Attitudes toward euthanasia, assisted suicide and termination of life-sustaining treatment of Puerto Rican medical students, medical residents, and faculty.
OBJECTIVE
To elicit the opinion of Puerto Rican medical students, residents and internal medicine faculty as to the appropriateness of euthanasia and physician-assisted suicide and end-of-life management.


METHODS
Survey using a 16-item questionnaire answered within a two-month period in the fall of 1996.


METHODS
Rounds or faculty meetings at teaching hospitals located in the north, south and southwest of the island of Puerto Rico.


METHODS
There were 424 participants. The questionnaires of 279 medical students, 75 medical residents, and 35 internal medicine faculty members were analyzed. Thirty-five questionnaires, which were incomplete or answered by non-Puerto Rican participants, were excluded.


METHODS
Frequency of support of active euthanasia, physician-assisted suicide, withholding or withdrawing life-sustaining treatment with informed consent was determined. Whether it was ethical to prescribe full doses of drugs needed to alleviate pain even if it would hasten death, or agree to limit or restrict resources for the terminally ill was also determined.


RESULTS
Forty per cent of the students, 33% of the residents, and 20% of the faculty supported euthanasia. If physician-assisted suicide were legalized, 50 per cent of the students, 43 per cent of the residents and 45 percent of the faculty would not be opposed to it. Sixty-eight per cent of the students, 67 per cent of the residents and 88 per cent of the faculty would support withholding or withdrawing life-sustaining treatment for dying patients with informed consent. Seventy-nine per cent of residents, 80 per cent of the faculty but only 54 per cent of medical students would prescribe full doses of drugs needed to alleviate pain in dying patients even if they would hasten death. Thirty-six per cent of the residents and faculty would agree to limit the use of medical resources for the terminally ill but only sixteen per cent of medical students would do so.


CONCLUSIONS
The acceptance of euthanasia was inversely proportional to the clinical experience of the respondents: 40 per cent among students but only 20 per cent by the faculty. Withholding and withdrawing of life-sustaining treatment was most acceptable to the faculty (88 per cent) but it was also favored by most of the students and residents (68 and 67 per cent respectively). Eighty per cent of the faculty, 79 per cent of the residents, but only 50 per cent of the students considered that prescribing full doses of drugs to alleviate pain if they knew it would hasten death, was ethical. The medical profession should take notice of evolving concepts in end-of-life management.
Ramirez Rivera
J
J
Department of Medicine, La Concepción Hospital, San Germán, Puerto Rico.
Rodríguez
R
R
Otero Igaravidez
Y
Y
D001291:Attitude of Health Personnel; D003627:Data Interpretation, Statistical; D004992:Ethics, Medical; D005065:Euthanasia; D005066:Euthanasia, Passive; D005180:Faculty, Medical; D007258:Informed Consent; D007396:Internship and Residency; D008020:Life Support Care; D010146:Pain / Q000188:drug therapy; D011647:Puerto Rico; D013337:Students, Medical; D017236:Suicide, Assisted; D011795:Surveys and Questionnaires; D013727:Terminal Care