Doctors' Intentions To Hasten Death
A study of surgeons in Australia has found that over a third of the group surveyed reported giving drugs with an intention to hasten the death of terminally ill patients.
The survey, which was conducted by the University of Newcastle and the Hunter Centre for Health Advancement, in New South Wales, between August and November 1999, involved 992 surgeons, of whom 683 returned questionnaires.
The survey results - presented by Dr Charles Douglas, Dr Ian Kerridge, Mr John McPhee,
Dr Lynne Hancock and Professor Allan Spigelman, from the University of Newcastle, and
Dr Katherine Rainbird, Hunter Centre for Health Advancement - are published in the latest issue of the Medical Journal of Australia.
Dr Douglas said the objective of the study was to conduct a survey of attitudes to and practices of assisted death, using questions that were explicit about the doctor's intention.
For the purpose of relieving a patient's suffering, 247 respondents (36%) reported that they had given drugs in doses that they perceived to be greater than those required to relieve symptoms with the intention of hastening death. More than half of these (20% of all respondents) reported that they had never received an unambiguous request for a lethal dose of medication. Only 36 respondents (5%) reported that they had given a bolus lethal injection, or had provided the means to commit suicide, in response to an unambiguous request.
The only country that has openly allowed medically assisted death for an extended period is the Netherlands, where 3.4% of all deaths are reported to be (intentional) medically assisted deaths.
Outside of the Netherlands, few studies have broadened the question of assisted death to include instances where there has been no explicit request.
"Our main question on experience with assisted death was deliberately written to include the use of infusions of drugs, with or without a request.
"At least 20% of our entire sample appears to have given drugs with the intention of hastening death in the absence of an explicit request, similar to the 23% of Dutch doctors who report performing 'life-terminating acts without explicit request'," Dr Douglas said.
Dr Douglas said that some doctors are prepared to hasten death by infusion (a continuous flow of drugs over several hours or days), but not by bolus (a single, high dose injection) and that this was confirmed by the comments that some respondents volunteered.
"Surgeons who said that they had given drugs with an intention to hasten death may in many cases have used an infusion of pain-killers or sedatives, making it difficult to distinguish their actions from accepted palliative care, except on the basis of their self-reported intention. Legal and moral distinctions based solely on a doctor's intention are problematic," Dr Douglas concludes.