Medical students' knowledge about end-of-life decision-making

Abstract

The influence of medical students' knowledge concerning end-of-life care, considering ethical theories and clinical practice, remains controversial. We aimed to investigate medical students' knowledge of bioethical concepts related to moral kinds of death (euthanasia, disthanasia, and orthothanasia) and to analyze the influence of their clinical experience on practicing such approaches in a tertiary hospital in the state of São Paulo, Brazil. We interviewed 180 medical students [distributed in Group 1 (G1) - first to third- year students, and Group 2 (G2) - fourth to sixth-year students] to evaluate the influence of the course on "medical ethics" on ethical theories and clinical practice, using a closed questionnaire. The course on "medical ethics" did not distinguish the groups (P=0.704) in relation to bioethical concepts. Neologisms such as "cacothanasia" and "idiothanasia" were incorrectly viewed as bioethical concepts by 28% of the interviewees. Moreover, 45.3% of the sample considered health care professionals incapable of managing terminally ill patients, especially G2 (29%) as compared to G1 (16.5%, P=0.031). The concept of euthanasia was accepted by 41% of sample, as compared to 98.2% for orthothanasia. Among medical students that accepted ways to abbreviate life (22.9%), 30.1% belonged to G1, and only 16.1% to G2 (P=0.049). These medical students were unfamiliar with common bioethical concepts. Moreover, they considered healthcare professionals incapable of managing terminally ill patients. The ethical ideal of the "good death" reflects better acceptance of orthothanasia by medical students, suggesting a tendency to apply it in their future clinical practice.

Percepção de formandos de medicina sobre a terminalidade da vida

“…The word cloud (Figure 2) created from the participants' response to euthanasia confirms a study by Felix and collaborators 27 , which verified that the term is little known, although the conduct it denotes is widely practiced. In another study, conducted in São Paulo, medical students also showed ignorance of the concept 54 .…”

Are our Indian medical graduates equipped and informed to handle end of life dilemmas?

“…And it was said to lower the level of acceptance of euthanasia among medical students from fourth to sixth year compared to first three years. 21,[29][30][31] Studies involving nonmedical students also observed that year of study was incongruous to their knowledge and opinion about euthanasia. 27,28 But studies among nurses found that year of study did not influence the opinion about euthanasia.…”

“…Previous studies stand divided in their observation that religion place a major influence on the attitude of medical professional towards euthanasia. 1,[19][20][21][22][23][24][25][26][27] It's been reported that there exists difference in knowledge about euthanasia between a medical student and students from other streams. 28,29 Also among medical graduate the year of study and the clinical exposure was observed to exert its influence on their attitudes towards euthanasia.…”

Physicians’ Self-assessment in Intercultural Clinical Communication in Jeddah, Saudi Arabia: A Pilot Study

“…Various sets of questionnaire covering knowledge and attitude towards palliative care (1,4,13), end of life (5,8), advanced directive (6) and bioethical concept in palliative care (7) were utilised. These questionnaires were reviewed in the initial stage and minimal changes were made to accommodate local relevancy, before distribution to the participants.…”