[Show abstract][Hide abstract] ABSTRACT: Background. Euthanasia remains controversial in Canada and an issue of debate among physicians. Most studies have explored the opinion of health professionals regarding its legalization, but have not investigated their intentions when faced with performing euthanasia. These studies are also considered atheoretical. The purposes of the present study were to fill this gap in the literature by identifying the psychosocial determinants of physicians' intention to practice euthanasia in palliative care and verifying whether respecting the patient's autonomy is important for physicians.
Methods. A validated anonymous questionnaire based on an extended version of the Theory of Planned Behavior was mailed to a random sample of 445 physicians from the province of Quebec, Canada.
Results. The response rate was 38.3% and the mean score for intention was 3.94 +/- 2.17 (range: 1 to 7). The determinants of intention among physicians were: knowing patients' wishes (OR = 10.77; 95%CI: 1.33-86.88), perceived behavioral control--physicians' evaluation of their ability to adopt a given behavior--(OR = 4.35; 95%CI: 1.44-13.15), moral norm--the appropriateness of adopting a given behavior according to one's personal and moral values--(OR = 3.22; 95%CI: 1.29-8.00) and cognitive attitude--factual consequences of the adoption of a given behavior--(OR = 3.16; 95%CI: 1.20-8.35). This model correctly classified 98.8% of physicians. Specific beliefs that might discriminate physicians according to their level of intention were also identified. For instance, physicians' moral norm was related to the ethical principle of beneficence.
Conclusions. Overall, physicians have weak intentions to practice euthanasia in palliative care. Nevertheless, respecting patients' final wishes concerning euthanasia seems to be of particular importance to them and greatly affects their motivation to perform euthanasia.
Full-text · Article · Jan 2015 · BMC Medical Ethics
[Show abstract][Hide abstract] ABSTRACT: Background: Respecting patients’ autonomy is often put forward as one of the main reasons why certain health professionals are favourable to euthanasia. Few studies have compared whether nurses and physicians hold different beliefs regarding euthanasia. The objective of the study was to experimentally test whether knowing patients’ wishes and profession can affect health professionals’ intentions and beliefs regarding performing euthanasia. Methods: This a 2×2 random factorial design study (experimental conditions: patient’s wishes known or not; professions: nurses or physicians). A vignette describing the case of a person near death was used to manipulate knowledge of patient’s wishes. Random samples of nurses and physicians from the province of Québec, Canada, were obtained using random digit tables. Samples were weighted according to the domains of practice and medical specialties included in the study. Data were collected by means of an anonymous questionnaire based on an extended version of the Theory of Planned Behaviour. Results: Overall, the response rate was 41.3%. There was a significant known wishes×profession interaction for intention, F (3, 266)=7.38, p=0.0070 and only a known wishes effect for the other beliefs, F (6, 256)=2.86, p=0.0102. Scores for intention and the other beliefs were lower among physicians who were exposed to the vignette where patient’s wishes were unknown. Conclusion: Knowing patients’ wishes regarding euthanasia appears to influence physicians, but not nurses. This is the first study to test whether knowledge of patient’s wishes and profession have an impact on health professionals’
intention and beliefs regarding euthanasia.
[Show abstract][Hide abstract] ABSTRACT: The induction of sedation at the end of life is a much debated practice and not very documented. The goal of this study was to explore the practice from both a clinical and ethical point of view.
Data were collected through semistructured interviews with 19 Quebec physicians working in palliative care.
Doctors' first priority was their patients, not patients' families. Clinically, the therapeutic aim of sedation was strictly to relieve suffering on the part of the patient. Ethically, getting the patient's consent was imperative. The family's consent was only required in cases of incapacity. Generally, sedation and euthanasia were seen as two distinct practices.
There are still very few guidelines regarding end-of-life sedation in Québec, and its normative framework is more implicit than explicit. It should be noted that most of the respondents regarded sedation and euthanasia as two distinct practices.
No preview · Article · Sep 2009 · Palliative and Supportive Care
[Show abstract][Hide abstract] ABSTRACT: End-of-life sedation remains a controversial and ill-defined clinical practice; its applications vary considerably. With this in mind, a study was conducted using a 2 x 2 experimental design. The variables experimented with were prognosis (short- or long-term) and type of suffering (physical or existential). The goal was to study the influence of the two independent variables on attitude toward sedation. Four clinical vignettes were completed by 124 clinicians, doctors, and pharmacists working in different palliative care environments in the Province of Quebec. The results indicate that the type of suffering influences a subject's attitude to end-of-life sedation. Thus, when a patient was suffering physically, the respondents were significantly in favour of sedation, whereas they were not in favour of this practice if the suffering was existential. Lastly, it is clear that health professionals are uncomfortable when confronted with their patients' existential suffering. This is an issue worth exploring in future studies.
Full-text · Article · Feb 2005 · Journal of palliative care