title: Physician-assisted suicide, euthanasia and palliative sedation: attitudes and knowledge of medical students.
abstract: OBJECTIVE
  In November 2015, the German Federal Parliament voted on a new legal regulation regarding assisted suicide. It was decided to amend the German Criminal Code so that any "regular, repetitive offer" (even on a non-profit basis) of assistance in suicide would now be considered a punishable offense. On July 2, 2015, a date which happened to be accompanied by great media interest in that it was the day that the first draft of said law was presented to Parliament, we surveyed 4th year medical students at the Technical University Munich on "physician-assisted suicide," "euthanasia" and "palliative sedation," based on a fictitious case vignette study.
  
  
  METHODS
  The vignette study described two versions of a case in which a patient suffered from a nasopharyngeal carcinoma (physical suffering subjectively perceived as being unbearable vs. emotional suffering). The students were asked about the current legal norms for each respective course of action as well as their attitudes towards the ethical acceptability of these measures.
  
  
  RESULTS
  Out of 301 students in total, 241 (80%) participated in the survey; 109 answered the version 1 questionnaire (physical suffering) and 132 answered the version 2 questionnaire (emotional suffering). The majority of students were able to assess the currently prevailing legal norms on palliative sedation (legal) and euthanasia (illegal) correctly (81.2% and 93.7%, respectively), while only a few students knew that physician-assisted suicide, at that point in time, did not constitute a criminal offense. In the case study that was presented, 83.3% of the participants considered palliative sedation and the simultaneous withholding of artificial nutrition and hydration as ethically acceptable, 51.2% considered physician-assisted suicide ethically legitimate, and 19.2% considered euthanasia ethically permissible. When comparing the results of versions 1 and 2, a significant difference could only be seen in the assessment of the legality of palliative sedation: it was considered legal more frequently in the physical suffering version (88.1% vs. 75.8%).
  
  
  CONCLUSIONS
  The majority of the students surveyed wrongly assumed that physician-assisted suicide is a punishable offense in Germany. However, a narrow majority considered physician-assisted suicide ethically acceptable in the case study presented. Compared to euthanasia, more than twice as many participants considered physician-assisted suicide acceptable. There was no significant difference between personal attitudes towards palliative sedation, physician-assisted suicide or euthanasia in light of physical or emotional suffering. Educational programs in this field should be expanded both qualitatively and quantitatively, especially considering the relevance of the subject matter, the deficits within the knowledge of legal norms and the now even higher complexity of the legal situation due to the new law from December 2015.
authors.affiliation: TU München, Klinikum rechts der Isar, Klinik für Psychosomatische Medizin und Psychotherapie, Palliativmedizinischer Dienst, München, Deutschland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Anneser
authors.affiliation: LMU München, Institut für Ethik, Geschichte und Theorie der Medizin, München, Deutschland.
authors.forename: Ralf J
authors.initials: RJ
authors.lastname: Jox
authors.affiliation: TU München, Klinikum rechts der Isar, Klinik für Psychosomatische Medizin und Psychotherapie, Palliativmedizinischer Dienst, München, Deutschland.
authors.forename: Tamara
authors.initials: T
authors.lastname: Thurn
authors.affiliation: Universität Lausanne, Centre Hospitalier Universitaire Vaudois (CHUV), Service de Soins Palliatifs, Lausanne, Schweiz.
authors.forename: Gian Domenico
authors.initials: GD
authors.lastname: Borasio
mesh_terms: D001291:Attitude of Health Personnel; D003479:Curriculum; D054810:Deep Sedation / Q000941:ethics / Q000523:psychology*; D004992:Ethics, Medical / Q000193:education; D005065:Euthanasia / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology*; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000523:psychology / Q000628:therapy; D010146:Pain / Q000523:psychology; D010166:Palliative Care / Q000941:ethics / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology; D013337:Students, Medical / Q000331:legislation & jurisprudence / Q000523:psychology*; D017236:Suicide, Assisted / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Euthanasia; Legal aspects; Medical students; Palliativ; Physician-assisted suicide; Sedation; Undergraduate Medical Education