Nephrologists'subjective attitudes towards end-of-life issues and the conduct of terminal care.
Decisions which determine the duration and outcome of terminal care should be influenced by patient autonomy.
Studies suggest, however, that end-of-life decision-making is more complex than a single principle and that physicians may be responsible for selected aspects of terminal care independent of patient choice.
To study how nephrologists'perceptions toward end-of-life issues may affect decision-making, we anonymously surveyed 125 of them.
The study employed the straightforward terminology of « hastening death » rather than adopting the ambiguous term « euthanasia » or the narrow term « assisted suicide. » Subjective physician profiles demonstrated that nephrologists who are less comfortable with dying patients were significantly less likely to report that they omitted life-prolonging measures (p=0.02) and more likely to report that they would not initiate measures in order to hasten death even were it legal (p=0.04).
Ninety-eight percent of nephrologists reported omissions in terminal care with patient knowledge and 80% without patient knowledge.
In contrast, forty-three percent of the nephrologists said that were it to become legal to initiate measures in order to hasten death, they would « never » do so.
The ethical framework utilized for discontinuation of dialysis decisions incorporated medical benefit (cancer as criterion, 48% ; multisystem complications, 84% ; dementia 79%) and quality of life criteria. (...)
Mots-clés Pascal : Maladie, Stade terminal, Critère décision, Arrêt traitement, Dialyse péritonéale, Indication, Euthanasie, Suicide, Assistance technique, Enquête opinion, Médecin, Ethique, Homme, Epuration extrarénale
Mots-clés Pascal anglais : Disease, Terminal stage, Decision criterion, Withdrawal, Peritoneal dialysis, Indication, Euthanasia, Suicide, Technical assistance, Opinion inquiry, Physician, Ethics, Human, Extrarenal dialysis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0472055
Code Inist : 002B30A09. Création : 03/02/1998.