Attitudes of Tennessee physicians toward euthanasia and assisted death

BACKGROUND: Although many studies of euthanasia and physician-assisted death (PAD) have been performed in the United States, none have specifically addressed attitudes among physicians practicing in Tennessee. METHODS: In January 2001, we mailed a 30-item survey instrument to a stratified random sample of 1,117 physicians drawn from the Tennessee Licensing Bureau. RESULTS: Tennessee physicians are highly polarized over the issues of euthanasia and assisted death. A slight majority (47%) did not favor euthanasia or PAD and would oppose the legalization of such procedures. Of the physicians supporting euthanasia or PAD (43%), only 25% would administer a lethal overdose and less than a third would counsel/prescribe medication for an overdose. Attitudes were influenced by three primary factors: ethics, religion, and the role of the physician to relieve pain and suffering. CONCLUSION: Regardless of their overall position, the majority of physicians agreed on basic restrictions and safeguards to prevent abuses and to protect vulnerable patients.     

初诊2型糖尿病患者疾病态度对短期胰岛素泵强化治疗后血糖控制的影响

目的：探讨初诊2型糖尿病患者对疾病的态度对短期胰岛素泵强化治疗后血糖控制的影响。方法：118例持续皮下胰岛素输注（CSII）治疗后获得临床缓解的初诊2型糖尿病患者完成1年随访,分别于基线期、出院后3个月、6个月、1年使用密西根糖尿病管理评定量表（DCP）评价患者对糖尿病的态度（包括积极态度、消极态度、自我护理能力、自我管理重要性认识、自我管理坚持性认识）,并检测患者糖化血红蛋白水平（HbA1c）水平,采用Spearman相关分析探讨患者对疾病态度与HbA1c水平的相关性。结果：65例缓解期≥1年患者为缓解组,53例缓解期〈1年患者为治疗失效组;缓解组患者初中文化的比例明显低于治疗失效组,大学或以上文化的比例明显高于治疗失效组（P〈0.05）。经过2周CSII治疗后两组患者血糖指标均明显改善,缓解组患者CSII治疗后的空腹血糖（FPG）和餐后2 h血糖（2 hPG）低于治疗失效组,伴随胰岛素第一时相分泌（AIR）值高于治疗失效组（P〈0.05）。随访期内缓解组患者积极态度、自我护理能力、自我管理重要性认识和坚持性认识得分较基线升高,并高于同时期的治疗失效组（P〈0.05）,消极态度得分逐渐降低,并低于同时期的治疗失效组（P〈0.05）,而治疗失效组患者积极态度、自我护理能力、自我管理重要性认识和坚持性认识得分较基线下降,消极态度得分则始终维持较高的水平;Spearmen相关分析显示,除0个月外,各随访期HbA1c水平与积极态度、自我护理能力、自我管理重要性认识和坚持性认识得分呈显著负相关,与消极态度得分呈正相关。结论：糖尿病患者对疾病的态度对初诊糖尿病患者CSII后血糖控制具有重要影响,因此应重视对初诊2型糖尿病患者进行心理教育,使患者形成良好的管理疾病的态度,进而更好的控制病情,维持理想的生存质量。     

Attitudes toward euthanasia and physician-assisted suicide among Italian primary care physicians

The public debate about euthanasia and assisted suicide is less pronounced in Italy than in other countries, and data about this topic are lacking. The aim of this study was to investigate primary care physicians' experience in requests for and opinions about euthanasia and/or assisted suicide for terminally ill patients and the relationship between attitudes and professional variables. Three-hundred thirty-six general practitioners completed the Euthanasia Questionnaire to assess attitudes toward euthanasia and/or assisted suicide and the Maslach Burnout Inventory to examine burnout symptoms. The rate of requests for euthanasia or assisted suicide was low (11% and 4.5%, respectively). Only a minority of the physicians endorsed euthanasia and/or assisted suicide. Agreement with the practice of euthanasia/assisted suicide was correlated with non-Catholic religious affiliation, inexperience in treating terminally ill patients, and the burnout dimension of depersonalization. The fact that professional as well as individual factors (e.g., inexperience, non-Catholic affiliation, burnout) were associated with favorable attitudes toward euthanasia and/or assisted suicide underscores the need to examine the problem as a complex phenomenon involving the dyadic patient-doctor relationship.     

Attitudes toward euthanasia in Hong Kong--a comparison between physicians and the general public

This article reports the findings of a cross-sectional study that compared the attitudes of 618 respondents of a general household survey and a random sample of 1,197 physicians toward different types of euthanasia in Hong Kong. The general public was found to agree with active euthanasia and non-voluntary euthanasia and was neutral about passive euthanasia. On the other hand, physicians agreed with passive euthanasia, were neutral about non-voluntary euthanasia, and disagreed with active euthanasia. Factors affecting the respondents' attitudes were also explored. The article ends with policy and research implications of the findings.     

Attitudes toward integration of complementary and alternative medicine with hospital-based care

OBJECTIVE: To characterize those who have used, expect to use, or are opposed to the use of holistic therapies, especially in a conventional medical (hospital) setting. SAMPLE DESCRIPTION AND METHODS: Cross-sectional survey of a random sample of Hamilton-Wentworth residents between March and June 1998 (n = 416; response rate, 63%); analysis used logistic regression. RESULTS: Thirty-seven percent (37%) used at least one holistic therapy in the previous year: the three most common were chiropractic, massage, and herbal/phytology. The three most common reasons for use were general health, fatigue, and arthritis. Thirty-three percent (33%) would use holistic therapy in the future. Barriers to use were lack of information, perceived ineffectiveness, and cost; approximately 40% agreed they would only use holistic therapies with medical advice. Approximately 13% were opposed to holistic therapy and objected to its use in hospitals. Younger age, preference for holistic therapy over conventional medicine, and prior use of holism independently predicted high likelihood for future use. Lower income and high self-perceived health were associated with negative attitude toward use of holistic therapies in hospital. CONCLUSION: Most respondents would accept integration of holistic techniques into a hospital; therapies would be more acceptable if there were clear evidence of their efficacy. A few might find their opinion of a sponsoring hospital lowered by such integration.     

Attitudes toward complementary and alternative medicine amongst oncology professionals in Brazil

Complementary and alternative medicines (CAM) are popular amongst cancer patients in the Brazilian context, however little is known about oncology health professionals’ attitudes toward the role of CAM and their perspectives on the potential for integration into oncological care. In this study, drawing on a series of interviews with oncology professionals (i.e. doctors, nurses, nutritionists, pharmacologists and psychologists), we provide insight into their views on the rise, validity, and role of CAM in cancer care. The results reveal two key dynamics in relation to CAM in cancer care in Brazil. First, that doctors, nurses and other allied professionals hold considerably different views on the value and place of CAM, and in turn ascribe it varying levels of legitimacy potentially limiting integration. Second, that while some health professionals may articulate a degree of support for CAM, this is limited by perceptions of CAM as lacking efficacy and intruding on their respective jurisdictional claims. Further research is needed in the Brazilian context to explore patient and professional perspectives on experiences on CAM in cancer care, including how oncology professionals’ varying positions on CAM may influence what patients are prepared to use, or discuss, in the context of cancer care.     

Attitudes to and use of complementary medicine among physicians in the United Kingdom

OBJECTIVES: To evaluate the use of attitudes to complementary and alternative medicine (CAM) among UK physicians. DESIGN: Postal questionnaire. SUBJECTS: All Members and Fellows of the Royal College of Physicians. RESULTS: Twelve thousand, one hundred and sixty eight Members and Fellows were surveyed and a response rate of 23% (n = 2,875) was obtained. Responses from the small numbers of general practitioners (n = 127) were not included in the analyses, resulting in a sample size of 2,748: 79% of respondents were in NHS practice, 32% of respondents practised CAM themselves, and 41% referred patients to CAM; of those who referred patients, 78% referred between 0-3 patients per month. CAM is used by physicians more frequently in private as compared to NHS practice. Acupuncture, aromatherapy and manipulative medicine (osteopathy and chiropractic) are the most commonly referred to and the most commonly practised therapies. Eighty seven percent of those using CAM themselves, or as part of their clinical team's commitment, had not had any CAM training. Attitudes to CAM were generally positive, particularly among those in palliative care, rehabilitation, nuclear medicine, and genito-urinary medicine. CONCLUSIONS: Our conclusions must be tempered by the limited response rate, but assuming all non-responders were disinterested in CAM, then at least one in ten UK specialist physicians are actively involved in CAM treatments, although only 13% of our sample had received any CAM training.