Impact of specialty on attitudes of Australian medical practitioners to end-of-life decisions.
OBJECTIVE
To compare attitudes and practices of Australian medical practitioners, by specialty, to a range of medical decisions at the end of life.


METHODS
As part of an international study, in 2003, a structured questionnaire was mailed to 2964 medical practitioners drawn from membership registers of Australian and Australasian professional colleges. Data from 1478 questionnaires were statistically analysed using validated instruments.


METHODS
Practitioners' willingness to comply with requests from patients and/or their relatives for symptom relief which might also hasten death; provision of terminal sedation and euthanasia, or willingness to provide these on their own initiative.


RESULTS
Respondents reported being much more willing to comply with a patient's request for increasing symptom relief, even at risk of hastening death, than for terminal sedation. Over a quarter of respondents would provide terminal sedation to competent patients on their own initiative. A small number of respondents would intentionally hasten death. There were significant differences by specialty for all three actions. Oncologists, palliative care physicians and geriatricians were least likely to actively hasten death, and more likely to act unilaterally to relieve symptoms as a medical necessity.


CONCLUSIONS
Perceptions about the causation of death and aspects of medical culture appear to influence physicians' attitudes towards medical decisions at the end of life. Our findings have implications for medical education, interprofessional communication and discussion between the medical profession and the community.
Parker
Malcolm H
MH
University of Queensland, Brisbane, QLD. m.parker@uq.edu.au
Cartwright
Colleen M
CM
Williams
Gail M
GM
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003657:Decision Making; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D010820:Physicians / Q000523:psychology*; D011793:Queensland; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*