Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers

CONTEXT: Euthanasia and physician-assisted suicide (PAS) are highly controversial issues. While there are studies of seriously ill patients' interest in euthanasia and PAS, there are no data on the attitudes and desires of terminally ill patients regarding these issues. OBJECTIVE: To determine the attitudes of terminally ill patients toward euthanasia and PAS, whether they seriously were considering euthanasia and PAS for themselves, the stability of their desires, factors associated with their desires, and the proportion of patients who die from these interventions. DESIGN: Prospective cohort of terminally ill patients and their primary caregivers surveyed twice between March 1996 and July 1997. SETTING: Outpatient settings in 5 randomly selected metropolitan statistical areas and 1 rural county. PARTICIPANTS: A total of 988 patients identified by their physicians to be terminally ill with any disease except for human immunodeficiency virus infection (response rate, 87. 4%) and 893 patient-designated primary caregivers (response rate, 97. 6%). MAIN OUTCOME MEASURES: Support for euthanasia or PAS in standard scenarios; patient-expressed considerations and discussions of their desire for euthanasia or PAS; hoarding of drugs for suicide; patient death by euthanasia or PAS; and patient-reported sociodemographic factors and symptoms related to these outcomes. RESULTS: Of the 988 terminally ill patients, a total of 60.2% supported euthanasia or PAS in a hypothetical situation, but only 10. 6% reported seriously considering euthanasia or PAS for themselves. Factors associated with being less likely to consider euthanasia or PAS were feeling appreciated (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.52-0.82), being aged 65 years or older (OR, 0.52; 95% CI, 0.34-0.82), and being African American (OR, 0.39; 95% CI, 0. 18-0.84). Factors associated with being more likely to consider euthanasia or PAS were depressive symptoms (OR, 1.25; 95% CI, 1.05-1. 49), substantial caregiving needs (OR, 1.09; 95% CI, 1.01-1.17), and pain (OR, 1.26; 95% CI, 1.02-1.56). At the follow-up interview, half of the terminally ill patients who had considered euthanasia or PAS for themselves changed their minds, while an almost equal number began considering these interventions. Patients with depressive symptoms (OR, 5.29; 95% CI, 1.21-23.2) and dyspnea (OR, 1.68; 95% CI, 1.26-2.22) were more likely to change their minds to consider euthanasia or PAS. According to the caregivers of the 256 decedents, 14 patients (5.6%) had discussed asking the physician for euthanasia or PAS and 6 (2.5%) had hoarded drugs. Ultimately, of the 256 decedents, 1 (0.4%) died by euthanasia or PAS, 1 unsuccessfully attempted suicide, and 1 repeatedly requested for her life to be ended but the family and physicians refused. CONCLUSIONS: In this survey, a small proportion of terminally ill patients seriously considered euthanasia or PAS for themselves. Over a few months, half the patients changed their minds. Patients with depressive symptoms were more likely to change their minds about desiring euthanasia or PAS. JAMA. 2000;284:2460-2468.     

Attitudes of primary care physicians toward corporal punishment.

OBJECTIVE--The purpose of this study was to determine whether or not family physicians and pediatricians support the use of corporal punishment. The frequency with which these physicians offer anticipatory guidance on discipline was also studied. DESIGN--Self-report survey, mailed to study participants. PARTICIPANTS--The sample for this study was 800 family physicians and 400 pediatricians, randomly selected from the Ohio State Medical Board's roster of family physicians and pediatricians. Physicians with a subspecialty were excluded. Participants who did not return their surveys received a second, and if necessary, a third mailing of the survey. After three mailings, a total of 619 physicians (61%) completed a survey. MAIN OUTCOME MEASURE--Participants were considered to support corporal punishment if they would tell a parent in their medical practice that spanking would be an appropriate response to any one of a series of childhood misbehaviors presented in the survey. RESULTS--Of family physicians, 70% (95% confidence interval [CI], 66% to 75%) support use of corporal punishment. Of pediatricians, 59% (95% CI, 52% to 66%) support corporal punishment. Of pediatricians, 90% (95% CI, 86% to 94%) indicated that they include discipline issues either always or most of the time when providing anticipatory guidance to parents. Significantly fewer family physicians (52%; 95% CI, 47% to 57%) indicated that they discuss discipline either always or most of the time when providing anticipatory guidance (P less than .01). CONCLUSIONS--Most family physicians and pediatricians support the use of corporal punishment in spite of evidence that it is neither effective nor necessary, and can be harmful. Pediatricians offer anticipatory guidance on discipline more often than family physicians.     

Attitudes on organ donation among Hawaii physicians

A survey of physicians attending the recent Hawaii Medical Association meeting was conducted in order to assess physician attitudes on organ donation. Physicians were asked 6 questions and demographics were collected. Results indicate that Hawaii physicians generally support organ donation and are aware of some of the current federal legislation regarding donation.     

大连市部分地区农村人群的自杀态度分析

目的研究中国农村人群的自杀态度。方法采取序贯抽样的方法,采集了2000年度、2001年度大连市金州和庄河两地区66个自杀死亡病例的132个信息人和66个正常对照本人及其132个信息人。用自杀态度问卷了解病例组信息人和对照组本人及其信息人对自杀的态度,然后运用SPSS11.5进行数据整理与分析。结果自杀组信息人对自杀总的理解程度以及对不同性别自杀者的理解程度[评分平均秩次分别为总理解程度121.57,对男性自杀者理解程度121.41,对女性自杀者理解程度121.53],均低于对照组信息人[对应的评分平均秩次分别为143.43,143.59,143.47,差异具有显著性。Z值、P值分别为(-2.628,0.009),(-2.681,0.007),(-2.624,0.009)]。信息人对女性自杀者的理解和宽容程度高于对男性自杀者(Z=-2.565,P=0.010),男性信息人更倾向于理解和接受女性自杀(Z=-2.060,P=0.039)。结论该地区农村人群总体上对自杀持不接受态度,但是对女性自杀比对男性自杀更加认可和宽容。此发现可能有助于解释中国女性较高的自杀率。     

大连市部分地区农村人群的自杀态度分析

目的 研究中国农村人群的自杀态度.方法 采取序贯抽样的方法,采集了2000年度、2001年度大连市金州和庄河两地区66个自杀死亡病例的132个信息人和66个正常对照本人及其132个信息人.用自杀态度问卷了解病例组信息人和对照组本人及其信息人对自杀的态度,然后运用SPSS11.5进行数据整理与分析.结果 自杀组信息人对自杀总的理解程度以及对不同性别自杀者的理解程度[评分平均秩次分别为总理解程度121.57,对男性自杀者理解程度121.41,对女性自杀者理解程度121.53],均低于对照组信息人[对应的评分平均秩次分别为143.43,143.59,143.47,差异具有显著性.Z值、P值分别为(-2.628,0.009),(-2.681,0.007),(-2.624,0.009)].信息人对女性自杀者的理解和宽容程度高于对男性自杀者(Z ＝-2.565,P ＝0.010),男性信息人更倾向于理解和接受女性自杀(Z ＝-2.060,P ＝0.039).结论 该地区农村人群总体上对自杀持不接受态度,但是对女性自杀比对男性自杀更加认可和宽容.此发现可能有助于解释中国女性较高的自杀率.     

Attitudes of a sample of California physicians toward criteria of high-quality care

The criteria of high-quality care as determined by a sample of practicing Californian physicians were analyzed. In addition, the effects of year of graduation and specialty choice were examined relative to choice of criteria. As a group these physicians perceived the cognitive competencies of the doctor, the traditional doctor-patient relationship, and the outcome of treatment as the essential ingredients in high-quality care. They paid considerably less attention to criteria reflecting sensitivity to costs, geographic availability of care, and differences in cultural expectations regarding care. Specialty choice exerted very little influence on the selection of criteria; year of graduation from medical school was more influential. Physicians graduating in 1970-71 were more sensitive to the place of preventive medicine in ensuring quality as well as more aware of social and economic factors affecting care.