'Many Doctors Would Consider Assisted Dying at Their End of Life'

 

• More than half of surveyed physicians said they would consider assisted dying if faced with advanced cancer or severe Alzheimer's disease.
• Few doctors considered life-sustaining practices a good or very good option in advanced cancer or Alzheimer's.
• The survey involved over 1,100 doctors in five countries, including three U.S. states.

Many physicians said they would consider assisted dying if they were faced with advanced cancer or severe Alzheimer's disease, survey data showed.

In eight jurisdictions spanning five countries, about half of physicians would consider euthanasia a good or very good option if they had very painful end-stage cancer (54.2%) or severe end-stage Alzheimer's disease (51.5%), reported Sarah Mroz, PhD, of Vrije Universiteit Brussel in Belgium, and co-authors.

In the cancer situation, the proportion of physicians considering euthanasia a good or very good option ranged from 37.9% in Italy to 80.8% in Belgium. In the Alzheimer's scenario, the proportion ranged from 37.4% in the U.S. state of Georgia to 67.4% in Belgium, Mroz and colleagues said in the Journal of Medical Ethicsopens in a new tab or window.

Doctors who practiced in jurisdictions with legal options for both euthanasia and assisted dying were more likely to consider euthanasia in both the cancer (OR 3.1, 95% CI 2.2-4.4) and Alzheimer's (OR 1.9, 95% CI 1.4-2.6) situations. In the cancer scenario, 33.5% of doctors said they would consider drugs at their disposal to end their own life.

"Over half of the physicians surveyed would consider assisted dying for themselves, with their attitudes shaped by their specialty and whether they practice in a jurisdiction where it is legally available," Mroz said.

"This is notable and confirms prior research showing that acceptance of assisted dying increases following its legalization," she told MedPage Today.

The survey also showed that few doctors considered life-sustaining practices a good or very good option in advanced cancer or Alzheimer's; less than 1% wanted cardiopulmonary resuscitation (CPR) or mechanical ventilation, and less than 4% wanted tube feeding.

"This is in line of what we know: that most physicians wouldn't want aggressive end-of-life care, whether it's CPR or intubation, and would consider even more intensive ways to relieve suffering at the very end of life," observed geriatrician Eric Widera, MD, of the University of California San Francisco, who wasn't involved with the study.

"This is in contrast to the increasing use of certain life-sustaining treatments like invasive mechanical ventilation in diseases like advanced dementia without a clear mortality benefit of doing so," he told MedPage Today.

More than 91% of survey respondents considered intensifying symptom relief a good or very good option. Just over half considered palliative sedation a good or very good option; those who considered palliative sedation for Alzheimer's disease ranged from 39.3% in Georgia to 66.3% in Italy.

In 2022 and 2023, Mroz and colleagues surveyed 1,157 doctors in eight jurisdictions with differing laws and attitudes about assisted death: Belgium; Italy; Canada; the U.S. states of Oregon, Wisconsin, and Georgia; and the Australian states of Victoria and Queensland. Two hypothetical situations were presented to probe doctors' views about end-of-life care.

In the cancer scenario, doctors assumed they had extensive lung and bone metastases; their treating oncologist had said no further treatments were available and their estimated life expectancy was no more than 2 weeks. In the Alzheimer's situation, doctors assumed they no longer recognized their family or friends; they had refused to eat or drink, and it was no longer possible to communicate with them about treatment options.

In Oregon, physician-assisted dying has been legal since 1997. Medical aid in dying requires the capacity to consent and a patient must have an incurable or irreversible disease that would result in death within 6 months, so the Alzheimer's scenario would not be realistic there. Physician-assisted dying is illegal in Wisconsin and Georgia.

In Canada, both physician-assisted dying and euthanasia have been allowed since 2016. Assisted dying has been legal in Belgium since 2002, but it is illegal in Italy. In Australia, Victoria implemented assisted dying legislation in 2019. Queensland passed legislation in 2021, but it was not in place when the survey was conducted.

Opposition to medical aid in dying laws used to come from three groups in the U.S., noted ethicist Arthur Caplan, PhD, of the NYU Grossman School of Medicine.

"There was religious opposition, mainly led by the Catholic Church," he said. The disability community also voiced concerns "and doctors -- the [American Medical Association] and other medical organizations -- were very firm in opposing legalization, particularly at the state medical society level," Caplan told MedPage Today.

"The opposition still has a religious component and a disability component, but the medical profession is shifting in the U.S. -- not necessarily to come out and support medical aid in dying, but it's moving toward neutrality," he continued. "It's the older generation that opposes legalization. As younger doctors begin to take over and move into more powerful positions, they are not as opposed. That shift is somewhat reflected in this survey."

The survey included general practitioners, palliative care doctors, and medical specialists highly likely to treat patients at the end of their life like cardiologists, emergency medicine doctors, oncologists, neurologists, and intensive care specialists. While sex, age, and ethnicity did not appear to influence preferences for end-of-life practices, prevailing legislation in a doctor's jurisdiction did.

Several ethical considerations arise from the study findings, Mroz and colleagues said. Previous work has suggested a link between physicians' consideration of their own end of life and their clinical practice, they pointed out.

But most physicians do not want to impose their values on other people, noted Gary Gala, MD, of UNC Health in Chapel Hill. "It's a rare thing in my career experience to see that," he said.

"On the other hand, so many patients and families ask: What would you do, doc? What would you do in this situation? Sometimes it's helpful for patients and families to understand a physician's perspective while not overwhelming them with your own values."

Disclosures

This study was funded by Vrije Universiteit Brussel and Ghent University.

Mroz and co-authors reported no conflicts of interest.

Widera, Caplan, and Gala reported no disclosures.

Primary Source

Journal of Medical Ethics

Source Reference: opens in a new tab or windowMroz S, et al "Physicians' preferences for their own end-of- life: a comparison across North America, Europe, and Australia" J Med Ethics 2025; DOI: 10.1136/jme-2024-110192.

https://www.medpagetoday.com/neurology/alzheimersdisease/116005