Role and responsibility of oncologists in assisted suicide. Practice and views among members of the German Society of Haematology and Medical Oncology.

BACKGROUND: Physician-assisted suicide (PAS) is a controversial practice and regulatory frameworks differ regarding assigned physicians' roles. This study explores clinical experience and views of German oncologists concerning ethically and legally relevant aspects of PAS after change of the law. MATERIALS AND METHODS: An online survey was conducted among members of the German Society of Haematology and Medical Oncology (DGHO) in March 2021. Descriptive analysis, bivariate and multivariable logistic regression of quantitative data on determinants related to (un)willingness to assist with suicide as well qualitative analysis of free-text comments were carried out. RESULTS: Seven hundred and forty-five of 3588 DGHO members responded (20.8%). Of these, 29.9% reported requests for a lethal drug and 3.0% (n = 22) reported to have assisted with suicide. Almost half of them (47.0%, n = 350) objected to providing PAS, whereas 45.9% indicated a willingness at least under certain conditions. Of those respondents who did not object to PAS, 25.4% would also consider assistance if those willing to die had a psychiatric disease and 10.2% if requestors had no disease at all. A majority viewed a role for physicians regarding different tasks associated with assisted suicide. Respondents with <10 years of professional experience, working in hospital with religious affiliation and with subspecialisation in palliative care were significantly less frequently willing to assist suicide. CONCLUSIONS: Respondents are divided in their personal attitudes towards PAS but a majority supports involvement of physicians regarding different tasks related to assisted suicide. Data about the practice and envisaged professional role may inform development of an acceptable ethico-legal framework for a controversial practice.

[End-of-life practices of physicians in Germany]. / Ärztliche Handlungspraxis am Lebensende.

BACKGROUND: Ethical questions at the end of life are at the centre of scientific and public debates. Up to the present there is scarcity of empirical data regarding physicians' end-of-life practices in Germany. METHODS: Cross-sectional study among a random sample of German physicians by means of the questionnaire of the EURELD Consortium with additional questions on experiences and attitudes regarding physician assisted suicide. RESULTS: 734 physicians from five state chambers of physicians responded (response rate 36.9 %). 403 physicians reported about end-of-life practices regarding adult patients. Alleviation of symptoms took place in 86.7 % of cases and in 50.7 % medical treatment had been withheld. In three cases death was the consequence of a drug which was provided or administered by respondents. 20.7 % of respondents had been requested to perform physician-assisted suicide (PAS). 41.7 % of participants could not imagine participating in PAS, whereas 40.2 % could imagine this under certain circumstances. A prohibition of PAS by professional law war rejected by 33.7 %, 25.0 % support such a ban and 41.4 % were undecided. CONCLUSION: Physicians in Germany perform a broad spectrum of end-of-life practices. The empirical findings can serve as a starting point for the reflection about an appropriate normative framework for physicians' end-of-life practices.

Clinical and ethical challenges of palliative sedation therapy. The need for clear guidance and professional competencies.

Palliative sedation therapy (PST) has become a frequent practice in end-of-life care and advocated in the literature as a less problematic alternative to practices of physician-assisted dying, such as ending patients' lives on request or assisted suicide . However, in clinical practice, patients, healthcare professionals and other parties involved in decisions about PST are facing numerous clinical and ethical challenges. This perspective aims to analyse important challenges associated with professional decision-making about PST and to explore the recommendations of guidelines, which have been published in recent years.

'One also needs a bit of trust in the doctor ... ': a qualitative interview study with pancreatic cancer patients about their perceptions and views on information and treatment decision-making.

BACKGROUND: Information about diagnosis, treatment options and prognosis has been emphasized as a key to empower cancer patients to make treatment decisions reflecting their values. However, surveys indicate that patients' preferences regarding information and treatment decision-making differ. In this qualitative interview study, we explored pancreatic cancer patients' perceptions and preferences on information and treatment decision-making. PATIENTS AND METHODS: Qualitative in-depth interviews with patients with pancreatic cancer. Purposive sampling and qualitative analysis were carried out. RESULTS: We identified two stages of information and treatment decision-making. Patients initially emphasize trust in their physician and indicate rather limited interest in details about surgical and medical treatment. In the latter stage of disease, patients perceive themselves more active regarding information seeking and treatment decision-making. All patients discuss their poor prognosis. Reflecting on their own situation, all patients interviewed pointed out that hope was an important driver to undergo further treatment also in advanced stages of the disease. Interviewees unanimously emphasized the difficulty of anticipating the time at which stopping cancer treatment would be the right decision. CONCLUSIONS: The findings can serve as starting point for reflection on professional decision-making in pancreatic cancer and larger representative surveys on ethical issues in treatment decision-making in pancreatic cancer.

[Shared decision making (SDM): a systematic survey of terminology use and concepts]. / Partizipative Entscheidungsfindung (PEF): eine systematische Übersichtsarbeit zu Begriffsverwendung und Konzeptionen.

Shared decision making (SDM) has been investigated in numerous research projects. In 2001 the German Ministry of Health initiated a research program on patients as partners in medical decision making ("Der Patient als Partner im medizinischen Entscheidungsprozess"). In this context a large number of studies has been conducted on SDM. In this review the concept of SDM and the use of this term in scientific publications of German study groups is explored. A systematic literature review generated 147 publications on SDM by German researchers, which had been published between 2000 and 2009. The majority of publications identified in this study refer to clinical studies on patients with chronic diseases. Content analysis of the retrieved publications indicates that SDM as a term is used heterogeneously. There is only little research on the theoretical foundations and ethical implications of SDM. In addition to existent Anglo-Saxon definitions of SDM, new concepts of SDM such as involvement of relatives in the process of decision making were identified as part of this review of the German literature. There is only a limited number of empirical studies with a consistent approach towards a definition of SDM and the respective measurements. Against this background, the "SDM questionnaire", which had been developed as part of the German Ministry of Health's research programme, is an important contribution with respect to operationalising SDM and testing possible effects of SDM in clinical practice.

[Treatment decisions in advanced cancer. An empirical-ethical study on physicians' criteria and the process of decision making]. / Behandlungsentscheidungen bei Patienten mit fortgeschrittenen Tumorerkrankungen. Eine empirisch-ethische Untersuchung zur ärztlichen Indikationsstellung und Entscheidungsfindung.

BACKGROUND AND RESEARCH QUESTION: Physicians' decisions regarding the indication of medical treatment are central to the application or limitation of medical measures in advanced cancer. This qualitative study explores criteria and procedural aspects of treatment decisions with patients with cancer near the end of life from the perspective of oncologists. RESEARCH PARTICIPANTS AND METHODS: In this qualitative interview study physicians working in the field of oncology were asked about their decisional criteria and procedural aspects of treatment decision making in cases of patients with advanced cancer. All interviews were audiotaped and transcribed. Qualitative data analysis was conducted in accordance with principles of "Grounded Theory". RESULTS: 17 research interviews had been analysed. Next to medical criteria the life-circumstances of the patients with respect to age and social situation as well as the perceived quality of the physician-patient-relationship were named as foundation for decisions about the application or limitation of medical treatment at the end of life. In addition situational factors such as time pressure or the available technical equipment were cited as relevant factors for the decisions. "Silent acquiescence" as the predominant decision making model which has been reconstructed on the basis of the narratives means that decisions about the limitation of medical treatment are not communicated explicitly within the physician-patient-relationship. This approach was justified by the interviewees in light of the long standing relationship between physicians and patients. CONCLUSIONS: The decisional criteria and procedural aspects of decision making in patients with advanced cancer which have been elicited in this qualitative study inform the current scientific and societal debate on ethically relevant aspects of end-of-life decision making in medicine.