Abstract
Objectives
To elicit Quebec physicians’ attitudes towards extending medical aid in dying (MAiD) to incompetent patients and to compare the attitudes of family physicians to those of other medical specialists.
Methods
We conducted a postal survey among physicians caring for patients with dementia. We used hypothetical vignettes to elicit their attitudes towards MAiD and continuous deep sedation (CDS) to relieve suffering at end of life. Two patients were depicted in the vignettes: one with cancer eligible for MAiD and one with dementia. The generalized estimating equation approach was used to investigate factors associated with attitudes, including the stage of the illness (advanced vs terminal dementia) and the presence or absence of a prior written request.
Results
A total of 136 physicians out of 653 returned the questionnaire. Physicians favoured CDS over MAiD for relieving suffering in the cancer vignette (93% vs 79%; p = 0.002). In advanced dementia, 45% of physicians supported giving the patient access to MAiD with a written request and 14% without such request. At the terminal stage of dementia, these proportions increased to 71% and 43%, respectively (p < 0.001), reaching 79% and 52% among family physicians. Support for CDS in terminal dementia was lower than in end-stage cancer (68% vs 93%; p < 0.001) and equal to MAiD with a written request (68% vs 71%; p = 0.623).
Conclusion
Many Quebec physicians support extending MAiD to incompetent patients with dementia to relieve suffering at the terminal stage. This finding will inform current deliberations as to whether MAiD should be extended to these patients.
Résumé
Objectifs
Mesurer les attitudes des médecins du Québec face à l’idée d’étendre l’aide médicale à mourir (AMM) à des patients inaptes et comparer les attitudes des médecins de famille à celles d’autres médecins spécialistes.
Méthodes
Nous avons mené une enquête postale auprès de médecins qui soignent des patients avec démence. Les attitudes face à l’AMM et à la sédation palliative continue (SPC) ont été mesurées au moyen de vignettes faisant intervenir un patient atteint de cancer qui est admissible à l’AMM et un second patient atteint de démence. Des équations d’estimation généralisée ont servi à étudier l’influence de facteurs sur les attitudes, dont le stade de la maladie (avancé vs terminal) et la présence ou non d’une directive écrite.
Résultats
136 médecins parmi les 653 sollicités ont retourné le questionnaire. Les médecins préfèrent la SPC à l’AMM pour soulager la souffrance d’un patient atteint de cancer (93 % vs 79 %; p = 0,002). Au stade avancé de la démence, 45 % des médecins appuient l’idée de donner au patient accès à l’AMM avec une directive écrite, et 14 % sans une telle directive. Au stade terminal, ces proportions augmentent à 71 % et 43 % respectivement (p < 0,001), atteignant 79 % et 52 % chez les médecins de famille. Toujours au stade terminal, l’appui à la SPC en contexte de démence est moindre qu’en contexte de cancer (68 % vs 93 %; p < 0,001) et égal à l’AMM avec directive écrite (68 % vs 71 %; p = 0,623).
Conclusion
Nombre de médecins du Québec appuient l’idée d’étendre l’AMM à des patients inaptes, qui sont au stade terminale d’une démence, pour soulager leur souffrance. Ce constat informera les discussions en cours visant à déterminer si l’AMM devrait être étendue à ces patients.
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Acknowledgements
Special thanks are extended to the Collège des médecins du Québec for its collaboration, as well as to all physicians who took the time to fill out the questionnaire.
Funding
The study was funded by an unrestricted grant from the Alzheimer Society of Canada (Grant # 16-11).
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The authors declare that they have no conflict of interest. Jocelyn Downie is member of the Council of Canadian Academies Expert Panel on Medical Assistance in Dying (Mental Disorders Working Group).
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“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”
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Bravo, G., Rodrigue, C., Arcand, M. et al. Quebec physicians’ perspectives on medical aid in dying for incompetent patients with dementia. Can J Public Health 109, 729–739 (2018). https://doi.org/10.17269/s41997-018-0115-9
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DOI: https://doi.org/10.17269/s41997-018-0115-9