Faculty of Medicine, Nursing and Health Science, Monash University, Clayton, Victoria, Australia.
Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom.
PLoS One. 2021 Mar 26;16(3):e0247193. doi: 10.1371/journal.pone.0247193. eCollection 2021.
Many patients at the end of life require analgesia to relieve pain. Additionally, up to 1/5 of patients in the UK receive sedation for refractory symptoms at the end of life. The use of sedation in end-of-life care (EOLC) remains controversial. While gradual sedation to alleviate intractable suffering is generally accepted, there is more opposition towards deliberate and rapid sedation to unconsciousness (so-called "terminal anaesthesia", TA). However, the general public's views about sedation in EOLC are not known. We sought to investigate the general public's views to inform policy and practice in the UK.
We performed two anonymous online surveys of members of the UK public, sampled to be representative for key demographic characteristics (n = 509). Participants were given a scenario of a hypothetical terminally ill patient with one week of life left. We sought views on the acceptability of providing titrated analgesia, gradual sedation, terminal anaesthesia, and euthanasia. We asked participants about the intentions of doctors, what risks of sedation would be acceptable, and the equivalence of terminal anaesthesia and euthanasia.
Of the 509 total participants, 84% and 72% indicated that it is permissible to offer titrated analgesia and gradual sedation (respectively); 75% believed it is ethical to offer TA. Eighty-eight percent of participants indicated that they would like to have the option of TA available in their EOLC (compared with 79% for euthanasia); 64% indicated that they would potentially wish for TA at the end of life (52% for euthanasia). Two-thirds indicated that doctors should be allowed to make a dying patient completely unconscious. More than 50% of participants believed that TA and euthanasia were non-equivalent; a third believed they were.
These novel findings demonstrate substantial support from the UK general public for the use of sedation and TA in EOLC. More discussion is needed about the range of options that should be offered for dying patients.
许多生命末期的患者需要镇痛来缓解疼痛。此外，英国多达 1/5的患者在生命末期因难治性症状接受镇静治疗。生命末期的镇静治疗（EOLC）的使用仍然存在争议。虽然逐渐镇静以减轻难以忍受的痛苦通常是可以接受的，但对于故意和快速镇静至无意识（所谓的“终末麻醉”，TA）则存在更多反对意见。然而，公众对 EOLC 中镇静的看法尚不清楚。我们旨在调查公众的观点，以为英国的政策和实践提供信息。
我们对英国公众进行了两次匿名在线调查，抽样代表了关键人口统计学特征（n=509）。参与者被提供了一个假设的患有绝症的患者的情景，预计患者的剩余生命还有一周。我们征求了他们对提供滴定镇痛、逐渐镇静、终末麻醉和安乐死的可接受性的看法。我们询问了参与者医生的意图、可接受的镇静风险以及终末麻醉和安乐死的等同性。
在 509 名总参与者中，84%和 72%分别表示提供滴定镇痛和逐渐镇静是允许的（分别）；75%的人认为提供 TA 是合乎道德的。88%的参与者表示他们希望在 EOLC 中提供 TA （安乐死为 79%）；64%的人表示他们在生命结束时可能希望接受 TA（安乐死为 52%）。三分之二的人表示，医生应该允许让即将死亡的患者完全无意识。超过 50%的参与者认为 TA 和安乐死不等同；三分之一的人认为它们是等同的。
这些新发现表明，英国公众对 EOLC 中镇静和 TA 的使用表示出了实质性的支持。需要进一步讨论应该为临终患者提供的一系列选择。
