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Physicians' labelling of end-of-life practices: a hypothetical case study
H M Buiting1, A van der Heide, B D Onwuteaka-Philipsen
1Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands. h.buiting@erasmusmc.nl
Journal of Medical Ethics
|December 23, 2009
Summary
Physicians label end-of-life acts differently, impacting reporting. Case characteristics like medication and intent influence labeling, affecting willingness to report physician-assisted dying. This inconsistency hinders societal oversight.
Area of Science:
- Medical Ethics
- End-of-Life Care Research
Background:
- Physician labeling of end-of-life acts varies significantly.
- This variation impacts the reporting of these sensitive medical procedures.
Purpose of the Study:
- To investigate physician labeling of end-of-life acts as 'euthanasia/ending of life' versus 'alleviation of symptoms/palliative or terminal sedation'.
- To examine the association between case labeling and the intended reporting of these acts by physicians.
Main Methods:
- A survey was distributed to 2100 Dutch physicians, with a 55% response rate.
- Physicians labeled six hypothetical end-of-life cases varying in medication, intent, patient request, life expectancy, and time to death.
- Multilevel multivariable logistic regression analyzed factors associated with physician labeling.
Main Results:
- Muscle relaxants (99%) and disproportional morphine (63%) strongly predicted 'euthanasia/ending of life' labeling.
- Intent to hasten death (54%) and several months life expectancy (46%) also influenced labeling.
- Physicians were more willing to report acts labeled 'euthanasia' (87%) or 'ending of life' (56%).
Conclusions:
- End-of-life acts are not uniformly labeled by physicians, even in similar cases.
- Physician labeling is strongly linked to their willingness to report the acts.
- Discrepancies in labeling impede societal oversight of end-of-life practices; enhanced education and debate are needed.
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