Division of Oncology with affiliated Unit of Palliative Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
J Med Internet Res. 2021 Sep 20;23(9):e28635. doi: 10.2196/28635.
End-of-life decisions, specifically the provision of euthanasia and assisted suicide services, challenge traditional medical and ethical principles. Austria and Germany have decided to liberalize their laws restricting assisted suicide, thus reigniting the debate about a meaningful framework in which the practice should be embedded. Evidence of the relevance of assisted suicide and euthanasia for the general population in Germany and Austria is limited.
The aim of this study is to examine whether the public awareness documented by search activities in the most frequently used search engine, Google, on the topics of palliative care, euthanasia, and advance health care directives changed with the implementation of palliative care services and new governmental regulations concerning end-of-life decisions.
We searched for policies, laws, and regulations promulgated or amended in Austria, Germany, and Switzerland between 2004 and 2020 and extracted data on the search volume for each search term topic from Google Trends as a surrogate of public awareness and interest. Annual averages were analyzed using the Joinpoint Regression Program.
Important policy changes yielded significant changes in search trends for the investigated topics. The enactment of laws regulating advance health care directives coincided with a significant drop in the volume of searches for the topic of euthanasia in all 3 countries (Austria: -24.48%, P=.02; Germany: -14.95%, P<.001; Switzerland: -11.75%, P=.049). Interest in palliative care increased with the availability of care services and the implementation of laws and policies to promote palliative care (Austria: 22.69%, P=.01; Germany: 14.39, P<.001; Switzerland: 17.59%, P<.001). The search trends for advance health care directives showed mixed results. While interest remained steady in Austria within the study period, it increased by 3.66% (P<.001) in Switzerland and decreased by 2.85% (P<.001) in Germany.
Our results demonstrate that legal measures securing patients' autonomy at the end of life may lower the search activities for topics related to euthanasia and assisted suicide. Palliative care may be a meaningful way to raise awareness of the different options for end-of-life care and to guide patients in their decision-making process regarding the same.
临终决策，特别是安乐死和协助自杀服务的提供，挑战了传统的医学和伦理原则。奥地利和德国已决定放宽限制协助自杀的法律，从而再次引发了关于应在何种有意义的框架内纳入该做法的辩论。有关安乐死和协助自杀在德国和奥地利普通民众中的相关性的证据有限。
本研究旨在探讨通过最常用搜索引擎 Google 上的搜索活动记录的公众意识是否随着姑息治疗服务的实施以及有关临终决策的新政府法规的出台而改变，这些搜索活动记录了姑息治疗、安乐死和预先医疗指示这三个主题。
我们搜索了奥地利、德国和瑞士在 2004 年至 2020 年间颁布或修订的政策、法律和法规，并从 Google Trends 中提取每个搜索主题的搜索量数据，作为公众意识和兴趣的替代指标。使用 Joinpoint 回归程序分析年度平均值。
重要的政策变化导致调查主题的搜索趋势发生了显著变化。监管预先医疗指示的法律的颁布与这 3 个国家的安乐死主题搜索量的显著下降相一致（奥地利：-24.48%，P=.02；德国：-14.95%，P<.001；瑞士：-11.75%，P=.049）。随着姑息治疗服务的提供以及促进姑息治疗的法律和政策的实施，公众对姑息治疗的兴趣增加（奥地利：22.69%，P=.01；德国：14.39，P<.001；瑞士：17.59%，P<.001）。预先医疗指示的搜索趋势结果喜忧参半。虽然在研究期间，奥地利的兴趣保持稳定，但在瑞士增加了 3.66%（P<.001），而在德国则减少了 2.85%（P<.001）。
我们的研究结果表明，保障患者在生命末期自主权的法律措施可能会降低与安乐死和协助自杀相关主题的搜索活动。姑息治疗可能是提高对不同临终护理选择的认识并指导患者做出相同决策的一种有意义的方式。
