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Research suggests doctor-assisted suicide wouldn't undermine patient trust

December 02, 2005

There is little evidence to support the argument that legalizing physician-assisted death would reduce patients' trust in their doctors, according to a researcher from Wake Forest University Baptist Medical Center and colleagues.

"Overall, three times as many people disagree as agree that legalizing physician-assisted death would cause them to trust their personal doctors less," said Mark Hall, J.D., professor of public health sciences at Wake Forest Baptist and Fred D. and Elizabeth L. Turnage Professor of Law at Wake Forest University.

Hall and colleagues designed a random telephone survey of 1,117 adults in the United States to measure attitudes about physician aid in dying. The results are reported in the current issue of the Journal of Medical Ethics.

Survey participants were asked to use a five-point scale to state their agreement or disagreement with this statement: "Assume for the purpose of this question that euthanasia were legal. If doctors were allowed to help patients die, you would trust your doctor less." The question did not distinguish between physician-assisted suicide, where the physician helps a patient take his or her own life, and euthanasia, where the physician directly administers the lethal dosage, because prior studies found that attitudes are essentially the same for both.

A majority (58 percent) of participants disagreed with the statement. Only 20 percent said that legalizing euthanasia would cause them to trust their personal physician less. These attitudes were the same in men and women.

Older adults (age 65 or older) and blacks were more likely than other groups to say physician aid in dying would lower trust, but this view was still in the minority. Only 27 percent of older participants and 32 percent of blacks said euthanasia would lower trust.

"Despite the widespread concern that legalizing physician-assisted death would seriously threaten or undermine trust in physicians, the weight of the evidence in the United Sates is to the contrary, although views vary significantly," said Hall.

The debate over physician-assisted death often includes assertions about the impact on patient trust, yet there has been little data on the subject, Hall said. There are two prior studies on the topic, but they were confined to residents of Massachusetts and Iowa, and they were generally consistent with the findings from this study.

Hall said that public policy advocates often overstate their case when they argue that particular legal or ethical rules are necessary to support trust. Even the U.S. Supreme Court has noted that physician-assisted suicide could "undermine the trust that is essential to the doctor-patient relationship by blurring the time-honored line between healing and harming."

Hall said that evidence for this argument is weak.

"Our study shows that only about 20 percent of people believe they would trust their physician less if euthanasia were legalized," he said. "The empirical support is weak for those who confidently assert that legalizing physician-assisted death would undermine trust in physicians for most people in the United States."

The researchers said, however, that the research doesn't necessarily support the opposing side, either.

"We should not be cavalier about potential threats to trust because, once it is lost, it is far harder to rebuild than to sustain," write the authors. Banning physician-assisted suicide or euthanasia could thus still be justified as a measure to avoid any diminution in trust.\\\

Wake Forest University Baptist Medical Center