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J Med Ethics 2004;30:499-503 doi:10.1136/jme.2003.004895
  • Clinical ethics

Internists’ attitudes towards terminal sedation in end of life care

  1. L C Kaldjian1,
  2. J F Jekel2,
  3. J L Bernene3,
  4. G E Rosenthal4,
  5. M Vaughan-Sarrazin5,
  6. T P Duffy6
  1. 1Department of Internal Medicine, Yale University, New Haven, CT, USA
  2. 2Griffin Hospital, Derby, CT, USA
  3. 3American College of Physicians, CT, USA
  4. 4University of Iowa, Iowa City, IA, USA
  5. 5University of Iowa, Iowa City, IA, USA
  6. 6Yale University, New Haven, CT, USA
  1. Correspondence to:
 L C Kaldjian
 Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA; lauris-kaldjianuiowa.edu
  • Received 19 May 2003
  • Accepted 24 September 2003
  • Revised 3 September 2003

Abstract

Objective: To describe the frequency of support for terminal sedation among internists, determine whether support for terminal sedation is accompanied by support for physician assisted suicide (PAS), and explore characteristics of internists who support terminal sedation but not assisted suicide.

Design: A statewide, anonymous postal survey.

Setting: Connecticut, USA.

Participants: 677 Connecticut members of the American College of Physicians.

Measurements: Attitudes toward terminal sedation and assisted suicide; experience providing primary care to terminally ill patients; demographic and religious characteristics.

Results: 78% of respondents believed that if a terminally ill patient has intractable pain despite aggressive analgesia, it is ethically appropriate to provide terminal sedation (diminish consciousness to halt the experience of pain). Of those who favoured terminal sedation, 38% also agreed that PAS is ethically appropriate in some circumstances. Along a three point spectrum of aggressiveness in end of life care, the plurality of respondents (47%) were in the middle, agreeing with terminal sedation but not with PAS. Compared with respondents who were less aggressive or more aggressive, physicians in this middle group were more likely to report having more experience providing primary care to terminally ill patients (p = 0.02) and attending religious services more frequently (p<0.001).

Conclusions: Support for terminal sedation was widespread in this population of physicians, and most who agreed with terminal sedation did not support PAS. Most internists who support aggressive palliation appear likely to draw an ethical line between terminal sedation and assisted suicide.

Footnotes

  • This study was funded in part by a Dissertation Fellowship to the principal investigator (LCK) from the Graduate School, Yale University, which had no role in the collection, analysis, interpretation, or publication of data.

  • Results from this study were presented at the Society of General Internal Medicine 25th Annual Meeting (Atlanta, GA, 3 May 2002) and published as an abstract (J Gen Intern Med2002;(Suppl 1):).

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