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Transcript of Management of Death, Dying and Euthanasia: Attitudes MANAGEMENT OF DEATH. DYING AND EUTHANASIA ;...

  • CRc

    MANAGEMENT OF DEATH. DYING AND EUTHANASIA ; ATTITUDES AND

    PRACTICES OF MEDICAL PRACTITIONERS AND NURSES IN SOUTH

    AUSTRALIA

    by

    DR. CHRISTINE A. STEVENSPROFESSOR RIAZ HASSAN

    Sociology DisciplineSchool of Social Sciences

    The Flinders University of South AustraliaBedford Park

    South Australia

    August 1992

  • ACKNOWLEDGEMENTS

    A number of people have given helpful advice and assistance in this researchundertaking, and we would like to thank in particular, Dr Phillip Harding, the Presidentof the Australian Medical Association (SA Branch), for the help given in the early stagesof the research; Ms Elizabeth Percival, the Director of The Nurses Board of SouthAustralia for invaluable help in giving access to nurses registered in South Australia, andin posting the questionnaires; Dr. Daniel Overduin, the Adjunct Director of TheSouthern Cross Bioethics Institute, Dr. Eric Gargett, the President of the SouthAustralian Voluntary Euthanasia Society, and Associate Professor Alex Gallus andAssociate Professor John Willoughby of Flinders Medical Centre for their helpfulcomments on the early versions of the questionnaires. We are especially indebted to allthe medical practitioners and nurses who took part in the survey. We would also like tothank Ms Sue Manser for her assistance with typing. Finally, this research would nothave been possible without the generous funding of the Criminology Research Council.

  • 11

    TABLE OF CONTENTS

    PAGEACKNOWLEDGEMENTS i

    LIST OF TABLES

    CHAPTER 1 1

    INTRODUCTION 1

    CHAPTER 2: EUTHANASIA: THE ETHICAL ISSUES 5

    INTRODUCTION 5

    DEFINITION 6

    ETHICAL POSITIONS 9(1) The Sanctity of Life Position 9(2) The Quality of Life Position 11

    THE ETHICAL DEBATES 12(a) Argument in Favour of Strict Interpretation of the

    Sanctity of Life Position 12(b) Argument in Favour of Modification of the Sanctity

    of Life Position 12(c) Criticisms of these Modifications 13(d) Argument in Favour of the Quality of Life Perspective 15(e) Argument in Favour of Euthanasia from the Quality

    of Life Perspective 15(f) Criticism of Arguments in Favour of Euthanasia from

    the Quality of Life Perspective 17

    MORAL AUTONOMY AND SELF DETERMINATION 18

    SUMMARY 19

    CHAPTER 3: LEGAL ISSUES 20

    THE LEGAL POSITION 20

    LEGISLATIVE CHANGE 21

    LEGISLATION IN SOUTH AUSTRALIA 24

    THE SCOPE OF THE ACT 25

    LIMITATIONS OF THE NATURAL DEATH ACT 26

    PROPOSALS FOR FURTHER LEGISLATIVE CHANGE INSOUTH AUSTRALIA 28

    CONCLUSION 30

    CHAPTER 4: ISSUES IN MEDICAL PRACTICE 31

    INTRODUCTION 31

  • Ill

    MEDICAL PRACTICE IN AUSTRALIA 31

    MEDICAL PRACTICE AND THE LAW 32

    ATTITUDES TOWARDS CHANGES IN MEDICAL PRACTICE 34(a.) Attitudes of Medical Practitioners 34(b) Attitudes of Nurses 36(c) Community Attitudes

    RESOURCE ALLOCATION

    CHAPTERS: METHODOLOGY 41

    RESEARCH AIMS 41

    METHODOLOGY 41Response Rate 43Data Analysis and Presentation 43

    CHARACTERISTICS OF THE SAMPLE POPULATION 44

    CHAPTER 6: SURVEY RESULTS 45

    INTRODUCTION 45

    REQUESTS TO HASTEN THE DEATH OF PATIENTS RECEIVEDBY MEDICAL PRACTITIONERS AND NURSES 45Medical Practitioners 45Nurses 47Differences in Rates of Request to Hasten Death Made toDoctors and Nurses 48

    REASONS FOR REQUESTS TO HASTEN DEATH 49

    ATTITUDES TO HASTENING DEATH 50Opinions on Whether a Request to Hasten Death is Rational 50Differences between Medical Practitioners and Nurses 52Attitudes to Passive and Active Euthanasia 54Is it Right to Bring About a Patient's Death by Withdrawalof Treatment 54

    a) Total Population 548b) Medical Practitioners 55c) Nurses 55d) Differences in Response Rates Between Medical

    Practitioners and Nurses 57Is it Ever Right to Bring About a Patient's Death by TakingActive Steps 57

    (a) Total Population 57(b) Differences in Response Rates Between Medical

    Practitioners and Nurses 58

    CURRENT MANAGEMENT OF DEATH AND DYING 60Extent of Consultation Following Requests to Hasten Death 60

    Total Population 60Differences in Response Rates Between MedicalPractitioners and Nurses 60

    Treatment Options Offered by Medical Practitioners 61

    \SL V

    88

  • IV

    Extent of Practice of Active Euthanasia ................................................................ 63(a) Practice of Active Euthanasia and its Relationship

    with Requests to take Active Steps ................................................ 63(b) Relationship Between Practice of Active Euthanasia

    and Attitudes to Euthanasia ............................................................ 63(c) Practice of Active Euthanasia and its Relationship

    with Age, Sex and Religious Affiliation ........................................ 66(i) Medical Practitioners ........................................................... 66(ii) Nurses ..................................................................................... 66

    Did Those who had Undertaken Active Steps Still Feel They HadDone the Right Thing .................................................................................... 67Effect of Current Law on Action ............................................................................. 70

    FUTURE MANAGEMENT OF DEATH AND DYING ................................. 71Utility of Current Legislation .................................................................................. 71Attitudes to Possible Guidelines for Withdrawal orWithholding of Treatment ........................................................................................ 71

    (a) Medical Practitioners ....................................................................... 72(b) Nurses ................................................................................................. 73(c) Differences in Response Rates between Medical

    Practitioners and Nurses .................................................................. 73Suggested Guidelines for Withdrawal and Withholding of Treatment ............ 75

    Total Population ............................................................................... 75Differences in Response Rates Between MedicalPractitioners and Nurses .................................................................. 75

    Attitudes Towards Legalisation of Active Euthanasia ........................................ 76(a) Total Population ............................................................................... 76(b) Differences in Response Rates Between Medical

    Practitioners and Nurses .................................................................. 78Circumstances in which it was Thought Appropriate for ActiveSteps to be Taken ...................................................................................................... 81

    (a) Total Population ............................................................................... 81(b) Differences in Response Rates Between Medical

    Practitioners and Nurses .................................................................. 81

    (a)(b)

    ISSUES RAISED BY RESPONDENTS 81

    CHAPTER 7: CONCLUSION 87

    APPENDIX A 94

    APPENDIX B 95

    THE NATURAL DEATH ACT, 1983 95

    APPENDIX C 98

    DEBATE SURROUNDING THE SOUTH AUSTRALIANNATURAL DEATH ACT, 1983 98(a) Submissions to the Select Committee of the Legislative

    Council on The Natural Death Bill, 1980 98(1) Medical aspects 98(2) Moral, ethical and religious considerations 99(3) Legal Points 100

    (b) Parliamentary Debate 100

  • APPENDIX D 103

    DOCTORS 103

    NURSES 112

    APPENDIX E 125

    QUESTIONNAIRE FOR DOCTORS 125

    QUESTIONNAIRE FOR NURSES 129

    BIBLIOGRAPHY 133

  • VI

    LIST OF TABLES

    TABLE PAGE

    1 Survey Response Rate 43

    2 Sample Population 44

    3 Requests to Hasten a Patient's Death by Withdrawal ofTreatment or by Taking Active Steps 46

    4 Requests for Withdrawal of Treatment or Active Stepsby Age, Sex and Religion 47

    5 Ranking of Reasons for Requests to Hasten Death 50

    6 Reasons for Thinking a Request to Hasten Death isRational or Not - Total Population 51

    7 Reasons for Thinking a Request to Hasten Death isRational or Not - Doctors and Nurses 52

    8 Is it Ever Right to Bring About the Death of a Patientby Withdrawing Treatment - Total Population 55

    9 Is it Ever Right to Bring About the Death of a Patientby Withdrawing Treatment - Doctors and Nurses 56

    10 Is it Ever Right to Bring About the Death of a Patientby Taking Active Steps - Total Population 58

    11 Is it Ever Right to Bring about the Death of a Patientby Taking Active Steps - Doctors and Nurses 59

    12 Have Doctors Ever Suggested Withholding or WithdrawingTreatment when Discussing the Options of MedicalTreatment Available to Patients 62

    13 Ever Taken Active Steps which have Brought About theDeath of a Patient by Whether there Had Been aRequest for this Action 64

    14 Ever Taken Active Steps which have Brought About theDeath of a Patient by Whether Active Steps are everConsidered to be Right 65

    15 Ever Taken Active Steps which have Brought About theDeath of a Patient by Age, Sex and Religion 67

    16 Number of Times Doctors and Nurses Have Been Presentedwith Living Wills Made in Accordance with the NaturalDeath Act, 1983 71

    17 Should Guidelines be Established so that the LegalPosition of Doctors Regarding Withholding andWithdrawal of Treatment could be Clarified 73

  • Vll

    18 Suggested Guidelines for Withdrawal/Withholdingof Treatment 77

    19 Should it be Legally Permissible for Doctors to TakeActive Steps to Bring About a Patient's Death underSome Circumstances 79

    20 Suggested Circumstances under whic