Study: Doctors Will Prescribe Pain Drugs Even if They Hasten Death

Bioethics   |   Steven Ertelt   |   Dec 10, 2004   |   9:00AM   |   WASHINGTON, DC

Study: Doctors Will Prescribe Pain Drugs Even if They Hasten Death Email this article
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by Maria Vitale Gallagher Staff Writer
December 10, 2004

Iowa City, IA ( — Two new studies indicate doctors are willing to administer drugs to ease pain — even if it means hastening the dying process.

The studies, conducted at the University of Iowa and at Yale, involve a process known as terminal sedation, in which sedatives are used to control a patient’s symptoms even if they result in a loss of consciousness.

In fact, most of the doctors in the studies saw a clear difference between assisted suicide and terminal sedation. But other medical experts worry terminal sedation could be a "creative" approach to the controversy surrounding assisted suicide.

"End-of-life care involves many treatment decisions, some of which are focused on extreme pain and other symptoms that are very challenging to control," said Lauris Kaldjian, M.D., an assistant professor of internal medicine who conducted both studies.

"We studied the specific ethical issues of treatments that control symptoms versus interventions that intend to cause or hasten death," Kaldjian added.

The first study, which involved a survey of internal medicine doctors, appeared in the October issue of the Journal of Medical Ethics. The other study, focusing on doctors in training, appeared in the September/October issue of the American Journal of Hospice and Palliative Medicine.

Seventy-eight percent of the internal medicine physicians surveyed supported the use of terminal sedation, while 66 percent of the doctors in training, or residents, agreed with the practice.

However, a surprising one in three doctors and residents supported physician-assisted suicide, which is legal only in the state of Oregon.

The study of internal medicine doctors involved 677 members of the American College of Physicians in Connecticut. The study of residents involved 236 doctors in training in three internal medicine residency programs in Connecticut as well.

Participants in each study responded anonymously.

The studies showed that doctors were more likely to support terminal sedation but oppose assisted suicide if they had had significant experience with terminally ill patients or if they frequently attend religious services.

In fact, 68 percent of doctors who had cared for 50 or more terminally ill patients in the past year were against assisted suicide.

"It was clear from our statistical analysis that those who had cared for a greater number of terminally patients in the preceding year were more opposed to assisted suicide and also more supportive of terminal sedation," Kaldjian said.

"There seemed to be both a greater willingness to be rigorous in end-of-life care but also less willingness to cross that line into actually intending death," the researcher added.

A significant 76 percent of those doctors who attended weekly religious services oppose assisted suicide.

"We found that the more frequently respondents attended religious services, there was a trend toward less support for assisted suicide but more support for terminal sedation," Kaldjian said. "To my knowledge, this is the first study to show such a stepwise trend."

Kaldjian added, "Medical ethics involve not just a patient’s autonomy but also a physician’s integrity. On matters of such importance as end-of-life care, physicians’ integrity must be respected. Patients should not see themselves as mere consumers of health care but as partners in a decision-making process with physicians, who are not mere robots."

But some medical professionals say terminal sedation itself can be ethically problematic. They note that, in some cases, such sedation is accomplished, in part, by withholding food and water — the nutrition and hydration necessary for survival.

In an article entitled, "Sedated to Death?" nurse Nancy Valko stated, "As a former hospice nurse and now as an ICU nurse caring for some patients who turn out to be dying, I support the appropriate use of pain and sedating medications as ethical comfort care. However, even in circumstances where such medications are necessary, I have never seen a case where a patient ‘needed’ to be made permanently unconscious."

Valko, a spokeswoman for Nurses for Life, a national pro-life nurses groups, added, "The euthanasia movement is nothing if not creative and persistent. Many people now mistakenly believe that tolerating just a little bit of deliberate death — with safeguards, of course — will give them control at the end of their own lives."

"But as the ‘culture of death’ keeps seducing even well-meaning patients, families and medical professionals into making death decisions based on fear of suffering or diminished quality of life rather than following the traditional principles of not causing or hastening death, ultimately we are all at risk of being ‘compassionately’ rationalized to death," Valko wrote.