Oncologists trained in end-of-life care less likely to support both options. More education still needed to help physicians care for dying patients
Alexandria, VA -- Results of a survey of 3,299 members of the American Society of Clinical Oncology (ASCO) indicate support among U.S. oncologists for euthanasia and physician-assisted suicide of terminally ill cancer patients declined dramatically in recent years. The survey, sponsored by ASCO, also found that oncologists who had been trained in end-of-life care were less likely to support or carry out euthanasia or physician-assisted suicide.
The survey’s results, published in the October 3rd issue of the Annals of Internal Medicine (Vol. 133, No. 7), emphasize the need to educate physicians about ways to provide high-quality pain management and palliative care to dying patients, says lead researcher Ezekiel J. Emanuel, M.D., Ph.D., Chief of the National Institutes of Health’s Department of Clinical Bioethics. "End-of-Life and palliative care need to be formally taught and incorporated into physician training programs and continuing medical education," he adds. "Physicians who receive better training in end-of-life care seem less likely to perform euthanasia or physician-assisted suicide."
The survey, conducted in 1998, is the largest to assess the attitudes and practices of physicians about euthanasia and physician-assisted suicide. When researchers compared these results to a similar survey conducted in 1994 by Dr. Emanuel, they found that oncologists’ support for euthanasia for dying cancer patients in excruciating pain declined by nearly 70% -- from 23% in 1994 to just below 7% in 1998. Support among oncologists for physician-assisted suicide in the case of a terminally ill cancer patient with unremitting pain declined by over 50% -- from 45% to 22% in the same four years.
The overall decline in support for euthanasia and physician-assisted suicide may reflect an improved ability by some oncologists to provide appropriate care for their dying patients, says Dr. Emanuel. In fact, oncologists who said they could get their dying patients all the care they needed were far less likely to perform euthanasia than those who reported administrative, fiscal or other barriers to providing care.
"ASCO believes that physicians have an obligation to talk to their terminally ill patients and their family about their options for palliative care and what type of symptomatic management will be provided. We urge physicians to assure their patients that they will not be left to make these difficult decisions on their own." said Charles M. Balch, M.D., Executive Vice President and Chief Executive Officer of ASCO. "ASCO has pledged to take every responsible measure to assure that all physicians are well versed in providing optimal end-of-life care and to remove all barriers to the delivery of such care."
More than 70% of patients using euthanasia and physician-assisted suicide have cancer. As a result, oncologists are more likely to have to address the issue of euthanasia and physician-assisted suicide more often than other physicians.
Of those oncologists surveyed in 1998, almost 16% said they would be willing to provide physician-assisted suicide and 2% would be willing to carry out euthanasia. Least likely to support euthanasia or physician-assisted suicide were physicians who had sufficient time to talk to their dying patients about end-of-life care and those who were religious.
Nearly one-third of the oncologists surveyed also said they would be reluctant to increase the dosage of morphine for a dying cancer patient in excruciating pain. This reticence to relieve patients’ pain seems to reflect some physicians’ fears that increasing the dose of morphine may also raise a patient’s risk of respiratory depression and death, which might be construed as a from of euthanasia. "Unfortunately, equating increasing morphine for pain relief with euthanasia seems to lead to inadequate pain management for patients, which is troubling," said Dr. Emanuel. "Physicians must be educated about the ethical and legal acceptability of increasing narcotics for pain control, even at the risk of death."
"These study results underscore the need for physician education of optimal pain and palliative care practices," said researcher Robert J. Mayer, M.D., Vice Chair for Academic Affairs, Dana-Farber Cancer Institute, Professor of Medicine, Harvard Medical School, and Past-President of ASCO, under whose leadership the study was initiated. "Physicians who are better informed about end-of-life issues feel less need to use euthanasia and physician-assisted suicide."
Seventeen percent of oncologists surveyed were female and 33% worked in an academic setting; two-thirds said that 25 or more of their patients had died in the past year. Oncologists’ attitudes did not differ by age, sex, geographic region, year of graduation from medical school or the number of their patients who died in the previous year. Sixty-three percent of oncologists had received requests for euthanasia and physician-assisted suicide during their careers, and 31% had received such requests during the previous 12 months. Overall, nearly 11% of respondents had performed physician-assisted suicide and almost 4% had carried out euthanasia.
Euthanasia is the step of administering a known lethal dose of medication to intentionally end the life of someone suffering from an incurable illness, such as cancer. Physician-assisted suicide is when a physician supplies information and/or a prescription with the understanding that the patient will use these to commit suicide.
The American Society of Clinical Oncology (ASCO) is the world’s leading professional society representing 15,000 physicians from 95 countries who treat people with cancer. ASCO’s members set the standard for patient care worldwide and lead the fight for more effective cancer treatment, increased funding for clinical and translational research, and ultimately, cures for the myriad different cancers that strike 1.2 million Americans every year.
Journal
Annals of Internal Medicine