从医务人员对安乐死认识的问卷调查结果浅议安乐死

本文对195名医务人员的随机问卷调查表明,74.87％的人支持安乐死,25.13％的人不支持。作者结合文献和临床工作的体会,讨论了安乐死的必要性和可行性。     

医学生与医务人员对安乐死的认识和评价调查

采用问郑调查方法调查了４０１名医学生与医务人员对安乐死的认识与接受程度。结果 赞成安乐死的占９０．７７％,其主要理由是认为安乐死是人道的,可以帮助患者及其家属解脱痛苦。认为最佳安尔死方式的,有３２．０３％造反主动安乐死,只有１８．１３％选择被动安乐死。６６．２９％的安尔死造成者对于安乐死的态度存在理智上与感情上的矛盾心理。法制不健全和传统习俗的影响被认为是安乐死的所面临的两大障碍。     

大学工科生、医学生与医务人员自杀态度的对照研究

为了解大学工科生、医学生与医务人员对自杀的态度及三者之间的异同，该研究应用自杀态度问卷，采取随机抽样的方法取样，对383名大学工科生、医学生和医务人员进行问卷调查。结果：3组人群对自杀行为性质的认识、对自杀者的态度、对自杀者家属的态度都持矛盾或中立态度，医务人员和医学生对安乐死持肯定、认可、理解和宽容的态度，工科生对安乐死持矛盾或中立态度。认为自杀的干预应根据不同的情况引导与教育社会公众保持适当的态度。     

医学生对安乐死的认知和态度调查

目的:调查医学生对安乐死的认知和态度,并分析可能的影响因素,为医学伦理教育提供参考依据.方法:采用自行设计的问卷对某医学院校526名本科生进行关于安乐死认知和态度方面的调查.结果:526名被调查者中,安乐死知晓率为63.9%,被调查者表示对安乐死有所了解,但了解的内容和范围有限,94.3%的被调查者认为生命权属于个人,但对于个人是否有权利决定自己生死则表现得较为矛盾.被调查者均承认安乐死属于跨学科、跨领域的争议性问题,63.9%赞成安乐死,63.5%表示安乐死在我国立法是非常必要的.58.7%表示在本人面临是否选择安乐死时要视具体情况而定,64.6%的被调查者在面对亲人选择安乐死时表示不会主动建议,但会支持其决定.结论:多数调查者对安乐死有一定的了解,但是受我国传统思想观念的影响,医学生对于死亡和安乐死的认识有限,被调查者对实施安乐死态度较为严谨,应加强医学生伦理教育和死亡教育,正确引导医学生认识死亡,正确看待安乐死.     

不同人群对安乐死态度及现状的调查

目的：调查中小城市不同人群对安乐死及其现状的态度,了解公众对安乐死的认同度以及安乐死在我国实施的合理性和可能性,发现我国安乐死合法化进程中遇到的主要困难并提出建议。方法：采用自制问卷,在当地社区进行问卷的发放和回收,发放问卷210份,共回收有效问卷202份,回收率为96.2％。结果：市民对于安乐死问题了解不足,仅有36％的被调查者表示对安乐死问题有了解,有75％的人赞同在我国实施安乐死,被调查的11名医生全部赞成在我国实施安乐死;有宗教信仰的人对安乐死的认同度较低;文化程度越高,越能意识到解决安乐死问题立法是关键。结论：中小城市市民对于安乐死问题了解偏少,不同人群对其在我国实施的合理性及主要困难认识存在差异,这在社会上引起了广泛争议,阻滞了我国安乐死合法化的进程。为推动安乐死在我国实施,有必要加强对市民的宣传教育,改革我国教育体制,推动安乐死立法工作进行,为我国的安乐死合法化提供保障。     

北京地区安乐死社会心态的调查分析

通过对北京地区部分医院的医务人员、患者和医学院在校学生以及社区人群等进行问卷调查,旨在从一个侧面反映社会对安乐死及相关问题的态度。从调查中发现,社会对安乐死的认知程度较高,并且人群对安乐死的不同态度与其文化程度和职业背景具有相关性。另外,通过对人们谈论死亡时的心态进行分析发现拥有健康生死观的人更倾向于赞同积极安乐死。     

不同年级护生对安乐死的认知与伦理教育的启示

目的 了解不同年级护生对安乐死认知情况及影响因素,为护理伦理教育提供参考依据.方法 采用整群抽样,对四年制护理本科二、三及四年级学生就其对安乐死的认知和态度进行典型案例测试.结果 717名本科护生,绝大多数护生对安乐死持积极态度,有正确的认识,赞成安乐死的648人,占90.4%,持中立观点的15人,占2.1%.但不同年级的护生对安乐死的认知程度有所不同.二年级护生中赞成安乐死的占93.2%;三年级护生中赞成安乐死的占77.1%;四年级护生中赞成安乐的占82.7%.结论 护生随着受教育的程度及走向临床,对安乐死的态度发生着改变,存在着差异.护理伦理教学中应加以正确的引导,使护士对安乐死有科学的认识.妥善面对和解决伦理问题,提升对患者的护理品质.     

论恶性肿瘤患者的放弃治疗——消极安乐死

在临床工作中,恶性肿瘤患者确诊后放弃治疗的现象极为常见,对恶性肿瘤患者放弃治疗其实就是一种消极的、被动的安乐死,是严重违背我们的社会伦理准则和医学宗旨的,通过分析其原因,对解决办法进行了初步的探讨。     

对武汉师范院校应届毕业生有关安乐死的伦理学调查与思考

通过随机抽样,对276名华中师范大学09届毕业生进行安乐死意愿调查。调查数据表明,安乐死在大学生中的认知程度不高,还有很多人不了解安乐死;在主动安乐死和被动安乐死的接受程度中,两者的接受程度都不超过50％,而被动安乐死的接受程度更是低于25％。但大学生们认为人有权选择安乐死,安乐死也符合人道主义原则,希望进行安乐死立法。大学生的专业、性别以及户口来源都对其对于安乐死的认识有所影响。因此,安乐死的立法还需要广泛深入的调查研究。     

护理大专生对安乐死的态度及意向调查分析

目的 了解护理大专生对安乐死的态度及意向情况,为护理伦理教育提供参考依据.方法 采用自行设计的问卷对长沙市某职业学院的护理大专三年级全体学生共350人进行现场自填式问卷调查.结果 350名护理大专生中,64.9%的学生赞同安乐死,70%的护生表示如果自己患不治之症愿意选择安乐死,如果亲人要求安乐死,45.1%的护生会同意,绝大部分护生认为安乐死应该合法化.而对于对濒临死亡患者实施主动安乐死和被动安乐死的回答,持反对态度者（44.3%和64.8%）均多于持赞同态度者（31.1%和13.7%）.男女生在是否同意亲人安乐死方面存在差异（P〈0.05）,不同家庭住址的学生在是否支持亲人安乐死、是否赞同主动安乐死和被动安乐死方面存在差异（均P〈0.05）,而是否学习过〈护理伦理学〉课程的学生除了在是否支持亲人安乐死方面无差异外,其他方面均有差异（均P〈0.05）.结论 绝大多数护理大专生支持安乐死,且对安乐死意向较明确.应加强对其护理伦理学的教学,积极正确引导护生,使护生对安乐死有科学的认识.     

Alberta euthanasia survey: 1. Physicians' opinions about the morality and legalization of active euthanasia.

OBJECTIVE: To ascertain the opinions of a sample of Alberta physicians about the morality and legalization of active euthanasia, the determinants of these opinions and the frequency and sources of requests for assistance in active euthanasia. DESIGN: Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. SETTING: Alberta. PARTICIPANTS: A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). RESULTS: Of the respondents 44% did believe that it is sometimes right to practice active euthanasia; 46% did not. Moral acceptance of active euthanasia correlated with type of practice and religious affiliation and activity. In all, 28% of the physicians stated that they would practice active euthanasia if it were legalized, and 51% indicated that they would not. These opinions were significantly related to sex, religious affiliation and activity, and country of graduation. Just over half (51%) of the respondents stated that the law should be changed to permit patients to request active euthanasia. Requests (usually from patients) were reportedly received by 19% of the physicians, 78% of whom received fewer than five. CONCLUSIONS: This survey revealed severely disparate opinions among Alberta physicians about the morality of active euthanasia. In particular, religious affiliation and activity were associated with the polarized opinions. The desire for active euthanasia, as inferred from requests by patients, was not frequent. Overall, there was no strong support expressed by the physicians for the personal practice of legalized active euthanasia. These data will be vital to those involved in health education and public policy formation about active euthanasia in Alberta and the rest of Canada.     

Alberta euthanasia survey: 2. Physicians' opinions about the acceptance of active euthanasia as a medical act and the reporting of such practice.

OBJECTIVE: To ascertain the opinions of Alberta physicians about the acceptance of active euthanasia as a medical act (the "medicalization" of active euthanasia) and the reporting of colleagues practising active euthanasia, as well as the sociodemographic correlates. DESIGN: Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. SETTING: Alberta. PARTICIPANTS: A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). RESULTS: Although only 44% of the respondents considered active euthanasia morally "right" at least 70% opted to medicalize the practice if it were legal by restricting it to be performed by physicians and to be taught at medical sites. Even though active euthanasia is criminal homicide in Canada, 33% of the physicians stated that they would not report a colleague participating in the act of anyone, and 40% and 60% stated that they would not report a colleague to medical or legal authorities respectively. Acceptance or rejection of active euthanasia as a medical act was strongly related to religious affiliation and activity (p < 0.01). CONCLUSIONS: This survey about active euthanasia revealed profound incongruities in the opinions of the sample of Alberta physicians concerning their ethical and social duties in the practice of medicine. These data highlight the need for relevant modifications of health education policies concerning biomedical ethics and physicians' obligations to society.     

Alberta Euthanasia Survey: 3-year follow-up.

OBJECTIVE: To determine whether the opinions of Alberta physicians about active euthanasia had changed and to assess the determinants of potential changes in opinion. DESIGN: Follow-up survey (mailed questionnaire) of physicians included in the 1991 Alberta Euthanasia Survey. SETTING: Alberta. PARTICIPANTS: Of the 1391 physicians who participated in the 1991 survey 1291 (93%) had indicated that they were willing to take part in a follow-up survey. A follow-up questionnaire was mailed in 1994 to 1146 physicians who could be traced through the 1994 Medical Directory of the provincial college of physicians and surgeons; 25 questionnaires were returned because they could not be delivered. OUTCOME MEASURES: Physicians' opinions about (a) the morality of active euthanasia, (b) changes in the law to permit active euthanasia and (c) the practice of legalized euthanasia. RESULTS: Of the 1121 physicians sent a follow-up questionnaire 866 (77%) returned it completed. The responses of these same 866 physicians in 1991 provided a basis for comparison. Of the 866, 360 (42%) stated in the 1994 survey that it is sometimes right to practise active euthanasia; a similar proportion (384 [44%]) gave this response in 1991. However, other opinions changed significantly. In 1991, 250 of the respondents (29%) indicated that they would practise active euthanasia if it were legalized, as compared with 128 (15%) in 1994 (p < 0.01). In 1991, 429 (50%) of the respondents thought that the law should be changed to permit active euthanasia, as compared with 316 (37%) in 1994 (p < 0.01). Religious activity was the most important characteristic associated with changes in opinion. Despite the decrease in support for the practice and legalization of active euthanasia between 1991 and 1994, in both surveys at least 70% of those who responded to this question indicated that active euthanasia, if it were legalized, should be performed only by physicians and should be taught at medical sites. CONCLUSION: Alberta physicians' support for the practice and legalization of active euthanasia decreased considerably between 1991 and 1994. However, most physicians remain in favour of restricting active euthanasia, if it were legalized, to the medical profession. These results suggest a need for caution and deliberation when changes in the law concerning active euthanasia are examined.     

Abortion and euthanasia of Down''s syndrome children--the parents'' view.

A study of 78 parents of Down's syndrome children shows that, while most were in favour of abortion for a handicapped fetus, they were divided equally on whether euthanasia (no distinction made between active and passive euthanasia) was an acceptable practice. Only a third considered an average Down's syndrome child could be a suitable candidate for euthanasia. While parents argued that the degree of handicap of the child was the crucial factor in making this decision, in fact the social class of the parents themselves was the only variable which was statistically significantly related to their opinions. Differences arose from the parents' lack of agreement on what constituted a sufficiently severe handicap.     

French district nurses' opinions towards euthanasia, involvement in end-of-life care and nurse patient relationship: a national phone survey

OBJECTIVES: To assess French district nurses' opinions towards euthanasia and to study factors associated with these opinions, with emphasis on attitudes towards terminal patients. DESIGN AND SETTING: An anonymous telephone survey carried out in 2005 among a national random sample of French district nurses. PARTICIPANTS: District nurses currently delivering home care who have at least 1 year of professional experience. Of 803 district nurses contacted, 602 agreed to participate (response rate 75%). MAIN OUTCOME MEASURES: Opinion towards the legalisation of euthanasia (on a five-point Likert scale from "strongly agree" to "strongly disagree"), attitudes towards terminal patients (discussing end-of-life issues with them, considering they should be told their prognosis, valuing the role of advance directives and surrogates). RESULTS: Overall, 65% of the 602 nurses favoured legalising euthanasia. Regarding associated factors, this proportion was higher among those who discuss end-of-life issues with terminal patients (70%), who consider competent patients should always be told their prognosis (81%) and who value the role of advance directives and surrogates in end-of-life decision-making for incompetent patients (68% and 77% respectively). Women and older nurses were less likely to favour legalising euthanasia, as were those who believed in a god who masters their destiny. CONCLUSIONS: French nurses are more in favour of legalising euthanasia than French physicians; these two populations contrast greatly in the factors associated with this support. Further research is needed to investigate how and to what extent such attitudes may affect nursing practice and emotional well-being in the specific context of end-of-life home care.     

A Dutch report on the ethics of neonatal care.

The Dutch Paediatric Association reports consensus among its members regarding the necessity to take the future quality of life into account when reaching decisions regarding the continuation or dis-continuation of life-prolonging treatment. The paramount importance of the discussion with the parents is stressed. Dissension exists regarding active euthanasia in the newborn, both opinions being respected. If dissension exists within the profession parents should be informed and if necessary referred to a doctor who shares their moral views.     

福建省安乐死民意初探

为了探讨福建省居民及身患绝症病人对安乐死的承受心理和接受程度,以问卷调查的方法,对福州市561名学生、干部、医护人员、恶性肿瘤病人进行民意测验.结果发现,多数人对安乐死是可以接受的.同时还发现,对安乐死的态度还受年龄、职业、身体健康状况等因素的影响.建议加强宣传,进行“优死”教育.     

军医伦理学视域下生命伦理问题研究

源于战争实践的军医伦理学,自产生之时就涵涉着对生命伦理的高度关注。生命伦理在军事领域中有着独立生成性。由此形成了军医伦理学对生命伦理关注的特定视域：战地安乐死、战场器官移植、军事医学科研、疫苗使用、突发公共卫生事件、生态伦理等。     

促进中国安乐死立法的建议

中国安乐死合法化进程中出现的现实障碍主要有：传统伦理道德观念;法律依据缺乏,法制建设不完善;针对这些障碍,提出了促进我国安乐死合法化进程的相关建议：加强宣传教育,引导人们正确认识安乐死;明确操作程序,实施全面监控;加强理论研究,界定安乐死实施要件;以循序渐进的方式多方位为安乐死立法;健全医疗卫生制度,提高医疗＂软硬件＂。     

Active euthanasia in The Netherlands

Active euthanasia in the Netherlands remains a topic for both professional and public debate. However, many aspects of the medical practice of active euthanasia remain unclear, and no figures on the actual incidence of this practice exist. Legally, active euthanasia is a criminal offense, but a pattern of jurisprudence has developed since the first court case in 1973 that has allowed physicians to practice euthanasia under certain strict conditions. Two proposals, one from the Royal Dutch Medical Association and one from a government-appointed state commission, have advised that the current law be changed. While the debate continues, a number of Dutch institutions have developed procedures and policies to enable physicians and health care providers to participate in active euthanasia in an acceptable and controllable manner. However, many Dutch physicians remain uncomfortable with the professional and public tolerance of this practice.