Facing a request for assisted death - views of Finnish physicians, a mixed method study

Area of Science:

• Medical Ethics
• End-of-Life Care
• Physician Attitudes

Background:

• Assisted death, encompassing euthanasia and physician-assisted suicide (PAS), is a global topic of discussion and practice in Western nations.
• Physicians' perspectives on assisted death differ internationally, yet their actual responses to patient requests remain under-researched, particularly in countries where these practices are illegal.
• A significant knowledge gap exists regarding how physicians manage and react to patient requests for assisted death in legal grey areas.

Purpose of the Study:

• To investigate Finnish physicians' attitudes toward euthanasia and physician-assisted suicide (PAS).
• To explore physicians' actions and ethical considerations when confronted with requests for assisted death in Finland.
• To identify the range of physician responses to assisted death requests in a context where these practices are not legalized.

Main Methods:

• A nationwide survey distributed to all Finnish physicians, including questions on euthanasia and PAS, and an open-ended query about their actions when faced with such requests.
• Quantitative analysis of survey data using frequencies, percentages, and Pearson chi-square tests for statistical significance.
• Qualitative analysis of open-ended responses employing an inductive content analysis approach to identify emergent themes and categories.

Main Results:

• A 26% response rate from 6889 physicians/medical students was achieved.
• One-third of respondents indicated willingness to assist in a patient's suicide, while 69% supported euthanasia for difficult physical symptoms.
• 16% of physicians reported receiving requests for euthanasia or PAS, with qualitative analysis revealing six main response categories: alternatives, care/support, ignoring, refusal, compliance, and viewing as a possibility.

Conclusions:

• Finnish physicians exhibit diverse actions and attitudes concerning requests for assisted death.
• There is a substantial variation in how physicians handle requests for euthanasia and PAS.
• The findings highlight the need for open dialogue, education, and clear recommendations on assisted death ethics, especially in jurisdictions where it is not legally sanctioned.