ABCD Exchange : September 1998 : Research - Physician Misunderstanding of PAS & Euthanasia

Upfront - Community Coalitions & EOL Care
President's Letter - Suffering in Nursing Homes
QuickScan - News in Brief
Public Policy - Pain Relief
On the Hill - Coalition to Improve Pain Management
Research - Women's Distrust of Physicians

New Study Points to Physician Misunderstanding of Physician-Assisted Suicide and Euthanasia: Many Fail To Follow Proposed Safeguards
by Janice Lynch Schuster

The August 12 issue of The Journal of the American Medical Association describes results from a new study on the practice of physician-assisted suicide (PAS) and euthanasia in the United States. Led by Ezekiel J. Emanuel, M.D., Ph.D., researchers surveyed 355 oncologists to determine whether they had participated in PAS and euthanasia, and whether they had followed the major safeguards currently recommended. These safeguards include having the patient initiate and repeat requests for PAS, determining that a patient's pain is severe and intractable, and consulting with a colleague.

Of the 355 oncologists surveyed, 56 reported having participated in PAS or euthanasia. In-depth interviews revealed that of these physicians, 12 had not actually participated in PAS or euthanasia, and had mistakenly believed that withholding life-sustaining treatment or administering opioids for pain relief are forms of PAS or euthanasia. Such misunderstanding of terms, the researchers report, suggests that other studies that survey doctors on PAS and euthanasia may be overstating the extent to which either occurs.

Of those doctors who hastened death, half reported feeling comforted by having helped a patient to die, almost a quarter regretted having participated, and almost 40 percent feared prosecution.

All three safeguards were followed in 34.2 percent of the PAS cases reported. In virtually all cases, patients were in unremitting pain, or were in such poor health they could not care for themselves. However, in six cases, patients did not participate in the decision for PAS or euthanasia. Physicians consulted with a colleague in 39.5 percent of the cases; there were very few consultations with psychiatrists.

The study concludes:

  1. Future studies must carefully phrase questions about PAS and euthanasia because existing data may overstate the practice of euthanasia and PAS.
  2. Physicians often confuse the meaning of PAS and euthanasia.
  3. Practices may not adhere to proposed safeguards, although severe physical symptoms were uniformly described as a requirement for a doctor to perform PAS or euthanasia.
  4. For some patients, receiving opioid analgesia and/or hospice care was not enough to prevent requests for PAS.
  5. Some attempts at PAS or euthanasia were unsuccessful.
A significant minority of doctors regret having participated in euthanasia or PAS.

<<< Previous Next >>> [ Go Up ]

This content is provided by Americans for Better Care of the Dying. For more information, visit www.abcd-caring.org.