Surveys on attitudes towards legalisation of euthanasia: importance of question phrasing

AIM: To explore whether the phrasing of the questions and the response alternatives would influence the answers to questions about legalisation of euthanasia. METHODS: Results were compared from two different surveys in populations with similar characteristics. The alternatives "positive", "negative", and "don't know" (first questionnaire) were replaced with an explanatory text, "no legal sanction", four types of legal sanctions, and no possibility to answer "don't know" (second questionnaire). Four undergraduate student groups (engineering, law, medicine, and nursing) answered. RESULTS: In the first questionnaire (n = 684) 43% accepted euthanasia (range 28-50%), 14% (8-33%) did not, and 43% (39-59%) answered "don't know". Two per cent of the respondents declined to answer. In comparison with previous surveys on attitudes to euthanasia the proportion of "don't know" was large. The results of the second questionnaire (n = 639), showed that 38% favoured "no legal prosecution" (26-50%). However, 62% (50-74%) opted for different kinds of legal sanctions, and two of four groups expressed significantly different views in the two surveys. A proportion of 10% declined to answer the second questionnaire. CONCLUSION: An introduction of an explanatory text and a wider range of response alternatives produced differences between the results of the two surveys conducted.     

Professed religious affiliation and the practice of euthanasia.

Attitudes towards active voluntary euthanasia (AVE) and physician-assisted suicide (PAS) among 1,238 doctors on the medical register of New South Wales varied significantly with self-identified religious affiliation. More doctors without formal religious affiliation ('non-theists') were sympathetic to AVE, and acknowledged that they had practised AVE, than were doctors who gave any religious affiliation ('theists'). Of those identifying with a religion, those who reported a Protestant affiliation were intermediate in their attitudes and practices between the agnostic/atheist and the Catholic groups. Catholics recorded attitudes most opposed to AVE, but even so, 18 per cent of Catholic medical respondents who had been so requested, recorded that they had taken active steps to bring about the death of patients.     

What people close to death say about euthanasia and assisted suicide: a qualitative study

OBJECTIVE: To explore the experiences of people with a "terminal illness", focusing on the patients' perspective of euthanasia and assisted suicide. METHOD: A qualitative study using narrative interviews was conducted throughout the UK. The views of the 18 people who discussed euthanasia and assisted suicide were explored. These were drawn from a maximum variation sample, who said that they had a "terminal" illness, malignant or non-malignant. RESULTS: That UK law should be changed to allow assisted suicide or voluntary euthanasia was felt strongly by most people. Those who had seen others die were particularly convinced that this should be a right. Some had multiple reasons, including pain and anticipated pain, fear of indignity, loss of control and cognitive impairment. Those who did not want to be a burden also had other reasons for wanting euthanasia. Suicide was contemplated by a few, who would have preferred a change in the law to allow them to end their lives with medical help and in the company of family or friends. The few who opposed a change in UK law, or who felt ambivalent, focused on involuntary euthanasia, cited religious reasons or worried that new legislation might be open to abuse. CONCLUSION: Qualitative research conducted on people who know they are nearing death is an important addition to the international debate on euthanasia and assisted suicide. Those who had seen others die were particularly convinced that the law should be changed to allow assisted death.     

Euthanasia and the doctors--a rejection of the BMA's report.

The working party on euthanasia set up by the British Medical Association produced its report in 1988 (1). The first of its terms of reference was 'to examine the ethical problems relating to euthanasia, terminal illness, and suicide' and as far as active voluntary euthanasia (AVE) is concerned it failed conspicuously to do its job. The purpose of this article is not to restate the case for AVE but to examine the reason for the failure. (Figures in square brackets refer to sections in the report.)     

Attitudes of medical students towards euthanasia in a multicultural setting

A cross-sectional survey of 400 medical students of multicultural backgrounds at the University of Malaya was conducted to understand their attitudes towards euthanasia and factors related to medical decisions and ethical reasoning concerning the prolongation of life, the right to die and euthanasia. The student respondents completed self-administered questionnaires that comprised of twelve questions with multiple stems addressing personal perceptions, knowledge, attitudes, and decisions about euthanasia and the relief of suffering. The majority of respondents (52%) were for the withdrawal of active therapy in a patient suffering from a terminal painful disease while 48% of them were against it. Seventy-one percent of the students involved in the study were against the idea of active euthanasia i.e. the administration of a lethal injection. However, 27% of the respondents felt that there was a moral justification to assist patients to die. Thirty-two percent of the respondents favoured the legalization of euthanasia in Malaysia while 67% of them were strongly against it. The majority (61%) of respondents would not practice euthanasia as a doctor nor would they have performed on themselves if or when it became legal. The main issue surrounding euthanasia that concerned the respondents was the misuse of it by unethical practitioners and they felt that further debate on the matter was essential, both within the local and international communities.     

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.     

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 problem for the idea of voluntary euthanasia.

I question whether, in those cases where physician-assisted suicide is invoked to alleviate unbearable pain and suffering, there can be such a thing as voluntary euthanasia. The problem is that when a patient asks to die under such conditions there is good reason to think that the decision to die is compelled by the pain, and hence not freely chosen. Since the choice to die was not made freely it is inadvisable for physicians to act in accordance with it, for this may be contrary to the patient's genuine wishes. Thus, what were thought to be cases of voluntary euthanasia might actually be instances of involuntary euthanasia.     

互联网+护理服务背景下安徽省皖南地区护士对网约护士认知调查分析

目的了解"互联网+护理服务"背景下护士对"网约护士"的认知情况以及影响护士做"网约护士"意愿的因素。 方法选取安徽省皖南地区12所医院的2 241名护士为研究对象,采用自行设计的问卷对其进行"网约护士"认知和意愿的调查。 结果不同年龄段、工作年限、婚姻状况、子女情况、职称、是否喜欢护士职业者做"网约护士"意愿比较,差异均有统计学意义（P < 0.05~P < 0.01）。>50岁年龄段中34.6%的护士,>20年工作年限中28.6%的护士,副主任护师及以上中43.1%的护士,有子女中26.0%的护士,婚姻状况为其他中35.3%的护士,喜欢护士职业的护士中24.5%的护士均非常愿意做"网约护士"。是否听说过"网约护士"政策、对"网约护士"了解程度、是否赞成实施"网约护士"、对"网约护士"前景的看法对护士做"网约护士"意愿的影响差异有统计学意义（P < 0.01）。506名（22.6%）护士表示非常愿意做"网约护士",表示一般愿意有811名（36.2%）,表示不确定有801名（35.7%）,表示不愿意有73名（3.3%）,表示非常不愿意有50名（2.2%）。1 159名（51.7%）护士没有听说过"网约护士"政策,621名（27.7%）护士对"网约护士"了解程度表示一般,858名（38.3%）护士对"网约护士"不了解。896名（40.0%）护士对实施"网约护士"表示一般赞成,878名（39.2%）护士对实施"网约护士"态度表示不确定,1 171名（52.3%）护士看待"网约护士"的前景表示一般。 结论"网约护士"目前没有在全国推广,三、四线城市和地区大部分护士对"网约护士"的态度较为谨慎,有待进一步宣传。可以优先引导高年资护理人员向社区下沉。通过市场经济,合理经济收入能更好体现护士专业价值,降低护士流失率。工作具有更多的自主性和灵活性对护士做"网约护士"有很大的吸引力。如果给予护理职业更多选择,可以更好的维持护士的低招聘率和高流动率。     

Battlefield euthanasia - courageous compassion or war crime?

Issues relating to voluntary euthanasia that are currently being debated by Australian society are distinctly different from those encountered by battlefield doctors. Doctors in war undertake to treat those affected by conflict; their participation in euthanasia challenges the profession's definition of "duty of care". Euthanasia must be distinguished from "triage" and medical withdrawal of care (which are decided within a medical facility where, although resources may be limited, comfort care can be provided in the face of treatment futility). Battlefield euthanasia is a decision made, often immediately after hostile action, in the face of apparently overwhelming injuries; there is often limited availability of pain relief, support systems or palliation that would be available in a civilian environment. The battlefield situation is further complicated by issues of personal danger, the immediacy of decision making and difficulties with distinguishing civilians from combatants. Regardless of the circumstances on a battlefield, doctors, whether they are civilians or members of a defence force, are subject to the laws of armed conflict, the special provisions of the Geneva Conventions and the ethical codes of the medical profession.     

河南省公众对安乐死的认知、态度及意向调查

目的：了解河南省公众对安乐死的认知、态度及意向,为在该人群中开展有针对性的知识宣传及相关部门采取相应措施提供参考依据。方法：针对河南省公众特点,自行编制＂河南省公众对自愿安乐死认知调查问卷＂,对1000位河南省公民进行调查,内容包括一般人口社会学特征,对安乐死的认知、态度及意向。结果：75.6%的被调查者对安乐死有一定了解,不同职业的被调查者对安乐死的认知差异有统计学意义（P〈0.05）;50.3%的被调查者赞成安乐死,52.6%的被调查者赞成安乐死合法化,并且学历越高者越倾向于赞成安乐死合法化（P〈0.05）,医生的赞同率仅有36.8%。60.5%和58.8%的被调查者分别认为安乐死属于社会问题和伦理问题。结论：河南省公众对安乐死总体知晓率较高,多数人对实施安乐死和安乐死合法化持谨慎态度。普通公民应在现代医学伦理观的指导下正确看待安乐死。     

自主性、他者与安乐死

自愿而积极的安乐死的实现必须有“他者”的介入才具有现实性。完全的自主性是个抽象的理论原则，在实践中存在着逻辑困难。“他者”在生命态度、家庭关系、社会关系和医师方面对自主性构成了限制，也使安乐死的实现有了现实根据。个体在自主选择安乐死意愿时，应当坚持尊重原则、协商原则和自主原则。这些原则也是未来安乐死立法中应当坚持的原则。     

End-of-life decisions in medical practice: a survey of doctors in Victoria (Australia)

OBJECTIVES: To discover the current state of opinion and practice among doctors in Victoria, Australia, regarding end-of-life decisions and the legalisation of voluntary euthanasia. Longitudinal comparison with similar 1987 and 1993 studies. DESIGN AND PARTICIPANTS: Cross-sectional postal survey of doctors in Victoria. RESULTS: 53% of doctors in Victoria support the legalisation of voluntary euthanasia. Of doctors who have experienced requests from patients to hasten death, 35% have administered drugs with the intention of hastening death. There is substantial disagreement among doctors concerning the definition of euthanasia. CONCLUSIONS: Disagreement among doctors concerning the meaning of the term euthanasia may contribute to misunderstanding in the debate over voluntary euthanasia. Among doctors in Victoria, support for the legalisation of voluntary euthanasia appears to have weakened slightly over the past 17 years. Opinion on this issue is sharply polarised.     

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.     

A comparison of death certificates and autopsies in the Australian Capital Territory.

OBJECTIVE: To determine the accuracy of death certificates in the Australian Capital Territory (ACT) by comparison with autopsy reports. DESIGN: A retrospective study of 495 deaths occurring from 1979 to 1987, excluding coronial deaths and deaths of infants under one year of age. The main cause of death on the death certificate was compared with the main cause of death recorded on an autopsy-supported death certificate created for the study. SETTING: The deaths occurred in both major institutional hospitals in the ACT. These hospitals are government-funded and administered, catering for both private and public patients. PATIENTS: There were 495 autopsies recorded in the ACT over the study period. The age data were lost in two cases. MAIN OUTCOME MEASURES: To find a simple measure of death certificate accuracy and compare the results with previous work. RESULTS: The accuracy of death certificates was 77%. Age, sex and length of hospital stay made little difference to the accuracy. Neoplastic diseases were accurately reported in 90% of cases, digestive and cardiovascular diseases in 81%. CONCLUSIONS: There is a need for practical methods and standard criteria to evaluate accuracy of death certificates.     

某市三级医院护士组织认同与志愿行为的关系研究

目的:研究某市三级医院护士组织认同、志愿行为的状况及二者之间的关系.方法:采用便利整群抽样的方法,使用《组织认同量表》和《志愿行为问卷》,对242名三级医院护士进行问卷调查.结果:既往参加过各种志愿服务活动的88人(36.4%),从未参加过志愿活动的154人(63.6%);组织认同评分为(31.83±5.27)分,志愿行为评分为(2.20±1.09)分;护理管理者的组织认同评分显著高于护士(P<0.01),≥36岁的护士组织认同评分高于26~35年龄段的护士(P<0.01),工作时间6~10年的护士组织认同评分最低(P<0.01),主管护师及以上职称的护士组织认同评分大于护师(P<0.05);护理管理者的志愿行为评分显著高于护士(P<0.01);护士组织认同与志愿行为成显著正相关关系(r=0.230,P<0.01).结论:三级医院护士组织认同较积极,志愿行为情况不乐观;组织认同对志愿行为具有一定的预测作用;护理管理者应着力进一步提高护士的组织认同,促使护士参与志愿服务活动.     

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.     

Early discharge and postnatal depression: a prospective cohort study

OBJECTIVES: To determine whether women discharged from hospital < or = 72 hours after childbirth (early discharge) were at greater risk of developing symptoms of postnatal depression during the following six months than those discharged later (late discharge), their reasons for early discharge and their level of postnatal support. DESIGN AND SETTING: Population-based, prospective cohort study with questionnaires at Day 4, and at 8, 16 and 24 weeks postpartum, conducted at all birth sites in the Australian Capital Territory (ACT). PARTICIPANTS: Women resident in the ACT giving birth to a live baby from March to October 1997. MAIN OUTCOME MEASURE: A score > 12 on the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: 1295 (70%) women consented to participate; 1193 (92%) were retained in the study to 24 weeks and, of these, 1182 returned all four questionnaires. Of the 1266 women for whom length-of-stay data were available, 467 (37%) were discharged early and 799 (63%) were discharged late. There were no significant differences between the proportion of women discharged early who ever scored > 12 on the EPDS during the six postpartum months and those discharged late (17% v. 20%), even after controlling for other risk factors (adjusted OR, 0.67; 95% CI, 0.44-1.01). Of women discharged early, 93% had at least one postnatal visit at home from a midwife and 81% were "very satisfied" with the care provided. Most women (96%) reported they had someone to help in practical ways. CONCLUSIONS: Women discharged early after childbirth do not have an increased risk of developing symptoms of postnatal depression during the following six months.     

The acceptability of ending a patient's life

Objectives: To clarify how lay people and health professionals judge the acceptability of ending the life of a terminally ill patient.

Design: Participants judged this acceptability in a set of 16 scenarios that combined four factors: the identity of the actor (patient or physician), the patient's statement or not of a desire to have his life ended, the nature of the action as relatively active (injecting a toxin) or passive (disconnecting life support), and the type of suffering (intractable physical pain, complete dependence, or severe psychiatric illness).

Participants: 115 lay people and 72 health professionals (22 nurse's aides, 44 nurses, six physicians) in Toulouse, France.

Main measurements: Mean acceptability ratings for each scenario for each group.

Results: Life ending interventions are more acceptable to lay people than to the health professionals. For both, acceptability is highest for intractable physical suffering; is higher when patients end their own lives than when physicians do so; and, when physicians are the actors, is higher when patients have expressed a desire to die (voluntary euthanasia) than when they have not (involuntary euthanasia). In contrast, when patients perform the action, acceptability for the lay people and nurse's aides does not depend on whether the patient has expressed a desire to die, while for the nurses and physicians unassisted suicide is more acceptable than physician assisted suicide.

Conclusions: Lay participants judge the acceptability of life ending actions in largely the same way as do healthcare professionals.