Attitudes and Practices of U.S. Oncologists regarding Euthanasia and Physician-Assisted Suicide

Attitudes and Practices of U.S. Oncologists regarding Euthanasia and Physician-Assisted Suicide

From the Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland; AMC Cancer Research Center, Denver, Colorado; Center for Survey Research, University of Massachusetts, Beth Israel Deaconess Medical Center, and Dana-Farber Cancer Institute, Boston, Massachusetts; Cancer Care, Inc., New York, New York; M.D. Anderson Cancer Center, Houston, Texas; and Baptist Hospital, Nashville, Tennessee.

Abstract

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.

Design: Cohort study.

Setting: United States.

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

Measurements: 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.

Article and Author Information

Requests for Single Reprints: Robert J. Mayer, MD, Department of Medical Adult Oncology, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115.
Current Author Addresses: Dr. Emanuel: Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, National Institutes of Health, Building 10, Room 1C118, Bethesda, MD 20892-1156.
Dr. Fairclough: Center for Research Methodology and Biometrics, AMC Cancer Research Center, 1600 Pierce Street, Denver, CO 80210.
Dr. Clarridge: Center for Survey Research, University of Massachusetts, Boston, 100 Morrissey Boulevard, Boston, MA 02125-3393.
Ms. Blum: Cancer Care, Inc., 275 7th Avenue, New York, NY 10001.
Dr. Bruera: Department of Symptom Control and Palliative Care, M.D. Anderson Cancer Center, 151 Holcombe Boulevard, Houston, TX 77030.
Dr. Penley: Division of Medical Oncology, Baptist Hospital, 2011 Church Street, Suite 800, Nashville, TN 37221.
Dr. Schnipper: Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.
Dr. Mayer: Department of Medical Adult Oncology, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115.
Author Contributions: Conception and design: E.J. Emanuel, B.C. Clarridge, D. Blum, E. Bruera, L.E. Schnipper, R.J. Mayer.
Analysis and interpretation of the data: E.J. Emanuel, D. Fairclough, D. Blum, E. Bruera, W.C. Penley, L.E. Schnipper, R.J. Mayer.
Drafting of the article: E.J. Emanuel, D. Fairclough, D. Blum, E. Bruera, W.C. Penley, R.J. Mayer.
Critical revision of the article for important intellectual content: E.J. Emanuel, B.C. Clarridge, E. Bruera, W.C. Penley, L.E. Schnipper, R.J. Mayer.
Final approval of the article: E.J. Emanuel, E. Bruera, W.C. Penley, R.J. Mayer.
Statistical expertise: D. Fairclough.
Administrative, technical, or logistic support: E.J. Emanuel, B.C. Clarridge.
Collection and assembly of data: B.C. Clarridge.