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Studies reveal physicians' attitudes on end-of-life care

Doctors appear willing to use intensive treatment to lessen otherwise untreatable pain or other severe symptoms in dying patients even if the treatment, at least in theory, risks hastening the dying process, according to two University of Iowa and Yale University studies on end-of-life care.

Known as "terminal sedation," the practice involves the use of sedating medications to control a patient's symptoms even if it results in decreased or complete loss of consciousness. In contrast to physician-assisted suicide, terminal sedation may risk, but does not intend, hastening or causing death.

A majority of physicians in the studies drew a clear line between terminal sedation and assisted suicide. In addition, physicians' attitudes were related to two notable factors: their experience in caring for terminally ill patients and their frequency of attending religious services.

One study, which focused on internal medicine physicians, appeared in the October issue of the Journal of Medical Ethics. The second study, which focused on internal medicine residents (doctors in training), was published in the September/October issue of the American Journal of Hospice and Palliative Medicine.

Both studies were led by Lauris Kaldjian, M.D., assistant professor of internal medicine in the UI Roy J. and Lucille A. Carver College of Medicine and member of the college's Program in Biomedical Ethics and Medical Humanities. Kaldjian was formerly on the faculty at Yale University.

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

The study of internal medicine physicians, who had been in practice for at least several years, involved 677 Connecticut members of the American College of Physicians
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Contact: Becky Soglin
becky-soglin@uiowa.edu
319-335-6660
University of Iowa
6-Dec-2004


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