Doctors' practices and attitudes regarding voluntary euthanasia

We report the results of a survey of the attitudes and practices of doctors in Victoria with respect to requests for active help in dying from patients who were suffering from a terminal or incurable disease. Questionnaires were sent to 2000 Victorian doctors who had been selected at random, 869 of whom returned completed questionnaires. The survey indicates that a clear majority of those who responded to the questionnaire support active voluntary euthanasia and that many doctors have provided active help in dying. Forty per cent of doctors indicated that they would practise active voluntary euthanasia if it were legal. We compare the results of our survey with a recent telephone survey of British general practitioners.     

Conditions required for a law on active voluntary euthanasia: a survey of nurses' opinions in the Australian Capital Territory

OBJECTIVES: To ascertain which conditions nurses believe should be in a law allowing active voluntary euthanasia (AVE). DESIGN: Survey questionnaire posted to registered nurses (RNs). SETTING: Australian Capital Territory (ACT) at the end of 1996, when active voluntary euthanasia was legal in the Northern Territory. SURVEY SAMPLE: A random sample of 2,000 RNs, representing 54 per cent of the RN population in the ACT. MAIN MEASURES: Two methods were used to look at nurses' opinions. The first involved four vignettes which varied in terms of critical characteristics of each patient who was requesting help to die. The respondents were asked if the law should be changed to allow any of these requests. There was also a checklist of conditions, most of which have commonly been included in Australian proposed laws on AVE. The respondents chose those which they believed should apply in a law on AVE. RESULTS: The response rate was 61%. Support for a change in the law to allow AVE was 38% for a young man with AIDS, 39% for an elderly man with early stage Alzheimer's disease, 44% for a young woman who had become quadriplegic and 71% for a middle-aged woman with metastases from breast cancer. The conditions most strongly supported in any future AVE law were: "second doctor's opinion", "cooling off period", "unbearable protracted suffering", "patient fully informed about illness and treatment" and "terminally ill". There was only minority support for "not suffering from treatable depression", "administer the fatal dose themselves" and "over a certain age". CONCLUSION: Given the lack of support for some conditions included in proposed AVE laws, there needs to be further debate about the conditions required in any future AVE bills.     

The complexity of nurses' attitudes toward euthanasia: a review of the literature

In this literature review, a picture is given of the complexity of nursing attitudes toward euthanasia. The myriad of data found in empirical literature is mostly framed within a polarised debate and inconclusive about the complex reality behind attitudes toward euthanasia. Yet, a further examination of the content as well as the context of attitudes is more revealing. The arguments for euthanasia have to do with quality of life and respect for autonomy. Arguments against euthanasia have to do with non-maleficence, sanctity of life, and the notion of the slippery slope. When the context of attitudes is examined a number of positive correlates for euthanasia such as age, nursing specialty, and religion appear. In a further analysis of nurses' comments on euthanasia, it is revealed that part of the complexity of nursing attitudes toward euthanasia arises because of the needs of nurses at the levels of clinical practice, communication, emotions, decision making, and ethics.     

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.     

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.     

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.     

A survey on the attitudes of doctors towards health insurance payment in the medical consortium

Background  Medical consortium is a specific vertical integration model of regional medical resources. To improve medical resources utilization and control the health insurance costs by fee-for-service plans (FFS), capitation fee and diagnosis-related groups (DRGs), it is important to explore the attitudes of doctors towards the different health insurance payment in the medical consortium in Shanghai.

Methods  A questionnaire survey was carried out randomly on 50 doctors respectively in 3 different levels medical institutes.

Results  The statistical results showed that 90% of doctors in tertiary hospitals had the tendency towards FFS, whereas 78% in secondary hospitals towards DRGs and 84% in community health centers towards capitation fee.

Conclusions  There are some obvious differences on doctors’ attitudes towards health insurance payment in 3 different levels hospitals. Thus, it is feasible that health insurance payment should be supposed to the doctors’ attitudes using the bundled payments along with the third-party payment as a supervisor within consortium.

     

高年级医学生性观念和婚恋观调查分析

目的 了解高年级医学生婚恋观和性观念。为健康教育和心理咨询提供依据。方法 采用分层整群抽样方法。对广东某医学院476名三、四年级学生进行问卷调查。结果 97.90%的学生对大学期间谈恋爱持赞成态度,84.87%的学生认为恋爱是婚姻的基础。59.87%学生认为恋爱目的是选择人生伴侣,在选择配偶时考虑的前5位条件是：诚实可靠（83.19%)、富有感情（82.56%)、受过良好教育（75.42%)、身体健康（75.00%)、长相好（50.84%)。67.44%的学生认为当今社会贞操仍然重要,70.80%的学生接受婚前性行为,32.14%的学生接受婚外性行为,多数观念存在男女差别。调查时32.58的男生和50.60%的女生处恋爱或恋爱前期状态。结论 高年级医学生大多有正确的婚词类观和性观念。但应加强教育。     

The experiences and attitudes of general practitioners and hospital staff towards prehospital thrombolysis in a rural community

Background  

In rural areas it is impossible for eligible patients presenting with acute myocardial infarction (AMI) to receive thrombolysis within the recommended 90 minutes unless administered in the community by the general practitioner.     

Sexual harassment of psychiatric trainees: experiences and attitudes

A survey was carried out of psychiatric trainees'' work-related experiences of unwanted sexual contact. A structured postal questionnaire was administered to 100 psychiatric trainees from senior house officer to specialist registrar level in a large psychiatric rotation. There was an 85% response rate; 86% (73) of the sample had experienced unwanted sexual contact, with 47% (40) experiencing deliberate touching, leaning over or cornering, and 18% (15) receiving letters, telephone calls or material of a sexual nature. Three-quarters (64) of respondents had experienced unwanted sexual contact from patients and 64% (54) from staff. Experiences and attitudes did not generally differ by gender, grade or training experience. Four out of 48 female respondents described stalking by patients. Of the 39 respondents who had reported harassment by patients, 31 felt supported by colleagues, while of the 13 who had reported harassment by colleagues, eight felt supported. Two-thirds of the respondents considered sexual harassment `sometimes'' or `frequently'' a problem for the profession. Diagnoses of confusional states, mania or schizophrenia made subjects less likely to consider unwanted sexual behaviour to be `sexual harassment'' (86%, 80%, and 67%, respectively), but not for other diagnoses. Levels of threatening and intrusive sexual harassment are unacceptably high in this study group. Health trusts should adopt policies of `zero tolerance'' and all incidents should be reported. Psychological impact on victims should be acknowledged even when the behaviour of the perpetrator can be explained by diagnosis.
     

Survey of Japanese physicians'' attitudes towards the care of adult patients in persistent vegetative state.

OBJECTIVES: Ethical issues have recently been raised regarding the appropriate care of patients in persistent vegetative state (PVS) in Japan. The purpose of our study is to study the attitudes and beliefs of Japanese physicians who have experience caring for patients in PVS. DESIGN AND SETTING: A postal questionnaire was sent to all 317 representative members of the Japan Society of Apoplexy working at university hospitals or designated teaching hospitals by the Ministry of Health and Welfare. The questionnaire asked subjects what they would recommend for three hypothetical vignettes that varied with respect to a PVS patient's previous wishes and the wishes of the family. RESULTS: The response rate was 65%. In the case of a PVS patient who had no previous expressed wishes and no family, 3% of the respondents would withdraw artificial nutrition and hydration (ANH) when the patient did not require any other life-sustaining treatments, 4% would discontinue ANH, and 30% would withhold antibiotics when the patient developed pneumonia. Significantly more respondents (17%) would withdraw ANH in the case of a PVS patient whose previous wishes and family agreed that all life support be discontinued. Most respondents thought that a patient's written advance directives would influence their decisions. Forty per cent of the respondents would want to have ANH stopped and 31% would not want antibiotics administered if they were in PVS. CONCLUSIONS: Japanese physicians tend not to withdraw ANH from PVS patients. Patients' written advance directives, however, would affect their decisions.     

公费与非公费医学生对大学英语课程教学方法的态度调查

目的　对公费与非公费医学生对大学英语课程教学方法的态度进行调查,以检验其有效性。方法　对162名学生（98名公费医学生、64名非公费医学生）进行问卷调查。所收集的数据采用SPSSAU统计软件进行分析,用独立样本t检验分析公费与非公费医学生的英语水平是否存在差异、其对大学英语课程教学方法的评价是否存在差异,以及其对各个教学环节所起作用的态度是否存在差异。结果　公费医学生的英语水平显著低于非公费医学生;他们对第一、第二与第四模块的态度一致,对第三与第五模块的态度不同,但只对第五模块的态度存在显著差异。与非公费医学生相比,公费医学生明显对个别教学环节的作用持更肯定的态度。结论　根据产出导向法对目前的教学模块做出调整,具体的教学环节也将根据两类学生的实际需求做出调整或删减。     

Smoking rates and attitudes to smoking among medical students: a 2009 survey at the Nagoya University School of Medicine

Since smoking is implicated in many diseases, medical professionals are expected to contribute to the reduction of smoking rates in their practice. Medical students are also expected to learn the importance of practical measures against smoking. This study surveyed the smoking rates and attitudes to smoking among medical students of the Nagoya University School of Medicine. Out of 612 students in their 1st to 6th year in 2009, 31 students answered "yes" to the question "Did you smoke one or more cigarettes this past month?" and eight students did not respond. The maximum smoking rate was 6.4% (39/612). The respective rates of students to accept smoking by doctors, co-medical personnel, patients in general, and terminally ill patients were 50.8% in males and 38.9% in females, 51.3% in males and 41.6% in females, 41.4% in males and 23.0% in females, 80.5% in males and 84.1% in females. This survey demonstrated that though smoking rates among medical students were relatively low, many accepted smoking, especially for terminally ill patients.