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Alan Meisel, JD; Jan C. Jernigan, PhD; Stuart J. Youngner, MD

Arch Intern Med. 1999;159:1089-1095.

Objective  To examine personal beliefs and professional behavior of state criminal prosecutors toward end-of-life decisions.

Design  Mail survey.

Setting  District attorney offices nationwide.

Participants  All prosecuting attorneys who are members of the National District Attorneys Association. A total of 2844 surveys were mailed with 2 follow-up mailings at 6-week intervals; 761 surveys were returned for a response rate of 26.8%. The majority of respondents were white men, Protestant, and served in rural areas.

Interventions  None.

Main Outcome Measures  On the basis of 4 case scenarios, (1) professional behavior as determined by respondents' willingness to prosecute and what criminal charges they would seek; and (2) personal beliefs as determined by whether prosecutors believed the physicians' actions were morally wrong and whether they would want the same action taken if they were in the patient's condition.

Results  Most respondents would not seek prosecution in 3 of the 4 cases. In the fourth case, involving physician-assisted suicide, only about one third of the respondents said that they definitely would prosecute. Those who would prosecute would most often seek a charge of criminal homicide. A majority of respondents believed that the physicians' actions were morally correct in each of the 4 cases and would want the same action taken if they were in the patient's position. There was a strong correlation between personal beliefs and professional behaviors.

Conclusions  A large majority of responding prosecutors were unwilling to prosecute physicians in cases that clearly fall within currently accepted legal and professional boundaries. In the case of physician-assisted suicide, results reflected a surprisingly large professional unwillingness to prosecute and an even greater personal acceptance of physician-assisted suicide.

From the School of Law and Center for Bioethics and Health Law (Dr Meisel) and Health Services Administration, Graduate School of Public Health (Dr Jernigan), University of Pittsburgh, Pittsburgh, Pa; and Clinical Ethics Program, University Hospitals of Cleveland, Department of Medicine and Center for Biomedical Ethics, Case Western Reserve University, Cleveland, Ohio (Dr Youngner).

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