Barć Krzysztof, Finsel Julia, Helczyk Olga, Baader Susanne, Aho-Özhan Helena, Ludolph Albert C, Lulé Dorothée, Kuźma-Kozakiewicz Magdalena
Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland.
Department of Neurology, University of Ulm, Ulm, Germany.
Brain Behav. 2024 Jan 6;14(2):e3243. doi: 10.1002/brb3.3243.
This paper examines neurologists' approaches to exit strategies (ESs), such as euthanasia and physician-assisted suicide, in patients with amyotrophic lateral sclerosis (PALS) in two European countries.
In a nationwide anonymous survey, we collected responses from 237 Polish and 228 German neurologists, focusing on their practices and beliefs about ESs, as well as their viewpoints on life-sustaining measures (LSMs) (percutaneous endoscopic gastrostomy, non-invasive, and invasive ventilation). To analyze the data, we employed statistical methods, including Mann-Whitney U, Kruskal-Wallis, chi-square tests, Spearman's rank correlation, and multiple regression analysis.
One third of the neurologists initiated the discussion about ESs with PALS. Half were ready to have this conversation upon patient's request. Age, gender, religiousness, and nationality were closely associated with this approach. One in 9 neurologists received a request to terminate an LSM, whereas 1 in 10 to implement an ES. German neurologists and palliative care trainees acquired both demands more commonly. Neurologists quoted a low quality of life, decreased mood, and being a burden to the family/closest ones as primary reasons for a wish to hasten death among PALS. Although the majority expressed a willingness to terminate an LSM at a request of the patient, most opposed the legalization of euthanasia. Younger and less religious individuals were more likely to favor accepting euthanasia.
Neurologists vary significantly in their approaches to terminal care. Complex relationships exist among personal indices, shared beliefs, and current practices.
本文考察了两个欧洲国家的神经科医生针对肌萎缩侧索硬化症患者（PALS）采取的诸如安乐死和医生协助自杀等退出策略（ESs）。
在一项全国性匿名调查中，我们收集了237名波兰神经科医生和228名德国神经科医生的回复，重点关注他们对ESs的做法和信念，以及他们对维持生命措施（LSMs）（经皮内镜下胃造口术、无创和有创通气）的观点。为了分析数据，我们采用了统计方法，包括曼-惠特尼U检验、克鲁斯卡尔-沃利斯检验、卡方检验、斯皮尔曼等级相关分析和多元回归分析。
三分之一的神经科医生会主动与PALS患者讨论ESs。有一半的医生会在患者提出要求时准备好进行这样的谈话。年龄、性别、宗教信仰和国籍与这种做法密切相关。每9名神经科医生中有1人收到过终止LSM的请求，而每10名中有1人收到过实施ES的请求。德国神经科医生和姑息治疗实习生更常收到这两种请求。神经科医生指出，生活质量低下、情绪低落以及成为家人/最亲近的人的负担是PALS患者希望加速死亡的主要原因。尽管大多数人表示愿意应患者要求终止LSM，但大多数人反对安乐死合法化。年轻且宗教信仰较少的人更倾向于接受安乐死。
神经科医生在临终关怀的方法上存在显著差异。个人指标、共同信念和当前做法之间存在复杂的关系。
