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

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.

Incidence of uncomplicated genital infections in women using oral contraception or an intrauterine device: a prospective study.

Over a period of 2 years, the authors prospectively followed a cohort of 123 women using an intrauterine device (IUD) and 108 women using oral contraception (OC) in one family practice. They found nine new episodes of cervical chlamydial infection in OC users (7/100 woman years (WY] as compared to 1 new episode in IUD users (0.8/100 WY), yielding a relative risk (RR) for OC users of 8.8 (95% confidence interval (CI): 1.3-59.0). During the 24 months of observation, 15% of OC and 2% of IUD users acquired at least one episode of Chlamydia trachomatis infection (P = .01). Bacterial vaginosis occurred more frequently in IUD users (25/100 WY) than in OC users (9/100 WY) (RR = 2.8; 95% CI: 1.5-5.1). During the 24-month period, 50% of women using an IUD had at least one episode of bacterial vaginosis, compared with 20% of the OC users (P = .001). Symptomatic bacterial vaginosis was associated with the use of an IUD (RR for IUD users was 7.7; 95% CI: 2.1-28.4), whereas asymptomatic bacterial vaginosis was associated with sexual promiscuity.

Sexually transmitted diseases and Chlamydia trachomatis in women consulting for contraception.

To study the frequency of genital infections in women consulting their family doctor for contraception, 248 women (median age 23 years) were examined for a range of genital microorganisms. The prevalence of clue cells, Candida albicans and Trichomonas vaginalis were 21.0%, 12.9% and 2.0%, respectively. Neisseria gonorrhoeae was isolated in only one case, whereas Chlamydia trachomatis was found in 6.3% of women. A specific clinical picture for an infection with C. trachomatis in women was not seen. Given the prevalence of over 5% for C. trachomatis and the absence of typical signs and symptoms in infected women, screening for this organism is recommended in women requesting an intrauterine contraceptive device, to prevent complications such as pelvic inflammatory disease and their sequelae.

PIP: The prevalence of genital micro-organisms was investigated in 248 women who presented to a family practice in Belgium in 1981-84 to obtain contraception. 141 were seeking a new or replacement IUD, while the remaining 107 were oral contraceptive (OC) users. Study participants had no signs or symptoms of a genital infection at the time of screening. The cultures revealed clue cells in 21.0%, Candida albicans in 12.9%, Trichomonas vaginalis in 2%, and Neisseria gonorrhoeae in 0.5%. Chlamydia trachomatis was isolated in 14 women (6.3%); among women requesting an IUD, the prevalence of C trachomatis was 7.5%. A history of 2 or more sex partners in the preceding 3 month period and previous use of OCs each conferred a 2.5 times increased risk of a positive chlamydia finding. Isolation of C trachomatis was not correlated with age at first intercourse, gravidity, an abnormal cervix, or a history of pelvic inflammatory disease (PID), however. 9 of the 14 women infected with chlamydia had nonspecific symptoms of a genital infection, e.g., vulval irritation, odor, or vaginal discharge, and 2 had an abnormal bimanual palpation. Available evidence suggests that IUD linked PID is caused by genital micro-organisms, especially C trachomatis and N gonorrhoeae, that enter the uterine cavity during IUD insertion. Given the 6% prevalence of C trachomatis in the young women presenting for contraception in this study, screening for this micro-organism is urged before an IUD is inserted in order to reduce the complication of PID.