Faced with a terminal illness themselves, doctors prefer assisted dying
When it comes to advanced cancer or Alzheimer's disease, over half of doctors would consider assisted dying for themselves, but preferences seem to vary according to their jurisdiction's legislation on euthanasia, reveal the results of an international survey, published online in the Journal of Medical Ethics .
And most say they would prefer symptom relief rather than life sustaining treatment for their own end of life care, indicate the responses.
Previously published research suggests that doctors' views on their own end of life care inform their clinical practice, and that their perceptions of their patients' treatment wishes are influenced by their own preferences, note the researchers.
But most of the studies on physicians' preferences for end of life practices are outdated and/or narrow in focus, added to which little is known about whether doctors would consider assisted dying for themselves, and whether this might be influenced by national or state legislation on the practice, point out the researchers.
Survey in five countries
To shed more light on these issues, the researchers surveyed doctors in eight jurisdictions with differing laws and attitudes to assisted dying: Belgium; Italy; Canada; the states of Oregon, Wisconsin, and Georgia in the United States; and the states of Victoria and Queensland in Australia.
Physician-assisted suicide law entered the statute book in Oregon in 1997, while Death with Dignity legislation has been introduced in Wisconsin numerous times over the past 20 years but remains illegal.
It is also illegal in Georgia which is one of the most religious states in the US.
In Canada, both physician-assisted suicide and euthanasia have been permitted since 2016.
In Belgium, assisted dying has been legal since 2002, but remains illegal in Italy, one of the most religious countries in Europe.
The Australian state of Victoria implemented assisted dying legislation in June 2019.
In Queensland, assisted dying legislation was passed in 2021, but had not yet come into force when the data for this study were collected (May 2022–February 2023).
Two hypothetical situations were included to probe doctors' views on end of life care: advanced cancer and Alzheimer's disease.
Respondents were asked the extent to which they would consider various end of life practices for themselves.
These included cardiopulmonary resuscitation (CPR), mechanical ventilation, tube feeding, intensified alleviation of symptoms, palliative sedation, the use of available drugs to end life, physician-assisted suicide, and euthanasia.
Responses were sought from family doctors (GPs), palliative care doctors, and other medical specialists highly likely to treat patients at the end of their life, such as cardiologists, emergency medicine doctors, oncologists, neurologists, and intensive care specialists.
What's a good option?
Of the 1,408 survey responses received, 1,157 were included in the final analysis.
These showed that doctors rarely considered life sustaining practices a (very) good option in cancer and Alzheimer's, respectively: CPR 0.5% and 0.2%; mechanical ventilation 0.8% and 0.3%; tube feeding 3.5% and 3.8%.
Most (94% and 91%, respectively) considered intensifying symptom relief a good or very good option, while 59% and 50%, respectively, considered palliative sedation a good or very good option.
Respondents who considered palliative sedation for Alzheimer's disease as a good or very good option ranged from just over 39% in Georgia to just over 66% in Italy.
About half of respondents considered euthanasia a (very) good option: just over 54% and 51.5%, respectively, for cancer and Alzheimer's disease.
The proportion of those considering euthanasia a (very) good option ranged from 38% in Italy to 81% in Belgium (cancer scenario), and almost 37.5% in Georgia, to almost 67.5% in Belgium (Alzheimer's disease scenario).
Around one in three (33.5%) respondents said they would consider drugs at their disposal to end their own life (cancer scenario).
While sex, age and ethnicity didn't seem to influence doctors' preferences for end of life practices, prevailing legislation in their jurisdiction did.
Doctors working in a jurisdiction with a legal option for both euthanasia and physician-assisted suicide were three times as likely to consider euthanasia a (very) good option for cancer and almost twice as likely to consider it a (very) good option for Alzheimer's disease.
'This may be because these physicians are more familiar and comfortable with the practices and have observed positive clinical outcomes.
'It also suggests that macro-level factors heavily impact personal attitudes and preferences, and physicians are likely influenced by what is considered 'normal' practice in their own jurisdiction,' say the researchers.
Religious views
GPs and other specialists were less likely to consider palliative sedation a good or very good option than palliative care doctors, and they were more likely to consider euthanasia, physician-assisted suicide, and the use of available medication to end their own life a (very) good option.
And doctors who weren't religious were more likely to consider physician-assisted suicide or euthanasia a preferable option than those with a strongly held faith: physician-assisted suicide 65% vs 38%; euthanasia 72% vs 40%.
Due to the study design and nature of surveys the results can't be considered fully representative, and those doctors with a particular interest in the subject may have been more likely to take part, acknowledge the researchers.
While the overall recruitment of respondents was satisfactory in all jurisdictions, GPs were under-represented among the Canadian respondents.
But note the researchers: 'Our findings show that across all jurisdictions physicians largely prefer intensified alleviation of symptoms and to avoid life-sustaining techniques like CPR, mechanical ventilation, and tube feeding.
'This finding may also relate to the moral distress some physicians feel about the routine continuation of treatment for their patients at the end of life.
'These findings warrant reflection on current clinical practice since life-prolonging treatment is still widely used for patients,yet is not preferred by physicians for themselves.'
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Responses were sought from family doctors (GPs), palliative care doctors, and other medical specialists highly likely to treat patients at the end of their life, such as cardiologists, emergency medicine doctors, oncologists, neurologists, and intensive care specialists. What's a good option? Of the 1,408 survey responses received, 1,157 were included in the final analysis. These showed that doctors rarely considered life sustaining practices a (very) good option in cancer and Alzheimer's, respectively: CPR 0.5% and 0.2%; mechanical ventilation 0.8% and 0.3%; tube feeding 3.5% and 3.8%. Most (94% and 91%, respectively) considered intensifying symptom relief a good or very good option, while 59% and 50%, respectively, considered palliative sedation a good or very good option. Respondents who considered palliative sedation for Alzheimer's disease as a good or very good option ranged from just over 39% in Georgia to just over 66% in Italy. 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