CHICAGO—When given all the facts about physician-assisted suicide and such alternatives as hospice care and natural death, Americans by a 5-to-1 margin said they would choose the alternatives if terminally ill, according to a new American Medical Association survey.
Titled End-of-Life Care Survey, the report was released in Chicago Jan. 6, just two days before the U.S. Supreme Court was to hear oral arguments in two widely publicized physician-assisted suicide cases.
“This survey reinforces our belief that, once informed of their available options and rights at the end of life, most patients would opt for comfort care and natural death,” said Dr. Nancy Dickey, chairwoman of the AMAboard, in releasing the study.
“The notion that a terminal or advanced chronic illness is a sentence to a horrible, painful death is simply not true,” noted Dickey, who said the survey highlighted a critical need for public education on the issue.
“Through hospice care, providing adequate pain medication and encouraging advance care planning to clarify patients'wishes for end-of-life care, physicians can offer patients a dignified death with quality, autonomy and value,” she added.
The telephone survey was conducted for the AMA by the Global Strategy Group of New York, which used a random digitdial method to interview 1,000 adults nationwide Dec. 9-11. The survey has a sampling error of plus or minus 3.1 percent.
Before asking certain questions, interviewers read explanations of the terms physician-assisted suicide, euthanasia and hospice care. The survey showed, generally, that 52 percent of Americans approve—and 35 percent disapprove—of “intentionally ending a patient's life in cases of unrelievable suffering or expected suffering from a terminal illness.” The other 13 percent remain undecided.
In this response, there were differences by gender and age. More men—56 percent of them compared to 48 percent of women—said they approve of physician-assisted suicide, while 47 percent of those older than 55 said they disapprove.
However, general support for physician-assisted suicide weakened significantly when respondents were given more information about other end-of-life options and about how euthanasia, including euthanasia not requested, and physicianassisted suicide are practiced in the Netherlands.
For example, after hearing a description of hospice or palliative care, only 13 percent of respondents said they would opt for physician-assisted suicide if terminally ill. Forty percent said they would choose hospice or palliative care and 33 percent would opt for natural death without medical assistance, providing the 5-to-1 margin.
Also, only 13 percent of those surveyed actually knew how physician-assisted suicide currently is practiced in the Netherlands: that it is illegal but not prosecuted if done according to certain standards. The rest either did not know Dutch law or were mistaken about it.
In the Netherlands, assisted suicide and euthanasia are criminal offenses, but a law allows doctors to carry out those activities if they meet criteria established by the government.
When respondents were questioned about a policy—based on Dutch data—“that resulted in physicians openly performing assisted suicide or euthanasia to about 2 percent of all people who die and around 1 percent of people who die were given euthanasia they did not request,” 64 percent said they disapproved of such a policy, while 24 percent approved and 12 percent did not know or did not answer.
Regarding terminology, 83 percent of respondents reported familiarity with the terms physician-assisted suicide and euthanasia, while only 65 percent said they are familiar with the terms hospice or palliative care.
When asked about existing rights, 84 percent of those surveyed said they know U.S. patients can refuse any medical treatment, even treatment to keep them alive. But 43 percent did not know it is legally and medically possible in the United States to give patients medicine to control pain that might unintentionally contribute to their deaths. According to Evangelium Vitae, “… it is licit to relieve pain by narcotics, even when the result is decreased consciousness and a shortening of life, ‘if no other means exist, and if, in the given circumstances, this does not prevent the carrying out of other religious and moral duties’” (65.3).
In evaluating the data, Global Strategy's Jefrey Pollock said, “The average American wants to see the laws we already have for respecting a patient's right to refuse treatment and obtain comfort care used more effectively.”
The AMA, a voluntary organization for physicians, is in the midst of an educational campaign for its members, other health care professionals and patients concerning end-of-life care options.
The Catechism of the Catholic Church states: “Everyone is responsible for his own life before God who has given it to him. It is God who remains the sovereign Master of life. We are obliged to accept life gratefully and preserve it for his honor and the salvation of our souls. We are stewards, not owners, of the life God