Ezekiel J. Emanuel, MD, PhD; Diane Fairclough, DPH; Brian C. Clarridge, PhD; Diane Blum, MSW; Eduardo Bruera, MD; W. Charles Penley, MD; Lowell E. Schnipper, MD; Robert J. Mayer, MD
The practices of euthanasia and physician-assisted suicide remain controversial.
To achieve better understanding of attitudes and practices regarding euthanasia and physician-assisted suicide in the context of end-of-life care.
3299 oncologists who are members of the American Society of Clinical Oncology.
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.
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).
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.
Sociodemographic Characteristics of Surveyed U.S. Oncologists
Appendix Table. Survey Questions
Attitudes and Practices regarding Euthanasia and Physician-Assisted Suicide among Oncologic Specialties
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.
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.
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Emanuel EJ, Fairclough D, Clarridge BC, Blum D, Bruera E, Penley WC, et al. Attitudes and Practices of U.S. Oncologists regarding Euthanasia and Physician-Assisted Suicide. Ann Intern Med. 2000;133:527-532. doi: 10.7326/0003-4819-133-7-200010030-00011
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Published: Ann Intern Med. 2000;133(7):527-532.
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