School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
Consultation-Liaison Psychiatry, Hunter New England Local Health District, Newcastle, Australia.
Palliat Support Care. 2020 Feb;18(1):82-88. doi: 10.1017/S1478951519000518.
The debate regarding euthanasia and physician-assisted suicide (E/PAS) raises key issues about the role of the doctor, and the professional, ethical, and clinical dimensions of the doctor-patient relationship. This review aimed to examine the published evidence regarding the response of doctors who have participated in E/PAS.
Original research papers were identified reporting either qualitative or qualitative data published in peer-reviewed literature between 1980 and March 2018, with a specific focus on the impact on, or response from, physicians to their participation in E/PAS. PRISMA and CASP guidelines were followed.
Nine relevant papers met selection criteria. Given the limited published data, a descriptive synthesis of quantitative and qualitative findings was performed. Quantitative surveys were limited in scope but identified a mixed set of responses. Where studies measured psychological impact, 30-50% of doctors described emotional burden or discomfort about participation, while findings also identified a comfort or satisfaction in believing the request of the patient was met. Significant, ongoing adverse personal impact was reported between 15% to 20%. A minority of doctors sought personal support, generally from family or friends, rather than colleagues. The themes identified from the qualitative studies were summarized as: 1) coping with a request; 2) understanding the patient; 3) the doctor's role and agency in the death of a patient; 4) the personal impact on the doctor; and 5) professional guidance and support.
Participation in E/PAS can have a significant emotional impact on participating clinicians. For some doctors, participation can contrast with perception of professional roles, responsibilities, and personal expectations. Despite the importance of this issue to medical practice, this is a largely neglected area of empirical research. The limited studies to date highlight the need to address the responses and impact on clinicians, and the support for clinicians as they navigate this challenging area.
安乐死和医师协助自杀（E/PAS）的争论提出了关于医生角色的关键问题，以及医患关系的专业、伦理和临床维度。本综述旨在检查有关参与 E/PAS 的医生的反应的已发表证据。
确定了 1980 年至 2018 年 3 月期间发表在同行评议文献中的报告医生参与 E/PAS 后影响或反应的原始研究论文，重点关注医生对参与 E/PAS 的影响或反应。遵循 PRISMA 和 CASP 指南。
符合选择标准的有 9 篇相关论文。鉴于已发表数据有限，对定量和定性研究结果进行了描述性综合分析。定量调查范围有限，但确定了一系列混合的反应。在衡量心理影响的研究中，30-50%的医生描述了对参与的情绪负担或不适，而研究结果也发现满足患者的请求会感到舒适或满意。报告了 15%至 20%的人有持续的严重的个人影响。少数医生寻求个人支持，通常来自家人或朋友，而不是同事。从定性研究中总结出的主题包括：1）应对请求；2）了解患者；3）医生在患者死亡中的角色和代理；4）对医生的个人影响；5）专业指导和支持。
参与 E/PAS 会对参与的临床医生产生重大的情绪影响。对一些医生来说，参与可能与对专业角色、责任和个人期望的看法相冲突。尽管这个问题对医疗实践很重要，但这是一个很大程度上被忽视的实证研究领域。迄今为止有限的研究强调了需要解决对临床医生的反应和影响，以及为他们在这一具有挑战性的领域提供支持。
