Kuhse H, Singer P, Baume P, Clark M, Rickard M
Centre for Human Bioethics, Monash University, Clayton, VIC.
Med J Aust. 1997 Feb 17;166(4):191-6.
To estimate the proportion of medical end-of-life decisions in Australia, describe the characteristics of such decisions and compare these data with medical end-of-life decisions in the Netherlands, where euthanasia is openly practised.
Postal survey, conducted between May and July 1996, using a self-administered questionnaire based on the questionnaire used to determine medical end-of-life decisions in the Netherlands in 1995.
A random sample of active medical practitioners from all Australian States and Territories selected from medical disciplines in which there were opportunities to be the attending doctor at non-acute patient deaths, and hence to make medical end-of-life decisions.
Proportion of Australian deaths that involved a medical end-of-life decision, using ratio-to-size estimation based on the sampled doctors' responses to the questionnaire. The response rate was 64%.
The proportion of all Australian deaths that involved a medical end-of-life decision were: euthanasia, 1.8% (including physician-assisted suicide, 0.1%); ending of patient's life without patient's concurrent explicit request, 3.5%; withholding or withdrawing of potentially life-prolonging treatment, 28.6%; alleviation of pain with opioids in doses large enough that there was a probable life-shortening effect, 30.9%. In 30% of all Australian deaths, a medical end-of-life decision was made with the explicit intention of ending the patient's life, of which 4% were in response to a direct request from the patient. Overall, Australia had a higher rate of intentional ending of life without the patient's request than the Netherlands.
Australian law has not prevented doctors from practising euthanasia or making medical end-of-life decisions explicitly intended to hasten the patient's death without the patient's request.
评估澳大利亚医疗临终决策的比例，描述此类决策的特征，并将这些数据与荷兰的医疗临终决策进行比较，荷兰公开实行安乐死。
1996年5月至7月进行的邮政调查，使用基于1995年荷兰用于确定医疗临终决策的问卷的自填式问卷。
从澳大利亚所有州和领地的在职医生中随机抽样，这些医生选自有可能成为非急症患者死亡时的主治医生从而做出医疗临终决策的医学学科。
根据抽样医生对问卷的回答，采用比率估计法计算涉及医疗临终决策的澳大利亚死亡病例的比例。回复率为64%。
澳大利亚所有死亡病例中涉及医疗临终决策的比例为：安乐死，1.8%（包括医生协助自杀，0.1%）；未经患者同时明确请求而结束患者生命，3.5%； withhold或撤回可能延长生命的治疗，28.6%；使用剂量足以产生可能缩短生命效果的阿片类药物缓解疼痛，30.9%。在澳大利亚所有死亡病例的30%中，做出医疗临终决策的明确意图是结束患者生命，其中4%是应患者直接请求做出的。总体而言，澳大利亚未经患者请求而故意结束生命的比例高于荷兰。
澳大利亚法律并未阻止医生实施安乐死或做出明确意图在未经患者请求的情况下加速患者死亡的医疗临终决策。
