From the 13 192 questionnaires sent, 1148 (9%) were received. The demographic data of the doctors are displayed in Table 1. Concerning gender and age, there are significant differences (p < 0.001) between the entire population of physicians and those who replied to the questionnaires. Therefore, it is not representative of the population studied. The questionnaires were completed carefully and consistently, as most questions had a 100% rate of replies, and the highest rate for any missing answers was never higher than 0.7%.
Cognitively incompetent patients
To the question “Would you give one or more drugs in lethal doses to someone unable to make decisions because of impaired consciousness and suffering from an incurable, advanced and progressive disease that would inexorably lead to death, at the request of a family member or other close person?”, 117 (10%) answered “yes” (Table 2). In the univariable analysis, gender, religion, religious practice, specialty, and number of patients seen in the last year, were associated with the doctors’ opinion, whereas age, marital status, and workplace were not. In the multivariate analysis, catholic doctors, religious practicing and to have clinical specialty were less often in favor of those practice (Table 3). Fourteen (1%) doctors said they received such requests frequently, and 146 (13%) received them rarely; 10(1%) said they had already performed such an act.
Table 2
Cognitively Incompetent patients
Question
|
Total
|
Yes
Nº (%)
|
No
Nº (%)
|
I do not have a definite opinion
Nº (%)
|
Would you give one or more drugs in lethal doses to someone unable to make
decisions because of impaired consciousness and suffering from an
incurable, advanced, and progressive disease that would inexorably lead to
death, at the request of a family member or other close person?
|
1147
|
117 (10)
|
876 (76)
|
154 (14)
|
Do you think that those acts should be allowed by the legislation? (referring
to the question above)
|
1144
|
230 (20)
|
669 (58)
|
245 (22)
|
If you had an incurable, advanced, and progressive disease that would
inexorably lead to death and you were unable to make decisions because of
impaired consciousness, would you like that a doctor gives you one or more
drugs in lethal doses, at the request of a family member or other close person?
|
1145
|
321 (28)
|
596 (52)
|
228 (20)
|
Would you give one or more drugs in lethal doses to someone unable to make
decisions because of impaired consciousness and suffering from an
incurable, advanced, and progressive disease that would inexorably lead to
death, by your own initiative (not on the request of anybody)?
|
1145
|
57 (5)
|
982 (86)
|
106 (9)
|
Do you think that those acts should be allowed by the legislation? (referring
to the question above)
|
1143
|
181 (16)
|
718 (63)
|
224 (21)
|
If you had an incurable, advanced, and progressive disease that would
inexorably lead to death and you were unable to make decisions because of
impaired consciousness, would you like that a doctor gives you one or more
drugs in lethal doses, based only on his or her judgment?
|
1145
|
161 (14)
|
796 (69)
|
188 (17)
|
Table 3
Cognitively incompetent patients - multivariable analyses
Variables
|
Q1
|
Q2
|
Q3
|
Q4
|
Q5
|
Q6
|
I do not have a definite opinion
|
OR
|
95% CI
|
OR
|
95% CI
|
OR
|
95% CI
|
OR
|
95% CI
|
OR
|
95% CI
|
OR
|
95% CI
|
|
Age
|
|
|
|
.
|
|
|
.
|
.
|
|
|
|
|
|
|
< 31 years
31–40
41–57
> 57
|
|
|
1.07
0.97
0.69
1
|
0.67–1.71
0.62–1.49
0.44–1.10
|
1.43
1.36
0.92
1
|
0.87–2.36
0.86–2.16
0.57–1.49
|
|
|
0.99
1.22
0.82
1
|
0.62–1.62
0.79–1.88
0.51–1.30
|
0.79
0.91
0.38
1
|
0.50–1.26
0.58–1.43
0.38–0.99
|
|
Gender
|
|
|
|
|
|
|
|
.
|
|
|
|
|
|
|
Female
Male
|
0.77
1
|
0.54–1.11
|
|
|
|
|
|
|
|
|
|
|
|
Marital status
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Married/ nonmarital partnership
Other
|
|
|
|
|
|
|
|
.
|
|
|
|
|
|
Religion
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Catholic
Other religion
No religion
|
0.37
0.36
1
|
0.14–0.95
0.10–1.25
|
0.42
0.29
1
|
0.18–0.96
0.10–0.86
|
059
0.30
1
|
0.25–1.39
0.10–0.93
|
|
|
0.36
0.24
1
|
0.16–0.80
0.08–0.71
|
0.39
0.04
1
|
0.15–1.01
0.01–0.37
|
|
Religion Practising
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes
No
|
0.46
1
|
0.29–0.72
|
0.46
1
|
0.31–0.67
|
0.60
1
|
0.41–0.87
|
0.56
1
|
0.33–0.95
|
0.50
1
|
0.34–0.73
|
0.57
1
|
0.39–0.85
|
|
Specialty
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Clinical
Non-clinical
|
1.06
1
|
0.35–3.22
|
1.20
1
|
0.47–3.04
|
2.35
1
|
0.65–8.55
|
|
|
|
|
|
|
|
Workplace
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cancer Institute
General public hospital
Private hospital
Non-hospital
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Number of patients seen in the last year
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
> 30
16–30
6–15
1–5
0
|
0.35
0.77
0.79
1.29
1
|
0.18–0.71
0.37–1.63
0.42–1.47
0.76–2.20
|
0.44
0.98
0.68
1.34
1
|
0.24–0.79
0.52–1.88
0.38–1.20
0.82–2.20
|
0.40
0.89
0.66
1.19
1
|
0.22–0.74
0.46–1.72
0.36–1.18
0.71–1.98
|
|
|
|
|
0.40
0.68
0.74
1.27
1
|
0.21–0.74
0.33-1-39
0.42–1.33
0.77–2.08
|
Variables
|
Q1
|
Q2
|
Q3
|
Q4
|
Q5
|
Q6
|
Yes
|
OR
|
95% CI
|
OR
|
95% CI
|
OR
|
95% CI
|
OR
|
95% CI
|
|
|
|
|
|
Age
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
< 31 years
31–40
41–57
> 57
|
|
|
0.58
0.61
0.79
1
|
0.35–0.96
0.39–0.95
0.52–1.22
|
0.79
0.68
0.77
1
|
0.50–1.24
0.45–1.02
0.51–1.15
|
|
|
0.52
0.46
0.80
1
|
0.30–0.88
0.28-074
0.51–1.24
|
0.44
0.32
0.51
1
|
0.27–0.72
0.19–0.53
0.32–0.82
|
|
Gender
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Female
Male
|
0.77
1
|
0.51–1.15
|
|
|
|
|
|
|
|
|
|
|
|
Marital status
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Married/ nonmarital partnership
Other
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Religion
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Catholic
Other religion
No religion
|
0.35
0.48
1
|
0.14–0.92
0.14–1.63
|
0.39
0.38
1
|
0.18–0.85
0.14–1.05
|
0.31
0.27
1
|
0.15–0.66
0.11–0.70
|
|
|
0.52
0.21
1
|
0.23–1.21
0.05–0.64
|
0.45
0.39
1
|
0.20–1.05
0.12–1.05
|
|
Religion Practicing
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes
No
|
0.47
1
|
0.27–0.84
|
0.35
1
|
0.23–0.52
|
0.31
1
|
0.21–0.44
|
0.57
1
|
0.26–1.25
|
0.74
1
|
0.23–0.55
|
0.32
1
|
0.19–0.53
|
|
Specialty
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Clinical
Non-clinical
|
0.36
1
|
0.15–0.86
|
0.87
1
|
0.36–2.06
|
|
|
|
|
0.56
1
|
0.24–1.33
|
|
|
|
Workplace
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cancer Institute
General public hospital
Private hospital
Non-hospital
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Number of patients seen in the last year
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
> 30
16–30
6–15
1–5
0
|
0.69
1.05
1.17
1.27
1
|
0.33–1.46
0.45–2.48
0.57–2.43
0.65–2.49
|
0.53
0.77
0.71
1.15
1
|
0.30–0.93
0.39–1.52
0.40–1.24
0.70–1.90
|
0.67
0.74
0.86
1.32
1
|
0.39–1.13
0.39–1.41
0.50–1.45
0.82–2.12
|
|
|
0.93
1.00
0.84
1.18
1
|
0.51–1.70
0.48–2.09
0.46–1.56
0.69–2.01
|
0.83
1.03
0.80
1.21
1
|
0.45–1.55
0.49–2.16
0.42–1.51
0.69–2.11
|
The reference category is: No |
Q1. Would you give one or more drugs in lethal doses to someone unable to make decisions because of impaired consciousness and suffering from an incurable, advanced, and progressive disease that would inexorably lead to death, at the request of a family member or other close person? |
Q2. Do you think that those acts should be allowed by the legislation? (referring to the question above) |
Q3. If you had an incurable, advanced, and progressive disease that would inexorably lead to death and you were unable to make decisions because of impaired consciousness, would you like that a doctor gives you one or more drugs in lethal doses, at the request of a family member or other close person? |
Q4. Would you give one or more drugs in lethal doses to someone unable to make decisions because of impaired consciousness and suffering from an incurable, advanced, and progressive disease that would inexorably lead to death, by your own initiative (not on the request of anybody)? |
Q5. Do you think that those acts should be allowed by the legislation? (referring to the question above) |
Q6. If you had an incurable, advanced, and progressive disease that would inexorably lead to death and you were unable to make decisions because of impaired consciousness, would you like that a doctor gives you one or more drugs in lethal doses, based only on his or her judgment? |
Referring to the question above, 230 (20%) patients thought that these acts should be allowed by the legislation (Table 2). In the univariable analysis, age, religion, religious practice, specialty, and the number of patients seen, were associated with that opinion whereas gender, marital status, and workplace were not. In the univariable analysis, age, religion, religious practice, specialty, and number of patients seen, were associated with that opinion whereas gender, marital status, and workplace were not. In a multivariable analysis, younger doctors, religion, religious practicing, and the higher number of patients with advanced diseases seen, were less likely to agree with the legalization of these practices (Table 3).
To the question “If you had an incurable, advanced, and progressive disease that would inexorably lead to death and you were unable to make decisions because of impaired consciousness, would you like that a doctor gives you one or more drugs in lethal doses, at the request of a family member or other close person?”, 321 (28%) answered “yes (Table 2). In the univariable analysis age, religion, religious practicing, specialty, and the number of patients seen were related to that opinion, whereas gender, marital status, and workplace were not. In the multivariable analysis, only religion and religious practices were more likely to be against that practice.
The question “Would you give one or more drugs in lethal doses to someone unable to make decisions because of impaired consciousness and suffering from an incurable, advanced, and progressive disease that would inexorably lead to death, by your own initiative (not on the request of anybody)?”, had a positive answer from 57 (5%) doctors (Table 2), and 15 (1%) said they had already done it; 181 (16%) thought that those acts should be allowed by the law. In the univariable analysis, religion and religious practicing were associated with that opinion, and in the multivariable analysis, only religion practicing doctors were less likely to support that practice.
To the question “If you had an incurable, advanced, and progressive disease that would inexorably lead to death and you were unable to make decisions because of impaired consciousness, would you like that a doctor gives you one or more drugs in lethal doses, based only on his or her judgment?”, 161 (14%) answered “yes” (Table 2). In the univariable analysis, age, religion, religious practice, and the number of patients seen, were associated with that opinion. in the multivariable analysis, only age and religious practice were associated with that opinion, being less likely to support it.
Treatment Withdrawal
To the question “Do you think that in relation to someone with an incurable, advanced, and progressive disease that would inexorably lead to death, it is legitimate to withdraw support of life measures at his or her explicit, repeated, informed, and well-pondered request?” 890 (78%) doctors replied “yes” (Table 4). In a univariable analysis age, gender, marital status, religion, religious practicing, workplace, and the number of patients with advanced diseases seen in the last year had a significant association with that opinion. In the multivariable analysis, the younger doctors and those who see more patients are more likely to answer yes, whereas religious non-Catholic doctors and religious practicing were more likely to answer differently (Table 5). Concerning the question “Would you withdraw measures such as feeding and hydration? (referring to the question above)” Only 220 (19%) replied “yes” (Table 4). In the univariable analysis, age, religion, religion practicing, workplace, and the number of patients with advanced diseases seen were associated with that opinion. In the multivariable analysis, feeding and hydration withdrawal were favored by doctors who saw more patients and unfavored by younger and catholic doctors.
Table 4
Question
|
Total
|
Yes
No. (%)
|
No
No. (%)
|
I some circumstances
No. (%)
|
Do you think that in relation to someone with an incurable, advanced, and
progressive disease that would inexorably lead to death, it is legitimate to
withdraw support of life measures at his or her explicit, repeated,
informed, and well-pondered request?
|
1148
|
890 (78)
|
66 (6)
|
192 (17)
|
Would you withdraw measures such as feeding and hydration? (referring
to the question above)
|
1148
|
220 (19)
|
532 (46)
|
396 (35)
|
Do you think that in relation to someone with an incurable, advanced, and
progressive disease that would inexorably lead to death, who is unable to
make decisions because of impaired consciousness, it is legitimate to
withdraw support of life measures at the request of a family member or other close person?
|
1146
|
315 (27)
|
357 (31)
|
474 (41)
|
Would you withdraw measures such as feeding and hydration? (referring
to the question above)
|
1144
|
136 (12)
|
643 (56)
|
365 (32)
|
Do you think that in relation to someone with an incurable, advanced, and
progressive disease that would inexorably lead to death, who is unable to
make decisions because of impaired consciousness, it is legitimate to
withdraw support of life measures by the unilateral decision of the doctor
or the healthcare team?
|
1145
|
325 (28)
|
412 (36)
|
408 (36)
|
Would you withdraw measures such as feeding and hydration? (referring
to the question above)
|
1146
|
158 (14)
|
652 (57)
|
336 (29)
|
Table 5
Treatment withdrawal - multivariable analyses
Variables
|
Q1
|
Q2
|
Q3
|
Q4
|
Q5
|
Q6
|
In some circumstances
|
OR
|
95% CI
|
OR
|
95% CI
|
OR
|
95% CI
|
OR
|
95% CI
|
OR
|
95% CI
|
OR
|
95% CI
|
|
Age
|
|
|
|
.
|
|
|
.
|
.
|
|
|
|
|
|
|
< 31 years
31–40
41–57
> 57
|
2.66
2.83
1.15
1
|
0.93–7.58
1.06–7.61
0.54–2.44
|
1.05
1.33
0.85
1
|
0.68–1.61
0.89–1.98
0.57–1.27
|
|
|
|
|
|
|
0.92
1.26
1.02
1
|
0.59–1.44
0.84–1.88
0.68–1.52
|
|
Gender
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Female
Male
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Marital status
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Married/ nonmarital partnership
Other
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Religion
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Catholic
Other religion
No religion
|
0.41
0.15
1
|
0.03–6.47
0.01–2.40
|
1.59
1.18
1
|
0.47–2.92
0.73–1.44
|
1.23
0.86
1
|
0.58–2.60
0.35–2.08
|
1.37
0.93
1
|
0.67–2.81
0.38–2.26
|
0.53
0.74
1
|
0.24-1-16
0.29–1.84
|
1.30
1.13
1
|
0.63–2.69
0.47–2.76
|
|
Religion Practicing
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes
No
|
0.24
1
|
0.12–0.47
|
|
|
0.76
1
|
0.55–1.04
|
0.68
1
|
0.49–0.93
|
0.68
1
|
0.48–0.93
|
|
|
|
Specialty
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Clinical
Non-clinical
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Workplace
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cancer Institute
General public hospital
Private hospital
Non-hospital
|
|
|
|
|
|
|
|
|
2.06
1.73
0.86
1
|
0.78–5.47
1.25–2.40
0.46–1.61
|
2.35
1.21
0.79
1
|
1.02–5.41
0.87–1.68
0.41–1.53
|
|
Number of patients seen in the last year
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
> 30
16–30
6–15
1–5
0
|
9.24
1.55
1.24
0.94
1
|
1.07–79.65
0.44–5.50
0.45–3.37
0.41–2.14
|
2.66
1.65
1.04
0.73
1
|
1.58–4.46
0.92–2.98
0.64–1.71
0.47–1.14
|
|
|
2.13
1.23
1.10
0.74
1
|
1.29–3.51
0.68–2.24
0.67–1.79
0.47–1.16
|
1.88
1.06
0.95
0.85
1
|
1.08–3.25
0.57–1.98
0.57–1.56
0.55–1.31
|
3.22
1.87
1.18
0.90
1
|
1.89–5.46
1.02–3.42
0.70–1.98
0.56–1.46
|
Variables
|
Q1
|
Q2
|
Q3
|
Q4
|
Q5
|
Q6
|
Yes
|
OR
|
95% CI
|
OR
|
95% CI
|
OR
|
95% CI
|
OR
|
95% CI
|
|
|
|
|
|
Age
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
< 31 years
31–40
41–57
> 57
|
3.33
4.68
1.54
1
|
1.24–8.97
1.84–11.90
0.77–3.07
|
0.49
1.05
0.69
1
|
0.27–0.86
0.65–1.70
0.42–1.11
|
|
|
|
|
|
|
0.93
1.76
1.07
1
|
0.49–1.78
1.01–3.06
0.61–1.88
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Gender
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Female
Male
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Marital status
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Married/ nonmarital partnership
Other
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Religion
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Catholic
Other religion
No religion
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0.14
0.03
1
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0.10–1.98
0.00-0.45
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0.39
0.50
1
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0.16–0.91
0.17–1.44
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0.58
0.31
1
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0.25-1-31
0.11–0.90
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0.25
0.26
1
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0.10–0.64
0.74–0.92
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0.48
0.32
1
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0.21–1.10
0.11–0.93
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0.39
0.43
1
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0.15–0.97
0.13–1.41
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Religion Practicing
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Yes
No
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0.17
1
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0.09–0.33
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0.65
1
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0.45–0.93
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0.81
1
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0.50–1.33
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0.80
1
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0.55–1.16
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Specialty
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Clinical
Non-clinical
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Workplace
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Cancer Institute
General public hospital
Private hospital
Non-hospital
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3.91
2.28
2.25
1
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1.50-10.15
1.55–3.36
1.19–4.24
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3.34
1.17
2.62
1
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1.28–8.75
0.72–1.92
1.28–5.34
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Number of patients seen in the last year
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> 30
16–30
6–15
1–5
0
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18.87
1.43
1.30
0.73
1
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2.31-154.03
0.44–4.63
0.52–3.26
0.34–1.55
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5.16
2.59
1.21
0.67
1
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2.71–9.84
1.24–5.40
0.63–2.32
0.36–1.23
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3.24
2.47
0.79
0.61
1
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1.57–6.69
1.09–5.59
0.36–1.73
0.30–1.24
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4.59
2.48
1.65
0.92
1
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2.47–8.56
1.23–4.97
0.90-3.00
0.52–1.61
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4.36
2.03
0.09
0.12
1
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2.18–8.74
0.90–4.55
0.46–1.99
0.28–1.15
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The reference category is: No |
Q1. Do you think that in relation to someone with an incurable, advanced, and progressive disease that would inexorably lead to death, it is legitimate to withdraw support of life measures at his or her explicit, repeated, informed, and well-pondered request? |
Q2. Would you withdraw measures such as feeding and hydration? (referring to the question above) |
Q3. Do you think that in relation to someone with an incurable, advanced, and progressive disease that would inexorably lead to death, who is unable to make decisions because of impaired consciousness, it is legitimate to withdraw support of life measures at the request of a family member or other close person? |
Q4. Would you withdraw measures such as feeding and hydration? (referring to the question above) |
Q5. Do you think that in relation to someone with an incurable, advanced, and progressive disease that would inexorably lead to death, who is unable to make decisions because of impaired consciousness, it is legitimate to withdraw support of life measures by the unilateral decision of the doctor or the healthcare team? |
Q6. Would you withdraw measures such as feeding and hydration? (referring to the question above) |
To the question “Do you think that in relation to someone with an incurable, advanced, and progressive disease that would inexorably lead to death, who is unable to make decisions because of impaired consciousness, it is legitimate to withdraw support of life measures at the request of a family member or other close person?”, 315 (27%) doctors responded “yes (Table 4). In the univariable analysis, religion, religious practice and specialty had a statistic association with that answer. In the multivariable analysis, only non-Catholic religion and religious practice were more likely to disapprove that opinion (Table 5). To the question “Would you withdraw measures such as feeding and hydration? (referring to the question above), only 136 (12%) answered “yes”. In the multivariable analysis, doctors who see more patients were more likely to favor that position and religious doctors were more likely to disapprove it.
To the question “Do you think that in relation to someone with an incurable, advanced, and progressive disease that would inexorably lead to death, who is unable to make decisions because of impaired consciousness, it is legitimate to withdraw support of life measures by the unilateral decision of the doctor or the healthcare team?” 325 (28%) patients responded “yes”. In a univariable analysis age, marital status, religion, religious practicing, specialty, workplace, and the number of patients seen were statistically associated with that answer. In the multivariable analysis, doctors working in hospitals were more likely to favor that practice, as well as doctors who see more patients; on the other hand, doctors with non-Catholic religions were more likely to be against that opinion. To the question “Would you withdraw measures such as feeding and hydration? (referring to the question above)” only 158 (14%) replied “yes”. In a multivariable analysis, doctors in the age range between 31 and 40 years, doctors working in cancer institutes, and doctors who see more patients were more likely to favor that practice, whereas Catholic doctors were more likely to disapprove that practice (Table 5).
Suffering Control
To the question of administering drugs (ex., morphine) for suffering control, even foreseeing they could shorten life, 969 (84%) answered: whenever it is necessary. And on the hypothesis of the doctor being in that suffering situation, 1103 (96%) would like for someone to administer such a drug that would relieve their suffering even if it could shorten their lives.