Attitudes of terminally ill patients toward euthanasia and physician-assisted suicide.

BACKGROUND: In jurisdictions that permit euthanasia or physician-assisted suicide, patients with cancer comprise the largest group to die by these methods. We investigated the personal attitudes toward these practices of patients receiving palliative care for advanced cancer. METHODS: Seventy patients (32 men and 38 women; median survival, 44.5 days) took part in a survey using in-depth semistructured interviews. The interviews were audiotaped for transcription and content analysis of themes. RESULTS: Most participants (73%) believed that euthanasia or physician-assisted suicide should be legalized, citing pain and the individual's right to choose as their major reasons. Participants who were opposed to legalization cited religious and moral objections as their central concerns. Forty (58%) of the 69 participants who completed the entire interview also believed that, if legal, they might personally make a future request for a hastened death, particularly if pain or physical symptoms became intolerable. Eight of these individuals (12%) would have made such a request at the time of the interview. These 8 participants differed from all others on ratings of loss of interest or pleasure in activities, hopelessness, and the desire to die (Ps<.02). They also had a higher prevalence of depressive disorders (P<.05). However, they did not differ on ratings of pain severity. CONCLUSIONS: Many patients with advanced cancer favor policies that would allow them access to both euthanasia and physician-assisted suicide if pain and physical symptoms became intolerable. For patients who would actually make requests for a physician-hastened death, however, psychological considerations may be at least as salient as physical symptoms.

Factors important in promoting mammography screening among Canadian women.

Among women aged 50 to 69 years, regular screening by mammography in combination with clinical examination, can substantially decrease the morbidity and mortality associated with breast cancer by facilitating early detection. Unfortunately, many Canadian women are not screened in accordance with current guidelines. Research to date is based primarily on large surveys conducted in the United States and less is known about the relevance of specific barriers to mammography screening among Canadian women. Multivariate results from the 1994-95 National Population Health Survey (NPHS) indicate that younger (40-49) and older (70+) women, those who are socioeconomically disadvantaged, and minority women are least likely to report having had a mammogram. Conversely, women with positive health behaviours, high social support, and positive mental health attributes are more likely to participate in mammography screening. These findings are discussed in terms of the implications for developing successful intervention programs for Canadian women and for setting priorities for further research.

Primary care providers' perceptions of care.

The Regional Palliative Care Unit in Ottawa conducted a retrospective study to determine how satisfied patients and families were with the service the Unit offers. Forty-five primary care providers, bereaved from 6 to 12 months, completed the 64-item semistructured telephone interview in a mean time of 20 minutes. The 59 closed-ended questions rated satisfaction levels concerning various aspects of the palliative care service on a 5-point Likert scale. Five open-ended questions elicited family priorities and suggestions for improvement. The major finding was that care was perceived to be highly satisfactory. Unexpected outcomes of the study were the identification by family members of the criteria for a "good death" and families' perceptions that the Unit offers the best quality of life and death even for those patients who resist admission to the hospice setting.

Use of background interference procedure to assess visual retention deficits in multiple-sclerosis, psychiatric, and brain-damaged patients.

The performances of three groups of patients were compared during two conditions of interference on a visual retention task. During the noninterference condition, the psychiatric, multiple-sclerosis, and brain-damaged patients functioned at a comparable level. The introduction of a distracting background reduced the level of functioning for only the brain-damaged group. This effect remained significant for the correct score when age and postmorbid intelligence functioning were controlled. These results were interpreted as reflecting the cortical nature of the deficits in resisting the distracting influence of the background interference procedure. Serial testing was recommended for the evaluation of the multiple-sclerosis group.