Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public.
BACKGROUND
Euthanasia and physician-assisted suicide are pressing public issues. We aimed to collect empirical data on these controversial interventions, particularly on the attitudes and experiences of oncology patients.


METHODS
We interviewed, by telephone with vignette-style questions, 155 oncology patients, 355 oncologists, and 193 members of the public to assess their attitudes and experiences in relation to euthanasia and physician-assisted suicide.


RESULTS
About two thirds of oncology patients and the public found euthanasia and physician-assisted suicide acceptable for patients with unremitting pain. Oncology patients and the public found euthanasia and physician-assisted suicide least acceptable in vignettes involving "burden on the family" and "life viewed as meaningless". In no vignette--even for patients with unremitting pain--did a majority of oncologists find euthanasia or physician-assisted suicide ethically acceptable. Patients actually experiencing pain were more likely to find euthanasia or physician-assisted suicide unacceptable. More than a quarter of oncology patients had seriously thought about euthanasia or physician-assisted suicide and nearly 12 percent had seriously discussed these interventions with physicians or others. Patients with depression and psychological distress were significantly more likely to have seriously discussed euthanasia, hoarded drugs, or read Final Exit. More than half of oncologists had received requests for euthanasia or physician-assisted suicide. Nearly one in seven oncologists had carried out euthanasia or physician-assisted suicide.


CONCLUSIONS
Euthanasia and physician-assisted suicide are important issues in the care of terminally ill patients and while oncology patients experiencing pain are unlikely to desire these interventions patients with depression are more likely to request assistance in committing suicide. Patients who request such an intervention should be evaluated and, where appropriate, treated for depression before euthanasia can be discussed seriously.
Emanuel
E J
EJ
Division of Cancer Epidemiology and Control, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA.
Fairclough
D L
DL
Daniels
E R
ER
Clarridge
B R
BR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D034723:Double Effect Principle; D004989:Ethics; D005065:Euthanasia / Q000523:psychology; D033101:Euthanasia, Active, Voluntary; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010148:Intractable Pain / Q000523:psychology; D011639:Public Opinion; D012959:Socioeconomic Factors; D017236:Suicide, Assisted / Q000523:psychology; D013727:Terminal Care; D035502:Trust; D026712:Value of Life