Medicine, Health Care and Philosophy

, Volume 7, Issue 3, pp 333–339 | Cite as

Attitudes on euthanasia, physician-assisted suicide and terminal sedation -- A survey of the members of the German Association for Palliative Medicine

  • H. C. Müller-busch
  • F. S. Oduncu
  • S. Woskanjan
  • E. Klaschik
Scientific Contribution


Background: Due to recent legislations on euthanasia and its current practice in the Netherlands and Belgium, issues of end-of-life medicine have become very vital in many European countries. In 2002, the Ethics Working Group of the German Association for Palliative Medicine (DGP) has conducted a survey among its physician members in order to evaluate their attitudes towards different end-of-life medical practices, such as euthanasia (EUT), physician-assisted suicide (PAS), and terminal sedation (TS). Methods: An anonymous questionnaire was sent to the 411 DGP physicians, consisting of 14 multiple choice questions on positions that might be adopted in different hypothetical scenarios on situations of “intolerable suffering” in end-of-life care. For the sake of clarification, several definitions and legal judgements of different terms used in the German debate on premature termination of life were included. For statistical analysis t-tests and Pearson-correlations were used. Results: The response rate was 61% (n=251). The proportions of the respondents who were opposed to legalizing different forms of premature termination of life were: 90% opposed to EUT, 75% to PAS, 94% to PAS for psychiatric patients. Terminal sedation was accepted by 94% of the members. The main decisional bases drawn on for the answers were personal ethical values, professional experience with palliative care, knowledge of alternative approaches, knowledge of ethical guidelines and of the national legal frame. Conclusions: In sharp contrast to similar surveys conducted in other countries, only a minority of 9.6% of the DGP physicians supported the legalization of EUT. The misuse of medical knowledge for inhumane killing in the Nazi period did not play a relevant role for the respondents’ negative attitude towards EUT. Palliative care needs to be stronger established and promoted within the German health care system in order to improve the quality of end-of-life situations which subsequently is expected to lead to decreasing requests for EUT by terminally ill patients.


attitudes euthanasia German Association for Palliative Medicine palliative care physician-assisted suicide survey terminal sedation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Akademie für Ethik in der Medizin: 1998, ‘Patientenverfügung, Betreuungsverfügung, Vorsorgevollmacht. Eine Handreichung für Ärzte und Pflegende’, Working Group on Death and Dying (Arbeitsgruppe “Sterben und Tod”); the author F.S. Oduncu of the current article is an active member of this Working Group.Google Scholar
  2. Ahmed, A.M., Kheir, M.M., Abdel Rahman, A., Ahmed, N.H., Abdalla, M.E. 2001‘Attitudes Towards Euthanasia and Assisted Suicide Among Sudanese Doctors’East Mediterr Health7551555Google Scholar
  3. Beauchamp, T.L., Childress, J.F. 2001Principles of Biomedical Ethics5Oxford University PressNew YorkGoogle Scholar
  4. Billings, J.A., Block, S.D. 1996Slow Euthanasia’Journal of Palliative Care122130PubMedGoogle Scholar
  5. Bittel, N., Neuenschwander, H., Stiefel, F. 2002“Euthanasia”: A Survey by the Swiss Association for Palliatve Care’Support Care Cancer10265271CrossRefPubMedGoogle Scholar
  6. Broeckaert, B., Nunez Olarte, J.M. 2002

    ‘Sedation in Palliative Care: Facts and Concepts’

    ten Have, HClark, D eds. The Ethics of Palliative Care: European Perspectives, Facing Death seriesOpen University PressBuckingham166180
    Google Scholar
  7. Bundesärztekammer: 1998, ‘Grundsätze der Bundesärztekammer zur Ärztlichen Sterbebegleitung’, Deutsches Ärzteblatt 95, A-2365-2366. (For the English translation see: Principles of the German Medical Association Concerning Terminal Medical Care: 2000, Journal of Medicine and Philosophy 25, 254–258).Google Scholar
  8. Bundesärztekammer1999‘Handreichung für Ärzte zum Umgang mit Patientenverfügungen’Deutsches Ärzteblatt 96A 27202721Google Scholar
  9. Bundesgerichtshof: 2003, Beschluss vom 17. März 2003, XII. Zivilsenat: XII ZB 2/03. Google Scholar
  10. Byock, I.R. 1994‘When Suffering persists’Journal of Palliative Care10813Google Scholar
  11. Carver, A.C., Vickrey, B.B., Bernat, J.L., Keran, C., Ringel, S.P., Foley, K.M. 1999‘End-of-Life Care: A Survey of US Neurologists’ Attitudes, Behavior, and Knowledge’Neurology53284293PubMedGoogle Scholar
  12. Chater, S., Viola, R., Paterson, J, Jarvis,  1998‘Sedation for Intractable Distress in the Dying–A Survey of Experts’Palliative Medicine12225269CrossRefGoogle Scholar
  13. Cowan, J.D., Palmer, T.W. 2002‘Practical Guide to Palliative Sedation’Curr Oncol Rep4242249PubMedGoogle Scholar
  14. Cowan, J.D., Walsh, D. 2001‘Terminal Sedation in Palliative Medicine–Definition and Review of the Literature’Support Care Cancer9403407CrossRefPubMedGoogle Scholar
  15. Dickinson, G.E., Lancaster, C.J., Clark, D., Ahmedzai, S.H., Noble, W. 2002‘U.K. Physicians Attitudes Toward Active Voluntary Euthanasia and Physician-Assisted Suicide’Death Stud26479490CrossRefPubMedGoogle Scholar
  16. Di Mola, G., Borsellino, P., Brunelli, C., Gallucci, M., Gamba, A., Lusignani, M., Regazzo, C., Santosuosso, A., Tamburini, M., Toscani, F. 1996‘Attitudes Toward Euthanasia of Physician Members of the Italian Society of Palliative Care’Ann Oncol7907911PubMedGoogle Scholar
  17. Doctor-Assisted-Suicide: 2004, ‘A Guide to Web Sites and the Literature, Scholar
  18. Document nr. 2-244/26 of the Belgian Senate, session 2000–2001, 9 July 2001.Google Scholar
  19. Douglas, C.D., Kerridge, I.H., Rainbird, K.J., McPhee, J.R., Hancock, L., Spigelman, A.D. 2001‘The Intention to Hasten Death: A Survey of Attitudes and Practices of Surgeons in Australia’eMJA175511515PubMedGoogle Scholar
  20. Enck, R.E. 1991‘Drug Induced Terminal Sedation for Symptom Control’Am J Hosp Palliat Care835Google Scholar
  21. Enquete Kommission des Deutschen Bundestages: ‘Recht und Ethik der modernen Medizin’: 2004, Scholar
  22. Essinger, D. 2003‘Attitudes of Tennessee Physicians Toward Euthanasia and Assisted Death’South Med J96427435CrossRefPubMedGoogle Scholar
  23. Folker, A.P., Holtug, N., Jensen, A.B., Kappel, K., Nielsen, J.K., Norup, M. 1996‘Experiences and Attitudes Towards End-of-Life-Decisions Amongst Danish Physicians’Bioethics10233249PubMedGoogle Scholar
  24. Forde, R., Aasland, O.G., Falkum, E. 1997‘The Ethics of Euthanasia–Attitudes and Practice Among Norwegian Physicians’Soc Sci Med11140144Google Scholar
  25. Furst, C.J., Hagenfeldt, K. 2002‘End-of-Life Sedation–Definition and Clinical Guidelines Needed’Lakartidningen9938303835PubMedGoogle Scholar
  26. Geißendörfer, S.E., A. Tietze and A. Simon. In Cooperation with Lipp, V., A.T. May, F. Oduncu, K.W. Schmidt and T. Wernstedt: 2004, ‘Sicherung der Patientenautonomie am Ende des Lebens. Gesetzliche Regelung der Patientenverfügung als Rechtsinstitut und Änderung des Strafgesetzbuches. Betreuungsrechtliche Praxis, in press.Google Scholar
  27. Goldstein-Shirley, J. and P.G. Fine: 2001, “Ethics of Total Sedation”, “Total Sedation Educational Resources Draft”, Prepared by a Task Force of the NHPCP Ethics Committee’, Session 8A: 3–8, March 25, 2001.Google Scholar
  28. Hedberg, K., Hopkins, D., Kohn, M. 2003‘Five Years of Legal Physician-Assisted Suicide in Oregon’New England Journal of Medicine348961964CrossRefPubMedGoogle Scholar
  29. Krakauer, E.L., Penson, R.T., Truog, R.D., King, L.A., Chabner, B.A., Lynch, T.J. 2000‘Sedation for Intractable Distress of a Dying Patient’The Oncologist55362CrossRefPubMedGoogle Scholar
  30. Mangan, J.T. 1949‘An Historical Analysis of the Principle of Double Effect’Theological Studies104161Google Scholar
  31. Materstvedt, L.J., Clark, D., Ellershaw, J., Forde, R., Boeck Gravgaard, A.-M., Müller-Busch, H.C., Porta i Sales, J., Rapin, C.-H. 2003‘Euthanasia and Physician- assisted Suicide: A View from an EAPC Ethics Task Force’Palliative Medicine1797101CrossRefPubMedGoogle Scholar
  32. McGlade, K.J., Slaney, L., Bunting, B.P., Gallagher, A.G. 2000‘Voluntary Euthanasia in Northern Ireland: General Practitioners’ Beliefs, Experiences, and Actions’Br J Gen Pract50794797PubMedGoogle Scholar
  33. Morita, T., Tsuneto, S., Shima, Y. 2002a‘Definition of Sedation for Symptom Relief: A Systematic Literature Review and a Proposal of Operational Criteria’Journal of Pain Symptom Management24447453CrossRefGoogle Scholar
  34. Morita, T., Hirai, K., Okazaki, Y. 2002b‘Preferences for Palliative Sedation Therapy in the Japanese General Population’Journal of Palliative Medicine5375385CrossRefGoogle Scholar
  35. Morita, T., Tsuneto, J., Inoue, S., Chihara, S. 2000‘Terminal Sedation for Existential Distress’American Journal of Hosp Palliative Care17189195Google Scholar
  36. Morita, T., Tsuneto, S., Shima, Y. 2001‘Proposed Definitions for Terminal Sedation’Lancet358335336CrossRefGoogle Scholar
  37. Müller-Busch, H.C., Klaschik, E., Oduncu, F.S., Schindler, T., Woskanjan, S. 2003a‘Euthanasie bei unerträglichem LeidEine Studie der Deutschen Gesellschaft für Palliativmedizin zum Thema Sterbehilfe im Jahre 2002’ Zeitschrift für Palliativmedizin7584Google Scholar
  38. Müller-Busch, H.C., Andres, I., Jehser, T. 2003b‘Sedation in Palliative Care–A Critical Analysis of 7 years Experience’BMC Palliative Care 22CrossRefGoogle Scholar
  39. Nationaler Ethikrat: 2004, Scholar
  40. Oduncu, F.S. 2003a‘Euthanasie bei unheilbarem Leid?’Stimmen der Zeit221121130Google Scholar
  41. Oduncu, F.S. 2003b‘Euthanasia: Killing as Due Care?’Wiener Medizinische Wochenschrift153387391CrossRefGoogle Scholar
  42. Oduncu, F.S.: 2003c, ‘Sterbehilfe und Sterbebegleitung’, Soziales Seminar 2/2003 (Oktober).Google Scholar
  43. Oduncu, F.S. 2002‘Belgien verabschiedet Euthanasie-Gesetz’Zeitschrift für medizinische Ethik48310312Google Scholar
  44. Oduncu, F.S. 2001‘Begleiten statt töten!’Stimmen der Zeit219520532Google Scholar
  45. Oduncu, F. 1999‘Sterbebegleitung und Sterbehilfe’Stimmen der Zeit217541554Google Scholar
  46. Oduncu, F.S. and W. Eisenmenger: 2003, ‘Geringe Lebensqualität. Die finstere Praxis der Sterbehilfe in Holland – bis hin zum Mord’, Süddeutsche Zeitung no. 162, Feuilleton, p. 11.Google Scholar
  47. Oduncu, F.S., Eisenmenger, W. 2002‘Euthanasie, Sterbehilfe, Sterbebegleitung. Eine kritische Bestandsaufnahme im internationalen Vergleich’Medizinrecht20327337CrossRefGoogle Scholar
  48. Oduncu, F.S., S. Hesse, H. Dietzfelbinger, W. Wibmer and R. Nun: 2004a, ‘Sterbebegleitung und Seelsorge’, in: V. Heinemann (ed.), Supportive Maßnahmen und symptomorientierte Therapie in der Hämatologie und Onkologie, 2nd edn. Schriftreihen des Tumorzentrums München, in press.Google Scholar
  49. Oduncu, F.S., G.D. Borasio, M. Hussain, U. Schroth and W. Eisenmenger: 2004b, ‘Patientenverfügung und Testament’, in: V. Heinemann (ed.), Supportive Maßnahmen und symptomorientierte Therapie in der Hämatologie und Onkologie, 2nd edn. Schriftreihen des Tumorzentrums München, in press.Google Scholar
  50. Oregon Death with Dignity Act: Oregon Revised Statute 127.800–127.995; 1997.Google Scholar
  51. Quill, T.E., Dresser, R., Brock, D.W. 1997‘The Rule of Double Effect - A Critique of its Role in End-of-Life Decision Making’New England Journal of Medicine33717681771CrossRefPubMedGoogle Scholar
  52. Ramirez Rivera, J., Rodriguez, R., Igaravidez, Y. Otero 2000‘Attitudes Towards Euthanasia, Assisted Suicide and Termination of Life-Sustaining Treatment of Puerto Rican Medical Students, Medical Residents, and Faculty’Bol Asoc Med P R92 (1-3)1821Google Scholar
  53. Rousseau, P.C. 2002‘Palliative Sedation’American Journal of Hosp Palliative Care19295297Google Scholar
  54. Rousseau, P. 2001‘Existential Suffering and Palliative Sedation: A Brief Commentary with a Proposal for Clinical Guidelines’American Journal of Hosp and Palliative Care18151153Google Scholar
  55. Ryynanen, O.P., Myllykangas, M., Viren, M., Heino, H. 2002‘Attitudes Towards Euthanasia Among Physicians, nurses and the General Public in Finland’Public Health116322331CrossRefPubMedGoogle Scholar
  56. Strätling, M., V. Lipp, A.T. May, K. Kutzer, P. Glogner, U. Schlaudraff, G. Neuman and A. Simon: 2003, ‘Passive und indirekte Sterbehilfe. Eine praxisorientierte Analyse des Regelungsbedarfs gesetzlicher Rahmenbedingungen in Deutschland, Empfehlungen einer interdisziplinären Arbeitsgruppe in der Akademie für Ethik in der Medizin e.V.’, Göttingen, June 2003.Google Scholar
  57. Suizid-Tourismus: 2004. php/D/190/9189.Google Scholar
  58. Swiss Association for Palliative Care: 2001, ‘Position Paper of the SAPC with Regard to the Debate on Euthanasia’, Lausanne: SAPC.Google Scholar
  59. Tannsjo, T 2000‘Terminal Sedation–A Possible Compromise in the Euthanasia Debate?’Bulletin Med Ethics1631322Google Scholar
  60. Termination of Life on Request and Assisted Suicide Act: 2000, Review Procedures for the Termination of Life on Request and Assisted Suicide and Amendment of the Criminal Code and the Burial and Cremation Act. Chapter II, Section 2.Google Scholar
  61. Valverius, E., Nilstun, T., Nilsson, B. 2000‘Palliative Care, Assisted Suicide and Euthanasia’Palliative Medicine14141148CrossRefPubMedGoogle Scholar
  62. Verhoef, M.J., Kinsella, T.D. 1996‘Alberta Euthanasia Survey: 3 Year Follow-Up’Can Med Assoc Journal155885890Google Scholar
  63. Walton, O., Weinstein, S.M. 2002‘Sedation for Comfort at End of Life’Curr Pain Headache Rep6197201PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • H. C. Müller-busch
    • 1
  • F. S. Oduncu
    • 2
  • S. Woskanjan
    • 3
  • E. Klaschik
    • 4
  1. 1.Department of Anesthesiology, Pain Therapy and Palliative CareUniversity Witten/HerdeckeBerlinGermany
  2. 2.Klinikum der Universität München, Medizinische Klinik – InnenstadtMunich
  3. 3.PalliativZentrum Berlin-BrandenburgBerlin
  4. 4.Center for Palliative MedicineUniversity of Bonn, Malteser KrankenhausBonnGermany

Personalised recommendations