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When enough is enough; terminating life-sustaining treatment at the patient's request: a survey of attitudes among Swedish physicians and the general public
  1. Anna Lindblad1,
  2. Niklas Juth1,
  3. Carl Johan Fürst2,
  4. Niels Lynöe1
  1. 1LIME, Karolinska Institutet, Stockholm, Sweden
  2. 2Stockholms Sjukhem, Mariebergsgatan, Stockholm, Sweden
  1. Correspondence to Dr Anna Lindblad, Centre for Healthcare Ethics, LIME, Karolinska Institutet, Stockholm 171 77, Sweden; anna.lindblad{at}


Objectives To explore attitudes and reasoning among Swedish physicians and the general public regarding the withdrawal of life-sustaining treatment at a competent patient's request.

Design A vignette-based postal questionnaire including 1202 randomly selected individuals in the county of Stockholm and 1200 randomly selected Swedish physicians with various specialities. The vignettes described patients requesting withdrawal of their life-sustaining treatment: (1) a 77-year-old woman on dialysis; (2) a 36-year-old man on dialysis; (3) a 34-year-old ventilator-dependent tetraplegic man. Responders were asked to classify the act of terminating treatment and to prioritise arguments for/against.

Results A majority in both groups prioritised arguments in favour of terminating treatment and classified the act as defensible in all vignettes. However, among the general public, 16% classified the act as euthanasia in all vignettes; among physicians this view was most expressed regarding ventilator treatment (26%). Some who classified the act as euthanasia prioritised arguments in favour of terminating treatment: among physicians 18% in vignette 1, 19% in vignette 2 and 34% in vignette 3; among the general public 35% in vignette 1, 20% in vignette 2 and 48% in vignette 3.

Conclusion There is a widespread consensus regarding competent patients' right to abstain from life-sustaining treatment. An association between the hastening of death, caused by the withdrawal of life-sustaining treatment and the concept of euthanasia is proposed. The results also suggest that classifying the withdrawal of life-sustaining treatment as ‘euthanasia’ does not necessarily mean that the act is interpreted as ethically unacceptable.

  • Care of the dying patient
  • mechanical/attitude/ethics
  • medical
  • prolongation of life and euthanasia
  • right to refuse treatment
  • suicide/assisted suicide
  • withholding treatment/euthanasia/dialysis/ventilators

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  • Funding This study was funded by the Swedish National Board of Health and Welfare, Socialstyrelsen, 106 30 Stockholm, Sweden.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the the Regional Ethical Review Board in Stockholm.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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