Attitudes and practices of U.S. oncologists regarding euthanasia and physician-assisted suicide.
BACKGROUND
The practices of euthanasia and physician-assisted suicide remain controversial.


OBJECTIVE
To achieve better understanding of attitudes and practices regarding euthanasia and physician-assisted suicide in the context of end-of-life care.


METHODS
Cohort study.


METHODS
United States.


METHODS
3299 oncologists who are members of the American Society of Clinical Oncology.


METHODS
Responses to survey questions on attitudes toward euthanasia and physician-assisted suicide for a terminally ill patient with prostate cancer who has unremitting pain, requests for and performance of euthanasia and physician-assisted suicide, and sociodemographic characteristics.


RESULTS
Of U.S. oncologists surveyed, 22.5% supported the use of physician-assisted suicide for a terminally ill patient with unremitting pain and 6.5% supported euthanasia. Oncologists who were reluctant to increase the dose of intravenous morphine for terminally ill patients in excruciating pain (odds ratio [OR], 0.61 [95% CI, 0.48 to 0.77]) and had sufficient time to talk to dying patients about end-of-life care issues (OR, 0.79 [CI, 0.71 to 0.87]) were less likely to support euthanasia or physician-assisted suicide. During their career, 3.7% of surveyed oncologists had performed euthanasia and 10.8% had performed physician-assisted suicide. Oncologists who were reluctant to increase the morphine dose for patients in excruciating pain (OR, 0.58 [CI, 0.43 to 0.79]) and those who believed that they had received adequate training in end-of-life care (OR, 0.86 [CI, 0.79 to 0.95]) were less likely to have performed euthanasia or physician-assisted suicide. Oncologists who reported not being able to obtain all the care that a dying patient needed were more likely to have performed euthanasia (P = 0.001).


CONCLUSIONS
Requests for euthanasia and physician-assisted suicide are likely to decrease as training in end-of-life care improves and the ability of physicians to provide this care to their patients is enhanced.
Emanuel
E J
EJ
Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, National Institutes of Health, Building 10, Room 1C118, Bethesda, MD 20892-1156, USA.
Fairclough
D
D
Clarridge
B C
BC
Blum
D
D
Bruera
E
E
Penley
W C
WC
Schnipper
L E
LE
Mayer
R J
RJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D015331:Cohort Studies; D005065:Euthanasia; D033101:Euthanasia, Active, Voluntary; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010148:Intractable Pain / Q000188:drug therapy; D011471:Prostatic Neoplasms / Q000503:physiopathology; D012044:Regression Analysis; D017236:Suicide, Assisted; D011795:Surveys and Questionnaires; D014481:United States
D000701:Analgesics, Opioid; D009020:Morphine