APPENDIX 7: PUBLIC OPINION ON THE LEGALISATION
OF EUTHANASIA/PAS: A RESEARCH REVIEW CARRIED OUT BY MARKET RESEARCH
SERVICES, DECEMBER 2004
FOREWORD: BRIEF SUMMARY OF FINDINGS
1. This report summarises available research
findings, mainly focused on the last 10 years or so, on the subject
of attitudes to the legalisation of euthanasia and physician-assisted
suicide among the general public and the health sector.
2. The findings should be treated with great
caution. Very little research exists which is built on techniques
appropriate for so complex and sensitive a subject as euthanasia
and whether/how it should be legalised. Research sponsors frequently
appear to have been more concerned to achieve statistics for media
consumption than to work towards achieving a comprehensive understanding
of public and health sector attitudes.
3. Among the general public, research findings
over many years suggest, at least at face value, that there is
a widespread and growing concern to legalise the situation of
the terminally ill who wish to die and those prepared to help
them.
4. Opposition to the legalisation of euthanasia/PAS
is most readily linked to "religious" attitudes to life
as sacred. The concept of passive euthanasia (withdrawal/withholding
of treatment) appears as relatively uncontentious.
5. The concept of Living Wills is generally supported
in the small amount of mention given, though there is some feeling
that doctors should not necessarily be obliged to follow
them.
6. Views on potential implications of legalising
euthanasia/PAS, for specific groups of individuals and for society
in general emerge only in occasional strands of research. There
are suggestions that older people may become nervous of entering
hospital and that those who are dependent on others may feel motivated
to request euthanasia. There are marginal suggestions that trust
in doctors and nurses may suffer some erosion.
7. Disabled people's views are not clear from
the sources which are less than adequate for the purpose and tend
to be somewhat contradictory in their findings.
8. Public involvement in decisions around the
legalisation of euthanasia/PAS is requested strongly (referendum)
in surveys in Isle of Man and Guernsey, but not explored elsewhere.
9. Illegal euthanasia was also thought to sometimes
occur by very many on these two islands, but the question does
not feature in mainland research.
10. Politicians' views of the legalisation of
euthanasia/PAS appear to differ markedly from those of the general
public, with only a diminishing minority in favour.
11. Doctors also appear to be notably
less in favour of legalising euthanasia than the general public.
Variations in the format and in the quality of research into medical
sector views make summary difficult. At "face value",
the results suggest that support for legalising euthanasia is
diminishing latterly, after expanding over a number of years.
12. Euthanasia/PAS appears to be an area of difficulty
and dilemma for doctors. Many have received requests to provide
help but the data varies as to how many have helped patients wishing
to die to do so. Most doctors appear to believe that the incidence
of illegal euthanasia/PAS is small, but sources vary somewhat.
There is some suggestion that those who have been asked to provide
help to die are more open than others to the concept of legal
reform. GPs appear generally to be more open to reform than hospital
specialists.
13. Geriatricians form the only specific
medical group who appear, in one study, as strongly opposed to
legal reform, principally because of potential pressure on old
people to request euthanasia—and a sense that the social
processes of dying and grieving might become undermined.
14. Nurses' views are not very visible. A recent
Nursing Times readership poll (for which satisfactory details
were not available) suggested that 2:3 nurses would like euthanasia
to be legalised.
15. Pharmacists' views appear (from one limited
study) to be largely in line with doctors—less than half
were in favour of legalising PAS. The sample was split on whether
they should/would willingly dispense drugs for suicide.
16. The palliative care sector is represented
in one qualitative study, which suggests that, although some support
the concept of legalised euthanasia, there are many concerns about
the potential impact on care and on relationships between doctors,
carers and patients.
17. The key conclusion of this report is that,
although some idea of the basic attitude of the general
public is available through research sources, this does not amount
to an authentic picture of public opinion which is in any way
comprehensive. Deliberative research techniques, unused so far
for this subject, which can produce an account of informed
public opinion, are recommended if a proper understanding
of public opinion is to be achieved. This suggestion is also made
with regard to the health sector, where much of the research carried
out has been too limited in value to rely on for the purposes
of informing decisions on the reform of current legislation.
1. INTRODUCTION
The House of Lords Select Committee on the Assisted
Dying for the Terminally Ill Bill requested a survey to be carried
out of any existing sources of information on public attitudes
to euthanasia and physician-assisted suicide (PAS), including
the attitudes of those in the health sector.
The objectives of the study were to:
- identify what research had been
carried out in recent years into public attitudes to euthanasia/PAS
- to provide an account of the main findings as
relevant to the Committee's purposes
- as far as feasible, to examine each element of
research and make a judgement as to its validity, relevance and
usefulness for understanding public and health sector attitudes
to the given topic
Some research sources were identified in advance
by the Clerk to the Committee and others by COI Communications.
Others became apparent in the course of following up initial sources
and through internet searches. The Voluntary Euthanasia Society
was particularly helpful in identifying relevant pieces of research,
as was the Pro-life Alliance and a range of other individuals
who had been involved in commissioning, carrying out or publicising
specific research projects.
Note on terminology: In general, the concepts of
"euthanasia"—active euthanasia, unless
otherwise stated—and "physician-assisted suicide"
are distinguished wherever the data allows. Only in some of the
data are the two potential roles of the doctor distinguished—providing
drugs/information for suicide or, at the patient's request, administering
drugs calculated to kill. Essentially, the debate is about the
concept of doctors helping very sick patients who wish to die,
to do so at a time of the patient's choosing, and it is to this
over-riding concept that the term "euthanasia" mainly
refers when used without qualification.
2. RESEARCH SOURCES
A list of the main research sources consulted for
this project appears as an appendix. These are numbered and are
frequently referred to by number throughout the text.
Overall, there is not a great deal of reliable detailed
guidance available as to attitudes to euthanasia/PAS, especially
among the general public. Virtually all the studies identified
are quantitative in nature, drawing upon a variety of sample sizes
and types, some clearly more adequate than others. In general,
both the questions posed and the analysis of the responses tend
to be limited in scope. There is little evidence of the employment
of in-depth exploratory research techniques such as would conventionally
be used to provide an initial understanding, especially of complex,
sensitive topics such as euthanasia/PAS, to guide survey design
and fuel the understanding of quantitative results.
As a result, the quantitative techniques employed,
which by definition are capable of providing breadth more than
any depth of understanding, often tend to produce findings which
at best may be considered one-dimensional. Simple, direct questions,
placed without a proper explanatory context and with limited options
for reply can sometimes produce results which may in fact be misleading.
Omnibus surveys, ongoing questionnaire surveys of
nationally-representative samples, which can include a wide variety
of topic areas, depending on the mix of clients at any given time,
are used very widely in the sources consulted for this project.
Omnibus surveys are particularly useful for simple issues such
as consumer choices or, in social topics, where respondents can
be assumed to have a broad understanding of the topic area and
of the consequences implied by particular response options. Where
these conditions cannot be assumed and, as with euthanasia, the
issues are potentially complex and far-reaching, the omnibus may
not be the ideal tool for providing understanding. This seems
to be particularly the case with surveys of the general public,
where an understanding of the potential impact of euthanasia/PAS
legislation clearly cannot be assumed.
A relatively recent development in United Kingdom
research techniques is the use of panels of respondents who are
paid for their participation in omnibus surveys. (E.g., 9, 11,
12, 13, 23, 25). This practice tends to produce very high response
rates, with hopefully no negative implications for the quality
of the response.[83]
Additionally, other research techniques used in the
sources, such as postal or web surveys, may produce some bias
in the response to the degree that respondents may effectively
be self-selecting. In theory, this can be particularly problematic
with a topic such as euthanasia which tends to invite passionate
responses from various directions.
This theme, of the limitations of much of the research
considered in this report for the purposes of gaining a real understanding
of attitudes to euthanasia, is continued in Section 5 Conclusions,
where suggestions are made for building upon what is already achieved.
3. GENERAL PUBLIC ATTITUDES TO EUTHANASIA/PAS
3.1 BASIC ATTITUDES TO EUTHANASIA/PAS
It is unfortunate that most of the research carried
out into public attitudes to euthanasia lack significant depth
and provide relatively one-dimensional results. As explained in
Section 2, the research techniques which have mainly been employed
have been those with the least capacity to deal with complex and
sensitive issues such as euthanasia. In most cases, respondents
were given only very limited options for response to relatively
simple, direct questions without any context of explanation of
what wider implications there might be from a change in the law
for individuals and for society.
Nevertheless, it is evident that there is a great
deal of sympathy within society, at least for the concept of
euthanasia, and it seems likely that the level of sympathy has
grown in recent years. Evidence for this can be drawn from numerous
polls carried out over the last 20-30 years. A small number of
them make some attempt to include some of the complexity of the
subject within their questioning, but in general the issue of
euthanasia is presented very simply. The key questions generally
ask respondents their attitude to a change in the law which would
favour those who:
- Are terminally ill
- Are in great pain
- Have made it clear that they do not wish to continue
living and
- Need help to die
The questions posed and the overall responses are
tabulated below, in rough chronological order.
1987 MORI Poll
The earliest survey for which detailed results were
available is the 1987 MORI poll conducted as part of the regular
MORI omnibus survey and sponsored by two organisations active
in the Pro-life movement—Doctors Who Respect Human Life
and the Human Rights Society.
The key question in this survey relating to basic
attitudes to euthanasia was Q.2 of a total of 8:
I would like to ask you some questions about euthanasia.
By euthanasia I mean when a doctor is allowed by law to terminate
the life of a patient.
In Holland some doctors carry out euthanasia when
their patients request it, by giving sedatives and injecting muscle
relaxants so as to paralyse breathing. Some people have said the
law in Britain should be changed so as to allow euthanasia in
some circumstances as is done in Holland. Others believe the law
should not be changed. Looking at this card, which of these options
comes closest to your view?
Results (1808 respondents)
| Euthanasia should be made legal in all cases when the patient requests it
| 23% |
| Euthanasia should be made legal only when a patient who requests it is suffering from a severe illness and is in a lot of pain
| 49% |
| The law should not be changed so as to allow euthanasia
| 19% |
| Don't know | 9%
|
The question presents respondents with what might
be termed a fairly stark picture of the process of euthanasia
"…to paralyse breathing" but nonetheless
half the sample were sympathetic to physician-assisted death in
circumstances of severe illness and great pain—and almost
a quarter appeared to believe in euthanasia "on request".
Only one in five stand out against the idea of legalising euthanasia.
MORI comment with apparent justification that the survey as a
whole indicates that "public opinion is somewhat more
in favour of than opposed to the idea of legalising euthanasia
in Britain" (1).
Again, it is important to repeat that even a survey
as carefully constructed and objectively analysed as this one
is, cannot be viewed as presenting more than a superficial view
of public attitudes to euthanasia because of the limitations of
the research technique employed. However, the survey has a broader
scope than some in that it asks a number of questions relating
to the possible implications of legalising euthanasia in terms
of the impact on elderly patient attitudes to health care, and
the potential role of relatives for patients no longer able to
communicate etc.—which are covered separately below.
1984-1995 British Social Attitudes Survey
The British Social Attitudes Survey (BSA),
from the National Centre for Social Research, is widely acknowledged
as an important source of understanding of public attitudes with
regard to a range of social, political and moral issues. For many
years NatCen has contributed importantly to the development of
methodologies and of standards within the field of social research.
Unlike standard omnibus surveys, which tend to produce raw data
for clients and at best a summary analysis of the main findings,
BSA data is expertly analysed and findings are presented within
a broad context of the general understanding of trends in public
attitudes which is generated by the survey as a whole.
The BSA survey of public attitudes to euthanasia
also differs from many others in at least one potentially important
aspect—it is not commissioned by any outside organisation
with a commitment to one side or other of the euthanasia debate.
The funding of this element of BSA by the Nuffield Trust has no
implications whatsoever for the objectivity of the coverage.
BSA (1995) claims that there is in the United Kingdom
"widespread and increasing support for the legalisation of
euthanasia- in certain circumstances". To the simple question
-
Suppose a person has a painful incurable disease.
Do you think that doctors should be allowed by law to end the
patient's life, if the patient requests it?
- the overall trend in response is clear:
| 1984
| 1989 | 1994
|
| % |
% | %
|
| Yes, the law should allow it | 75
| 79 | 82
|
| No, the law should not allow it | 24
| 20 | 15
|
| Base | 1562
| 1274 | 1000
|
BSA 1995 (fieldwork 1994/report 1995) focused upon
euthanasia in greater depth than before and discovered that attitudes
towards legalisation are more complex than the single question
given above might be taken to suggest. Varying levels of support
for euthanasia are expressed, linked to particular circumstances.
Support is highest when the case involves an individual not expected
to recover consciousness and on a life-support machine (86%) and
in the case of an incurable and painful terminal illness, such
as cancer (80%). Euthanasia for someone not expected to recover
consciousness, but not on a life-support machine, reduces
to 58% (in these cases, the support of relatives is assumed).
51% support the legalisation of euthanasia for those who become
totally dependent on others, 44% for a non-painful terminal
illness and 42% for a painful illness which is not terminal. Support
for legalising euthanasia for any who are simply tired of living
drops to 12%.
BSA proffers these findings more as indications of
the complexity of the issues, rather than as definitive statements
of public opinion. Complex processes of analysis of the survey
findings reveal that there is, for example, no significant link
between age and attitude to the legalisation of euthanasia, but
there is a significant (negative) link with the practice of religion
and with general attitudes to life as sacred, such as tend
to be derived from religion. The survey concludes that the apparent
trend towards the belief that euthanasia should be legalised in
certain circumstances is part and parcel of a broad process of
secularisation in western society—and as such, seems set
to grow. It notes that neither of the "principled" approaches
of those for or against legalising euthanasia—liberty of
the individual/duty of the state to preserve life—adequately
represents the more pragmatic approach taken by most individuals
when asked to view the issue on a case by case basis.
1976-1993 NOP for the Voluntary Euthanasia Society
The following question was asked in four surveys
within this period:
Some adults say that the law should allow adults
to receive medical help to an immediate peaceful death if they
suffer from an incurable physical illness that is intolerable
to them, provided they have requested such help in writing. Please
tell me whether you agree or disagree with this?
A simple "agree/disagree" response is required
in the rather emotive context of the contrast drawn between an
"intolerable" state of existence and the promise of
an "immediate, peaceful, death" through "medical
help". The question is not unfair but it seems to invite
agreement more than disagreement. In four omnibus surveys over
a period of 17 years, the question was answered as follows by
a nationally representative sample of around 2000 individuals
aged 15+:
| Year | % For
| % Against | % Undecided
|
| 1976 | 69
| 17 | 14
|
| 1985 | 72
| 21 | 8
|
| 1989 | 75
| 16 | 9
|
| 1993 | 79
| 10 | 11
|
For the reasons given earlier, these results cannot
be taken purely on "face value", nevertheless the apparent
trend towards agreeing with the concept of legalising medical
intervention for an assisted death cannot be dismissed, especially
as it emerges in other surveys around this time, including the
two surveys already quoted.
2002-2004 NOP for the Voluntary Euthanasia Society
More recent NOP omnibus surveys for VES ask the following
question.
Do you think that a person who is suffering unbearably
from a terminal illness should be allowed by law to receive medical
help to die, if that is what they want, or should the law not
allow them to receive this medical help to die?
Again, respondents are invited to respond simply
Yes, No or Don't Know. In October 2002, this was
the only question asked, but in July 2004, the question was one
of seven. In both cases, the sample was significantly smaller
than for the previous surveys (1000 and 790, respectively), indicating
slightly lower levels of reliability, though this factor lacks
significance in the context of the dominant number of respondents
agreeing with the (first part of) the question.
| Survey Date | % Yes
| % No | % Don't know
|
| October 2002 | 81
| 12 | 7
|
| July 2004 | 82
| 11 | 7
|
Again, high levels of sympathy are indicated for
physician-assisted suicide for the terminally ill who are "suffering
unbearably" though, as before, these results provide no guarantee
of public understanding in any depth of the issues involved.
Guernsey/Isle of Man 2004
Small sample omnibus research (500 respondents) was
held for VES by NOP in Guernsey and Isle of Man at a point that
the issue of euthanasia was current within the local parliaments.
The key question intended to measure basic attitudes to euthanasia
varied slightly in format between the two locations but effectively
brought a confirmation that feelings on these islands are roughly
similar to those expressed in mainland United Kingdom.
Guernsey
Do you think that a Guernsey resident who is suffering
unbearably from a terminal illness should be allowed by Guernsey
law to receive medical help to die, if this is what they want,
or should the law not allow them to receive this medical help
to die?
| Yes | 77%
|
| No | 16%
|
| Don't know | 7%
|
Isle of Man
On the Isle of Man, it is a criminal offence to assist a person
to commit suicide. Do you think this law should be changed so
that assisting a person to commit suicide is no longer a criminal
offence…
| Under any circumstances?
| 7% |
| When that person is suffering from an incurable disease?
| 68% |
| Under no circumstances whatsoever | 21%
|
| Don't know | 4%
|
'Straw polls'/reactions to the Diane Pretty case
A number of media polls have been held on the subject of euthanasia,
mostly in the wake of the Diane Pretty case. These are less reliable
as thermometers of public opinion even than conventional omnibus
surveys, mainly because they are based on self-selecting audiences,
and tend to use simplistic question formats, often with no response
functions beyond Yes/No. Importantly, in relation to the Diane
Pretty case, these polls functioned within the emotionally charged
context of media coverage of that event. The results have tended
to be even more strongly in favour of the legalisation of euthanasia
than more conventional polls.
The Voluntary Euthanasia Society have publicised
the following findings for 3 polls held between 20th
and 26th August 2001:
Teletext poll
We asked you if you back a terminally ill woman's
wishes to die without her husband facing prosecution.
Independent on Sunday
Diane Pretty, who suffers from motor neurone disease, began
her legal battle last week to establish that her husband will
not be prosecuted if he helps her to commit suicide. We asked:
should people have the right to die when they choose?
| Yes | 85%
|
| No | 15%
|
| Base | Not given
|
Sky Interactive Poll
Euthanasia: should it be legalised?
| Yes | 84.5%
|
| No | 15.5%
|
| Base | 3563
|
Heaven and Earth Show, September 26th 2004
A more recent media poll was held by the BBC Religion & Ethics
programme The Heaven and Earth Show. In the wake of a discussion
of the topic, viewers were invited to respond by email, text or
phone to the question:
Should assisted suicide be made legal?
Again, only Yes or No answers were sought, with the
following results:
| Yes | 73%
|
| No | 27%
|
| Base | Not given
|
At best, these polls can be said to offer no challenge
to a basic assumption in favour of the concept of legalising euthanasia
as indicated in the various surveys detailed above. However their
real value for gauging public opinion more meaningfully is perhaps
best summed up by the series producer for the programme last quoted:
"This is no more than a straw poll, based on
random input from viewers .There is no pretence that the sample
is scientifically selected or in any way representative of public
opinion as a whole"
3.2 PUBLIC ATTITUDES TO EUTHANASIA/PAS: SPECIFIC
ISSUES
Various issues linked to attitudes to euthanasia/physician-assisted
suicide appear in the findings of specific surveys and any research
results of interest for broadening the understanding of public
attitudes to the legalisation of euthanasia/PAS are summed up
here.
What differentiates those for from those against
euthanasia?
In fact few of the surveys are able to throw much
authoritative light on the socio-demographic make-up of the two
"sides" of the euthanasia debate (as constructed by
the general tendency to treat the topic on a simple basis of agreement/disagreement).
The best source for providing some commentary upon apparent differences
between the two "groups" remains the British Social
Attitudes survey of 1994/95. This suggests that, at least
at that time, opponents of the concept of euthanasia were inclined
to be found among people who, relative to those in favour of euthanasia,
tend to be:
- Regular churchgoers
- Ethnically mixed - those most in favour tend
to be mainly white
- Scottish (the only regional bias to emerge)
- Able-bodied
- Less educationally qualified
- More committed to "sanctity of life"
issues—anti-abortion/suicide/capital punishment (the last
is the least sure)
Importantly, there appeared to be little or no link
with age, gender or social class, nor with party political identity.
Attitudes of disabled people
There are three sources claiming some insight into
attitudes of disabled people to euthanasia—(2), (10), (11).
BSA (2) notes that disabled people are more pro-euthanasia than
able-bodied people, but that this link is only significant among
young disabled people. The link is interpreted in terms of a higher
level of sympathy for pain and dependency, gained through personal
experience.
A January 2003 survey for the Disability Rights Commission
(10) was based on an in-house constructed web poll of 162 individuals,
56% of whom categorised themselves as disabled. The results suggest
that disabled people are more concerned (than others are) for
disabled people to be protected against discrimination in potentially
end-of-life medical treatment—and less concerned (than others
are) for euthanasia to be legalised for disabled people. The value
of the survey is somewhat circumscribed both by the small size
of the sample and the self-selecting nature of the research technique
employed.
In November 2004, a YouGov omnibus survey for VES
was answered by 2091 respondents, around a quarter of whom categorised
themselves as disabled on the basis of a definition drawn from
the Disability Discrimination Act[84].
The results suggest that disabled people support the Assisted
Dying for the Terminally Ill Bill as strongly as able-bodied people
(80%) and also that, should euthanasia be legalised, they would
continue to trust doctors as much as they do at present. Disabled
people also appear to believe slightly more strongly than others
that the law currently discriminates against terminally ill disabled
people who wish to commit suicide but need assistance to do so.
The results also suggest that disabled people are slightly more
likely than others to believe that the Bill would improve society's
view of disabled people.
The questions raised in this survey are both complex
and sensitive and it can only be repeated that omnibus surveys
are probably the least suitable research technique for gaining
any depth of understanding of public attitudes to such topics,
at least without the benefit of a previous stage of in-depth research
to inform both the questioning and the interpretation of the results.
The potential impact of the legalisation of euthanasia.
Issues addressed at one point or another include:
- Attitudes to 'passive' euthanasia
- Levels of trust in doctors/the health service
- Impact upon hospice services
- Impact on 'vulnerable' patients
- Trust in relatives
- Need to take account of public opinion
Attitudes to 'passive' euthanasia
This issue is addressed once only, in a 1999 Capibus
omnibus survey for First Do No Harm, a pro-life grouping of doctors.
The single question (to 2042 respondents) is fairly emotively
expressed and the results show the population to be strongly against
the concept of a legal right to withhold food and fluid, but not
massively so:
The British Medical Association says that doctors
may withhold tube feeding and hydration from patients such as
victims of a stroke, who are not dying but might be permanently
disabled. This would make them die for lack of fluid. Some other
doctors' groups disagree with the BMA. Do you think doctors should
have a legal right to withhold food and fluid?
| Should have a legal right
| 30% |
| Should not have a legal right | 56%
|
| Don't know | 11%
|
Trust in doctors
Overall, trust in doctors appears likely to be marginally undermined
by the legalisation of euthanasia, as exemplified by the responses
to a direct question asked by VES in a YouGov omnibus survey (1574
respondents) of October 2004:
If the law were changed to allow, within strict
guidelines, a terminally ill adult who was suffering unbearably
to ask for and receive medication to end their life at a time
of their choosing from their doctor, overall would you trust doctors…
| More | 9%
|
| The same | 70%
|
| Less | 9%
|
| Don't know | 11%
|
A similar question concerning nurses suggested a similarly
high level of trust but one which was slightly more likely to
be eroded in the event of legalised euthanasia.
87% of the sample of 500 inhabitants of Guernsey
(5) felt they would still trust their doctor if assisted
dying were made legal. The latest VES/YouGov survey (11) produced
the following result:
If this Bill were to become law, would you trust
your doctor...
| More | 6%
|
| Same amount | 77%
|
| Less | 9%
|
| Don't know | 8%
|
Perhaps unsurprisingly, in one survey (7), doctors
are the lead choice for assistance to die legally, though not
overwhelmingly so:
If it were legal to ask for and receive assistance
to die, who would you ask to help you?
| Doctor | 55%
|
| Nurse | 2%
|
| Relative | 19%
|
| Friend | 9%
|
| None of these | 8%
|
| Don't know | 7%
|
There is some evidence (1) (in 1987) of a general
reluctance to oblige doctors to carry out (legalised) euthanasia
as part of their contract—only 31% of 902 respondents felt
they should, against 52% who disagreed.
Fear of hospitals
The last quoted survey also suggested that many people
(60%) feel that elderly people in particular might be more nervous
of going into hospital if euthanasia were legalised.
Living wills
The issue of living wills is addressed only in the
British Social Attitudes survey (1) and is mentioned here as it
is contingent to attitudes to doctors, in the case of euthanasia
being legalised. The survey showed broad approval for the concept
of living wills and 1:4 respondents felt that doctors should be
allowed to act on them and end a patient's life if so requested.
However, a somewhat lower proportion (62%) felt that doctors should
be obliged to do so.
Impact on hospice services
This issue was raised only in the Isle of Man where
response appears to suggest that 3:4 do not think that a change
in the law on euthanasia will damage the work currently done by
the Isle of Man Hospice. However, not inconsiderable minorities,
particularly of older people, feel either that it might—16/20%
(total/55+) or that they cannot judge (11/16%).
Impact on 'vulnerable' people
The 1987 MORI survey (1) suggests that a large majority
(71% - only 12% disagreeing) believe that people permanently dependent
on others for medical or nursing care might request euthanasia
in order not to be a burden on others. The question (3c) appears
to hypothesise euthanasia on request but nevertheless the weight
of agreement seems interesting.
Trust in relatives
The same survey (1) suggests that there is a fairly
widespread disinclination to trust next of kin to request euthanasia
for patients who are unable to communicate—31% believed
this should be permitted, but 47% did not.
Consulting the public
Only in the two off-shore surveys (Isle of Man and
Guernsey (5,6)) is the issue raised of how agreement should
be reached about changing the law on euthanasia. It may be that
the results of this question are mainly pertinent to the two locations,
but the suggestion is introduced that the issue of euthanasia
legislation requires an important level of input from the general
public and not just from politicians. In both cases, around 4:5
respondents chose a referendum as a means of deciding whether
assisted dying should be made legal—against a decision being
achieved by politicians in the normal way any Bill is voted
on.
Action in the absence of new legislation
The latest NOP/VES survey (7, July 2004) suggests
that an important proportion of the population might be prepared
to break the law to help someone else to die (47%) or would like
someone else to help them to do so (51%), in the case of a terminal
illness and unbearable suffering. A similar proportion (50%) felt
that in these circumstances they would consider going abroad to
receive assistance to die, to a country where this was legal—a
proportion which was replicated in Guernsey.
However, in the case of a change in the law, inhabitants
of the Isle of Man were fairly strongly against allowing the island
to become a refuge for those from countries where euthanasia is
illegal.
Is euthanasia currently practised - illegally?
This question has not been asked of the general public
on mainland United Kingdom but when it was raised in Guernsey
and the Isle of Man (5) (6) the results appear to demonstrate
a widespread belief that euthanasia is already a fact of life.
Do you think that euthanasia is already sometimes
practised, on terminally ill patients in the final stages of illness,
as an act of mercy?
| Guernsey %
| Isle of Man % |
| Yes | 68
| 71 |
| No | 12
| 11 |
| Don't know | 21
| 17 |
4. VIEWS OF POLITICIANS
Two surveys of Members of Parliament, 1995 and 2004,
(12, 13) both suggest that attitudes to the legalisation of euthanasia
among MPs is the reverse of what appears to be the case with the
general public.
In 1995, 70% of MPs opposed (and 27% supported) the
principle of voluntary euthanasia, where a patient is terminally
ill, subject to detailed legislative safeguards.
In 2004, 79% opposed and only 21% supported the principle
of a Bill to legalise voluntary euthanasia. In the earlier
survey, Labour MPs were rather more supportive of the proposition
than their Conservative colleagues, but both parties were similar
in attitude in the second survey.
Both surveys were said to produce results largely
similar to those of surveys carried out in 1992 and 1994.
The earlier survey was based on telephone interviews
with 151 MPs and in 2004, 100 MPs emailed their responses. In
both cases, the sample represented the composition of the House
of Commons in terms of party affiliation. The first survey was
carried out for the House Magazine and the more recent
one for the Pro-life Alliance.
The reasons for the apparent gulf in attitude between
MPs and those they represent can only be speculated upon at this
point, a process which lies beyond the capacity of this report.
However, an obvious factor of difference could be that MPs, by
definition, are more accustomed than most to taking into account
the implications for society as a whole of proposed legal reforms,
as a separate issue to their personal feelings on the subject.
5. VIEWS FROM THE HEALTH SECTOR
5.1 DOCTORS' VIEWS OF EUTHANASIA/PAS
In general
The views of the medical profession are expressed
through a number of surveys which, as with the surveys of the
general public considered in Section 3, vary importantly in quality
and in scope. However, the overall picture of doctors' attitudes
to euthanasia is more complex than that of the general public.
At the same time, the data generally enjoys a higher level of
credibility, on the assumption that medical practitioners can
be assumed to have at least some direct experience of end-of-life
conditions and therefore to be able to answer questions more meaningfully
on this basis than others. In this sense, the review of medical
feelings about euthanasia is a more straightforward undertaking
than that of the general public.
Euthanasia is clearly a subject which presents very
many doctors with profound professional and personal dilemmas
and overall tends to split the profession between those more and
less generally in favour of a change in the law. It seems likely
that medical professionals view the issue of the legalisation
of euthanasia as less straightforward than the lay public as a
whole because of their direct experience of working with patients
and there is some evidence to suggest that the closer the
experience of end-of-life patients, the less sure professionals
are about the prospect of a change of the law in favour of euthanasia.
Some of the evidence also suggests that, over time, doctors may
have become generally less favourable to the concept of legal
reform.
Significant differences exist in the quality of the
available research information—which ranges from rapid 'dip-stick'
media-sponsored surveys of the profession through to university-based
academic studies and inevitably includes an important number of
studies commissioned by organisations with a dedicated interest
in the concept of a change in the law related to euthanasia. The
evidence is therefore best considered on a piecemeal basis, with
some attempt at chronology.
1987: NOP telephone survey of 301 GPs for Voluntary
Euthanasia Society. (14)
The sample is small but was selected to 'broadly
represent' all NHS GPs throughout Britain, excluding vocational
trainees.
The results of this survey appear to typify the dilemma
of euthanasia for medical professionals—and the contrast
with lay public opinion.
59% of the sample disagreed with the concept of changing
the law in favour of voluntary euthanasia - 39% disagreed 'strongly'.
The proportion in favour of change totalled 30%, only one third
of these agreeing 'strongly'. 9% of the sample claimed to hold
'mixed views'.
NOP pointed to the contrast with a recent (1985)
study of the public (sample 1712) which asked the identical question[85]
and in which 72% of respondents declared themselves in favour
of the suggested change.
The dilemma of euthanasia, for doctors, is perhaps
also evident in the difference between attitudes to the concept
of euthanasia and what doctors might do in practice, were
the law to change.
At the moment, euthanasia is illegal. Suppose
the law was changed to permit voluntary euthanasia and there was
a patient on your list whose case you knew well, who suffered
from an incurable physical illness that was intolerable to them.
If that patient made a signed request that you end his/her life,
would you consider doing so or not?
| Yes, consider | Perhaps possibly
| No - would not |
| 35% | 10%
| 53% |
Base 301
Clearly, rather more GPs were prepared to consider
euthanasia in certain circumstances (45%) than had stated that
they were in favour of the concept of euthanasia (30%).
Male GPs appeared to be more favourable to the concept
of legalised euthanasia than females and in general, attitudes
tended to correlate negatively with age, but the small base of
the study limits confidence in this level of analysis.
1993: Attitudes among NHS doctors to requests
for euthanasia. Ward & Tate, Dept of Anatomy, Cambridge
University (15)
This survey was based on anonymous postal responses
from 312 GPs and hospital consultants (in roughly equal proportions)
within one area of England. The intention was to explore NHS doctors'
attitudes to 'competent' patients' requests for euthanasia
and to estimate the proportion of doctors who have taken active
steps to hasten a patient's death. The base of the sample tends
to vary as not all respondents answered each question. It is an
important study, apparently carried out with sensitivity and a
high level of concern for objectivity and for methodological rigour
within the bounds of the relatively small sample.
The key findings are that:
- 60% of doctors had been asked
at some point by a patient to hasten their death—64% of
GPs and 52% of consultants
- 51% of GPs and 36% of consultants had been asked
to provide active euthanasia, as opposed to passive
euthanasia by withholding or withdrawing treatment
- 1:3 of a sub-sample of 119 doctors (of which
83 were GPs) had taken active steps to bring about the death of
a patient. The research suggests that, for whatever reason, GPs
are more inclined than hospital consultants to comply with a request
for active euthanasia
- The great bulk of doctors (88% of GPs and 95%
of consultants) stated that in some circumstances they would be
prepared to practice passive euthanasia[86]
In this context, views of whether the United Kingdom
law on euthanasia should be changed to become similar to the Dutch
law are perhaps not surprising. Significantly more agreed than
disagreed with the proposition, as follows:
In the Netherlands, doctors are now virtually
certain to avoid prosecution if they end the life of a patient,
provided:
- This is the patient's well-considered
wish
- The patient has an irreversible condition causing
protracted physical or mental suffering which he or she finds
unbearable
- There is no reasonable alternative (from the
patient's point of view)to alleviate the suffering
- The doctor has consulted another professional
who agrees with his or her judgement
Do you think a similar situation should exist
in Britain?
| Response | % GPs
(Base 169)
| % Consultants
(Base 140)
| % Total
(Base 309)
|
| Strongly agree | 15
| 15 | 15
|
| Agree | 33
| 31 | 32
|
| Undecided | 23
| 15 | 19
|
| Disagree | 19
| 27 | 23
|
| Strongly disagree | 10
| 11 | 10
|
46% of this sample (51% of GPs and 40% of consultants)
stated that they would personally be prepared to consider practising
euthanasia, if asked to by competent patients—a total of
32% would not.
Attitudes to euthanasia
were consistent throughout the responses to the specific questions
on the subject, showing that doctors either supported euthanasia
or rejected it. However, practice could sometimes be at variance
with belief (most notably among those with religious beliefs,
who tended to reject the concept of legalising euthanasia but
had sometimes practised active euthanasia)—implying, in
the words of the study, 'painful personal dilemmas' experienced
by some doctors.
Addendum: GPs v Hospital Specialists
The suggestion running through the results of the
study quoted above, that GPs tend to be more open than hospital
consultants to changing the law in favour of euthanasia, appears
to receive some confirmation from a study for VES of around 2000,
only some details of which are clear (22). This study concluded
from a sample of 554 GPs and 398 hospital specialists that GPs
are significantly more in favour of a change in the law than hospital
specialists (Oregon provided the role model for change on this
occasion) and more willing to consider practicing active euthanasia.
1995: Doctor magazine omnibus survey of 2150
doctors, mix of GPs and hospital specialists. (17)
This survey continued the suggestion that the medical
profession was split in its attitude to legalising euthanasia.
Key findings were:
- 44% supported legal reform against
53% who rejected it
- Within the previous year, 57%
of doctors had been asked by patients and sometimes relatives/friends
of patients to practice one form or other of euthanasia
- If active euthanasia were legal, 43% - slightly
more GPs than hospital doctors—would consider it
- Around 80% of doctors (including religious believers)
saw passive euthanasia as an accepted part of medical practice
1996: BMA News
Review
survey of 750 general practitioners (18)
Overall, the results appear roughly similar in stance
to previous studies of GPs, though there are differences of detail:
- 46% of GPs supported and 44% rejected
legal reform
- If it were legal, 37% would consider active euthanasia
for terminally ill patients—only a small number admitted
to having practiced it
- 92% felt that passive euthanasia could sometimes
be justified
- 75% felt they would respect a refusal of treatment
required by a living will
1996: Survey of Medical Practitioners' Attitudes
towards Physician-Assisted Suicide. Study by Professor MacLean
on basis of omnibus survey of 1000 respondents, mainly a range
of doctors but including 180 pharmacists (19)
Key findings were:
- 1:5 believed suicide was never
justifiable and 1:4 felt it was justified simply by wishing it.
1:2 felt suicide was justifiable on the basis of a terminal condition
and/or extreme physical/mental suffering
- 65% were in favour of a change in the law, including
10% who believed in 'euthanasia on demand' i.e. no other conditions.
Again, the bulk of respondents stressed the importance of patients
having a terminal condition and/or experiencing extreme physical/mental
suffering
- Significantly less practitioners would be willing
to assist suicide if this were legal—53% in total, including
7% requiring only the wish of the patient
- 28% had been asked to provide the means for patients
to kill themselves
- 4% admitted to having provided the means for
patients to kill themselves and 93% claimed never to have done
so. However, 12% claimed to know other health professionals who
had assisted a patient to kill themselves
Importantly, this study distinguishes physician-assisted
suicide from euthanasia—43% were in agreement with the former,
in comparison to only 19% in favour of active euthanasia. This
was interpreted in the commentary as possibly reflecting a reluctance
to take full responsibility for the implications of euthanasia.
Also, reasons given for and against PAS were prioritised
for salience by the respondents. The top reasons in favour of
PAS were:
- The duty of doctors to relieve
suffering (60%)
- People suffer intolerable and incurable conditions
(59%)
Principal reasons against PAS were:
- Problems in judging when suffering
is sufficient to justify PAS (53%)
- Many who feel suicidal later regret those
feelings (50%)
- It is the duty of doctors to preserve life,
not end it (32%)
1998: Sunday Times survey of 300 GPs (20)
The findings of this rapid media survey are interesting
in that levels of involvement in active euthanasia are distinguished.
Full details of the study are not available. Key findings, as
presented by the paper, were:
- 1:7 of the respondents had 'helped
patients to die' at their request
- 60% felt that they should be allowed to administer
large amounts of painkillers even if this shortens life
- 18% felt they should be able to prescribe lethal
medication for patients to commit suicide
1998: National Survey of Psychiatrists' attitudes
to euthanasia, University Department of Psychiatry, Royal
Free Hospital, London. Postal questionnaire survey of 322 senior
psychiatrists. (26)
Only brief details are available for this study,
the first among United Kingdom psychiatrists to explore attitudes
to assisted suicide. Attitudes tended to be slightly more conservative
than those found among other medical professionals up to this
point. The key findings included the following:
- 38% of psychiatrists believed
euthanasia should be legalised—against 44% who did not
- 35% were willing to assess psychological suitability
for euthanasia (against 47% who preferred not to)
- 86% accepted that suicide can be rational; however,
2:3 felt that a psychiatric assessment should be made of all individuals
requesting euthanasia
- 83% felt that passive euthanasia could be justified,
but only 29% felt this of voluntary active euthanasia and 40%
of assisted suicide—only 1:5 stated a willingness to assist
suicide
- Living wills were acceptable to 36% and not acceptable
to 40% as a basis for assisting non-competent patients to commit
suicide.
1999: TNS Omnimed survey of 104 GPs, sponsor unknown.
(21)
This survey was very limited in scope and relatively
few details are given. The findings as given include the following:
- 2:3 favour euthanasia in certain
situations and believe this to be generally the case with their
colleagues
- 1:3 are 'very opposed' to euthanasia under any
circumstance
- 1:2 had discussed the subject of euthanasia with
colleagues
- 3:5 'knew of' patients who had made living wills
- 2:3 felt that potential legislation into euthanasia
should be further investigated
1999: United Kingdom Geriatricians attitudes
to active voluntary euthanasia and physician-assisted death. Universities
of Sheffield and Charleston, South Carolina. (27) 333 respondents
in a postal survey of all United Kingdom geriatricians (45% response)
This study was carried out by the Academic Palliative
Medicine Unit of the Sheffield Institute for Studies on Ageing
and formed part of an ongoing longitudinal study based on the
Department of Sociology at Charleston University. The study was
said to be neutral in orientation, though an underlying concern
was to respond to what was seen as a 'push' towards euthanasia
in society.
In fact, the responses made in this study are in
some contrast to the general thrust of other medical opinions
up to this point. Key findings are that United Kingdom geriatricians,
as represented by the sample of 45% of their number, tend to believe
that:
- Active euthanasia: Administering
an overdose primarily intended to end a patient's life can never
be justified ethically (80%)
- However, 23% felt it should be legal in some
circumstances
- PAS through prescription or counselling can never
be justified ethically (68%)—24% felt, however, that it
should be legal in some circumstances
- Only 12% and 13% respectively felt that they
would personally practice active euthanasia or PAS in some circumstances
The study offers no explanation for the contrast
between these views and the general trend of medical feeling about
these topics. It may be that respondents are influenced by their
high level of familiarity with patients in end-of-life situations.
The principal reasons given for not wanting euthanasia/PAS to
be legalised were stated as:
- A belief that legalisation might
put pressure on vulnerable patients to request euthanasia/PAS
(84%)
- A fear that the social process of dying and grieving
may become undermined (53%)
Two thirds of the small minority who favoured legalisation
of euthanasia/PAS did so as specific legal guidelines 'might help
prevent abuses'. Other majority reasons given by this small group
included:
- Respect for patient self-determination
- To prevent an unacceptable deterioration of the
quality of life
The study did not include an exploration of attitudes
to passive euthanasia.
2003: Hospital Doctor auto-response survey
of 3000 doctors.
Only bare details are available of this readership-based
study carried out in association with the Nuffield Trust. The
study claims that doctors' attitudes are hardening against the
legalisation of euthanasia, on a basis of a reduction in support
noted between this study and a similar study carried out in 1994—38%
against 44%.
2003: Survey on Euthanasia and Assisted Suicide,
Opinion Research Business for Right to Life. (24) An internet
omnibus study carried out by Doctors.Net.UK. 986 respondents,
2:3 of whom were GPs and the rest a spread of hospital specialists,
with some bias towards psychiatry (13%).
A permanent panel of respondents is regularly invited
to answer questions posted on the Doctors.Net web-site. As with
the last quoted study, this survey claims that the majority of
doctors are not in favour of either euthanasia or assisted suicide.
In this respect the key questions were:
As a doctor are you in favour of either of the
following?
| Euthanasia %
| Assisted Suicide % |
| Yes | 22
| 25 |
| No | 61
| 60 |
| Don't know | 14
| 13 |
If these actions were made legal, would you be
prepared to perform any of the following?
| Euthanasia %
| Assisted Suicide % |
| Yes | 23
| 26 |
| No | 76
| 74 |
| No reply | 1
| 0 |
Pressure from relatives, beneficiaries and medical and nursing
colleagues
If these actions were made legal, would you be confident that
you would be able to exercise your judgement free from pressure
from:
- Relatives?
- Beneficiaries?
- Medical and nursing colleagues?
| Freedom from pressure from:
| Relatives | Beneficiaries
| Medical/nursing colleagues
|
| Yes>% | 29
| 58 | 28
|
| No>% | 47
| 29 | 43
|
| Don't know>% | 24
| 12 | 28
|
Doctors interviewed showed high levels of concern about the potential
influence on their freedom to exercise their judgement of relatives
and colleagues in any new legalised situation. The sample as a
whole were not very concerned that consideration of NHS resources
would influence their judgement. Those willing to carry out euthanasia
or assisted suicide were generally less concerned about these
sorts of pressures.
Most of the total sample (59%) felt that the BMA
should not change its opposition to the legalisation of euthanasia
and assisted suicide though, unsurprisingly, the majority (75%)
of those willing to practise them would counsel change. A similar
divergence of opinion was evident on the issue of whether safe
bounds can be set on euthanasia—only 56% of the total sample
believed so, against 80% of the stated minority.
Two thirds of the sample were confident that they
would be able to detect whether a request for assisted suicide
was part of a depressive illness, suggesting that this could be
an area of some concern for an important minority.
A high proportion of the total sample felt that increased
resources for hospice (66%) and geriatric (55%) care would be
likely to reduce the pressure towards the legalisation of euthanasia/assisted
suicide.
Conclusion
This study suggests that medical opinion is now less
split than a few years ago on the issue of legalising euthanasia
and assisted suicide and that concerns about the potential implications
of legalisation may be growing.
2003/4: Medix web-based omnibus surveys for Voluntary
Euthanasia Society (January 2003 and August 2004)1000 respondents
These studies are carried out among a permanent panel
of doctors who are remunerated for responding to questionnaires
which are posted on the web-site.
The two studies, roughly a year and a half apart
have sufficient common elements to be compared. The key findings
are summarised below.
- In 2003, 33% of doctors believed
the law should be changed in favour of physician-assisted suicide
(48% were against and 19% unsure). The direct question was not
asked in 2004.
- The results of a question on the circumstances
for permitting PAS appearing in both years could be interpreted
to suggest a waning of support for the legalisation of PAS, i.e.:
Circumstances for permitting PAS
| 2003 %
| 2004 % |
| No circumstances | 39
| 42 |
| Terminal illness with uncontrollable physical suffering*
| 55 | 45
|
| When a terminally ill patient wishes it |
26 | 20
|
| Severe physical suffering, even without terminal illness
| 22 | 15
|
| When a patient wishes it | 3
| 2 |
Similarly, a question about the circumstances for
permitting physician-assisted euthanasia, i.e. direct help to
die, produced results which could also be interpreted as marking
a lessening of support for euthanasia among doctors. The key categories
were:
| 2003 %
| 2004 % |
| No circumstances | 44
| 53 |
| Terminal illness with uncontrollable physical suffering[87]
| 50 | 37
|
| When a terminally ill patient wishes it |
22 | 14
|
| When a patient wishes it | 2
| 1 |
The 2004 sample appeared to have less experience
of patient requests for assisted suicide or euthanasia than the
earlier sample, a factor which may throw some light on their generally
more conservative approach to the concept of legalising euthanasia.
Have you ever been asked by a patient to assist
in their suicide or euthanasia?
| 2003 %
| 2004 % |
| Yes | 40 |
27 |
| No | 57 |
70 |
Frequency of assisted suicide/euthanasia
The 2003 survey established that around 80% of doctors thought
that both practices are rare or fairly rare. In
2004, it was established that 45% of doctors believed that some
health professionals do sometimes assist the suicide/voluntary
euthanasia of their terminally ill patients—an equal proportion
could not say.
A separate question in 2004 supported these last
findings, suggesting that 1:2 doctors believe that there are circumstances
where some health professionals in the United Kingdom currently
give pain relief to terminally ill patients with the intention
of shortening their life.
Frequency of suicide/suicidal feelings among terminally
ill patients
Questions in both years to establish how many patients
with an untreatable and debilitating long-term or terminal
illness (2004 just terminal illness) attempt/commit
suicide—and (in 2003) what proportion of those attempting
suicide worsened their health in the process, achieved little
response.
Somewhat similarly, a question in 2003 aimed at measuring
the level of seriously ill patient statements of a preference
to die rather than live brought results suggesting that for the
great bulk of doctors, this is at most, an occasional rather than
a common experience.
Safeguards
In 2004, doctors were asked what safeguards should
be put in place for terminally ill patients requiring assisted
suicide/euthanasia and the doctors prepared to help them. Of the
two options offered, the concept of legislation with safeguards
and guidelines proved much more attractive than that of a criminal
law prohibiting the practices, though over 1:5 were unable to
reply.
Influence of religious belief upon attitudes to
euthanasia
Some link between religious belief and attitudes
to issues around euthanasia was established among the general
public, most notably in the British Social Attitudes survey.
Interestingly, a direct question in the later Medix survey
for VES asking whether respondents believe that their attitudes
on these topics are influenced by religious belief, revealed that
this was in fact the case, at least to a small extent, in the
judgement of 41% of the 1000 doctors interviewed. This factor
too may hold some relevance to the apparent differences in attitudes
between the two samples, but unfortunately it was not measured
in 2003—nor in any of the other surveys quoted above which
contribute to the sense of a withdrawal of medical profession
support for euthanasia.
Summary of doctor attitudes up to the present
The attitudes of doctors to euthanasia are not easy
to summarise accurately as different surveys approach the subject
in different ways and the nature and value of each exercise must
be borne in mind when interpreting the results. However, there
seems to be some value in focusing on two key aspects of the debate
which are measured more or less directly in most of the surveys
which have come to light. These are:
- Attitudes to legal reform in favour
of euthanasia/PAS
- Levels of willingness to practice euthanasia/PAS,
should it be legalised.
For the purposes of creating a meaningful and helpful
summary, the concepts of physician-assisted suicide and physician-assisted
euthanasia are mainly not distinguished—attitudes to each
tend to be broadly similar. Passive euthanasia, about which there
is relatively little debate, is not considered here. References
are included to the surveys as listed in the appendix. It was
not possible to include all and maintain a satisfactory consistency
of meaning.
Attitudes of doctors to the legalisation of euthanasia
1987-2004
| Year | Ref.
| % For | % Against
| Comment |
| 1987 | (14)
| 30 | 59
| Small sample (301) |
| 1993 | (15)
| 47 | 33
| Competent, but small in scale
|
| 1995 | (17)
| 44 | 53
| Self-selecting media survey
|
| 1996 | (18)
| 46 | 44
| Self-selecting media survey
|
| 1996 | (19)
| 65 | 30
| 'Willing to assist suicide, if legal'
Some pharmacists in the sample.
|
| 1998 | (20)
| Not | clear
| Small scale media poll - 18% felt they should be able to prescribe lethal medication for suicide legally
|
| 1998 | (26)
| 33 | 41
| Psychiatrists only |
| 1999 | (21)
| 66 | 33
| Details unclear, no grey areas allowed for
|
| 1999 | (27)
| 23/4 | n/a
| Geriatricians |
| 2003 | (23)
| 33 | 48
| Self-selecting web poll for VES
|
| 2003 | (16)
| 38 | n/a
| Self-selecting media poll
|
| 2003 | (24)
| 22/25 | 60/61
| Self-selecting web survey for Right to Life
|
| 2004 | (25)
| Not | comparable
| Self-selecting web poll for VES. Generally more conservative than similar poll in 2003 (23)
|
5.2 ATTITUDES OF OTHER HEALTH SECTOR PROFESSIONALS
TO EUTHANASIA/PAS
Nurses
Auto-response readership surveys were held by Nursing
Times in 1988 and 2003, achieving 1000 and 2700 responses
respectively.
The results for 1988 are not easily related to the
main theme of this report and mainly communicate a high level
of sympathy for patients with pain and a sense of division in
the profession concerning willingness to be involved in administering
drugs which will kill a terminally ill patient at their request—44%
were willing and 55% declared themselves unwilling.
The 2003 survey relates more readily to the theme
of this report but few details have been made available. The main
claim of the journal is that "two thirds" of the nurses
responding to the questionnaire believed that euthanasia should
be legalised—and that 31% believed that nurses should be
allowed to assist in the suicide of patients.
Pharmacists
A 1998 postal questionnaire survey of 169 pharmacists
by the Universities of Bristol and Manchester mainly explored
pharmacists' attitudes to becoming involved in physician-assisted
suicide through dispensing the required drugs. Key findings are:
- 70% believe that it is a patient's
right to choose to die
- 57% agree a patient should be able to involve
his/her doctor in the process
- 45% believed that it was right for such patients
to use prescription medicines for suicide
- 54% felt it is appropriate for pharmacists to
refuse to dispense a prescription to be used in PAS (89% felt
the conscience clause of the RPSGB code of ethics should incorporate
this)—but 49% said they would willingly dispense such a
prescription (24% would not)
- 44% felt the law should be changed to allow for
PAS 33% disagreed) and 52% that legislative change is required
primarily to regulate PAS
Palliative Care Staff
The findings of 2004 qualitative research among a
range of palliative care staff have been submitted separately
to the Select Committee by Help the Hospices.
The research is small in scale but appears adequate
to provide a useful commentary upon the views of euthanasia held
by those working in the sector. It is not easily related to the
main theme of this report, despite attempts to express the findings
through quantification. The great value of the research appears
to be in throwing some light upon the implications of a change
in the law in favour of euthanasia for end-of-life patients and
for those in their care. It brings a closeness to the 'reality'
of euthanasia which is beyond the reach of quantitative research.
Despite evident and well-informed sympathy for the
pain felt by terminally ill patients, it is clear that the introduction
of legalised euthanasia would be very contentious within the hospice
movement. Legalised euthanasia was seen as capable of changing
the ethos of hospice care for the worse and of eroding the relationship
of trust between physicians, carers and patients. It was also
seen as in danger of serving to reduce the focus on hospice/palliative
care. For many reasons, it was felt to be difficult to accurately
assess a terminal patient's psychological condition and fitness
for choosing euthanasia. Some were clearly open to the concept
of euthanasia, but it was also clear that many professionals/carers
would have ethical and other personal difficulties related to
any requirement for involvement in the practice of euthanasia.
6. CONCLUSIONS OF THE DESK RESEARCH
The research carried out up to this point into public
and health sector attitudes to the legalisation of euthanasia
is limited in value and cannot be accepted at face value as an
authentic account of opinion within the United Kingdom. The subject
matter is extremely complex and sensitive and therefore very challenging
for any attempting to gain a meaningful understanding of opinion.
Public opinion
This is particularly the case with regard to the
attitudes of the general public, whose real views on euthanasia
are clearly obscured by a lack of information on the subject and
by the lack of opportunity to reflect in an informed way upon
the implications of any change in the law for themselves and for
society. The levels of agreement/disagreement with the concept
of euthanasia which the numerous polls record are effectively
built on what might be termed a "knee-jerk" reaction
to the simple options provided by these polls and do not form
a very useful guide to public opinion as support for legislative
change.
Nevertheless, the apparent groundswell in public
agreement with the concept of euthanasia registered by the various
sources cannot be dismissed and it is evident that there is much
sympathy at a personal level for the concept of legally releasing
those wishing to die from their pain and those willing to help
them from legal consequences. However, if the decisions of the
Committee are to take authentic account of properly informed public
opinion, a significant investment in more appropriate forms of
research is undoubtedly required.
Deliberative research
Latterly, government is accustomed to exploring public
opinion on difficult and complex topics through various forms
of deliberative research Recent examples include studies of public
attitudes to the management of radioactive waste and to the commercialisation
of GM crops, carried out at part of an attempt at public consultation
on these complex and difficult subjects. Various techniques exist
for this, including deliberative polls, citizen juries, reconvened
focus groups etc., each aimed at achieving an authentic response
such as is only available on a basis of information.
Only research of this sort is capable of providing
a satisfactory understanding of public attitudes to the legalisation
of euthanasia/PAS and of quantifying it meaningfully.
Health Sector
As remarked in the body of this report, health sector
professionals tend by definition to be better informed about the
context and potential implications of the legalisation of euthanasia,
but here again most research is superficial in coverage and only
a few attempts have been made to understand the basis of the opinions
of doctors and others, which, from the data, appear to vary in
different directions over time. Here too, some fresh, impartial
research, again of a deliberative nature, is required in order
to gain a full and useful understanding of health sector views.
ANNEX 1: RESEARCH SOURCES
1. MORI omnibus poll December 1987, for
Doctors Who Respect Human Life/Human Rights Society. 4 questions
to 1808 adult respondents nationwide.
2. British Social Attitudes 1994/95, National
Centre for Social Research. The BSA has been run annually since
1983 to measure the attitudes, values and beliefs of the British
public, covering an extensive number of complex social, political
and moral issues. Euthanasia was included in 1984, 1989 and then
in much greater depth in 1994/95, based then on a sample of 1234
adults. The subject is likely to be included in BSA 2005 also.
3. 1999 Capibus omnibus, 2042 respondents,
single question on doctors' right to withhold food/fluid, for
First Do No Harm, an organisation of doctors concerned about a
perceived climate in favour of euthanasia
4. NOP omnibus survey of UK, October 2002
for Voluntary Euthanasia Society. Single question, 1000 respondents
aged 18+.
5. NOP omnibus Survey of Guernsey 2004,
for Voluntary Euthanasia Society. 5 questions, sample of 500 adults.
6. NOP omnibus survey of Isle of Man,
2004 for Voluntary Euthanasia Society. 5 questions, sample of
500 adults.
7. NOP omnibus survey of UK, July 2004,
for Voluntary Euthanasia Society. 7 questions, sample of 790 aged
18+.
8. BBC Heaven and Earth programme, September
2004. A single question put to viewers for immediate email/text/phone
response.
9. YouGov omnibus survey of UK October
2004, for Voluntary Euthanasia Society. 2 questions to sample
of 1584 adults.
10. Disability Rights Commission Web Poll
January 2003. 4 questions, 162 respondents, 56% of whom were
disabled.
11. YouGov omnibus survey of November
2004. 2072 respondents, focus on disability issues.
12. Harris Political Research Unit Parliamentary
Panel/The House Magazine. Poll of 151 MPs broadly representative
of the party composition of the House of Commons, July 1995.
13. Communicate Research Parliamentary Panel,
September 2004, for Prolife Alliance. A web poll of 100 MPs broadly
representative of the House of Commons in party terms.
14. NOP telephone survey for VES of 301
GPs, drawn from Medical Direct Mail Organisation mailing list
1987. Two questions to measure support for euthanasia.
15. Attitudes among NHS doctors to requests
for euthanasia, 1993. Ward & Tate, Department of Anatomy,
Cambridge University. 312 postal questionnaires from a mix of
GPs and a broad range of hospital doctors in one (unstated) area
of England.
16. Hospital Doctor survey of 3000 doctors,
funded by Nuffield Trust 2003, repeat of similar study carried
out in 1994.
17. Doctor survey of 2150 GPs and hospital
doctors nationwide 1995.
18. BMA News Review survey of 750 doctors
1996.
19. Survey of Medical Practitioners' attitudes
towards physician assisted suicide 1996. Omnibus by System
Three (Scotland) for Professor Sheila MacLean, Medical Law Unit,
University of Glasgow. Formed basis of book by Sheila MacLean
'Sometimes a small victory'.
20. Sunday Times survey of 300 doctors,
November 1998.
21. TNS Omnimed face-to-face questionnaire
survey of 104 GPs October 1999 for BMA.
22. Differences in attitudes towards physician-assisted
suicide between GPs and hospital specialists. Date uncertain—around
2000—4-question survey of 1025 doctors for VES.
23. Assisted suicide and euthanasia, Medix
web survey of 1002 doctors, January 2003, for VES.
24. Survey on Euthanasia and Assisted Suicide,
omnibus survey of 986 doctors by Opinion Research Business for
Right to Life, April 2003.
25. Physician-assisted suicide and euthanasia,
Medix web survey of 1000 doctors, August 2004, for VES.
26. National survey of United Kingdom psychiatrists'
attitudes to euthanasia, 1998, Shah, Warner, Blizzard, King,
University Department of Psychiatry, Royal Free Hospital, London.
Postal questionnaire survey of 322 senior psychiatrists.
27. United Kingdom geriatricians' attitudes
to active voluntary euthanasia and physician-assisted death.
1999. D. Clark, G. Dickenson et al, Sheffield Institute for Studies
on Ageing, Academic Palliative Medicine Unit, University of Sheffield;
Dept of Sociology, University of Charleston, South Carolina. Postal
questionnaire responses from 333 consultant geriatricians (from
national total of 742).
28. British community pharmacists' views of
physician-assisted suicide. Hanlon, Weiss, Rees, Universities
of Bristol and Manchester 2000, reported in Journal of Medical
Ethics, 2000/26/pp363-369. Postal survey of 179 full-time
community pharmacists.
29. Nursing Times readership surveys,
1988 and 2003 (1000 and 2700 responses, respectively).
30. Help the Hospices/Clear Thinking Consultancy.
Research among palliative care staff, 2004. Small-scale qualitative
research among a range of staff—focus groups with 62 professionals
drawn from 29 independent hospices.
83 Practitioners of panel surveys claim that the financial
motive and the familiarity with responding to surveys which inclusion
within a panel can bring do not interfere with the process of
obtaining authentic responses. Set against this is the traditional
concern of the United Kingdom market research industry that spontaneity
can be eroded by over-exposure to requests for response. Back
84
This refers to a mental or physical impairment which has had an
adverse effect upon the ability to carry out normal day to day
activities, but does not incorporate any concept of degree of
adverse effect. Back
85
Some people say that the law should allow adults to receive
medical help to an immediate peaceful death if they suffer from
an incurable physical illness that is intolerable to them, provided
they have previously requested such help in writing. Do you agree
or disagree with this? Back
86
Sometimes I would be prepared to withdraw or withhold a course
of treatment from a terminally ill patient, knowing the treatment
might prolong the patient's life Back
87
In 2004, this was changed to When a patient is terminally ill
with unbearable suffering and is physically unable to commit suicide,
e.g. MND Back
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