Cancer Management Branch, Research Institute, National Cancer Center, Goyang, Korea.
CMAJ. 2011 Jul 12;183(10):E673-9. doi: 10.1503/cmaj.110020. Epub 2011 May 30.
Whereas most studies have focused on euthanasia and physician-assisted suicide, few have dealt comprehensively with other critical interventions administered at the end of life. We surveyed cancer patients, family caregivers, oncologists and members of the general public to determine their attitudes toward such interventions.
We administered a questionnaire to four groups about their attitudes toward five end-of-life interventions--withdrawal of futile life-sustaining treatment, active pain control, withholding of life-sustaining measures, active euthanasia and physician-assisted suicide. We performed multivariable analyses to compare attitudes and to identify sociodemographic characteristics associated with the attitudes.
A total of 3840 individuals--1242 cancer patients, 1289 family caregivers and 303 oncologists from 17 hospitals, as well as 1006 members of the general Korean population--participated in the survey. A large majority in each of the groups supported withdrawal of futile life-sustaining treatment (87.1%-94.0%) and use of active pain control (89.0%-98.4%). A smaller majority (60.8%-76.0%) supported withholding of life-sustaining treatment. About 50% of those in the patient and general population groups supported active euthanasia or physician-assisted suicide, as compared with less than 40% of the family caregivers and less than 10% of the oncologists. Higher income was significantly associated with approval of the withdrawal of futile life-sustaining treatment and the practice of active pain control. Older age, male sex and having no religion were significantly associated with approval of withholding of life-sustaining measures. Older age, male sex, having no religion and lower education level were significantly associated with approval of active euthanasia and physician-assisted suicide.
Although the various participant groups shared the same attitude toward futile and ameliorative end-of-life care (the withdrawal of futile life-sustaining treatment and the use of active pain control), oncologists had a more negative attitude than those in the other groups toward the active ending of life (euthanasia and physician-assisted suicide).
尽管大多数研究都集中在安乐死和医师协助自杀上，但很少有研究全面涉及生命末期的其他关键干预措施。我们调查了癌症患者、家庭护理人员、肿瘤学家和普通公众，以确定他们对这些干预措施的态度。
我们向四个群体发放了一份关于他们对五种生命末期干预措施的态度的问卷——放弃无效的生命维持治疗、积极控制疼痛、不维持生命的措施、积极安乐死和医师协助自杀。我们进行了多变量分析，以比较态度，并确定与态度相关的社会人口学特征。
共有 3840 人——1242 名癌症患者、1289 名家庭护理人员和 17 家医院的 303 名肿瘤学家，以及 1006 名普通韩国民众——参与了这项调查。每个群体中绝大多数人都支持放弃无效的生命维持治疗（87.1%-94.0%）和使用积极的疼痛控制（89.0%-98.4%）。更大的多数（60.8%-76.0%）支持不维持生命的治疗。与家庭护理人员和肿瘤学家相比，患者和普通民众群体中约有 50%的人支持积极安乐死或医师协助自杀。较高的收入与支持放弃无效的生命维持治疗和积极的疼痛控制显著相关。年龄较大、男性和无宗教信仰与支持不维持生命的治疗措施显著相关。年龄较大、男性、无宗教信仰和较低的教育水平与支持积极安乐死和医师协助自杀显著相关。
尽管各个参与群体对无效和改善生命末期护理（放弃无效的生命维持治疗和使用积极的疼痛控制）的态度相同，但与其他群体相比，肿瘤学家对生命终结的态度更为消极（安乐死和医师协助自杀）。
