Are general practitioners prepared to end life on request in a country where euthanasia is legalised?

M Sercu, P Pype, T Christiaens, M Grypdonck, A Derese, M Deveugele

Journal of Medical Ethics
Journal of Medical Ethics

Background: In 2002, Belgium set a legal framework for euthanasia, whereby granting and performing euthanasia is entrusted entirely to physicians, and—as advised by Belgian Medical Deontology—in the context of a trusted patient–physician relationship. Euthanasia is, however, rarely practiced, so the average physician will not attain routine in this matter.

Aim: To explore how general practitioners in Flanders (Belgium) deal with euthanasia. This was performed via qualitative analysis of semistructured interviews with 52 general practitioners (GPs).

Results: Although GPs can understand a patient’s request for euthanasia, their own willingness to perform it is limited, based on their assumption that legal euthanasia equates to an injection that ends life abruptly. Their willingness to perform euthanasia is affected by the demanding nature of a patient’s request, by their views on what circumstances render euthanasia legitimate and by their own ability to inject a lethal dose. Several GPs prefer increasing opioid dosages and palliative sedation to a lethal injection, which they consider to fall outside the scope of euthanasia legislation.

Conclusions: Four attitudes can be identified: (1) willing to perform euthanasia; (2) only willing to perform as a last resort; (3) feeling incapable of performing; (4) refusing on principle. The situation where GPs have to consider the request and—if they grant it—to perform the act may result in arbitrary access to euthanasia for the patient. The possibility of installing transparent referral and support strategies for the GPs should be further examined. Further discussion is needed in the medical profession about the exact content of the euthanasia law.

Sercu M, Pype P, Christiaens T, Grypdonck M, Derese A, Deveugele M. Are general practitioners prepared to end life on request in a country where euthanasia is legalised? J Med Ethics. 2012 Jan 10;38(5) 274-280.

(Debate) Do FPs agree on what professionalism is? Yes

Michael Yeo

Canadian Family Physician
Canadian Family Physician

Closing Arguments

• Professionalism is in vogue today, as evidenced by the proliferation of discussion in the academic literature and in policy and guidance issued by various medical organizations.

• There is general agreement in the literature that, essentially, to be a medical professional is to profess competence in medicine and to use it primarily for the benefit of patients and communities.

• Although there has been no formal study of whether FPs agree on what professionalism is, there is reason to suppose that they agree on the general concept as it is generally elaborated in the literature and on the moral norms associated with the professional ideal.

• Family physicians might disagree about particular applications of the moral norms that make up the professional ideal, but such disagreement is perfectly compatible with the idea of professional judgment and is indeed a part of it.

Yeo M. (Debate) Do FPs agree on what professionalism is? Yes. Can Fam Physician. 2009 Oct;55:968-971.

Abortion attitudes and practices of family and general practice physicians

JM Westfall, KJ Kallail, AD Walling

Journal of Family Practice
Journal of Family Practice

Background: Approximately 1.5 million abortions are performed each year in the United States. Little information has been published on the abortion attitudes and practices of family physicians. The object of this investigation was to assess the abortion attitudes and practices of family and general practice physicians in Kansas.

Methods: A 19-item self-administered survey questionnaire was designed and mailed to 856 family and general practice physicians in Kansas.

Results: A 63% survey response rate was obtained. Seventy-eight percent of the physicians reported that abortion should be legal, but only 56% of the respondents classified themselves as pro-choice. Conversely, only 8% reported that legal abortion should not be available, even though 33% classified themselves as pro-life. The majority of physicians reported that abortion is an appropriate option to save the life of the mother, in cases of rape or incest, and when a fetal anomaly is diagnosed. Only three respondents (0.5%) had performed abortions during the previous year. In general, female physicians and physicians over the age of 40 years (regardless of sex) were more likely to be pro-choice and to view a women’s personal decision as a circumstance in which abortion may be appropriate.

Conclusions: Physician’s views about abortion and their practice patterns are important components of health care for thousands of women each day.

Westfall JM, Kallail KJ, Walling AD. Abortion attitudes and practices of family and general practice physicians. J Fam Pract. 1991 Aug;33(1):47-51.