Refolo Pietro, Raimondi Costanza, Masilla Salvatore Simone, Argo Antonina, Capulli Emma, Ceruti Silvia, Gonella Silvia, Ingravallo Francesca, Miccinesi Guido, Picozzi Mario, Redaelli Pietro, Spagnolo Antonio Gioacchino
Research Center for Clinical Bioethics and Medical Humanities, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Department of Healthcare Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
BMC Med Ethics. 2025 May 9;26(1):60. doi: 10.1186/s12910-025-01219-z.
End-of-life (EoL) decisions represent some of the most ethically complex and emotionally charged aspects of healthcare. Understanding the attitudes of physicians, nurses, and the public toward EoL decisions is crucial for aligning care provided with the personal values and preferences of patients.
To explore the attitudes of physicians, nurses, and the general public toward EoL decisions, including the withdrawal or withholding of life-sustaining treatments, euthanasia, physician-assisted suicide (PAS), palliative sedation, and advance care planning (ACP) within European countries.
An umbrella review was conducted, covering the period from January 2010 to June 2024. The search strategy included Medline, CINAHL, and PsycINFO, supplemented by manual searches of reference lists of all included studies to identify additional relevant studies.
The search identified 587 papers, 11 of which were included in the synthesis. Of these, six addressed euthanasia and PAS, three focused on ACP, one on the withdrawal of life-sustaining treatments, and one on palliative sedation. In Europe, the general public expressed the highest level of support for EoL practices such as euthanasia and PAS, followed by nurses, while physicians often held a more cautious perspective. For withdrawal of treatment, palliative sedation, and ACP, a critical recurring theme was the need to improve communication between patients and healthcare professionals.
The divergence underscores the intricate complexity of navigating ethical, cultural, and professional considerations in EoL care. Effective communication serves as a cornerstone for respecting patient autonomy and ensuring that healthcare decisions align with individual values, goals and preferences.
临终决策是医疗保健中一些伦理上最复杂且情感上最具冲击力的方面。了解医生、护士和公众对临终决策的态度对于使所提供的护理与患者的个人价值观和偏好相一致至关重要。
探讨欧洲国家的医生、护士和普通公众对临终决策的态度，包括撤销或停止维持生命的治疗、安乐死、医生协助自杀（PAS）、姑息性镇静和预先护理计划（ACP）。
进行了一项综合综述，涵盖2010年1月至2024年6月期间。检索策略包括Medline、CINAHL和PsycINFO，并通过人工检索所有纳入研究的参考文献列表以识别其他相关研究进行补充。
检索到587篇论文，其中11篇纳入了综述。其中，6篇涉及安乐死和医生协助自杀，3篇关注预先护理计划，1篇关注撤销维持生命的治疗，1篇关注姑息性镇静。在欧洲，普通公众对安乐死和医生协助自杀等临终实践表达了最高水平的支持，其次是护士，而医生通常持更谨慎的观点。对于停止治疗、姑息性镇静和预先护理计划，一个反复出现的关键主题是需要改善患者与医疗保健专业人员之间的沟通。
这种差异凸显了在临终护理中应对伦理、文化和专业考量的错综复杂的复杂性。有效的沟通是尊重患者自主权并确保医疗保健决策与个人价值观、目标和偏好相一致的基石。
