Doctors get requests for euthanasia, study finds

An outright majority of Malta’s general practitioners are opponents of euthanasia, but a survey of 160 doctors has revealed that over 14% of them received requests for euthanasia from their ailing patients.

A study published in the Malta Medical Journal, carried out by Dr Jurgen Abela from the University of Malta’s department of family medicine, surveyed general practitioners on their views on end of life ethics and the dilemma of giving dying patients a dignified death.

The 160 GPs interviewed revealed that they were believers in preserving life and would only consider intensifying painkillers to alleviate the pain of the dying.

The GPs interviewed were shown to be in the main believers in preserving life, and while they would not consider euthanasia, many do not shun the intensification of painkillers and analgesia at patients’ end of life.

The study further reveals that most doctors are guided by religious values when dealing with end-of-life issues.

Whereas a good number of GPs were not against the intensification of analgesia to control pain and other symptoms of disease when patients are dying, the majority are against sedating patients at the end of their life.

41.1% of the 160 doctors surveyed had intensified analgesia at end of life, but only 7.5% had sedated patients.

15% of GPs withdrew or withheld treatment in the care of these patients. One reason cited in the study for the reluctance to sedate patients is that in Maltese, as in the English language, a commonly used phrase in veterinary medicine is ‘putting an animal to sleep’.

“Hence sedation in patients might be associated with ‘killing’ even due to a linguistic issue,” Abela said in his study.

14.4% of GPs also said they had received requests for euthanasia but 89.1% of them would never consider euthanasia. 89.8% of respondents considered their respective religion or philosophy of life as being important or “very important” in guiding their end-of-life decisions.

Interestingly, a relative majority of respondents (45.3%) agreed that patients had a right to decide whether to hasten their end or not.

But there was a significant agreement that physicians should always aim to preserve life, with just 17.7% disagreeing with such an aim.

Respondents had cared for an average four terminal patients over the past 12 months.

The majority of GPs (58.1%) agree with the process of withdrawing or withholding various forms of treatment at the end of life. This response might seem to contradict the strong sense of preserving life. But the study notes that withdrawing or withholding treatment is not necessarily done with the aim or consequence of hastening death.

82.3% of family doctors identified Roman Catholicism as their religion. Further to this response, the doctors were asked to rate how important their religion or philosophy was in taking end-of-life decisions. 53% replied ‘very important’ while 37% replied ‘important’.

The study concludes that in general GPs believe in preserving life as a guiding principle at the end of life, but do not shun intensification of analgesia at the end of life.

But it also shows that there exists “some misunderstanding with respect to the role of sedation at the end of life” and calls for guidance for GPs in dealing with the legal aspect and ethics of end-of-life decisions. In the absence of such guidance, the doctors’ “religion and philosophy of life are used to guide them in this rather difficult area of practice”.