Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada.
, Windsor, Canada.
BMC Palliat Care. 2018 Apr 4;17(1):56. doi: 10.1186/s12904-018-0304-6.
On February 6th, 2015, the Supreme Court of Canada ruled that competent adults suffering intolerably from a grievous and irremediable medical condition have the right to the assistance of a physician in ending their own lives, an act known as physician-assisted death, and later defined as medical assistance in dying, allowing for provision by a physician or a nurse practitioner. As of June 6th, 2016, this is no longer illegal across Canada. There is strong support amongst the general population for physician-assisted death, however there is no recent data on the attitudes of terminally ill patients. Our main objective was to gain information on terminally ill patients' general and personal attitudes toward physician-assisted death.
This is an exploratory pilot study. We surveyed three groups of patients with life-limiting diagnoses: one with new referrals to palliative care; one with no palliative care involvement; and one with prior and ongoing management by a palliative care team. Respondents were surveyed twice, approximately two weeks apart, and rated their general attitudes toward physician-assisted death and the hypothetical consideration of physician-assisted death for oneself on a five-point Likert scale at baseline and follow-up. Respondents with new referrals to palliative care were surveyed before and after palliative care consultation. This study was approved by The Western University Health Sciences Research Ethics Board and Lawson Health Research Institute.
We surveyed 102 participants, 70 of whom completed both surveys (31% dropout rate). Participants in all groups predominantly responded between somewhat agree (4 on a 5-point Likert scale) and strongly agree (5 on the Likert scale) when asked about their general attitude toward physician-assisted death. Patients with prior palliative care involvement reported the highest average ratings of hypothetical consideration of physician-assisted death for oneself on a 5-point Likert scale (3.4 at baseline; 3.9 at follow-up), followed by patients with a new palliative consultation (3.2 at baseline; 3.3 at follow-up), and patients with no palliative involvement (2.6 at baseline; 2.9 at follow-up).
Given the preliminary results of this pilot study, we can conclude that terminally ill patients generally agree that physician-assisted death should be available to patients with life-limiting illnesses. Furthermore, descriptive data show a trend for higher hypothetical consideration of physician-assisted death in those patients with prior and ongoing palliative care involvement than patients without palliative involvement. Responses in all groups remained fairly consistent over the two-week period.
2015 年 2 月 6 日，加拿大最高法院裁定，患有无法忍受的严重和无法治愈的疾病的有能力的成年人有权在医生的协助下结束自己的生命，这种行为被称为医生协助死亡，后来被定义为医疗协助自杀，并允许医生或护士从业者提供。自 2016 年 6 月 6 日起，加拿大各地不再对此类行为进行非法化处理。公众普遍强烈支持医生协助死亡，但最近没有关于绝症患者态度的数据。我们的主要目的是了解绝症患者对医生协助死亡的普遍看法和个人看法。
这是一项探索性的试点研究。我们调查了三组患有生命有限的诊断的患者：一组是新转诊到姑息治疗的患者；一组是没有姑息治疗参与的患者；一组是由姑息治疗团队进行过先前和持续管理的患者。在基线和随访时，受访者被两次调查，大约两周一次，并在五点李克特量表上对他们对医生协助死亡的一般态度和对自己的医生协助死亡的假设考虑进行评分。新转诊到姑息治疗的患者在姑息治疗咨询前后接受了调查。本研究经西大学健康科学伦理审查委员会和劳森健康研究所批准。
我们调查了 102 名参与者，其中 70 名完成了两次调查（31%的辍学率）。当被问及他们对医生协助死亡的一般态度时，所有组的参与者主要在“有些同意”（5 分制中的 4 分）和“强烈同意”（5 分制中的 5 分）之间做出回应。有先前姑息治疗经历的患者在假设考虑自己接受医生协助死亡的平均评分最高（5 分制中的 3.4 分，基线时为 3.9 分），其次是有新的姑息治疗咨询的患者（5 分制中的 3.2 分，基线时为 3.3 分），以及没有姑息治疗参与的患者（5 分制中的 2.6 分，基线时为 2.9 分）。
根据这项试点研究的初步结果，我们可以得出结论，绝症患者普遍认为，医生协助死亡应该提供给患有生命有限疾病的患者。此外，描述性数据显示，在有先前和持续姑息治疗参与的患者中，对医生协助死亡的假设考虑高于没有姑息治疗参与的患者。所有组的反应在两周内都相对一致。
