End-of-life decisions in medical practice: a survey of doctors in Victoria (Australia)

Abstract

Disagreement among doctors concerning the meaning of the term euthanasia may contribute to misunderstanding in the debate over voluntary euthanasia. Among doctors in Victoria, support for the legalisation of voluntary euthanasia appears to have weakened slightly over the past 17 years. Opinion on this issue is sharply polarised.

The Traditional Account of Ethics and Law at the End of Life—and its Discontents

“…In the meantime, survey studies demonstrate that PAD continues to be discretely practiced among physicians in Australia (Douglas et al 2001;Kuhse et al 1997;Neil et al 2007), the United States (Emanuel 2002), and probably wherever else one cares to look , with the possible caveat that rates of involvement are lower in Britain (Seale 2006, 6-8). Surveys and qualitative studies confirm that these practices extend to nurses (De Beer et al 2004;Magnusson 2002).…”

“…Support for the legalization of PAD within the health professions is variable (Emanuel 2002;Miccinesi et al 2004). In recent studies, one third of American internists supported legalizing physician-assisted suicide (Kaldjian et al 2004), while over half of Victorian doctors supported the legalization of voluntary euthanasia (Neil et al 2007). …”

Euthanasia: A Confounding and Intricate Issue

“…As a result, unlike the previous study, here the responses were mutually exclusive, which makes it impossible to determine whether there is juxtaposition of confusion. Neil et al (2007) proposed three vignettes to a group of physicians (see box 3); 62% of respondents chose the statement emphasizing the intent of "hastening death" underlying the act performed as an inherent component of what constitutes euthanasia (an accurate definition according to the researchers), in comparison with two other statements that referred instead to the "double effect" (20%) and to withholding or treatment withdrawal (13%). Moreover, 4% of respondents wanted instead to suggest their own definitions, most of which emphasized the etymological meaning of the term euthanasia: "good death".…”

“… Provision of medication or drug that doctor believes will hasten the patient's death  As well as taking active steps, withdrawing or withholding  Actions count as euthanasia only if acts with the primary intention of hastening death Neil et al (2007) Unlike the study by Neil et al (2007. ), conducted in Australia where the legal status of end-of-life practices is the same as in most western countries, the study by Vilela & Caramelli (2009) .…”

“…In fact, some physicians appear to consider withdrawal of life-sustaining treatment, including withdrawal of a respirator or dialysis, to be euthanasia (Lindblad et al, 2010;Vilela & Caramelli, 2009). In the opinion of other physicians, the "double effect" also appears to constitute euthanasia (Neil et al, 2007;Vilela & Caramelli, 2009). These findings corroborate the conclusions of studies indicate that the prevalence of deaths by euthanasia as revealed by physicians may be inflated because of confusion, misclassification or misrepresentation of their actions (Emanuel et al, 1998;van der Maas et al, 1991), but also because of the wording of the questions (Seale, 2009;van der Maas et al, 1996).…”