting influences.
Collapse
Affiliation(s)
- B E Landon
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
| | | | | | | |
Collapse
|
33
|
Abstract
BACKGROUND In Oregon, physicians can prescribe lethal amounts of medication only if requested by competent, terminally ill patients. However, the possibility of extending the practice to patients who lack decisional capacity exists. This paper examines why the legal extension of physician-assisted suicide (PAS) to incapacitated patients is possible, and perhaps likely. METHODS The author reviews several pivotal court cases that have served to define the distinctions and legalities among "right-to-die" cases and the various forms of euthanasia and PAS. RESULTS Significant public support exists for legalizing PAS and voluntary euthanasia in the United States. The only defenses against sliding from PAS to voluntary euthanasia are adhering to traditional physician morality that stands against it and keeping the issue of voluntary euthanasia legally framed as homicide. However, if voluntary euthanasia evolves euphemistically as a medical choice issue, then the possibility of its legalization exists. CONCLUSIONS If courts allow PAS to be framed as a basic personal right akin to the right to refuse treatment, and if they rely on right-to-die case precedents, then they will likely extend PAS to voluntary euthanasia and nonvoluntary euthanasia. This would be done by extending the right to PAS to incapacitated patients, who may or may not have expressed a choice for PAS prior to incapacity.
Collapse
Affiliation(s)
- R M Walker
- Division of Medical Ethics and Humanities at the University of South Florida College of Medicine, Tampa 33612-4799, USA
| |
Collapse
|
34
|
Rosenfeld B, Breitbart W, Galietta M, Kaim M, Funesti-Esch J, Pessin H, Nelson CJ, Brescia R. The schedule of attitudes toward hastened death: Measuring desire for death in terminally ill cancer patients. Cancer 2000; 88:2868-75. [PMID: 10870074 DOI: 10.1002/1097-0142(20000615)88:12<2868::aid-cncr30>3.0.co;2-k] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The authors examined the reliability and validity of the Schedule of Attitudes toward Hastened Death (SAHD), a self-report measure of desire for death previously validated in a population of individuals with the acquired immunodeficiency syndrome (AIDS), among terminally ill patients with cancer. METHODS The authors interviewed 92 terminally ill cancer patients, all with a life expectancy of < 6 months, after admission to a palliative care hospital. Patients were administered the SAHD, a clinician-rated measure of desire for death (the Desire for Death Rating Scale [DDRS]), and several measures of physical and psychosocial well-being. RESULTS The average number of SAHD items endorsed was 4. 76 (standard deviation, 4.3); 15 patients (16.3%) endorsed > or = 10 items, indicating a high desire for death. Internal consistency was strong (coefficient alpha = 0.88, median item-total correlation = 0. 49), as were indices of convergent validity. Total SAHD scores were correlated significantly (correlation coefficient [r] = 0.67) with the DDRS, and somewhat less so with measures of depression (r = 0. 49) and hopelessness (r = 0.55). Lower, but substantial, correlations were observed between the SAHD and measures of spiritual well-being (r = -0.42), quality of life (r = -0.36), physical symptoms (r = 0.38), and symptom distress (r = 0.38). No significant correlation was observed between SAHD scores and social support (r = -0.06) or pain intensity (r = 0.16); however, pain-related functional interference and overall physical functioning were correlated significantly with SAHD scores (r = 0.31 and r = -0.23, respectively). CONCLUSIONS The SAHD appears to be a reliable and valid measure of desire for death among terminally ill cancer patients. Coupled with previous research in patients with AIDS, these results support the utility of the SAHD for research addressing interest in hastened death in patients with a life-threatening medical illness.
Collapse
Affiliation(s)
- B Rosenfeld
- Department of Psychology, Long Island University, Brooklyn, NY 11201, USA
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
A grounded theory study of senior citizens' preferences for end-of-life care was conducted in 1998 in Canada. Seniors who had experienced the deaths of others and who had considered their own death and dying were the target population. The sample was 49 seniors who met the study criteria. Participants provided end-of-life care in a variety of settings for 1-8 family members or friends. Two concepts identified were expected dependency while dying and appropriate end-of-life care. Almost all participants preferred to be cared for at home, yet family caregivers who could provide appropriate end-of-life care when dependent were needed for this to occur. The appropriateness of end-of-life care was contingent upon the place where end-of-life care occurred, as well as the type of care provided. Life prolongation was not desired, 53% even endorsed euthanasia as a way of bringing about the inevitable end to life.
Collapse
Affiliation(s)
- D M Wilson
- Associate Professor, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada T6G 2G3
| |
Collapse
|
36
|
Rousseau PC. Recent Literature. J Palliat Med 1999. [DOI: 10.1089/jpm.1999.2.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paul C. Rousseau
- Department of Geriatrics and Extended Care, VA Medical Center, Phoenix AZ
| |
Collapse
|