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PubMed1996

How Hawaii's doctors feel about physician-assisted suicide and euthanasia: an overview.

We polled, by questionnaire, all doctors and medical trainees in Hawaii (n = 3,017) to determine their attitudes towards physician-assisted suicide, euthanasia and other end-of-life medical issues. One thousand and twenty-eight (34.1%) responded. Medical trainees did not differ significantly from practicing physicians. Only a minority of respondents (15.6%) were willing to assist a terminally-ill patient to commit suicide. An even smaller number (9.8) would perform active euthanasia. On the other hand, an overwhelming majority would withhold (97.6%) or withdraw (78.6%) life-support upon request. Most doctors (88.0%) were also willing to administer high doses of narcotics for pain relief, even if such therapy hastened death. About half the doctors felt that physician-assisted suicide and active euthanasia may be justified under some circumstances, although most were unwilling to personally carry out these acts. Catholic, Filipino and Hawaiian/Polynesian doctors were statistically less likely to approve of or perform physician-assisted suicide or active euthanasia.

Attitude of Health Personnel↗
PubMed1995

Euthanasia: American attitudes toward the physician's role.

This is a study of American public opinion toward euthanasia and the physician's role in performing it. The authors examine how these attributes are affected by religious affiliation, religious self-perception, political self-perception and education. The data include 8384 American respondents from years 1977, 1978, 1982, 1985 and 1988 of the General Social Survey conducted by the National Opinion Research Center. The findings suggest that highly educated, politically liberal respondents with a less religious self-perception are most likely to accept active euthanasia or suicide in the case of terminally ill patient. The data also show that Americans tend to draw a distinction between the suicide of a terminally ill patient and active euthanasia under the care of a physician, preferring to have the physician perform this role in the dying process. The tendency to see a distinction between active euthanasia and suicide was clearly affected by religious affiliation and education.

Adolescent↗
PubMed1999

[Suicide of psychiatric inpatients assisted by euthanasia advocacy groups. Cases of assisted suicide?].

The debate on passive and active euthanasia has met a controversial echo both in the German-speaking media and in professional publications within recent years. This discussion, however, largely excluded mentally ill patients. Also, euthanasia advocacy groups have usually distanced themselves from euthanasia in psychiatric patients. We report here two cases from our hospital in which inpatients with affective disorders committed assisted suicide during a hospital pass. We discuss these events under the assumption that these are cases of questionable active euthanasia in mentally ill patients whose judgement was considerably compromised by their disorder.

Aged↗
PubMed1994

Withdrawal of life-support: four problems in medical ethics.

... In this paper I shall consider the following four beliefs which often cluster together: A) Passive euthanasia is justifiable, but "pulling the plug" and active euthanasia are wrong; B) There is no right to health care. We have no duty to provide free riders with health care; C) Abortion is immoral because it violates the right to life of the fetus; D) Justice sometimes requires us to increase a patient's risk of death by shifting a scarce resource to someone who needs it more. For the sake of concreteness I shall attribute these beliefs along with certain, often invoked rationales to a purely imaginary person named Ron. I shall not show that the individual beliefs are right or wrong or that the individual rationales are strong or weak. Instead, I shall show that Ron cannot consistently use these four rationales to justify these four beliefs. More precisely, I shall show that beliefs (A) through (D) together with certain common, general background beliefs involve incompatible views about the withdrawal of life-support. My objective is to make the incompatibility explicit and thus to persuade people like Ron to abandon some of their beliefs.

Abortion, Induced↗
PubMed1999

Exit association-mediated suicide: toxicologic and forensic aspects.

The Swiss German chapter of the Exit Association provides conditional assistance to individuals wishing to end their own lives. The Exit Association advocates death with dignity and fights for the right to freely choose the timing of one's own death. According to the Swiss criminal code (articles 114 and 115), altruistic assistance to suicide is not punishable. Active euthanasia is punished by imprisonment. An individual commits active euthanasia if he or she is driven by honorable motives (e.g., pity) and causes the death of another person wishing to die who seriously and insistently requests such action. Based on our information, the preparation for suicide and its completion relies on a well-defined protocol. First, the candidate's eligibility for Exit Association assistance is verified. The candidate then writes a farewell declaration that explicitly confirms the will to terminate his or her own life. A written report describes the events during the suicide procedure. Depending on the circumstances, the investigative judge requests a forensic autopsy and toxicologic analyses. The results of the forensic investigations conducted in the cases presented here are in agreement with the scenario described in the reports of the Exit Association, namely, suicide by massive ingestion of pentobarbital.

Aged↗
PubMed1995

Attitudes and behaviors on physician-assisted death: a study of Michigan oncologists.

PURPOSE: To ascertain the attitudes of oncologists toward physician-assisted death, ie, physician-assisted suicide and active euthanasia, as well as their experiences with these activities and their opinions toward their legalization. METHODS: A survey was mailed to all practicing 250 oncologists in the state of Michigan, with subsequent development of psychometric scales and their correlation with self-reported behaviors in physician-assisted death. RESULTS: Analysis revealed five distinct, meaningful factors regarding approval or disapproval of physician-assisted death. These factors reflected global attitudes toward physician-assisted death, passive euthanasia, philosophical prohibitions toward physician-assisted death, concerns of legal consequences with physician-assisted death, and attitudes that physician-assisted death could be avoided with better end-of-life care (alpha = .94, .74, .76, .87, and .84, respectively). High levels of therapy withdrawal were reported (81%), with significant reservations toward assisted suicide and active euthanasia, although reported participation in such actions was noteworthy (18% and 4%, respectively). The scales reflecting global and philosophical attitudes correlated with several attitudes and behaviors toward physician-assisted death (P < .001). Legislation that would allow physician-assisted death was favored by 20.8% of respondents. CONCLUSION: Although they have reservations about physician-assisted death, significant numbers of oncologists are willing to consider such actions should they become legal. Given the substantial number of physicians who report that they have already participated in physician-assisted death, these findings may help better understand the attitudes that motivate physician behaviors toward assisted death.

Attitude of Health Personnel↗
PubMed1988

Conflicting attitudes toward euthanasia for severely demented patients of health care professionals in Sweden.

This survey study of 1,798 Swedish health care workers in 31 acute and chronic institutional settings found considerable disagreement between staff concerning euthanasia. For example, attitudes of aides and LPNs, were significantly (chi 2 = 42.0, P less than .0001) more favorable toward active euthanasia (38.9% of aides and 28.8% of LPNs were neutral or approved) than were RNs and physicians (20% and 14.9%). This disagreement was most apparent among those staff in institutions with many demented patients. Favorable attitudes were also more frequent among aides experiencing job dissatisfaction and "burnout," younger staff, and those without a relative in long-term care. Possible reasons for favorable attitudes toward active euthanasia and staff attitude polarization are discussed along with implications for patient care.

Adolescent↗
PubMed1991

Medical aspects of euthanasia.

The practice of euthanasia in the Netherlands is often cited as an example of progressive social reform. While the Dutch penal code outlaws active euthanasia, the courts have interpreted the law in such a way as to allow doctors to kill their patients under certain conditions, chiefly when the patient has asked to die in preference to enduring unbearable suffering. Current practice in the Netherlands now includes the killing of patients who do not have a terminal disease, the killing of older children without the consent of their parents, and the killing of patients without their consent in circumstances where consent could have been sought. Estimates of the number of euthanasia killings range up to 20,000 per year, but there is no accurate information because of the common medical practice of falsely certifying the cause of death to avoid the need to justify euthanasia. Euthanasia in the Netherlands is now an alarming practice that oversteps ethical bounds and administrative controls, compromising doctors' moral commitment to healing by allowing them to become medical killers.

Adult↗
PubMed1991

Euthanasia: the way we do it, the way they do it.

Although the Netherlands, Germany, and the United States are alike in having aging populations who die primarily of deteriorative diseases, they face end-of-life dilemmas quite differently. In the United States, withholding and withdrawing of treatment are the only legally recognized means for easing dying. In Holland, voluntary active euthanasia is also practiced; in (West) Germany, assisted suicide is a legal option, usually outside the medical setting. This paper examines objections to these three practices, and observes the differences in the background cultures. Rather than reliance on any of the three, it argues that physician-assisted suicide in terminal illness is the practice most compatible with the United States' special characteristics.

Attitude to Death↗
PubMedDate not supplied

[Acceptance or rejection of euthanasia. Survey of 3021 Federal Government employees].

A survey was conducted with 3021 employees of the Federal Government using self-administered questionnaires in order to collect data on the socioeconomic background of those surveyed (sex, age, civil status, number of children, religious, affiliation, educational level and monthly income), as well as their opinions about euthanasia. For the purposes of this study, three types of euthanasia were considered: 1) passive (the suspension of life support systems); 2) active (the application of immediate death causing means for people who suffer from incurable illnesses); and 3) active in the medium term (the application of substances which keep a patient sedated and comfortable while all food is withheld). Passive and medium-term active euthanasia were accepted by 40 percent of the population surveyed, while active euthanasia was accepted by 20 percent. These percentages were higher among young people, among those who were not heavily influenced by or did not practice religion, among professionals and among post-graduates.

Adolescent↗
PubMed1993

Euthanasia in The Netherlands: facts and moral arguments.

Some facts about euthanasia practices in The Netherlands are given. It is shown that there are several possible courses of action at the end of life, of which active euthanasia is the most problematic. Euthanasia is related to respect for the patient and the patient's right to refuse medical treatment. Some moral arguments against and in favour of euthanasia are discussed.

Beneficence↗
PubMed1994

Management of death, dying and euthanasia: attitudes and practices of medical practitioners in South Australia.

This article presents the first results of a study of the decisions made by health professionals in South Australia concerning the management of death, dying, and euthanasia, and focuses on the findings concerning the attitudes and practices of medical practitioners. Mail-back, self-administered questionnaires were posted in August 1991 to a ten per cent sample of 494 medical practitioners in South Australia randomly selected from the list published by the Medical Board of South Australia. A total response rate of 68 per cent was obtained, 60 per cent of which (298) were usable returns. It was found that forty-seven per cent had received requests from patients to hasten their deaths. Nineteen per cent had taken active steps which had brought about the death of a patient. Sixty-eight per cent thought that guidelines for withholding and withdrawal of treatment should be established. Forty-five per cent were in favour of legalisation of active euthanasia under certain circumstances.

Adult↗
PubMed1998

Euthanasia and doctor-assisted suicide: responses by oncologists and non-oncologists.

PURPOSE: Public interest concerning euthanasia and doctor-assisted suicide is creating ethical dilemmas in the health care profession. We surveyed the views of oncologists and non-oncologists in Florida. METHODS: Physicians responded to an attitudinal questionnaire. The data collected were compared with standard statistical methods. RESULTS: Both oncologists and non-oncologists had similar opposition to euthanasia on philosophic or general grounds, with more opposition on general grounds expressed by oncologists. Both groups preferred better pain control and improved quality of life rather than euthanasia, but more oncologists than non-oncologists favored this alternative. Both groups admitted to participation in passive euthanasia, with little support for active euthanasia and doctor-assisted suicide. However, should the acts of euthanasia and doctor-assisted suicide become legalized, more non-oncologists than oncologists would agree to participate. CONCLUSION: In Florida, more opposition to aspects of the termination of life was expressed by oncologists than by non-oncologists.

Adult↗
PubMed1995

Assisted suicide: opinions of Alberta physicians.

The legal status of assisted suicide and active euthanasia are receiving increasing attention among physicians, legislators, the judiciary, and public lobby groups. Many seem to assume that these forms of assisted dying reside naturally within the practice of medicine but, surprisingly, comprehensive data about the opinions of Canadian physicians are not available. We report the results of a survey of the opinions of Alberta physicians about assisted suicide, compare their opinions to those about active euthanasia, and determine their relationships with various demographic and bioethical matters. A stratified random sample (n = 2,002) was drawn from all Alberta physicians. The response rate was 69% (1,391) and was representative of the reference population for age, sex, and type of practice. Fifty-five percent believed assisted suicide should remain a criminal offence, whereas 18% did not, and 27% were uncertain. Strong relationships were found between opinions about assisted suicide, and age and religious activity. These data demonstrate no ground swell of support by Alberta physicians for the decriminalization of assisted suicide. Our data confirm the need for a national study of the opinions of Canadian physicians about physician-assisted dying, and caution against precipitate changes in relevant legislation and health policy.

Alberta↗
PubMed1994

Nurses and the management of death, dying and euthanasia.

This article is one of two which report findings of research which examined the attitudes and practices of health professionals in South Australia towards the management of death, dying and euthanasia. The focus in this article is on findings related to nurses. Conducted in August 1991, mail-back, self-administered questionnaires were posted to a sample of 500 nurses on the general nurses register held by the Nurses Board of South Australia. A total response rate of 57.8% was obtained, and 55% (278) were usable returns. The survey found that 47% of the respondents had received requests from patients to hasten their deaths by withdrawing treatment, and 30% had received request from patients for active euthanasia. 'Persistent and irrelievable pain' was the main reason for such requests. The majority either would or did discuss such requests with relatives, other medical practitioners and nursing staff. Nineteen per cent had taken active steps which had brought about the death of a patient. Eighty-two per cent thought that guidelines for withholding and withdrawal of treatment should be established. Sixty per cent were in favour of legalization of active euthanasia under certain circumstances.

Adult↗
PubMed1994

Medical legal and ethical questions in palliative medicine and euthanasia.

The increasing importance of legal and ethical questions in palliative medicine and euthanasia due to the increased technical possibilities for extending life will be considered. In palliative medicine, the choice of the best therapy will be discussed, especially in the case of oncological diseases. Here, consideration of the prospects of success, for example, in chemotherapy, is faced with partly serious side-effects. The requirements of palliative medicine that the patient has to be fully informed of the fatal prognosis of his disease is equally debated as the optimum pain therapy. In this respect, the modification of the Narcotics Act of 1 February 1993 is also under discussion. In the field of euthanasia, the technical development of life extension versus dying has raised considerable legal and ethical problems regarding termination of therapy. Additionally, fiscal considerations are of increasing relevance. The common development of the legal and ethical discussion, for example, with regard to the publicity of the work of the so-called 'Gesellschaft für humanes Sterben', the public discussion leading up to a hearing of the 'Bundestag' regarding active euthanasia leads to a realization of the subject. The proposals for an active termination of life by discontinuing therapy for adults and also for malformed newborns are discussed. A dispute concerning the new legal regulation of active euthanasia in the Netherlands of February 1993 is also discussed. There, around 2% of all deaths per year result from active termination of life and also cases where persons are not able to consent. This also has enormous consequences for the position of the physician.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1975

Active and passive euthanasia.

The traditional distinction between active and passive euthanasia requires critical analysis. The conventional doctrine is that there is such an important moral difference between the two that, although the latter is sometimes permissible, the former is always forbidden. This doctrine may be challenged for several reasons. First of all, active euthanasia is in many cases more humane than passive euthanasia, Secondly, the conventional doctrine leads to decisions concerning life and death on irrelevant grounds. Thirdly, the doctrine rests on a distinction between killing and letting die that itself has no moral importance. Fourthly, the most common arguments in favor of the doctrine are invalid. I therefore suggest that the American Medical Association policy statement that endorses this doctrine is unsound.

American Medical Association↗