UK geriatricians' attitudes to active voluntary euthanasia and physician-assisted death

Understanding the Reasons Behind Healthcare Providers' Conscientious Objection to Voluntary Assisted Dying in Victoria, Australia

During the debates about the legalization of Voluntary Assisted Dying (VAD) in Victoria, Australia, the presence of anti-VAD health professionals in the medical community and reported high rates of conscientious objection (CO) to VAD suggested access may be limited. Most empirical research on CO has been conducted in the sexual and reproductive health context. However, given the fundamental differences in the nature of such procedures and the legislation governing it, these findings may not be directly transferable to VAD. Accordingly, we sought to understand how CO operates in the context of VAD. Prior to the implementation of the VAD legislation in June 2019, we conducted semi-structured interviews with seventeen health professionals with a self-declared CO to VAD, to explore what motivated their CO. Participants identified multiple motivations, which can be broadly categorized as: concerns for oneself; concerns for patients; concerns about the current Victorian legislation; and concerns for the medical profession. Participants' moral commitments included personal, professional, and political commitments. In some cases, one's CO was specific to Victoria's current legislation rather than VAD more broadly. Our findings suggest CO motivations extend beyond those traditionally cited and suggest a need to better understand and manage CO in the healthcare context.

Geriatricians' attitudes towards voluntary assisted dying: A survey of Australian and New Zealand Society for Geriatric Medicine members

OBJECTIVE

To identify the attitudes of Australian and New Zealand geriatricians to legalisation of voluntary assisted dying.

METHODS

An anonymous, voluntary, online survey of Australian and New Zealand Society for Geriatric Medicine (ANZSGM) members.

RESULTS

A total of 226 members completed the survey equating to a 20% response rate. About 24% of respondents supported legalisation of voluntary assisted dying, whilst 53% opposed. If voluntary assisted dying was legalised, 12% would be willing to prescribe to an appropriate patient, and 61% would be willing to refer them onto a third party. Risk to vulnerable patients was the most important concern identified.

CONCLUSIONS

Support for voluntary assisted dying among surveyed ANZSGM members is low, but varies according to patient circumstances. Key areas of concern highlighted were risk to vulnerable patients, estimating prognosis, and capacity assessments. Further training is required for doctors on discussing voluntary assisted dying options, estimating prognosis, and capacity assessments prior to implementation.

Attitudes of UK doctors towards euthanasia and physician-assisted suicide: a systematic literature review

OBJECTIVES

To review studies over a 20-year period that assess the attitudes of UK doctors concerning active, voluntary euthanasia (AVE) and physician-assisted suicide (PAS), assess efforts to minimise bias in included studies, determine the effect of subgroup variables (e.g. age, gender) on doctors' attitudes, and make recommendations for future research.

DATA SOURCES

Three electronic databases, four pertinent journals, reference lists of included studies.

REVIEW METHODS

Literature search of English articles between January 1990 and April 2010. Studies were excluded if they did not present independent data (e.g. commentaries) or if they related to doctors outside the UK, patients younger than 18 years old, terminal sedation, withdrawing or withholding treatment, or double-effect. Quantitative and qualitative data were extracted.

RESULTS

Following study selection and data extraction, 15 studies were included. UK doctors oppose the introduction of both AVE and PAS in the majority of studies. Degree of religiosity appeared as a statistically significant factor in influencing doctors' attitudes. The top three themes in the qualitative analysis were the provision of palliative care, adequate safeguards in the event of AVE or PAS being introduced, and a profession to facilitate AVE or PAS that does not include doctors.

CONCLUSIONS

UK doctors appear to oppose the introduction of AVE and PAS, even when one considers the methodological limitations of included studies. Attempts to minimise bias in included studies varied. Further studies are necessary to establish if subgroup variables other than degree of religiosity influence attitudes, and to thoroughly explore the qualitative themes that appeared.

Survey of doctors' opinions of the legalization of physician assisted suicide

BACKGROUND

Assisted dying has wide support among the general population but there is evidence that those providing care for the dying may be less supportive. Senior doctors would be involved in implementing the proposed change in the law. We aimed to measure support for legalizing physician assisted dying in a representative sample of senior doctors in England and Wales, and to assess any association between doctors' characteristics and level of support for a change in the law.

METHODS

We conducted a postal survey of 1000 consultants and general practitioners randomly selected from a commercially available database. The main outcome of interest was level of agreement with any change in the law to allow physician assisted suicide.

RESULTS

The corrected participation rate was 50%. We analysed 372 questionnaires. Respondents' views were divided: 39% were in favour of a change to the law to allow assisted suicide, 49% opposed a change and 12% neither agreed nor disagreed. Doctors who reported caring for the dying were less likely to support a change in the law. Religious belief was also associated with opposition. Gender, specialty and years in post had no significant effect.

CONCLUSION

More senior doctors in England and Wales oppose any step towards the legalization of assisted dying than support this. Doctors who care for the dying were more opposed. This has implications for the ease of implementation of recently proposed legislation.

Physician-assisted suicide: a survey of attitudes among Swedish physicians

AIMS

To investigate the attitudes of Swedish physicians towards physician-assisted suicide.

DESIGN

A postal questionnaire on the respondent's opinion of physician-assisted suicide was sent to a randomly selected sample of physicians in Sweden. The respondents were given the opportunity of furnishing arguments of their own and of prioritizing arguments. They were also asked about possible influence on their own and patients' trust in the healthcare system if physician-assisted suicide was to be legally accepted.

PARTICIPANTS

1,200 physicians from six specialties, approximately 200 individuals each in: general practice, geriatrics, internal medicine, oncology, psychiatry and surgery.

SETTING

The study was commissioned by the Swedish Medical Society and its logo was printed on questionnaires and envelopes.

RESULTS

The total response rate was 74%, ranging between 63%-80% among the specialties. On average 34% were pro physician-assisted suicide, 39% against it and 25% were doubtful; 2% per cent did not respond to the question at all. Psychiatrists were significantly more accepting than oncologists, who were the most restrictive specialty. Older physicians (>50 years) provided a significantly more accepting attitude than younger ones (<or=51 years).

CONCLUSIONS

Despite the fact that the World Medical Association condemns physician-assisted suicide as unethical, the present survey indicates that there is no clear majority for or against physician-assisted suicide among Swedish physicians, and that significantly more elderly physicians have an accepting attitude towards physician-assisted suicide. There is a need for further research explaining the differences between the age groups as well as the variation between specialities.

Views regarding physician-assisted suicide: a study of medical professionals at various points in their training

In this study, we sought to obtain detailed opinion on some of the practical issues that might arise should physician-assisted suicide (PAS) ever be legalized in the UK. We carried out an anonymous postal questionnaire of medical students, junior and senior doctors working at an acute hospital trust, over a three-week period. A total of 435 questionnaires were distributed and we had an overall return rate of 34%. We found that opinions changed very little as doctors progressed from medical school through to senior clinical positions. Overall, there was neutral opinion on whether PAS should be legalized. There was strong support for a multidisciplinary approach to the process and the involvement of the coroner. An opt-out clause for physicians who did not want to be involved in assisted suicide also received strong support.

El lugar de fallecimiento de las personas ancianas en Cataluña

STUDY OBJECTIVE

To describe the place of death of the elderly and to analyze the factors associated with death occurring in an acute care hospital.

DESIGN

Cross-sectional interview of a randomized sample of individuals aged 65 or over who died during the year 1998. Three to four months after the death of the elderly subject, the main caregiver was interviewed about the socio-demographic characteristics, chronic conditions, functional and cognitive status, and use of health services in the months previous to the death, as well as the place where death occurred and their preferences on this site.

SETTING

Six areas of Catalonia, Spain, differing in the level of health and end of life social services.

PARTICIPANTS

584 caregivers (78.6% response rate).

MAIN RESULTS

Mean age of the deceased elderly was 81.4 (+/- 8) and half of them were females. 52% (95% CI: 47.5-55.7) had died in acute care hospitals. 35% of the caregivers of those dying at an acute hospital reported that they would have preferred another place for death. After adjustment, variables associated with dying in acute care hospitals were: living in an area with lower availability of social and health services for the end of life (OR: 2.8; 95% CI: 1.4-5.5) and suffering from chronic obstructive pulmonary disease (OR: 1.7; 95% CI: 1.1-2.5).

CONCLUSIONS

Acute hospitals are the predominant place of death in Catalonia, Spain. The place of death seems to be more closely influenced by the availability of end-of-life care services. There is a clear preference for dying at an alternative place to acute hospitals.

Attitudes toward euthanasia in Hong Kong--a comparison between physicians and the general public

This article reports the findings of a cross-sectional study that compared the attitudes of 618 respondents of a general household survey and a random sample of 1,197 physicians toward different types of euthanasia in Hong Kong. The general public was found to agree with active euthanasia and non-voluntary euthanasia and was neutral about passive euthanasia. On the other hand, physicians agreed with passive euthanasia, were neutral about non-voluntary euthanasia, and disagreed with active euthanasia. Factors affecting the respondents' attitudes were also explored. The article ends with policy and research implications of the findings.