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Attitudes and Practices Concerning the End of Life
A Comparison Between Physicians From the United States and From the Netherlands
Dick L. Willems, MD, PhD;
Elisabeth R. Daniels;
Gerrit van der Wal, PhD;
Paul J. van der Maas, PhD;
Ezekiel J. Emanuel, PhD
Arch Intern Med. 2000;160:63-68.
Background This study compares attitudes and practices concerning the end-of-life decisions between physicians in the United States and in the Netherlands, using the same set of questions.
Methods A total of 152 physicians from Oregon and 67 from the Netherlands were interviewed using the same questions about (1) their attitudes toward increasing morphine with premature death as a likely consequence, physician-assisted suicide (PAS), and euthanasia; and (2) their involvement in cases of euthanasia, PAS, or the ending of life without an explicit request from the patient. Odds ratios, with 95% confidence intervals, were calculated to investigate relation between attitudes and various characteristics of the respondents.
Results American physicians found euthanasia less often acceptable than the Dutch, but there was similarity in attitudes concerning increasing morphine and PAS. American physicians found increasing morphine and PAS more often acceptable in cases where patients were concerned about becoming a burden to their family. There was a discrepancy between the attitudes and practices of Dutch physicians concerning PAS. The proportions of physicians having practiced euthanasia, PAS, or ending of life without an explicit request from the patient differ more between the countries than do their attitudes, with American physicians having been involved in these practices less often than the Dutch.
Conclusions In this study of American and Dutch physicians, 2 important differences emerge: different attitudes toward the patient who is concerned over being a burden, and different frequency of euthanasia and PAS in the two countries.
From the Institute for Research in Extramural Medicine and the Department of Social Medicine, Vrije Universiteit, Amsterdam, the Netherlands (Drs Willems and van der Wal); the Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Mass (Ms Daniels and Dr Emanuel); and the Institute for Public Health, Erasmus University, Rotterdam, the Netherlands (Dr van der Maas).
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