Medical house officers’ attitudes toward vigorous analgesia, terminal sedation, and physician-assisted suicide

Kaldjian, Lauris C.; Wu, Barry J.; Kirkpatrick, James N.; Thomas-Geevarghese, Asha; Vaughan‐Sarrazin, Mary

doi:10.1177/104990910402100514

Cited by 10 publications

(11 citation statements)

References 33 publications

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“…Results from existing U.S.-based studies suggest that residents are hesitant to participate in MAID (1–40%), but may be supportive of their colleagues’ involvement [7–11]. Similarly, in Mexico, residents have expressed limited support (18–29%) for MAID [12, 13].…”

Section: Introductionmentioning

confidence: 99%

Assessing attitudes towards medical assisted dying in Canadian family medicine residents: a cross-sectional study

2019

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BackgroundMedical Assistance in Dying (MAID) in Canada came into effect in 2016 with the passing of Bill C-14. As patient interest and requests for MAID continue to evolve in Canada, it is important to understand the attitudes of future providers and the factors that may influence their participation. Attitudes towards physician hastened death (PHD) in general and the specific provision of MAID (e.g., causing death by lethal prescription or injection) are unknown among Canadian residents. This study examined residents’ attitudes towards PHD and MAID, and identified factors (e.g., demographics, clinical exposure to death and dying) that may influence their decision to participate in PHD and provide MAID.MethodsA cross-sectional survey was adapted from prior established surveys on MAID to reflect the Canadian setting. All Canadian family medicine programs were invited to participate. The survey was distributed between December 2016 and April 2017. Analysis of the results included descriptive statistics to characterize the survey participants and multivariable logistic regressions to identify factors that may influence residents’ attitudes towards PHD and MAID.ResultsOverall, 247 residents from 6 family medicine training programs in Canada participated (response rate of 27%). While residents were most willing to participate in treatment withdrawal (52%), active participation in PHD (41%) and MAID by prescription of a lethal drug (31%) and lethal injection (24%) were less acceptable. Logistic regressions identified religion as a consistent and significant factor impacting residents’ willingness to participate in PHD and MAID. Residents who were not strictly practicing a religion were more likely to be willing to participate in PHD (OR = 17.38, p < 0.001) and MAID (lethal drug OR = 10.55, p < 0.01, lethal injection OR = 8.54, p < 0.05). Increased clinical exposure to death and dying crudely correlated with increased willingness to participate in PHD and MAID, but when examined in multivariable models, only a few activities (e.g., declaring death, completing a death certificate) had a statistically significant association. Other significant factors included the residents’ sex and location of training.ConclusionsResidents are hesitant to provide MAID themselves, with religious faith being a major factor impacting their decision.

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Section: Introductionmentioning

confidence: 99%

Assessing attitudes towards medical assisted dying in Canadian family medicine residents: a cross-sectional study

2019

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“…27 We are aware of a report that 89% of 53 palliative care physicians agreed that terminal sedation was sometimes necessary, 1 and we found that 66% of 236 medical house officers in Connecticut agreed that it is ethically appropriate to provide terminal sedation to treat intractable pain associated with terminal illness. 28 Given the interest that patients, their families, and professionals have in the availability of aggressive palliation for terminally ill patients with refractory symptoms, there is a need to document attitudes toward terminal sedation among physicians who care for patients at the end of life. 21 We surveyed internists to: (1) determine the frequency of physician support for terminal sedation in end of life care; (2) determine whether physicians who support terminal sedation also support physician assisted suicide, and (3) explore characteristics of physicians who support terminal sedation but not assisted suicide.…”

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confidence: 99%

Internists’ attitudes towards terminal sedation in end of life care

Kaldjian

Jekel²,

Bernene³

et al. 2004

J Med Ethics

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Objective: To describe the frequency of support for terminal sedation among internists, determine whether support for terminal sedation is accompanied by support for physician assisted suicide (PAS), and explore characteristics of internists who support terminal sedation but not assisted suicide. Design: A statewide, anonymous postal survey. Setting: Connecticut, USA. Participants: 677 Connecticut members of the American College of Physicians. Measurements: Attitudes toward terminal sedation and assisted suicide; experience providing primary care to terminally ill patients; demographic and religious characteristics. Results: 78% of respondents believed that if a terminally ill patient has intractable pain despite aggressive analgesia, it is ethically appropriate to provide terminal sedation (diminish consciousness to halt the experience of pain). Of those who favoured terminal sedation, 38% also agreed that PAS is ethically appropriate in some circumstances. Along a three point spectrum of aggressiveness in end of life care, the plurality of respondents (47%) were in the middle, agreeing with terminal sedation but not with PAS. Compared with respondents who were less aggressive or more aggressive, physicians in this middle group were more likely to report having more experience providing primary care to terminally ill patients (p = 0.02) and attending religious services more frequently (p,0.001). Conclusions: Support for terminal sedation was widespread in this population of physicians, and most who agreed with terminal sedation did not support PAS. Most internists who support aggressive palliation appear likely to draw an ethical line between terminal sedation and assisted suicide.

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“…[4][5][6][7][8] In all, 9 of 10 US physicians endorse some religious affiliation, and more than half say their religious beliefs influence their practice of medicine. 9 Moreover, studies have consistently found that physician religiosity is associated with physicians' approaches to a variety of ethically controversial medical practices.…”

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confidence: 99%

“…Some have divided physicians only into the categories of Protestants, Catholics, Jews, and other, 7,8,10,11,[19][20][21][22][23][24][25] thus potentially missing ways that less represented religious traditions shape physicians' practice. Others have included only generalized measures of religiousness (eg, frequency of prayer, religious service attendance, the importance of religion in one's life), 21,26 which cannot account for religious traditions' varying views on suffering and death and the variety of ways in which these views are internalized.…”

mentioning

confidence: 99%

To Die, to Sleep: US Physicians' Religious and Other Objections to Physician-Assisted Suicide, Terminal Sedation, and Withdrawal of Life Support

Curlin

Nwodim

Vance

et al. 2008

Am J Hosp Palliat Care

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This study analyzes data from a national survey to estimate the proportion of physicians who currently object to physician-assisted suicide (PAS), terminal sedation (TS), and withdrawal of artificial life support (WLS), and to examine associations between such objections and physician ethnicity, religious characteristics, and experience caring for dying patients. Overall, 69% of the US physicians object to PAS, 18% to TS, and 5% to WLS. Highly religious physicians are more likely than those with low religiosity to object to both PAS (84% vs 55%, P < .001) and TS (25% vs 12%, P < .001). Objection to PAS or TS is also associated with being of Asian ethnicity, of Hindu religious affiliation, and having more experience caring for dying patients. These findings suggest that, with respect to morally contested interventions at the end of life, the medical care patients receive will vary based on their physicians' religious characteristics, ethnicity, and experience caring for dying patients. Keywordsreligion; ethics; physician-assisted suicide; terminal sedation; withdrawal of life support; ethnicity In the United States, physicians remain the de facto arbiters for most aspects of medical care, including end-of-life interventions. Although all 50 states allow patients to refuse medical treatments, patients often lack decisional capacity in the final stages of their illness. 1,2 Even when surrogates have been appointed, physicians sometimes make critical decisions regarding care without consulting the patient or the patient's family. 2 Many people fear that, should they fall gravely ill, their physician may not follow their wishes. 3 For some patients, this could mean not having access to physician-assisted suicide (PAS) or terminal sedation (TS). For others, it could mean overzealous physicians refusing to withdraw life support in the face of imminent death or, conversely, implementing unwanted life-shortening interventions. Although health Patients and physicians may disagree about end-of-life care because they have differing interpretations of what a "good death" entails. In a study of the views of patients, clinicians, and other health care workers who had experience caring for the dying, Steinhauser et al 3 noted that "pain and symptom management, clear decision making, preparation for death, completion, contributing to others, and affirmation of the whole person" were all core components of a "good death." They also noted that each component has biomedical, psychological, social, and spiritual aspects and that these aspects were given different emphasis by different groups.Disagreements about what a good death entails have often become visible in light of controversies about PAS, TS, and withdrawal of artificial life support (WLS), where previous studies have found that physicians' opinions are associated with their religious characteristics. [4][5][6][7][8] In all, 9 of 10 US physicians endorse some religious affiliation, and more than half say their religious beliefs influence their practice of medicine....

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Medical house officers’ attitudes toward vigorous analgesia, terminal sedation, and physician-assisted suicide

Cited by 10 publications

References 33 publications

Assessing attitudes towards medical assisted dying in Canadian family medicine residents: a cross-sectional study

Assessing attitudes towards medical assisted dying in Canadian family medicine residents: a cross-sectional study

Internists’ attitudes towards terminal sedation in end of life care

To Die, to Sleep: US Physicians' Religious and Other Objections to Physician-Assisted Suicide, Terminal Sedation, and Withdrawal of Life Support

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