Aim. To study the effect of sociodemographic and attitudinal determinants of physicians making end-of-life decisions (ELDs). Methods. The physicians having signed 489 consecutive death certificates in the city of Hasselt (Belgium) were sent an anonymous questionnaire regarding their ELDs and another on their attitudes toward voluntary euthanasia (EUTH) and physician-assisted suicide (PAS).Results.55% response rate. Nontreatment decisions occurred in 16.7% of all death cases; in 16%, there was potentially life-shortening use of drugs to alleviate pain and symptoms; in 4.8% of cases,death was deliberately induced by lethal drugs, including EUTH, PAS, and life termination without explicit request by the patient. In their attitudes toward EUTH and PAS, the 92 responding physicians clustered into 3 groups: positive and rule oriented, positive rule-adverse, and opposed. Cluster groupmembership, commitment to life stance, years of professional experience, and gender were each associated with specific ELD-making patterns.
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References
1.
1. Lee MA, Nelson HD, Tilden VP, Ganzini L, Schnmidt TA, Tolle SW. Legalizing assisted suicide—views of physicians in Oregon . N Engl J Med. 1996;334: 310–331 .
2.
2. Kinsella TD, Verhoef MJ. Alberta Euthanasia Survey: 1. Physicians’ opinions about the morality and legalization of active euthanasia . Can Med Assoc J. 1993;148(1): 1921–1926 .
3.
3. Bachman JG, Alcser KH, Doukas DJ, Lichtenstein RL, Corning AD, Brody H. Attitudes of Michigan physicians and the rule toward legalizing physician-assisted suicide and voluntary euthanasia . N Engl J Med. 1996;334: 303–309 .
4.
4. Menon G. Social integration, age groups and attitudes toward euthanasia . Diss Abstr Int. 1990;51(5): 1797A-1797A .
5.
5. Grassi L, Magnani K, Ercolani M. Attitudes toward euthanasia and physician-assisted suicide among Italian primary care physicians . J Pain Symptom Manage. 1999;17: 188–196 .
6.
6. Verhoef MJ, Kinsella TD. Alberta Euthanasia Survey: 3-year follow-up . Can Med Assoc J. 1996;155(7): 885–889 .
7.
7. Cohen JS, Fihn SD, Boyko EJ, JonsenAR, Wood RW. Attitudes toward assisted suicide and euthanasia among physicians in Washington State . N Engl J Med. 1994;331: 89–94 .
8.
8. Shapiro RS, Derse AR, Gottlieb M, Schiedermayer D, Olson M. Willingness to perform euthanasia . A survey of physician attitudes. Arch Intern Med. 1994;154: 575–584 .
9.
9. Duberstein PR, Conwell Y, Cox C, Podgorski CA, Glazer RS, Caine ED. Attitudes toward self-determined death: a survey of primary care physicians . J Am Ger Soc. 1995;43: 395–400 .
10.
10. Emanuel EJ, Fairclough D, Clarridge BC, et al. Attitudes and practices of US oncologists regarding euthanasia and PAS . Ann Int Med. 2000;133: 527–532 .
11.
11. Haghbin Z, Stereltzer J, Danko GP. Assisted suicide and AIDS patients: a survey of physicians’ attitudes . Psychosomatics. 1998;39: 18–23 .
12.
12. Deluty R. Factors affecting the acceptability of suicide . Omega. 1988;89: 315–326 .
13.
13. Christakis NA, Asch DA. Physician characteristics associated with decisions to withdraw life support . Am J Public Health. 1995;85: 367–371 .
14.
14. Meier DE, EmmonsCA, Wallenstein S, QuillT, Morison S, Cassel CK. A national survey of physician-assisted suicide and euthanasia in the United States . N Engl J Med. 1998;338: 1193–1201 .
15.
15. Fried TR, SteinMD, O’Sullivan PS, BrockDW, Novack DH. Limits of patient autonomy. Physician attitudes and practices regarding life-sustaining treatments and euthanasia . Arch Int Med. 1993;153: 722–728 .
16.
16. Emanuel EJ, Fairclough DL, Daniels ER, Clarridge BR. Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the rule . Lancet. 1996;347: 1805–1810 .
17.
17. Doukas DJ,Waterhouse D, GorenfloDW, Seid J. Attitudes and behaviors on physician-assisted death: a study of Michigan oncologists . J Clin Oncol. 1995;13: 1055–1061 .
18.
18. Baume P, Omalley E, Bauman A. Professed religious affiliation and the practice of euthanasia . J Med Ethics. 1995;21: 49–54 .
19.
19. van der Maas PJ, vanDelden JJ, Pijnenborg L, LoomanCW. Euthanasia and other medical decisions concerning the end of life . Lancet. 1991;338: 669–674 .
20.
20. van der Maas PJ, van der Wal G, Haverkate I, et al. Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands . N Engl J Med. 1996;335: 1699–1705 .
21.
21. Weyers H. The process of legal change in the Netherlands: the making of the “requirements of careful practice.” In: Klijn A, Otlowski M, Trappenburg M, editors. Regulating Physician-Negotiated Death. ’s-Gravenhage: Elsevier ; 2001, p. 11–27.
22.
22. Deliens L, Mortier F, Bilsen J, et al. End-of-life decisions in medical practice in Flanders, Belgium: a nationwide survey . Lancet. 2000;356: 1806–1811 .
23.
23. Mortier F, Deliens L, Bilsen J, Cosyns M, Ingels K, Vander Stichele R. End-of-life decisions of physicians in the city of Hasselt (Flanders, Belgium) . Bioethics. 2000;14(3): 254–267 .
24.
24. Verstraete AG, Vander Stichele RH, Deliens LHJ. Ethical issues in pharmacoepidemiological research in Belgium . Pharmacoepidemiol Drug Saf. 2001;10: 595–599 .
25.
25. Dillman DA. The design and administration of mail surveys . Ann Rev Sociol. 1991;17: 225–249 .
26.
26. Deliens L, Bilsen J. Decisions of physicians in Hassett on the endof-life of their patients: a study of 269 death cases. Brussel/Gent :1998.
27.
27. Pellegrino ED. Intending to kill and the principle of double effect. In: Beauchamp TL, Veatch RM, editors. Ethical Issues in Death and Dying. 2nded. Upper Saddle River (NJ): PrenticeHall ; 1996, p. 240–242.
28.
28. Raymond D. Fatal practices: a feminist analysis of physician-assisted suicide and euthanasia . Hypatia. 1999;14(2): 1–25 .
