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安乐死法律中的医疗协助:对法国癌症医生的定性研究

Medical assistance in dying law: a qualitative study of French cancer physicians.

作者信息

Chastenet Mathilde, Renard Olivier, Laurain Pierre-Antoine, Bonnot Myriam, Chvetzoff Gisèle

机构信息

Interdisciplinary Department of Supportive Care in Oncology, Centre Leon Berard, Lyon, France

Interdisciplinary Department of Supportive Care in Oncology, Centre Leon Berard, Lyon, France.

出版信息

BMJ Support Palliat Care. 2023 Aug 4. doi: 10.1136/spcare-2023-004238.

Abstract

OBJECTIVES

The legal landscape surrounding end-of-life care in France is subject to frequent changes. A proposed law to legalise euthanasia in April 2021 has raised questions about the role of physicians. If enacted, oncologists would likely be among the first professionals impacted, as data from countries with legalised euthanasia reveal that patients with cancer constitute the majority of those seeking this option. Currently, little is known about the attitudes of French oncologists towards euthanasia. Therefore, the aim of this study was to explore the position of cancer physicians on euthanasia and their experiences in dealing with patients who request it.

METHODS

We conducted individual interviews with 24 cancer specialists (oncologists, radiotherapists and haematologists) at the Centre Léon Bérard in Lyon between August and October 2021. After full transcription, data were analysed thematically and for content. Data triangulation was used to establish the truthworthiness of the findings by two external researchers.

RESULTS

Most cancer specialists in our study were opposed to legalising euthanasia, citing concerns about the societal, medical and ethical implications of the practice. They refused physician-assisted suicide based on their ethical duty to preserve life, avoid harm and uphold the Hippocratic Oath. Patient requests for euthanasia were rare. Surprisingly, over a quarter of the physicians interviewed did not rule out receiving active assistance in dying themselves in cases of unbearable or hopeless situations.

CONCLUSIONS

This study highlights the complex and diverse attitudes of cancer physicians towards euthanasia and physician-assisted suicide, reflecting the challenges of integrating individual and collective perspectives on end-of-life issues.

摘要

目标

法国围绕临终关怀的法律环境经常变化。2021年4月一项将安乐死合法化的提案引发了关于医生角色的问题。如果该提案颁布,肿瘤学家很可能是首批受到影响的专业人员之一,因为安乐死合法化国家的数据显示,癌症患者是寻求这种选择的大多数。目前,对于法国肿瘤学家对安乐死的态度知之甚少。因此,本研究的目的是探讨癌症医生对安乐死的立场以及他们在处理患者安乐死请求方面的经历。

方法

2021年8月至10月期间,我们在里昂的莱昂·贝拉尔中心对24名癌症专家(肿瘤学家、放射治疗师和血液学家)进行了个人访谈。在全文转录后,对数据进行了主题分析和内容分析。两名外部研究人员采用数据三角验证法来确定研究结果的可信度。

结果

我们研究中的大多数癌症专家反对将安乐死合法化,理由是担心这种做法对社会、医学和伦理的影响。基于他们保护生命、避免伤害和遵守希波克拉底誓言的道德责任,他们拒绝医生协助自杀。患者提出安乐死请求的情况很少见。令人惊讶的是,超过四分之一的受访医生不排除在无法忍受或绝望的情况下接受积极的死亡协助。

结论

本研究突出了癌症医生对安乐死和医生协助自杀的复杂多样态度,反映了在临终问题上整合个人和集体观点的挑战。

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