Assisted Death: Physician Support Continues to Grow

December 29, 2016

Fifty-seven percent of physicians believe physician-assisted death should be available to terminally ill patients, up from 54% in 2014 and 46% in 2010, according to the Medscape Ethics Report 2016 on end-of-life and other hot-button issues.

The growing majority in medicine that support the practice — also called assisted dying, physician-assisted suicide — mirror public opinion. A Gallup Poll last year found that 68% of Americans favor legalizing physician-assisted death.

And Americans have been doing just that at the ballot box. In November, voters in Colorado passed a law already on the books in Oregon, Washington, Vermont, and California that allows a physician to prescribe a lethal drug to a terminally ill patient who independently requests it. The patient, who self-administers the drug, must be judged competent and counseled on palliative and hospice care. Physician-assisted death is also legal in Montana, where the supreme court there has declared that state law does not forbid it.

Stuart Youngner, MD, a professor of bioethics and psychiatry at Case Western Reserve University School of Medicine in Cleveland, Ohio, said the change in physician attitude toward assisted death reflects greater respect for patient autonomy. However, the trend doesn't necessarily mean supporters of physician-assisted death are ignoring the age-old injunction to "do no harm," Dr Youngner told Medscape Medical News.

"We're having a paradigm shift about what's viewed as harmful," said Dr Youngner. "People are getting used to the idea that death is sometimes the least worst alternative. It can be a deliverance. We've already accepted that legally and culturally when it comes to stopping life-sustaining treatment."

Another sign of the times, he said, is the growing number of medical societies, such as the California Medical Association, that have dropped their opposition to physician-assisted death and have adopted a neutral position. That's fine, said Dr Youngner, but these medical societies need to go a step further and offer guidelines, training, and consultation to those members who want to provide this service.

In the survey, support of assisted death is identical among male and female physicians at 57%, but that's not true for opposition (31% and 26%, respectively). Twelve percent of male and 17% of female physicians answered, "It depends."

Although physician respondents increasingly favor assisted death as an option for the terminally ill, majority support disappears when someone with irremediable suffering is not on death's doorstep. Forty-six percent of physicians oppose assisted death when a patient is not terminally ill. "Absolutely not — that would be murder," said one internist taking the ethics survey. Twenty-eight percent answered yes to this assisted-death question, and another 27% said, "It depends."

Honesty Was the Clear Winner on Some Questions

The medical profession is changing its mind not just about assisted death but also about abortion, according to the Medscape ethics survey.

The percentage of physician readers who would perform an abortion even if it went against their beliefs increased from 34% in 2010 to 45% in 2016. "I am an advocate for the patient's desires, not my own," said one obstetrician-gynecologist. In contrast, 42% of physicians said they would not act against their conscience in this scenario. "Abortion is the same as allowing capital punishment," an internist noted. "It is equally abhorrent and against the Hippocratic Oath."

The ethics survey explored other ethical issues, such as what information physicians ought to share with patients. Honesty was the clear winner when readers were asked if, for the sake of obtaining informed consent, they would less aggressively describe the risks of a procedure that they believed would help the patient. Seventy-eight percent said no, they would not downplay the risks, while 12% said yes, they would, with another 10% saying, "It depends."

Likewise, 72% said they would not withhold information about a terminal diagnosis from a patient to boost his or her morale, and 75% would refuse to withhold information from a competent patient at the family's request.

However, fewer physicians stood for transparency when they were asked if they would tell a patient before a procedure that they hadn't performed it very much. Fifty percent said they would reveal their inexperience compared with 20% who wouldn't. Another 30% answered, "It depends."

More than 7500 physicians in more than 25 specialties completed the 2016 ethics survey. Sixty-three percent of respondents were women, and 59% were younger than 55 years.

The complete survey results are available here.

Follow Robert Lowes on Twitter @LowesRobert

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