Changes in medical students' attitudes towards end-of-life decisions across different years of medical training.
BACKGROUND
Decisions to forgo life-sustaining medical treatments in terminally ill patients are challenging, but ones that all doctors must face. Few studies have evaluated the impact of medical training on medical students' attitudes towards end-of-life decisions and none have compared them with an age-matched group of non-medical students.


OBJECTIVE
To assess the effect of medical education on medical students' attitudes towards end-of-life decisions in acutely ill patients.


METHODS
Cross-sectional study.


METHODS
Four hundred and two students at The Chinese University of Hong Kong.


METHODS
Completion of a questionnaire focused on end-of-life decisions.


RESULTS
The number of students who felt that cardiopulmonary resuscitation must always be provided was higher in non-medical students (76/90 (84%)) and medical students with less training (67/84 (80%) in year 1 vs. 18/67 (27%) in year 5) (p < 0.001). Discontinuing life-support therapy was more accepted among senior medical students compared to junior medical and non-medical students (27/66 (41%) in year 5 vs. 18/83 (22%) in year 1 and 20/90 (22%) in non-medical students) (p = 0.003). An unexpectedly large proportion of non-medical students (57/89 (64%)) and year 1 medical students (42/84 (50%)) found it acceptable to administer fatal doses of drugs to patients with limited prognosis. Euthanasia was less accepted with more years of training (p < 0.001). When making decisions regarding limitation of life-support therapy, students chose to involve patients (98%), doctors (92%) and families (73%) but few chose to involve nurses (38%).


CONCLUSIONS
Medical students' attitudes towards end-of-life decisions changed during medical training and differed significantly from those of non-medical students.
Gruber
Pascale C
PC
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, New Territories, Hong Kong, China. pascalegruber@yahoo.com
Gomersall
Charles D
CD
Joynt
Gavin M
GM
Lee
Anna
A
Tang
Pui Yin Grace
PY
Young
Adelina Shuan
AS
Yu
Nga Yui Florrie
NY
Yu
Oi Ting
OT
D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003430:Cross-Sectional Studies; D003657:Decision Making; D004501:Education, Medical / Q000639:trends*; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000523:psychology; D008020:Life Support Care / Q000523:psychology / Q000639:trends*; D008297:Male; D010166:Palliative Care / Q000523:psychology / Q000639:trends; D013337:Students, Medical / Q000523:psychology; D013727:Terminal Care / Q000523:psychology / Q000639:trends; D055815:Young Adult