"Death talk": debating euthanasia and physician-assisted suicide in Australia.
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Australia↗
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Alberta euthanasia survey: 1. Physicians' opinions about the morality and legalization of active euthanasia.
OBJECTIVE: To ascertain the opinions of a sample of Alberta physicians about the morality and legalization of active euthanasia, the determinants of these opinions and the frequency and sources of requests for assistance in active euthanasia. DESIGN: Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. SETTING: Alberta. PARTICIPANTS: A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). RESULTS: Of the respondents 44% did believe that it is sometimes right to practice active euthanasia; 46% did not. Moral acceptance of active euthanasia correlated with type of practice and religious affiliation and activity. In all, 28% of the physicians stated that they would practice active euthanasia if it were legalized, and 51% indicated that they would not. These opinions were significantly related to sex, religious affiliation and activity, and country of graduation. Just over half (51%) of the respondents stated that the law should be changed to permit patients to request active euthanasia. Requests (usually from patients) were reportedly received by 19% of the physicians, 78% of whom received fewer than five. CONCLUSIONS: This survey revealed severely disparate opinions among Alberta physicians about the morality of active euthanasia. In particular, religious affiliation and activity were associated with the polarized opinions. The desire for active euthanasia, as inferred from requests by patients, was not frequent. Overall, there was no strong support expressed by the physicians for the personal practice of legalized active euthanasia. These data will be vital to those involved in health education and public policy formation about active euthanasia in Alberta and the rest of Canada.
Alberta↗
[Euthanasia and assisted suicide. Euthanasia and nursing care: the role of the critical care nurse in euthanasia and assisted suicide].
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Critical Care↗
Moving from voluntary euthanasia to non-voluntary euthanasia: equality and compassion.
The recent Dutch law legalising active voluntary euthanasia will reignite the euthanasia debate. An illuminating method for evaluating the moral status of a practice is to follow the implications of the practice to its logical conclusion. The argument for compassion is one of the central arguments in favour of voluntary active euthanasia. This argument applies perhaps even more forcefully in relation to incompetent patients. If active voluntary euthanasia is legalised, arguments based on compassion and equality will be directed towards legalising active non-voluntary euthanasia in order to make accelerated termination of death available also to the incompetent. The removal of discrimination against the incompetent has the potential to become as potent a catch-cry as the right to die. However, the legalisation of non-voluntary euthanasia is undesirable. A review of the relevant authorities reveals that there is no coherent and workable "best interests" test which can be invoked to decide whether an incompetent patient is better off dead. This provides a strong reason for not stepping onto the slippery path of permitting active voluntary euthanasia.
Civil Rights↗
French physicians' attitudes toward legalisation of euthanasia and the ambiguous relationship between euthanasia and palliative care.
In 1999, the French Parliament established a "right to palliative care", which reactivated public debate about euthanasia. In order to investigate jointly physicians' attitude toward palliative care and euthanasia, we conducted a cross-sectional survey of a national sample of French GPs, oncologists, and neurologists. Overall, 917 physicians participated in the survey. Significant proportions of respondents, especially among GPs and neurologists, considered that palliative sedation and withdrawing life-sustaining treatments (WLST) were euthanasia. Multivariate analysis showed that the physicians who had special medical training in palliative care, and those who distinguish palliative sedation and WLST from euthanasia were more likely to oppose legalisation of euthanasia. Thus, French physicians' attitude to the legalisation of euthanasia is strongly influenced by whether or not they distinguish palliative care from euthanasia. Improved palliative care requires better training of the entire medical profession, and clearer guidelines about which end-of-life care practices are legally and ethically acceptable.
Adult↗
Alberta euthanasia survey: 2. Physicians' opinions about the acceptance of active euthanasia as a medical act and the reporting of such practice.
OBJECTIVE: To ascertain the opinions of Alberta physicians about the acceptance of active euthanasia as a medical act (the "medicalization" of active euthanasia) and the reporting of colleagues practising active euthanasia, as well as the sociodemographic correlates. DESIGN: Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. SETTING: Alberta. PARTICIPANTS: A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). RESULTS: Although only 44% of the respondents considered active euthanasia morally "right" at least 70% opted to medicalize the practice if it were legal by restricting it to be performed by physicians and to be taught at medical sites. Even though active euthanasia is criminal homicide in Canada, 33% of the physicians stated that they would not report a colleague participating in the act of anyone, and 40% and 60% stated that they would not report a colleague to medical or legal authorities respectively. Acceptance or rejection of active euthanasia as a medical act was strongly related to religious affiliation and activity (p < 0.01). CONCLUSIONS: This survey about active euthanasia revealed profound incongruities in the opinions of the sample of Alberta physicians concerning their ethical and social duties in the practice of medicine. These data highlight the need for relevant modifications of health education policies concerning biomedical ethics and physicians' obligations to society.
Alberta↗
European public acceptance of euthanasia: socio-demographic and cultural factors associated with the acceptance of euthanasia in 33 European countries.
In many European countries, the last decade has been marked by an increasing debate about the acceptability and regulation of euthanasia and other end-of-life decisions in medical practice. Growing public sensibility to a 'right to die' for terminally ill patients has been one of the main constituents of these debates. Within this context, we sought to describe and compare acceptance of euthanasia among the general public in 33 European countries. We used the European Values Study data of 1999-2000 with a total of 41125 respondents (63% response rate) in 33 European countries. The main outcome measure concerned the acceptance of euthanasia (defined as 'terminating the life of the incurably sick', rated on a scale from 1 to 10). Results showed that the acceptance of euthanasia tended to be high in some countries (e.g. the Netherlands, Denmark, France, Sweden), while a markedly low acceptance was found in others (e.g. Romania, Malta and Turkey). A multivariate ordinal regression showed that weaker religious belief was the most important factor associated with a higher acceptance; however, there were also socio-demographic differences: younger cohorts, people from non-manual social classes, and people with a higher educational level tended to have a higher acceptance of euthanasia. While religious belief, socio-demographic factors, and also moral values (i.e. the belief in the right to self-determination) could largely explain the differences between countries, our findings suggest that perceptions regarding euthanasia are probably also influenced by national traditions and history (e.g. Germany). Thus, we demonstrated clear cross-national differences with regard to the acceptance of euthanasia, which can serve as an important basis for further debate and research in the specific countries.
Adolescent↗
Support and consultation for general practitioners concerning euthanasia: the SCEA project. Support and Consultation in Euthanasia in Amsterdam.
UNLABELLED: In the project 'Support and consultation in Euthanasia in Amsterdam' (SCEA) general practitioners can turn to 20 especially trained physicians for advice or consultation concerning euthanasia or physician-assisted suicide. In this study the implementation was evaluated and it was investigated whether the goals of SCEA, supporting physicians and improving the quality of consultation, the quality of decision-making and the willingness to report, were met. Methods used were a questionnaire send to all general practitioners registered in Amsterdam (n=398), registration forms SCEA physicians filled in for every time SCEA was contacted and records of the public prosecutor. After the study period of 14 months, of the general practitioners who had performed euthanasia during this period, 53% had contacted SCEA at least once. The vast majority of general practitioners felt supported by SCEA. The quality of consultation was (even) higher in cases of euthanasia in which a SCEA physician acted as consultant than in cases with another consultant. We found no relation between use of SCEA and the last two goals of SCEA. CONCLUSIONS: Whether the lack of relation found between SCEA and it's last two goals is real or due to the studies limitations remains unclear. The results of this study do suggest that SCEA, by further improving the quality of consultation, has contributed to the safeguarding of euthanasia and assisted suicide. Therefore, similar networks are being developed throughout the Netherlands.
Attitude of Health Personnel↗
Active euthanasia and assisted suicide: a perspective from an American abortion and Dutch euthanasia scenario.
PURPOSE/OBJECTIVES: To discuss the critical issues involved in the legalization of active euthanasia and physician-assisted suicide. DATA SOURCES: Nursing, medical, legal, and ethics literature; newspaper articles; book chapters. DATA SYNTHESIS: The major terms employed in the discussion of active euthanasia and physician-assisted suicide are defined. The implications of the recent Supreme Court decision on these practices are outlined. The Dutch euthanasia and the American abortion scenarios are used as models for the interpretation of the effects of future legislation on such practices. CONCLUSIONS: Oncology nurses need to be cognizant of the crucial issues involved in the practices of active euthanasia and physician-assisted suicide and determine their philosophical stance regarding the practices. IMPLICATIONS FOR NURSING PRACTICE: If active euthanasia and physician-assisted suicide practices are legalized, oncology nurses will have to make decisions about their desired degree of involvement in acts that will end their patients' lives.
Abortion, Legal↗
Differences between terminally ill cancer patients who died after euthanasia had been performed and terminally ill cancer patients who did not request euthanasia.
Palliative care, directed at improving the quality of life of terminally ill patients, is generally not aimed at any form of postponing or hastening death. It is possible that high quality palliative care could prevent requests for euthanasia. However, empirical evidence on this issue is scarce. In a national survey of end-of-life medical decisions in The Netherlands the subject of care at the end of life has been addressed. Data on terminally ill cancer patients who died after their request was granted and euthanasia had been performed were compared with those of terminally ill cancer patients who did not request euthanasia. The results show that the prevalence and severity of symptoms e.g., pain, feeling unwell, nausea, was higher in patients who died after their request was granted and euthanasia had been performed. No differences concerning the treatment of symptoms or the care provided were found between the two groups. The results suggest that the practice of euthanasia is mainly related to the patient's suffering.
Adult↗
Euthanasia--again. "Letting die" is not in the patient's best interests: a case for active euthanasia.
Recent discussions in the Journal on the subject of euthanasia have relied on intuitive appeals to distinctions traditionally considered to be morally relevant, such as the distinction between acts and omissions (or killing and letting die), or ordinary and extraordinary means of treatment. These discussions remained inconclusive. However, the question of euthanasia no longer remains inconclusive if one adopts the perspective suggested by the United States President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research and by the World Medical Assembly--that a doctor should act in his or her patient's best interests. From this vantage point, it is argued, there will be instances when active euthanasia is the proper cause of action.
Ethics, Medical↗
Does being against euthanasia legislation equate to being anti-euthanasia?
This study investigated issues raised in qualitative data from our previous studies of health professionals and community members, which suggested that being opposed to euthanasia legislation did not necessarily equate to being anti-euthanasia per se. A postal survey of 1002 medical practitioners, 1000 nurses and 1200 community members was undertaken. In addition to a direct question on changing the law to allow active voluntary euthanasia (AVE), four statements assessed attitudes to euthanasia with or without a change in legislation. Responses were received from 405 doctors (43%), 429 nurses (45%) and 405 community members (38%). Compared with previous studies there was a slight increase in support for a change in the law from medical practitioners, a slight decrease in support from community members and almost no change among nurses. Different interpretations of the results of the four attitude questions are possible, depending on the perspective of the interpreter.
Adult↗
Beliefs of Alberta physicians concerning active euthanasia: analysis of qualitative data collected in the Alberta Euthanasia Survey.
Often the type of information collected in surveys of physicians' opinions about active euthanasia has not revealed their experiences and the rationale(s) they use in arriving at their opinions. This paper presents a qualitative analysis of comments made in a large survey of Alberta physicians' opinions about active euthanasia to identify issues physicians commented upon, and to explore the rationale(s) behind their opinions. This information adds an important qualitative perspective to the current debate about euthanasia and assisted suicide.
Alberta↗
Does compassion include euthanasia? Physicians' roles in caring for the terminally ill preclude the use of euthanasia.
As technological advances continue to allow physicians to prolong dying patients' lives, healthcare providers face many issues surrounding physician-assisted suicide and euthanasia. When a physician performs euthanasia or assists in suicide, he or she is killing the patient. The action can in no way be interpreted as allowing an eventually inevitable death to occur earlier rather than later. The physician is culpable. Physicians play three important roles when caring for terminally ill patients: adviser, friend, and priest. The risks inherent in each of these could create an illusion that performing euthanasia and assisting in suicide are humane and logical options. Finally, physicians should not miss opportunities for grace when caring for dying patients. When physicians convey the diagnosis, when patients express the desire to control the timing of the death, and when patients are feeling sadness and anger, physicians must rise to the occasion to act as friend and minister and to introduce grace and healing to the dying.
Catholicism↗
[Euthanasia in the Third Reich--only a problem of psychiatry? On the development of the euthanasia debate 1933-1941 in Germany].
The devastating consequences of the Fascist dictatorship in Germany for the ethical thinking of the physicians are particularly clearly recognizable by the mass killings of severely damaged children and patients with chronic psychic diseases which were performed at that time. Recent investigations of the developments which began in 1938 show that by way of intensive efforts for a juridicial legalization of the "active euthanasia" an enlargement of this killing practice has been striven after. References to a motive of compassion and the free decision of the affected persons should cover the real intention for reducing welfare services. A bill presented in 1940 for a law "on euthanasia for incurable ill persons" found the unanimous consent of the renowned physicians consulted for this purpose. Though this law finally did not become legal beginning with 1941 the medical practice showed further forms of the repressive and antihumane association with ill persons who were regarded as incurable, which must be valuated as practical consequences of an unadmissible relativation of the life-preserving task of medicine.
Euthanasia↗
Of euphemisms and euthanasia: the language games of the Nazi doctors and some implications for the modern euthanasia movement.
Euphemisms are place-holders for important concepts. They may disguise a practice which one might abhor if it were given another name. In Nazi Germany during World War II, euphemisms were used to desensitize physicians and society to the horrors of a program of euthanasia. This article examines some of the euphemisms used by the Nazi physicians to redefine medicalized killing, compares the Nazi language games with those of contemporary proponents of medicalized killing, and concludes that the consistent application of euphemisms for medicalized killing significantly weakens arguments against assisted killing.
Euthanasia, Active↗
Voluntary euthanasia in The Netherlands.
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Euthanasia↗
Euthanasia: conclusions of a BMA working party set up to review the Association's guidance on euthanasia.
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Adult↗