The Journal of Medical Ethics has published a new global study that doesn’t just pull the curtain back on how doctors feel about their own end-of-life care. It reveals just how widely those personal preferences vary. Multiple factors figure into that calculus, from geography to local law to their own personal beliefs.
The paper, based on data culled from five countries spread across three continents, reports on physician perspectives on life-extending treatments, palliative care, and assisted dying in a pair of equally tragic scenarios: advanced cancer and Alzheimer’s disease.
Physicians Favor Comfort Over Extreme Measures
The overwhelming majority of the physicians surveyed – more than 90% – expressed a preference for symptom alleviation using medications in end-of-life scenarios. More than 95% would forgo life-sustaining interventions like CPR, mechanical ventilation, and tube feeding.
These findings persist across jurisdictions regardless of local laws and regulations. And they highlight a growing discomfort among doctors over aggressive treatment measures they often oversee in the real world.
The surveyed physicians appeared to be equally unsettled about palliative sedation. In Alzheimer’s disease cases, for example, 39% to 66% of physicians would entertain the idea. Those numbers were a little higher for the cancer hypothetical, with 43% to 82% of the survey respondents giving it serious consideration.
Legal Status Shapes Attitudes on Assisted Dying
The study’s primary revelation is the strong link between a jurisdiction’s legal environment and physician support for assisted suicide. Where euthanasia is legal, in areas such as Belgium, Canada, and Victoria, Australia, 59% to 81% of physicians said they would think about euthanasia for themselves in the advanced cancer situation. Physician support was about the same, though slightly lower, when they faced the Alzheimer’s case.
Even in Queensland, Australia, where lawmakers legalized euthanasia (but before it went into effect), half the physicians supported euthanasia in both scenarios.
These results, the authors argue, suggest that when assisted dying is legal (and morally accepted), physicians are more willing to embrace it for themselves. This shift probably stems from greater exposure, familiarity, and comfort with the practice, as well as seeing firsthand how it helps patients.
On the other hand, in jurisdictions where the practice remains illegal or tightly regulated, support fell off dramatically.
Practice Type (and Faith) Matter
Physician backgrounds also played a role. For example, palliative care physicians supported palliative sedation more often than euthanasia. General practitioners – who typically serve as the primary providers of assisted dying where it’s legal – showed higher levels of support for euthanasia.
Faith also emerged as a major factor. Physicians with stronger religious beliefs appeared less likely to support assisted dying, which underscore the ethical conflict between personal convictions and professional obligations.
Notably, other factors – such as age, gender, and ethnicity – seemed to exert little influence.
Ethical Bedside Dilemmas
While many physicians professed clear preferences for their own care, applying these preferences to the care of their patients raised more than a few ethical questions. Should a physician’s personal beliefs influence how they guide end-of-life discussions? Patients usually seek out their doctor’s opinion during making such decisions. But many doctors hesitate to share their views for fear of tipping the scales on what they see as the patient’s decision.
But research has (repeatedly) shown that some patients want to know what their doctor would do in a similar situation. This, the authors contend, points to the need for doctors to maintain a careful balance between professional neutrality and empathetic transparency.
In some places, such as Victoria and South Australia, legal restrictions prevent physicians from even initiating conversations about assisted dying with their patients. It’s obviously meant to protect patients. But, such policies also limit access to comprehensive end-of-life options and contribute to inequities in care.
A Call for Thoughtful Dialogue
The Alzheimer’s scenario that the researchers presented exposed something else: a lot of doctors would consider euthanasia for themselves. And this is despite the disease’s progressive nature, which can make informed consent problematic. This highlights the need for a longer conversation around assisted dying in cases involving cognitive decline, where competency is compromised and laws often erect barriers to such interventions.
Ultimately, the study reminds us of the significant ethical, legal, and emotional challenges physicians face in navigating end-of-life care – both for themselves and their patients. It reveals a robust consensus around avoiding life-prolonging treatments, broad variability in attitudes toward assisted dying, and a complicated relationship between personal beliefs, professional roles, and a shifting legal landscape.
Further Reading
Working With Decisionally Capable Patients Who Are Determined to End Their Own Lives
