Back A L, Wallace J I, Starks H E, Pearlman R A
Medical Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA.
JAMA. 1996 Mar 27;275(12):919-25.
To estimate how often physicians receive requests for physician-assisted suicide and euthanasia and to describe a case series of patient requests for physician-assisted suicide and euthanasia, including physician responses to these requests.
A mailed, anonymous two-part questionnaire.
A total of 828 physicians returned questionnaires sent to 1453 potential respondents, for a response rate of 57%. Questionnaires were mailed to random sample (25%) of primary care physicians and all physicians in selected medical subspecialties in Washington State.
The frequency of explicit patient requests for physician-assisted suicide and euthanasia reported by physicians and individual case descriptions of patient characteristics, physician perceptions of patient concerns, and physician responses to patient requests.
In the past year, 12% of responding physicians received one or more explicit requests for physician-assisted suicide, and 4% received one or more requests for euthanasia. These physicians provided 207 cases descriptions. The diagnoses most often associated with requests were cancer, neurological disease, and the acquired immunodeficiency syndrome (AIDS). The patient concerns most often perceived by physicians were worries about loss of control, being a burden, being dependent on others for personal care, and loss of dignity. Physicians provided assistance more often to patients with physical symptoms. Physicians infrequently sought advice from colleagues. Of 156 patients who requested physician-assisted suicide, 38 (24%) received prescriptions, and 21 of these died as a result. Of 58 patients who requested euthanasia, 14 (24%) received parenteral medication and died.
Patient request for physician-assisted suicide and euthanasia are not rare. As perceived by physicians, the most common patient concerns at the time these requests are made are nonphysical. Physicians occasionally provide these practices, even though they are currently illegal in Washington State. Physicians do not consult colleagues often about these requests. These findings raise the question of how to ensure quality in the evaluation of patient requests for physician-assisted death.
评估医生收到医生协助自杀和安乐死请求的频率，并描述一系列患者请求医生协助自杀和安乐死的案例，包括医生对这些请求的回应。
一份邮寄的、匿名的两部分问卷。
总共828名医生回复了寄给1453名潜在受访者的问卷，回复率为57%。问卷被邮寄给华盛顿州初级保健医生的随机样本（25%）以及选定医学亚专业的所有医生。
医生报告的患者明确请求医生协助自杀和安乐死的频率，以及患者特征、医生对患者担忧的看法和医生对患者请求的回应的个体案例描述。
在过去一年中，12%的回复医生收到了一个或多个明确的医生协助自杀请求，4%的医生收到了一个或多个安乐死请求。这些医生提供了207个案例描述。与请求最常相关的诊断是癌症、神经系统疾病和获得性免疫缺陷综合征（艾滋病）。医生最常察觉到的患者担忧是担心失去控制、成为负担、在个人护理上依赖他人以及失去尊严。医生更常向有身体症状的患者提供帮助。医生很少向同事寻求建议。在156名请求医生协助自杀的患者中，38人（24%）获得了处方，其中21人因此死亡。在58名请求安乐死的患者中，14人（24%）接受了注射药物并死亡。
患者请求医生协助自杀和安乐死并不罕见。正如医生所察觉到的，在提出这些请求时，患者最常见的担忧是非身体方面的。尽管目前在华盛顿州这些行为是非法的，但医生偶尔仍会提供这些帮助。医生在这些请求上不常咨询同事。这些发现提出了如何确保对患者请求医生协助死亡进行评估的质量的问题。
