Abstract
Objective—To demonstrate Japanese doctors' and nurses' attitudes towards and practices of voluntary euthanasia (VE) and to compare their attitudes and practices in this regard.
Design—Postal survey, conducted between October and December 1999, using a self-administered questionnaire.
Participants—All doctor members and nurse members of the Japanese Association of Palliative Medicine.
Main outcome measure—Doctors' and nurses' attitude towards and practices of VE.
Results—We received 366 completed questionnaires from 642 doctors surveyed (response rate, 58%) and 145 from 217 nurses surveyed (68%). A total of 54% (95% confidence interval (CI): 49-59) of the responding doctors and 53% (CI: 45-61) of the responding nurses had been asked by patients to hasten death, of whom 5% (CI: 2-8) of the former and none of the latter had taken active steps to bring about death. Although 88% (CI: 83-92) of the doctors and 85% (CI: 77-93) of the nurses answered that a patient's request to hasten death can sometimes be rational, only 33% (CI: 28-38) and 23% (CI: 16-30) respectively regarded VE as ethically right and 22% (CI: 18-36) and 15% (CI: 8-20) respectively would practise VE if it were legal. Logistic regression model analysis showed that the respondents' profession was not a statistically independent factor predicting his or her response to any question regarding attitudes towards VE.
Conclusions—A minority of responding doctors and nurses thought VE was ethically or legally acceptable. There seems no significant difference in attitudes towards VE between the doctors and nurses. However, only doctors had practised VE.
Key Words: Euthanasia • Japan • doctors • nurses • palliative care
Full Text
The Full Text of this article is available as a PDF (122.9 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Asai A., Fukuhara S., Inoshita O., Miura Y., Tanabe N., Kurokawa K. Medical decisions concerning the end of life: a discussion with Japanese physicians. J Med Ethics. 1997 Oct;23(5):323–327. doi: 10.1136/jme.23.5.323. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Asai A., Fukuhara S., Lo B. Attitudes of Japanese and Japanese-American physicians towards life-sustaining treatment. Lancet. 1995 Aug 5;346(8971):356–359. doi: 10.1016/s0140-6736(95)92230-x. [DOI] [PubMed] [Google Scholar]
- Asai A., Miura Y., Tanabe N., Kurihara M., Fukuhara S. Advance directives and other medical decisions concerning the end of life in cancer patients in Japan. Eur J Cancer. 1998 Sep;34(10):1582–1586. doi: 10.1016/s0959-8049(98)00148-8. [DOI] [PubMed] [Google Scholar]
- Baume P., O'Malley E. Euthanasia: attitudes and practices of medical practitioners. Med J Aust. 1994 Jul 18;161(2):137, 140, 142-4. [PubMed] [Google Scholar]
- Di Mola G., Borsellino P., Brunelli C., Gallucci M., Gamba A., Lusignani M., Regazzo C., Santosuosso A., Tamburini M., Toscani F. Attitudes toward euthanasia of physician members of the Italian Society for Palliative Care. Ann Oncol. 1996 Nov;7(9):907–911. doi: 10.1093/oxfordjournals.annonc.a010792. [DOI] [PubMed] [Google Scholar]
- Farsides B. Palliative care--a euthanasia-free zone? J Med Ethics. 1998 Jun;24(3):149–150. doi: 10.1136/jme.24.3.149. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ganzini L., Nelson H. D., Schmidt T. A., Kraemer D. F., Delorit M. A., Lee M. A. Physicians' experiences with the Oregon Death with Dignity Act. N Engl J Med. 2000 Feb 24;342(8):557–563. doi: 10.1056/NEJM200002243420806. [DOI] [PubMed] [Google Scholar]
- Ishiwata R., Sakai A. The physician-patient relationship and medical ethics in Japan. Camb Q Healthc Ethics. 1994 Winter;3(1):60–66. [PubMed] [Google Scholar]
- Kissane D. W., Street A., Nitschke P. Seven deaths in Darwin: case studies under the Rights of the Terminally Ill Act, Northern Territory, Australia. Lancet. 1998 Oct 3;352(9134):1097–1102. doi: 10.1016/s0140-6736(98)05406-3. [DOI] [PubMed] [Google Scholar]
- Kitchener B. A. Nurse characteristics and attitudes to active voluntary euthanasia: a survey in the Australian Capital Territory. J Adv Nurs. 1998 Jul;28(1):70–76. doi: 10.1046/j.1365-2648.1998.00775.x. [DOI] [PubMed] [Google Scholar]
- Konishi E., Davis A. J. Japanese nurses' perceptions about disclosure of information at the patients' end of life. Nurs Health Sci. 1999 Sep;1(3):179–187. doi: 10.1046/j.1442-2018.1999.00022.x. [DOI] [PubMed] [Google Scholar]
- Konishi E. Nurses' attitudes towards developing a do not resuscitate policy in Japan. Nurs Ethics. 1998 May;5(3):218–227. doi: 10.1177/096973309800500305. [DOI] [PubMed] [Google Scholar]
- Kuhse H., Singer P., Baume P., Clark M., Rickard M. End-of-life decisions in Australian medical practice. Med J Aust. 1997 Feb 17;166(4):191–196. [PubMed] [Google Scholar]
- Kuhse H., Singer P. Doctors' practices and attitudes regarding voluntary euthanasia. Med J Aust. 1988 Jun 20;148(12):623–627. doi: 10.5694/j.1326-5377.1988.tb116334.x. [DOI] [PubMed] [Google Scholar]
- Kuhse H., Singer P. Voluntary euthanasia and the nurse: an Australian survey. Int J Nurs Stud. 1993 Aug;30(4):311–322. doi: 10.1016/0020-7489(93)90103-2. [DOI] [PubMed] [Google Scholar]
- Lavery J. V., Dickens B. M., Boyle J. M., Singer P. A. Bioethics for clinicians: 11. Euthanasia and assisted suicide. CMAJ. 1997 May 15;156(10):1405–1408. [PMC free article] [PubMed] [Google Scholar]
- Miyashita M., Hashimoto S., Kawa M., Kojima M. [Attitudes towards terminal care among the general population and medical practitioners in Japan]. Nihon Koshu Eisei Zasshi. 1999 May;46(5):391–401. [PubMed] [Google Scholar]
- Steinberg M. A., Najman J. M., Cartwright C. M., MacDonald S. M., Williams G. M. End-of-life decision-making: community and medical practitioners' perspectives. Med J Aust. 1997 Feb 3;166(3):131–135. doi: 10.5694/j.1326-5377.1997.tb140042.x. [DOI] [PubMed] [Google Scholar]
- Tanida Noritoshi. 'Bioethics' is subordinate to morality in Japan. Bioethics. 1996 Jul;10(3):201–211. doi: 10.1111/j.1467-8519.1996.tb00119.x. [DOI] [PubMed] [Google Scholar]
- Tierney M. J., Minarik P. A., Tierney L. M., Jr Ethics in Japanese health care: a perspective for clinical nurse specialists. Clin Nurse Spec. 1994 Sep;8(5):235–240. doi: 10.1097/00002800-199409000-00004. [DOI] [PubMed] [Google Scholar]
- Van Der Maas P. J., Van Delden J. J., Pijnenborg L., Looman C. W. Euthanasia and other medical decisions concerning the end of life. Lancet. 1991 Sep 14;338(8768):669–674. doi: 10.1016/0140-6736(91)91241-l. [DOI] [PubMed] [Google Scholar]