Special Article
Attitudes toward Assisted Suicide and Euthanasia among Physicians in Washington State
N Engl J Med 1994; 331:89-94July 14, 1994
- Abstract
Background
Despite considerable public interest in legalizing physician-assisted suicide and euthanasia, little is known about physicians' attitudes toward these practices.
Methods
We sent questionnaires to 1355 randomly selected physicians in the state of Washington, including all hematologists and oncologists and a disproportionately high number of internists, family practitioners, psychiatrists, and general surgeons. To avoid ambiguity in our survey, instead of “physician-assisted suicide,” we used the phrase “prescription of medication [e.g., narcotics or barbiturates] or the counseling of an ill patient so he or she may use an overdose to end his or her own life.” Instead of “euthanasia,” we used the phrase “deliberate administration of an overdose of medication to an ill patient at his or her request with the primary intent to end his or her life.”
Results
Of the 1355 eligible physicians who received our questionnaire, 938 (69 percent) responded. Forty-eight percent of the respondents agreed with the statement that euthanasia is never ethically justified, and 42 percent disagreed. Fifty-four percent thought euthanasia should be legal in some situations, but only 33 percent stated that they would be willing to perform euthanasia. Thirty-nine percent of respondents agreed with the statement that physician-assisted suicide is never ethically justified, and 50 percent disagreed. Fifty-three percent thought assisted suicide should be legal in some situations, but only 40 percent stated that they would be willing to assist a patient in committing suicide. Of the groups surveyed, hematologists and oncologists were most likely to oppose euthanasia and assisted suicide, and psychiatrists were most likely to support these practices.
Conclusions
The attitudes toward physician-assisted suicide and euthanasia of physicians in Washington State are polarized. A slight majority favors legalizing physician-assisted suicide and euthanasia in at least some situations, but most would be unwilling to participate in these practices themselves.
Media in This Article
Figure 1
Physicians' Responses to Six Statements Expressing Attitudes toward Assisted Suicide and Euthanasia.Figure 2
Physicians' Responses to Six Statements Expressing Attitudes toward Assisted Suicide and Euthanasia, According to Medical Specialty.Article Activity
- Article
There is considerable public interest in the legalization of physician-assisted suicide and euthanasia1. By a margin of 54 to 46 percent, voters in Washington defeated Initiative 119, which would have legalized assisted suicide and euthanasia, in 1991. In 1992, voters in California defeated Proposition 161, a similar initiative, by the same margin. A Michigan law that forbids assisted suicide is currently under court challenge2. Several organizations strongly support physician-assisted suicide and euthanasia, and efforts to legalize these practices are likely to continue.
The debate on these issues among professionals and academic physicians has been contentious,3-12 and specific proposals for permitting assisted suicide or euthanasia have provoked controversy13-15. Despite extensive discussion, relatively little is known about the opinions of physicians on this subject. The available surveys of physicians concerning assisted suicide and euthanasia have been hampered by small samples,16-19 low response rates,16,19-22 limited generalizability,16,17,19,21,22 ambiguous terminology,17,19-22 and insufficiently detailed questions16,19,20,22. Most surveys have dealt with several ethical issues related to terminal care instead of focusing on assisted suicide and euthanasia. Few surveys have examined the beliefs underlying stated opinions or explored preferences for specific restrictions and safeguards.
We conducted a population-based survey of attitudes toward assisted suicide and euthanasia among randomly selected physicians practicing in Washington State. The study was designed to determine whether physicians believe assisted suicide and euthanasia are ethical, whether they believe either or both should be legalized, and whether physicians are willing to participate in these practices personally. We also investigated the reasons for physicians' positions and their views about the safeguards necessary in possible legislation permitting these practices.
Methods
Respondents
We selected potential respondents from a Washington State Medical Association data base that includes both members of the organization (62 percent) and nonmembers (38 percent) and that incorporates data supplied by the Washington State Division of Licensing, the American Medical Association, county medical societies, insurance companies, hospitals, and clinics. We excluded retired physicians, trainees, and physicians practicing outside the state. We randomly selected 250 physicians from each of the following fields: general internal medicine, family practice, general surgery, psychiatry, and a combination of all the other specialties except hematology and oncology, for a total of 1250 physicians. We also included 166 hematologists and oncologists: 98 from the medical-society data base and 68 from address lists of the American Society of Hematology, the American Society of Clinical Oncology, and the University of Washington faculty. The final sample thus totaled 1416 physicians.
Questionnaire
Our questionnaire was based on earlier surveys,19-22 discussions of issues in the literature,3-9 interviews with leading proponents and opponents of legalized assisted suicide and euthanasia in Washington, and extensive pilot testing. The survey consisted of 48 questions about the characteristics of the respondents, their attitudes toward assisted suicide and euthanasia, their opinions of possible legalization related to these practices, their willingness to participate in assisted suicide or euthanasia, the reasons for their positions, and their views about safeguards or restrictions that might be part of any legislation governing assisted suicide or euthanasia. Membership in the Washington State Medical Association was not ascertained. Responses were given in the form of ratings, on a five-point scale, of the degree of agreement with a variety of statements, ranging from “strongly agree” to “strongly disagree.” For clarity, we collapsed the responses into three categories: strongly agree or agree, neutral, and disagree or strongly disagree.
To avoid ambiguity, we did not use the terms “assisted suicide” and “euthanasia” in the survey. Instead of “physician-assisted suicide,” we used the following phrase: “prescription of medication [e.g., narcotics or barbiturates] or the counseling of an ill patient so he or she may use an overdose to end his or her own life.” Instead of “euthanasia,” we used the phrase “deliberate administration of an overdose of medication to an ill patient at his or her request with the primary intent to end his or her life.” Although other actions may arguably be considered assisted suicide or euthanasia, these descriptions provide a clear indication of intent and action, reflect the consensus of experts in the field, and are consistent with the definitions proposed by the American Medical Association23 and the American College of Physicians24. For simplicity, we have used the terms “assisted suicide” and “euthanasia” in reporting our findings.
We mailed questionnaires to the physicians in the sample in December 1992. Although the survey was anonymous, return envelopes were coded to permit the identification of nonrespondents, to whom we sent additional surveys in February 1993 and again in March 1993. (Copies of the questionnaires are available from the authors.) To measure potential response bias, we randomly selected a 10 percent subsample of the physicians who had not responded by March 1993, mailed them an anonymous questionnaire containing 12 items from the initial survey, and telephoned them to encourage them to respond. Because the responses in the survey were anonymous, the study was exempt from review by the University of Washington Human Subjects Committee.
Statistical Analysis
For each item, we computed the frequency or mean response, with 95 percent confidence intervals,25 and compared means between subgroups using the unpaired-samples t-test25. To adjust for the oversampling of some specialties, we performed a weighted analysis to reflect the actual distribution of specialists among physicians in Washington State. The results of the weighted analysis were nearly identical to those obtained with unadjusted data. Only the unadjusted results are therefore presented.
We used logistic regression to assess the independent effects of specialty, age, sex, and practice characteristics (the independent variables) on attitudes toward assisted suicide and euthanasia (the dependent variables)26 and estimated odds ratios for each independent variable. For comparisons between specialties, general internal medicine was used as the reference category. All P values are two-tailed.
To determine which medical conditions were considered by physicians to create a situation in which euthanasia or assisted suicide might be appropriate, we analyzed separately the replies of physicians who believed that both euthanasia and assisted suicide are sometimes ethical. To investigate which specific safeguards and restrictions physicians considered important, we analyzed separately the responses of physicians who supported legalizing both euthanasia and assisted suicide.
Results
Of the 1416 physicians surveyed, 61 were found to be ineligible because of address changes or retirement. Of the remaining 1355 physicians, 938 (69 percent) completed surveys. The characteristics of the respondents are shown in Table 1Table 1
Characteristics of the 938 Respondents to the Survey.. The differing proportions of respondents in the various specialties reflect the composition of our sample and the varying response rates. Women represented a higher proportion of the responding internists (30 percent) and family practitioners (25 percent) than of the hematologists or oncologists (16 percent) or surgeons (5 percent). The mean number of terminally ill patients seen in the previous month was 7; this figure ranged from 2 for psychiatrists to 28 for hematologists and oncologists. Forty-two percent of the respondents were affiliated with a student, residency, or fellowship training program (range, 33 percent for family practitioners to 64 percent for hematologists and oncologists).Attitudes toward Assisted Suicide and Euthanasia
Forty-eight percent of respondents said they agreed with the statement that euthanasia is never ethically justified, and 42 percent disagreed (Figure 1Figure 1
Physicians' Responses to Six Statements Expressing Attitudes toward Assisted Suicide and Euthanasia.). Fifty-four percent thought euthanasia should be legal in some situations, but only 33 percent stated that they would be willing to perform euthanasia themselves. There was slightly more support for physician-assisted suicide. Thirty-nine percent of respondents agreed with the statement that assisted suicide is never ethically justified, and 50 percent disagreed. Fifty-three percent thought assisted suicide should be legal in some situations, but only 40 percent stated that they would be willing to assist a patient in committing suicide.Differences among Groups of Physicians
Attitudes toward assisted suicide and euthanasia varied significantly among the specialties (Figure 2Figure 2
Physicians' Responses to Six Statements Expressing Attitudes toward Assisted Suicide and Euthanasia, According to Medical Specialty.). Of the groups surveyed, psychiatrists were most supportive of these two practices, and hematologists and oncologists were least supportive. These differences in attitudes persisted after logistic-regression models were used to adjust for potential confounding by sex and affiliation with a training program.Physicians affiliated with a training program were less likely than those who were not so affiliated to view euthanasia as unethical (odds ratio, 0.74; 95 percent confidence interval, 0.6 to 1.0; P = 0.04) or to view assisted suicide as unethical (odds ratio, 0.72; 95 percent confidence interval, 0.5 to 1.0; P = 0.03); they were more willing to perform euthanasia themselves (odds ratio, 1.4; 95 percent confidence interval, 1.0 to 1.9; P = 0.03) and assist in suicide (odds ratio, 1.5; 95 percent confidence interval, 1.1 to 2.0; P = 0.009). Men were more likely than women to regard assisted suicide as unethical (odds ratio, 1.7; 95 percent confidence interval, 1.1 to 2.4; P = 0.01). There was no significant difference between the sexes about the ethics of euthanasia (data not shown).
Reasons for Attitudes toward Assisted Suicide and Euthanasia
We analyzed the reasons physicians gave for their attitudes by grouping respondents with similar positions on euthanasia and assisted suicide and excluding those who either felt differently about the two forms of physician-assisted dying or were neutral toward either. Fifty-six percent of the 318 respondents who agreed that euthanasia and assisted suicide are never ethically justified stated that they were influenced by religious beliefs, as compared with 15 percent of the 343 respondents who disagreed with those statements. Seventy-four percent of those who opposed euthanasia and assisted suicide considered these practices inconsistent with the physician's role in relieving pain and suffering. In contrast, 91 percent of those who believed the practices to be ethical considered them consistent with the physician's role. Eighty percent of those who opposed euthanasia and assisted suicide cited the potential for abuse. Thirty-two percent of those who considered the practices unethical believed that currently available treatments may be inadequate to eliminate pain and suffering, as compared with 80 percent of those who believed that these practices are ethical. Ninety-seven percent of those who supported assisted suicide and euthanasia said that patients' right to self-determination should be respected, and 91 percent said that the availability of assisted suicide and euthanasia might reduce patients' fears of losing control or of a painful death.
Situations in Which Euthanasia or Assisted Suicide May Be Appropriate
Among the 343 physicians who believed that both euthanasia and assisted suicide are sometimes ethical, 88 percent thought that a poor quality of life, despite adequate pain control, might be sufficient justification for these practices; paradoxically, 51 percent thought that a patient's pain should be beyond control in order to justify euthanasia or assisted suicide, and 64 percent believed that a patient's life expectancy should be less than six months. Thirty-one percent agreed with the statement that if a “patient has a good quality of life at present, but has an illness which will cause severe mental and/or physical deterioration in the future, fatal overdose may still be appropriate.” Twenty-one percent agreed that euthanasia or assisted suicide may be appropriate if external factors (such as not wanting to burden the family or not wanting to deplete savings) led to the patient's request, despite adequate pain control and quality of life.
Restrictions and Safeguards
Among the 432 physicians who favored the legalization of both assisted suicide and euthanasia, the safeguard supported most strongly was the requirement that the patient's request be witnessed by an independent person who would not benefit from the patient's death (Table 2Table 2
Responses to Statements about Legal Restrictions and Safeguards among 432 Respondents Who Supported the Legalization of Assisted Suicide and Euthanasia.). Other favored safeguards included confirming the patient's mental competence, requiring that two physicians agree with the decision, and requiring that the physician administering or prescribing a fatal overdose have an established relationship with the patient.Survey of Nonrespondents
Of 40 physicians who did not respond to the initial questionnaire whom we surveyed after March 1993, 29 responded; 2 others had moved out of state, and 1 had retired. The attitudes of the nonrespondents, as measured by the briefer questionnaire, did not differ significantly from those obtained in the initial survey.
Discussion
Physicians in Washington have sharply polarized attitudes toward assisted suicide and euthanasia, which mirror the sharp divisions among voters in Washington and California. Only about 10 percent of physicians stated that they were neutral on the questions of euthanasia and assisted suicide. Only a minority of physicians expressed a willingness to participate in assisted suicide or euthanasia or believed these practices to be ethical. A slight majority, however, favored their legalization. In general, attitudes toward physician-assisted suicide were more favorable than those toward euthanasia, although the percentages of physicians favoring legalization of the two practices were similar.
There were wide variations in the responses according to specialty, sex, and affiliation with a training program. These variations could not be attributed to age, contact with terminally ill patients, or other practice characteristics. Hematologists and oncologists had the most exposure to terminally ill patients and were also the strongest opponents of euthanasia and assisted suicide. Psychiatrists, who had the least contact with terminally ill patients, were the strongest proponents of the two practices. One explanation for these findings may be that many hematologists and oncologists believe that more effective use of available treatments to relieve pain and suffering would obviate the need for euthanasia and assisted suicide. Further study of these issues is needed to clarify these divergent views.
Our study has several strengths. To enhance its validity, we used terminology in the questionnaire that was unlikely to be ambiguous, and we focused exclusively on assisted suicide and euthanasia. To enhance the generalizability of our findings, we randomly sampled a wide cross section of physicians in a variety of medical specialties, practice settings, and geographic locations. In addition, public debate about the ballot initiative in Washington that would legalize euthanasia and assisted suicide has presumably made physicians in the state better informed than average about the issues, perhaps with the results that their responses are more thoughtful than might be the case elsewhere27. The rate of response to our survey (69 percent) was relatively high. Moreover, in a small survey of physicians who did not complete the initial questionnaire we did not find evidence of a response bias.
Our study also has several limitations. First, the results of a survey of physicians in Washington may not be applicable to other regions of the country. Second, the Washington State Medical Association opposed Initiative 119, which would have legalized euthanasia and assisted suicide, and sent a newsletter outlining these views to its members, who make up 75 percent of the licensed physicians in the state. The views of the medical association may have influenced the attitudes of respondents. We did not ask respondents whether they were members of the association or whether the association's position had influenced their views. Finally, the fixed-response format of the questionnaire may have limited the amount of information obtained and the level of detail in the responses.
The results of this study have important implications for patients, physicians, and policy makers. The polarized attitudes of physicians will make it difficult to formulate and implement laws and policies concerning assisted suicide and euthanasia. Despite the lack of consensus on these issues, a substantial number of physicians believe that currently available treatments may be inadequate to eliminate pain and suffering for terminally ill patients and were dissatisfied with their legal options. To receive support from a large number of physicians, legislation permitting assisted suicide or euthanasia would have to contain ample safeguards. There was strong support among our respondents for previously proposed safeguards for physician-assisted suicide,14 which include the restriction of such suicides to mentally competent, terminally ill patients with a poor quality of life; the required exhaustion of all other reasonable treatment options; and the requirement that there be an established relationship between physician and patient.
The wide public interest in assisted suicide and euthanasia indicates clearly that physicians should work to improve the care of terminally ill patients. These efforts should include better communication with patients, maximal use of advance directives, effective control of pain and other symptoms, and development of hospices and similar programs for terminally ill patients28. Whether assisted suicide and euthanasia have a role in the care of such patients remains an issue for further debate.
Supported by the Northwest Health Services Research and Development Field Program, Department of Veterans Affairs Medical Center, Seattle.
Source Information
From the Section of General Internal Medicine, Minneapolis Veterans Affairs Medical Center and University of Minnesota, Minneapolis (J.S.C.); the Division of General Medicine, Seattle Veterans Affairs Medical Center and University of Washington, Seattle (S.D.F., E.J.B.); and the Departments of Medical History and Ethics (A.R.J.) and Medicine (R.W.W.), University of Washington, Seattle.
Address reprint requests to Dr. Cohen at the Minneapolis Veterans Affairs Medical Center, 1 Veterans Dr., Minneapolis, MN 55417.
- References
References
1
Blendon RJ ,Szalay US ,Knox RA . Should physicians aid their patients in dying? The public perspective. JAMA 1992;267:2658-2662
CrossRef | Web of Science | Medline2
Supreme Court will hear assisted suicide cases. Detroit Free Press. June 7, 1994:6B.
3
Battin M . Voluntary euthanasia and the risks of abuse: can we learn anything from the Netherlands? Law Med Health Care 1992;20:133-143
Medline4
Cassel CK ,Meier DE . Morals and moralism in the debate over euthanasia and assisted suicide. N Engl J Med 1990;323:750-752
Full Text | Web of Science | Medline5
Hendin H ,Klerman G . Physician-assisted suicide: the dangers of legalization. Am J Psychiatry 1993;150:143-145
Web of Science | Medline6
Misbin RI . Physicians' aid in dying. N Engl J Med 1991;325:1307-1311
Full Text | Web of Science | Medline7
Singer PA ,Siegler M . Euthanasia -- a critique. N Engl J Med 1990;322:1881-1883
Full Text | Web of Science | Medline8
Wanzer SH ,Federman DD ,Adelstein SJ , et al. The physician's responsibility toward hopelessly ill patients: a second look. N Engl J Med 1989;320:844-849
Full Text | Web of Science | Medline9
Weir RF . The morality of physician-assisted suicide. Law Med Health Care 1992;20:116-126
Medline10
CeloCruz MT . Aid-in-dying: should we decriminalize physician-assisted suicide and physician-committed euthanasia? Am J Law Med 1992;18:369-394
Web of Science | Medline11
Kamisar Y . Are laws against assisted suicide unconstitutional? Hastings Cent Rep 1993;23:32-41
Web of Science | Medline12
Annas GJ . Physician-assisted suicide -- Michigan's temporary solution. N Engl J Med 1993;328:1573-1576
Full Text | Web of Science | Medline13
Benrubi GI . Euthanasia -- the need for procedural safeguards. N Engl J Med 1992;326:197-199
Full Text | Web of Science | Medline14
Quill TE ,Cassel CK ,Meier DE . Care of the hopelessly ill: proposed clinical criteria for physician-assisted suicide. N Engl J Med 1992;327:1380-1384
Full Text | Web of Science | Medline15
Brody H . Assisted death -- a compassionate response to a medical failure. N Engl J Med 1992;327:1384-1388
Full Text | Web of Science | Medline16
Crosby C. Internists grapple with how they should respond to requests for aid in dying. The Internist. March 1992:16.
17
Caralis PV ,Hammond JS . Attitudes of medical students, housestaff, and faculty physicians toward euthanasia and termination of life-sustaining treatment. Crit Care Med 1992;20:683-690
CrossRef | Web of Science | Medline18
Fried TR ,Stein MD ,O'Sullivan PS ,Brock DW ,Novack DH . Limits of patient autonomy: physician attitudes and practices regarding life-sustaining treatments and euthanasia. Arch Intern Med 1993;153:722-728
CrossRef | Web of Science | Medline19
Overmeyer M. National survey: physicians' views on the right to die. Physician's Manage 1991;31:40-60.
20
The Center for Health Ethics and Policy. Withholding and withdrawing life-sustaining treatment: a survey of opinions and experiences of Colorado physicians. Denver: University of Colorado at Denver Graduate School of Public Affairs, 1988.
21
Heilig S . The SFMS euthanasia survey: results and analyses. San Francisco Med 1988;61:24-6, 3422
Washington State Medical Association. Informal survey of WSMA members on `death with dignity' initiative complete. WSMA Leadership Memo. March 14, 1991.
23
American Medical Association, Council on Ethical and Judicial Affairs
CrossRef | Web of Science24
American College of Physicians ethics manual
Web of Science | Medline25
Snedecor GW, Cochran WG. Statistical methods. 7th ed. Ames: Iowa State University Press, 1980:93-5, 121.
26
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research: principles and quantitative methods. Belmont, Calif.: Lifetime Learning, 1982:419, 491.
27
Converse PE. The nature of belief systems in mass publics. In: Apter DE, ed. Ideology and discontent. New York: Free Press, 1964:206-61.
28
Quill TE . Doctor, I want to die. Will you help me? JAMA 1993;270:870-873
CrossRef | Web of Science | Medline
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1
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C. Catania, V. Zagonel, V. Fosser, N. La Verde, O. Bertetto, C. Iacono, M. Venturini, D. Radice, L. Adamoli, F. Boccardo. (2008) Opinions concerning euthanasia, life-sustaining treatment and acceleration of death: results of an Italian Association of Medical Oncology (AIOM) survey. Annals of Oncology 19:11, 1947-1954
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Theresa A. Harvath, Lois L. Miller, Kathryn A. Smith, Lisa D. Clark, Ann Jackson, Linda Ganzini. (2006) Dilemmas Encountered by Hospice Workers When Patients Wish to Hasten Death. Journal of Hospice & Palliative Nursing 8:4, 200-209
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George E Dickinson, David Clark, Michelle Winslow, Rachael Marples. (2005) US physicians' attitudes concerning euthanasia and physician-assisted death: A systematic literature review. Mortality 10:1, 43-52
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M.K. Ben Diane, A. Galinier, H. Pegliasco, J.M. Lapiana, Roger Favre, Patrick Peretti-Watel, Yolande Obadia, Yolande Obadia. (2005) Deux points de vue des médecins sur les soins palliatifs. Santé Publique 17:1, 75
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Nathalie Teisseyre, Etienne Mullet, Paul Clay Sorum. (2005) Under what conditions is euthanasia acceptable to lay people and health professionals?. Social Science & Medicine 60:2, 357-368
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Johanna H Groenewoud, Agnes van der Heide, Alfons J Tholen, W.Joost Schudel, Michiel W Hengeveld, Bregje D Onwuteaka-Philipsen, Paul J van der Maas, Gerrit van der Wal. (2004) Psychiatric consultation with regard to requests for euthanasia or physician-assisted suicide. General Hospital Psychiatry 26:4, 323-330
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Douglas Essinger. (2003) Attitudes of Tennessee Physicians toward Euthanasia and Assisted Death. Southern Medical Journal 96:5, 427-435
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Ellen L. Csikai, Ameda A. Manetta. (2003) Preventing Unnecessary Deaths Among Older Adults. Journal of Gerontological Social Work 38:3, 85-97
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George E. Dickinson, Carol J. Lancaster, David Clark, Sam H. Ahmedzai, William Noble. (2002) U.K. PHYSICIANS'ATTITUDES TOWARD ACTIVE VOLUNTARY EUTHANASIA AND PHYSICIAN-ASSISTED SUICIDE. Death Studies 26:6, 479-490
CrossRef19
Frank J. Brescia. (2001) Lung cancer — a philosophical, ethical, and personal perspective. Critical Reviews in Oncology/Hematology 40:2, 139-148
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Teddy D Warner, Laura Weiss Roberts, Megan Smithpeter, Melinda Rogers, Brian Roberts, Teresita McCarty, Gregory Franchini, Cynthia Geppert, S.Scott Obenshain. (2001) Uncertainty and Opposition of Medical Students Toward Assisted Death Practices. Journal of Pain and Symptom Management 22:2, 657-667
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CrossRef23
Leslie Curry, Harold I. Schwartz, Cindy Gruman, Karen Blank. (2000) Physicians' Voices on Physician-Assisted Suicide: Looking Beyond the Numbers. Ethics & Behavior 10:4, 337-361
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Ellen L. Csikai. (2000) The Role of Values and Experience in Determining Social Workers' Attitudes Toward Euthanasia and Assisted Suicide. Social Work in Health Care 30:1, 75-95
CrossRef25
Ellen L. Csikai. (2000) Hospital Social Workers' Attitudes Toward Euthanasia and Assisted Suicide. Social Work in Health Care 30:1, 51-73
CrossRef26
Stephen Jamison. (2000) Factors to consider before participating in a hastened death: Issues for medical professionals.. Psychology, Public Policy, and Law 6:2, 416-433
CrossRef27
Barry Rosenfeld. (2000) Assisted suicide, depression, and the right to die.. Psychology, Public Policy, and Law 6:2, 467-488
CrossRef28
Judith Kennedy Schwarz. (1999) Assisted Dying and Nursing Practice. Journal of Nursing Scholarship 31:4, 367-374
CrossRef29
K. V. Heath, E. Wood, G. Bally, P. G. A. Cornelisse, R. S. Hogg. (1999) Experience in treating persons with HIV/AIDS and the legalization of assisted suicide: The views of Canadian physicians. AIDS Care 11:5, 501-510
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Ellen L. Csikai. (1999) Euthanasia and Assisted Suicide. Journal of Gerontological Social Work 31:3-4, 49-63
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Uzi Brook. (1999) The attitude of young adults with chronic disease or handicaps towards enforced treatment and euthanasia. Patient Education and Counseling 38:1, 43-48
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Gabriela Stoppe, Hagen Sandholzer, Claudia Huppertz, Hauke Duwe, Juergen Staedt. (1999) Family physicians and the risk of suicide in the depressed elderly. Journal of Affective Disorders 54:1-2, 193-198
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Luigi Grassi, Katia Magnani, Mauro Ercolani. (1999) Attitudes Toward Euthanasia and Physician-Assisted Suicide Among Italian Primary Care Physicians. Journal of Pain and Symptom Management 17:3, 188-196
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Raphael M Bonelli, Johannes Bonelli, Peter Költringer, Marc Kotter, Lukas Kenner. (1999) Psychiatrists' attitudes to euthanasia. The Lancet 353:9148, 243-244
CrossRef35
Nisha Shah, James Warner, Bob Blizard, Michael King. (1998) National survey of UK psychiatrists' attitudes to euthanasia. The Lancet 352:9137, 1360
CrossRef36
Term A. Schmidt, Andrew D. Zechnich, Melissa Doherty. (1998) Oregon Emergency Medical Technicians' Attitudes toward Physician-assisted Suicide. Academic Emergency Medicine 5:9, 912-918
CrossRef37
Daniel P. Sulmasy. (1998) Killing and Allowing to Die: Another Look. The Journal of Law, Medicine & Ethics 26:1, 55-64
CrossRef38
Ann Sanson, Elizabeth Dickens, Beatrice Melita, Mary Nixon, Justin Rowe, Anne Tudor, Michael Tyrrell. (1998) Psychological Perspectives on Euthanasia and the Terminally Ill: An Australian Psychological Society Discussion Paper. Australian Psychologist 33:1, 1-11
CrossRef39
Kathy Faber-Langendoen. (1998) Death by request. Cancer 82:1, 35-41
CrossRef40
Zhila Haghbin, Jon Streltzer, George P. danko. (1998) Assisted Suicide and AIDS Patients. Psychosomatics 39:1, 18-23
CrossRef41
David A. Asch, Judy A. Shea, M.Kathryn Jedrziewski, Charles L. Bosk. (1997) The limits of suffering: Critical care nurses' views of hospital care at the end of life. Social Science & Medicine 45:11, 1661-1668
CrossRef42
Reidun Førde, Olaf Gjerløw Aasland, Erik Falkum. (1997) The ethics of euthanasia—Attitudes and practice among Norwegian physicians. Social Science & Medicine 45:6, 887-892
CrossRef43
David B. Waisel, Robert D. Truog. (1997) The End-of-life Sequence. Anesthesiology 87:3, 676-686
CrossRef44
David A. Asch,,,, Michael L. DeKay,,. (1997) Euthanasia Among US Critical Care Nurses. Medical Care 35:9, 890-900
CrossRef45
Laura Weiss Roberts, Philip R. Muskin, Teddy D. Warner, Teresita McCarty, Brian B. Roberts, Donald C. Fidler. (1997) Attitudes of Consultation-Liaison Psychiatrists Toward Physician-Assisted Death Practices. Psychosomatics 38:5, 459-471
CrossRef46
Russell K. Portenoy, Nessa Coyle, Kathryn M. Kash, Frank Brescia, Colleen Scanlon, Daniel O’Hare, Robert I. Misbin, Jimmie Holland, Kathleen M. Foley. (1997) Determinants of the Wiffingness to Endorse Assisted Suicide. Psychosomatics 38:3, 277-287
CrossRef47
Foley, Kathleen M., . (1997) Competent Care for the Dying Instead of Physician-Assisted Suicide. New England Journal of Medicine 336:1, 54-58
Full Text48
George E. Dickinson, Carol J. Lancaster, Edward D. Sumner, Jonathan S. Cohen. (1997) Attitudes Toward Assisted Suicide And Euthanasia Among Physicians In South Carolina And Washington. OMEGA--Journal of Death and Dying 36:3, 201-218
CrossRef49
D PEILLON, F SALORD, H RICHE, M JENOUDET, R CHACORNAC. (1997) Décisions de limitation ou d'engagement thérapeutique maximal dans une unité de réanimation neurochirurgicale. Annales Françaises d’Anesthésie et de Réanimation 16:1, 25-29
CrossRef50
James G. Adams. (1996) Life or Death: Physician-assisted Suicide and Emergency Medicine. Academic Emergency Medicine 3:10, 909-910
CrossRef51
Terri A. Schmidt, Andrew D. Zechnich, Virginia P. Tilden, Melinda A. Lee, Linda Ganzini, Heidi D. Nelson, Susan W. Tolle. (1996) Oregon Emergency Physicians' Experiences with, Attitudes toward, and Concerns about Physician-assisted Suicide. Academic Emergency Medicine 3:10, 938-945
CrossRef52
T ZAUBLER, M SULLIVAN. (1996) PSYCHIATRY AND PHYSICIAN-ASSISTED SUICIDE. Psychiatric Clinics of North America 19:3, 413-427
CrossRef53
Orentlicher, David, . (1996) The Legalization of Physician-Assisted Suicide. New England Journal of Medicine 335:9, 663-667
Full Text54
(1996) Physician-Assisted Suicide. New England Journal of Medicine 335:7, 518-520
Full Text55
Thodoros Papapetropoulos, Vassilios Pelekoudas, Thanos Patrinos, Panayiotis Papathanasopoulos. (1996) Euthanasia, physician-assisted suicide, and persistent vegetative state. The Lancet 348:9026, 548
CrossRef56
E.J Emanuel, E.R Daniels, D.L Fairclough, B.R Clarridge. (1996) Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public. The Lancet 347:9018, 1805-1810
CrossRef57
Asch, David A., . (1996) The Role of Critical Care Nurses in Euthanasia and Assisted Suicide. New England Journal of Medicine 334:21, 1374-1379
Full Text58
Lee, Melinda A., Nelson, Heidi D., Tilden, Virginia P., Ganzini, Linda, Schmidt, Terri A., Tolle, Susan W., . (1996) Legalizing Assisted Suicide — Views of Physicians in Oregon. New England Journal of Medicine 334:5, 310-315
Full Text59
Bachman, Jerald G., Alcser, Kirsten H., Doukas, David J., Lichtenstein, Richard L., Corning, Amy D., Brody, Howard, . (1996) Attitudes of Michigan Physicians and the Public toward Legalizing Physician-Assisted Suicide and Voluntary Euthanasia. New England Journal of Medicine 334:5, 303-309
Full Text60
Mark A. Graber, Barcey I. Levy, Robert F. Weir, Robert A. Oppliger. (1996) Patients’ views about physician participation in assisted suicide and euthanasia. Journal of General Internal Medicine 11:2, 71-76
CrossRef61
George Domino, Susan Kempton, Jim Cavender. (1996) Physician Assisted Suicide: A Scale and Some Empirical Findings. OMEGA--Journal of Death and Dying 34:3, 247-257
CrossRef62
T. Howard Stone, William J. Winslade. (1995) Physician‐assisted suicide and euthanasia in the United States. Journal of Legal Medicine 16:4, 481-507
CrossRef63
John Dorman. (1995) The Hippocratic Oath. Journal of American College Health 44:2, 84-88
CrossRef64
Elizabeth W. Markson. (1995) To Be or Not To Be: Assisted Suicide Revisited. OMEGA--Journal of Death and Dying 31:3, 221-235
CrossRef65
(1994) Regulating Physician-Assisted Death. New England Journal of Medicine 331:24, 1656-1658
Full Text66
Annas, George J.. (1994) Death by Prescription. New England Journal of Medicine 331:18, 1240-1243
Full Text67
Bachman, Jerald G., Doukas, David J., Lichtenstein, Richard L., Alcser, Kirsten H., . (1994) Assisted Suicide and Euthanasia in Michigan. New England Journal of Medicine 331:12, 812-813
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