Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Studies reveal physicians’ attitudes on end-of-life care

07.12.2004


Doctors appear willing to use intensive treatment to lessen otherwise untreatable pain or other severe symptoms in dying patients even if the treatment, at least in theory, risks hastening the dying process, according to two University of Iowa and Yale University studies on end-of-life care.



Known as "terminal sedation," the practice involves the use of sedating medications to control a patient’s symptoms even if it results in decreased or complete loss of consciousness. In contrast to physician-assisted suicide, terminal sedation may risk, but does not intend, hastening or causing death. A majority of physicians in the studies drew a clear line between terminal sedation and assisted suicide. In addition, physicians’ attitudes were related to two notable factors: their experience in caring for terminally ill patients and their frequency of attending religious services.

One study, which focused on internal medicine physicians, appeared in the October issue of the Journal of Medical Ethics. The second study, which focused on internal medicine residents (doctors in training), was published in the September/October issue of the American Journal of Hospice and Palliative Medicine.


Both studies were led by Lauris Kaldjian, M.D., assistant professor of internal medicine in the UI Roy J. and Lucille A. Carver College of Medicine and member of the college’s Program in Biomedical Ethics and Medical Humanities. Kaldjian was formerly on the faculty at Yale University. "End-of-life care involves many treatment decisions, some of which are focused on extreme pain and other symptoms that are very challenging to control," Kaldjian said. "We studied the specific ethical issues of treatments that control symptoms versus interventions that intend to cause or hasten death."

The study of internal medicine physicians, who had been in practice for at least several years, involved 677 Connecticut members of the American College of Physicians (ACP). The study of doctors-in-training involved 236 residents in three internal medicine residency programs in Connecticut. Participants in each study responded anonymously to questions in a survey. The questions were phrased as statements, and respondents indicated their agreement or disagreement on a five-point scale, with "not sure" as a sixth option.

Among the ACP physicians, 78 percent of respondents supported the use of terminal sedation, while among the residents, 66 percent agreed with the practice. In both groups, about one-third of respondents supported physician-assisted suicide, in theory, as "ethically appropriate" in certain circumstances. The practice is legal only in Oregon, not in Connecticut or other states.

While general attitudes toward end-of-life care were similar among doctors in training and doctors who had been in practice, the ACP study revealed more about the roles that palliative care experience and religious involvement play in physicians’ views.

Of the ACP members who supported terminal sedation, nearly two-thirds of them (62 percent) did not support assisted suicide. Analysis revealed physicians were more likely to be for terminal sedation but against assisted suicide if they had either significant experience with dying patients or frequent religious service attendance.

Among ACP physicians who had cared for one to 10 terminally ill patients in the past year, 39 percent disagreed with the notion of assisted suicide. In contrast, among ACP physicians who had cared for 50 or more terminally ill patients in the past year, 68 percent disagreed with assisted suicide. "It was clear from our statistical analysis that those who had cared for a greater number of terminally patients in the preceding year were more opposed to assisted suicide and also more supportive of terminal sedation," Kaldjian said. "There seemed to be both a greater willingness to be rigorous in end-of-life care but also less willingness to cross that line into actually intending death," he added. Kaldjian said the reasons for this attitude are open for discussion because the statistical study was descriptive, not designed to establish cause and effect.

The ACP study also showed that the more frequently a doctor attended religious services, the more likely he or she was to disagree with assisted suicide, as shown by these disagreement rates: 30 percent for non-attendees, 33 percent for less-than-monthly attendees, 52 percent for monthly attendees and 76 percent for weekly attendees. "We found that the more frequently respondents attended religious services, there was a trend toward less support for assisted suicide but more support for terminal sedation," Kaldjian said. "To my knowledge, this is the first study to show such a stepwise trend."

The association with frequency of religious service attendance held true no matter what the religious affiliation of the physician. Kaldjian said the studies collectively suggest that physicians do not separate their religious beliefs from decision-making in end-of-life care. "We should not be surprised that physicians have religious beliefs and that, especially in some areas of medicine, these beliefs are operating in some way," he said. "A physician should not be seen as any less of a professional because of deeply-held religious convictions.

"Medical ethics involve not just a patient’s autonomy but also a physician’s integrity," he added. "On matters of such importance as end-of-life care, physicians’ integrity must be respected. Patients should not see themselves as mere consumers of health care but as partners in a decision-making process with physicians, who are not mere robots."

The ACP-based study was funded in part by a dissertation fellowship to Kaldjian from the Graduate School at Yale University.

Becky Soglin | EurekAlert!
Further information:
http://www.uiowa.edu

More articles from Studies and Analyses:

nachricht Smart Data Transformation – Surfing the Big Wave
02.12.2016 | Fraunhofer-Institut für Angewandte Informationstechnik FIT

nachricht Climate change could outpace EPA Lake Champlain protections
18.11.2016 | University of Vermont

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

Im Focus: Molecules change shape when wet

Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water

In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...

Im Focus: Fraunhofer ISE Develops Highly Compact, High Frequency DC/DC Converter for Aviation

The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.

Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

UTSA study describes new minimally invasive device to treat cancer and other illnesses

02.12.2016 | Medical Engineering

Plasma-zapping process could yield trans fat-free soybean oil product

02.12.2016 | Agricultural and Forestry Science

What do Netflix, Google and planetary systems have in common?

02.12.2016 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>