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Physician Resource Use and Willingness to Participate in Assisted Suicide
Daniel P. Sulmasy, MD, PhD;
Benjamin P. Linas, BA;
Karen F. Gold, PhD;
Kevin A. Schulman, MD
Arch Intern Med. 1998;158:974-978.
Objective To explore the relationship between general internists' tendency to conserve medical resources and their willingness to participate in physician-assisted suicide (PAS).
Design and Participants Survey of a random sample of general internists in 6 urban areas of the United States.
Measurements We assessed the physicians' use of medical resources by constructing a scale based on 6 hypothetical clinical scenarios in which respondents were given a choice between resource-intensive and resource-conserving options. We then presented a scenario of a competent terminally ill patient with breast cancer making stable and persistent requests for PAS.
Results Sixty-seven (33%) of the 206 respondents indicated that they would participate in the suicide of the depicted patient. In a multivariate model, physicians who were more conservative with resources were 6.4 times more likely than their resource-intensive counterparts to prescribe the requested drugs (P=.02); minority physicians were less willing than whites to participate in PAS (odds ratio, 0.34; P=.03). Physicians' number of years in practice, location, sex, reported percentage of fee-for-service patients, and self-reported strength and direction of financial incentives in the respondents' practices were not associated with willingness to prescribe drugs for PAS.
Conclusions Most general internists, especially minority physicians, are personally reluctant to participate in PAS. While the characteristics of their practices do not affect PAS, physicians who tend to practice resource-conserving medicine are significantly more likely than their resource-intensive counterparts to provide a lethal prescription at the request of a terminally ill patient.
From the Center for Clinical Bioethics (Dr Sulmasy), Clinical Economics Research Unit (Mr Linas and Dr Schulman), Division of General Internal Medicine (Drs Sulmasy and Schulman), and the Department of Biomathematics and Biostatistics (Dr Gold), Georgetown University Medical Center, Washington, DC.
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