Doctors favor physician-assisted suicide less than patients do
■ But an opinion poll shows doctors' support up 2 percentage points from a poll earlier this year.
By Kevin B. O’Reilly — Posted Nov. 21, 2005
Nearly six in 10 physicians believe doctors should be legally permitted to dispense prescriptions for life-ending drugs to terminally ill patients who request them, according to a poll released last month.
Of 677 doctors randomly surveyed by the independent market-research firm HCD Research, 59% said yes when asked, "Do you think physicians should be given the right to dispense prescriptions to patients to end their life?" Forty-one percent said no.
When asked who should decide whether physician-assisted suicide is a "legitimate medical purpose" -- the question at issue in Gonzales v. Oregon, now before the U.S. Supreme Court -- 25% said the state should decide and 21% said it should be the federal government. But 54% of doctors said neither level of government should be the one making the decision.
Some physicians questioned the poll's findings, saying the wording of the question skewed results. Others said it was a good reflection of what practicing physicians believe.
"It matters enormously what physicians think," said Barbara Coombs Lee, co-CEO of the Denver-based Compassion & Choices, which supports physician-assisted suicide under a set of strict circumstances. "People look to physicians for information, for wise counsel and for a clear explanation of the options." She said that she wishes the American Medical Association would change its policy against physician-assisted suicide.
AMA delegates have, on multiple occasions, passed policy stating physician-assisted suicide is "fundamentally inconsistent with the physician's role as healer." AMA policy asks physicians to respect a patient's end-of-life directive to withhold or withdraw treatment, though physicians also are duty-bound to ease suffering as much as possible, even when those directives are in place.
The vice president of a group against doctor-assisted suicide, Physicians for Compassionate Care Education Foundation, questioned the poll's validity, saying people should be "very cautious about polls."
"How was the question phrased and who were the respondents?" asked Kenneth Stevens, MD, a professor in the radiation oncology department at Oregon Health & Science University School of Medicine. "There's a lot of bias that can enter in."
The physicians surveyed were randomly sampled from HCD's opt-in marketing list of about 50,000 physicians. "We have no slant at all," said HCD Marketing Partner Glenn Kessler, noting the poll was conducted as part of the firm's efforts to publicize its bread-and-butter research work for pharmaceutical clients.
The survey's margin of error was plus or minus 3% at a 95% confidence level. HCD also polled the public, which, with 64% favoring physician-assisted suicide, was more supportive of the idea than were doctors.
Still, the poll results among doctors represented a 2 percentage point increase in support for physician-assisted suicide within the last year. A February survey of 1,088 physicians that HCD conducted on behalf of the Louis Finkelstein Institute for Religious and Social Studies at New York's Jewish Theological Seminary, found that 57% believed "it is ethical to assist an individual who has made a rational choice to die due to unbearable suffering," while 39% said it is unethical.
Notably, neither HCD poll included the word "suicide." In past public-opinion polling, avoidance of this word has swung favorable responses to the concept of physician-assisted suicide by as many as 17 percentage points.
"Using the word 'suicide' has a different connotation," said the HCD's Kessler. "We were careful to use the phrase 'life ending' because we thought it was neutral."
Dr. Stevens said even when physicians are polled, it's possible that euphemistic references to physician-assisted suicide could influence how people respond. "We need to be aware of people who twist the language," he said. "We should call things what they are. This is like someone robbing a bank and then being taken before a judge to say, 'I was only making a withdrawal.' "
Coombs Lee, a former nurse, argued the HCD poll's language was neutral. "Anything that has 'death' in it is not a euphemism," she said.
"Who's in favor of suicide?" she added. "I'm against suicide. Everybody's against suicide. Suicide is irrational, impulsive, a tragedy." Terminally ill Oregonians who ask their physicians for lethal drug doses are supported by friends, family and their doctors and make a last-resort, rational choice, Coombs Lee said.
A focus group of Californians commissioned by Compassion & Choices found that most people thought of "assisted suicide" as a term more applicable to telling someone to jump off a bridge than to a physician's prescribing a life-ending drug dose. The group is pushing for an Oregon-like law in California. A bill died in an Assembly committee earlier this year, but proponents have moved it to a Senate committee where they hope to fare better in 2006. A bill in Vermont's House is still in play.
Dr. Stevens said efforts to legalize physician-assisted suicide betray a broader change in patients' attitudes toward doctors.
"One of the subtle messages of proponents of assisted suicide is that the doctor cannot take care of your medical needs, but he sure can kill you," he said. "That frightens me."
Peter Goodwin, MD, who has helped patients end their lives under the Oregon law, said the focus on suicide, as such, misses the point.
"Our advocacy is advocacy for choice," said Dr. Goodwin, a former chair of the Oregon Academy of Family Physicians. "It's the patient's choice that is central here."