ABCD Exchange : September 1998 : Research - Women's Distrust of Physicians

Vulnerable Women's Concerns about Physician-Assisted Suicide Tied to Distrust of Physicians
by Donna Horton

Elizabeth Morrow, J.D., of the Pacific Institute for Women's Health in Los Angeles, authored "Attitudes of Women from Vulnerable Populations toward Physician-assisted Death: A Qualitative Approach," published in The Journal of Clinical Ethics, fall 1997.

PAS was presented as illegal in focus groups, but what concerned these women most was the involvement of physicians, whom they generally distrust. The first reason listed for the distrust was a belief that doctors' priority is to make money. One senior citizen said, "They're all out to make a buck. You know they are." One said, "I would not trust [doctors] to act in my best interests, but in the interests that are their own, which they feel is right."

Interviews and focus groups, conducted in Long Beach, California, during 1995, focused on the attitudes of women from vulnerable populations toward the persons and social pressures involved to make decisions at the end of life and about PAS. Senior citizens, non-English-speaking Latinas, women who were homeless, women who had experienced violence in their families, and young college students, spoke from experience as mothers, family members, patients, and poor women.

Study highlights included:

• A majority wanted end-of-life healthcare decisions to be made with family and loved ones, even when family might oppose their healthcare choices.
• Some women said inappropriate care was recommended because nurses or doctors did not adequately respect their culture or because doctors had financial incentives to recommend treatments.
• Some said physicians treat indigent people differently, making legalization of PAS dangerous.
• Participants said doctors should be prohibited from starting a discussion on PAS, so physicians would not encourage patients to use PAS.
• Participants said doctors should be prohibited from starting a discussion on PAS, so physicians would not encourage patients to use PAS.
• Participants said family involvement would help offset the power imbalance between doctor and patient.
• The strongest supporters of mandatory family notification were victims of domestic violence and Latinas.
• Some Latinas, who opposed PAS, said PAS should be contingent on a family's approval, not just on family notification.
• College students, in the process of separating from family, opposed requiring family involvement in end-of-life decision-making.
• Senior citizens, in the same economic positions as other respondents, trusted physicians more. (Seniors were also well-positioned in the healthcare marketplace, experienced with doctors, and covered by Medicare.)

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