Lavoie Mireille, Godin Gaston, Vézina-Im Lydi-Anne, Blondeau Danielle, Martineau Isabelle, Roy Louis
Faculty of Nursing, Laval University, Québec, G1V 0A6, Canada.
Équipe de Recherche Michel-Sarrazin en Oncologie psychosociale et Soins palliatifs (ERMOS), Centre de recherche du CHU de Québec - Hôtel-Dieu de Québec, Québec, Canada.
BMC Med Ethics. 2015 Jan 22;16:6. doi: 10.1186/1472-6939-16-6.
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.
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.
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.
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.
安乐死在加拿大仍存在争议，也是医生们争论的一个问题。大多数研究探讨了卫生专业人员对其合法化的看法，但未调查他们在面临实施安乐死时的意图。这些研究也被认为缺乏理论依据。本研究的目的是通过确定医生在姑息治疗中实施安乐死意图的社会心理决定因素，并验证尊重患者自主权对医生是否重要，来填补文献中的这一空白。
基于计划行为理论扩展版的一份经过验证的匿名问卷被邮寄给加拿大魁北克省445名医生的随机样本。
回复率为38.3%，意图的平均得分为3.94±2.17（范围：1至7）。医生意图的决定因素包括：了解患者的意愿（OR = 10.77；95%CI：1.33 - 86.88）、感知行为控制——医生对自己采取特定行为能力的评估——（OR = 4.35；95%CI：1.44 - 13.15）、道德规范——根据个人和道德价值观采取特定行为的适当性——（OR = 3.22；95%CI：1.29 - 8.00）以及认知态度——采取特定行为的实际后果——（OR = 3.16；95%CI：1.20 - 8.35）。该模型正确分类了98.8%的医生。还确定了可能根据医生意图水平区分他们的具体信念。例如，医生的道德规范与行善的伦理原则相关。
总体而言，医生在姑息治疗中实施安乐死的意图较弱。然而，尊重患者关于安乐死的最终愿望对他们似乎尤为重要，并极大地影响他们实施安乐死的动机。
