Half of doctors choose assisted death over cancer or Alzheimer’s treatment

By Stephen Beech

More than half of doctors would consider assisted dying if they had advanced cancer or Alzheimer’s disease, according to new research.

And most say they would prefer symptom relief rather than life-sustaining treatment for their own end-of-life care, according to the findings of an international survey published by the Journal of Medical Ethics.

Previously published research suggests that doctors’ views on their own end-of-life care inform their clinical practice, and that their perceptions of their patients’ treatment wishes are influenced by their own preferences.

But researchers who conducted the new survey say most previous studies on doctors’ preferences for end-of-life practices are outdated or narrow in focus.

The team polled doctors in eight places with differing laws and attitudes to assisted dying: Belgium, Italy, Canada, the US states of Oregon, Wisconsin and Georgia; and the states of Victoria and Queensland in Australia.

Physician-assisted suicide law entered the statute book in Oregon in 1997, while 'Death with Dignity' legislation has been introduced in Wisconsin numerous times over the past 20 years but remains illegal.

It is also illegal in Georgia, which is one of the most religious states in the US.

In Canada, both physician-assisted suicide and euthanasia have been permitted since 2016.

In Belgium, assisted dying has been legal since 2002, but it remains illegal in Italy, which is one of Europe's most religious nations.

The Australian state of Victoria implemented assisted dying legislation in June 2019.

Assisted dying legislation was passed in Queensland, 2021, but had not yet come into force when the data for the study were collected.

The research team included two hypothetical situations to probe doctors’ views on end-of-life care: advanced cancer and Alzheimer’s.

The participants were asked the extent to which they would consider various end-of-life practices for themselves.

These included CPR, mechanical ventilation, tube feeding, intensified alleviation of symptoms, palliative sedation, the use of available drugs to end life, physician-assisted suicide, and euthanasia.

Responses were sought from family doctors (GPs), palliative care doctors, and other medical specialists highly likely to treat patients at the end of their life, including cardiologists, emergency medicine doctors, oncologists, neurologists, and intensive care specialists.

A total of 1,157 responses were included in the final analysis.

The findings showed that doctors "rarely considered" life-sustaining practices a good option in the case of advanced cancer or Alzheimer’s.

More than 90% considered intensifying symptom relief a "good" or "very good" option.

Doctors who considered palliative sedation for Alzheimer’s disease as a good or very good option ranged from just over 39% in Georgia to over 66% in Italy.

Just over half of the doctors considered euthanasia a good option in cases of advanced cancer and Alzheimer’s.

The proportion of those considering euthanasia a good option in the cancer scenario ranged from 38% in Italy to 81% in Belgium, while in the Alzheimer’s scenario it ranged from 37.5% in Georgia to 67.5% in Belgium.

A third of the doctors surveyed (33.5%) said they would consider drugs at their disposal to end their own lives in the cancer scenario.

Study author Dr. Sarah Mroz, of Ghent University in Belgium, said: "While sex, age, and ethnicity didn’t seem to influence doctors’ preferences for end-of-life practices, prevailing legislation in their jurisdiction did.

"Doctors working in a jurisdiction with a legal option for both euthanasia and physician-assisted suicide were three times as likely to consider euthanasia a good option for cancer and almost twice as likely to consider it a good option for Alzheimer’s disease.

“This may be because these physicians are more familiar and comfortable with the practices and have observed positive clinical outcomes.

"It also suggests that macro-level factors heavily impact personal attitudes and preferences, and physicians are likely influenced by what is considered ‘normal’ practice in their own jurisdiction."

GPs and other specialists were less likely to consider palliative sedation a good or very good option than palliative care doctors, and they were also more likely to consider euthanasia, physician-assisted suicide, and the use of available medication to end their own life a good option.

Doctors who weren’t religious were far more likely to consider physician-assisted suicide or euthanasia a preferable option than those with a strongly held faith, according to the findings.

Dr. Mroz said: “Our findings show that across all jurisdictions, physicians largely prefer intensified alleviation of symptoms and to avoid life-sustaining techniques like CPR, mechanical ventilation, and tube feeding.

“This finding may also relate to the moral distress some physicians feel about the routine continuation of treatment for their patients at the end of life."

She added: "These findings warrant reflection on current clinical practice since life-prolonging treatment is still widely used for patients, yet is not preferred by physicians for themselves.”