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The
Impact
of
Family
Medicine
Residency
Training
on
Physicians’
Attitudes
Toward
Euthanasia
and
Physician-Assisted
Suicide
in
Texas
Hormazd
Sanjana,
M.D.;
Charles
Sponsel,
D.O.;
David
Baldwin,
Ph.D.;
Brett
Nile,
M.D.
Texas
Tech
University
Health
Sciences
Center,
Department
of
Family
and
Community
Medicine,
Odessa,
Texas
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Objective
To
analyze
the
impact
of
family
medicine
residency
training
in
developing
the
opinions
and
attitudes
of
residents
toward
euthanasia
and
physician-assisted
suicide
(PAS).
Design
This
is
a
prospective
study
designed
to
compare
the
change
in
attitudes
toward
PAS
and
euthanasia
of
family
medicine
residents
from
their
first
year
of
training
to
their
third
year.
The
sample
population
included
all
250
PGY3
family
medicine
residents
in
Texas,
in
2002-20031.
A
Euthanasia
Questionnaire2,
similar
to
the
one
completed
by
PGY1
residents
in
2000-2001,
was
given
to
PGY3
in
2002-2003.
These
were
completed
and
returned
in
self-addressed
and
stamped
envelopes.
The
results
of
the
later
questionnaire
were
then
compared
to
those
of
the
first
questionnaire
to
determine
whether
there
was
a
significant
difference
in
the
residents’
attitudes
toward
PAS
and
euthanasia
as
they
were
ready
to
graduate.
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Analysis
The
Euthanasia
Questionnaire2
evaluates
a
physician’s
beliefs
about
euthanasia
in
five
areas
using
a
five-point
Likert
scale.
These
five
areas
include:
1)
withholding
life-sustaining
measures
and
the
use
of
opioids
to
relieve
pain
despite
hastening
the
patient’s
death;
2)
philosophical
issues
about
Euthanasia;
3)
legal
issues
involving
euthanasia;
4)
alternative
choices
to
euthanasia;
and
5)
global
factors
assessing
attitudes
toward
euthanasia
and
PAS.
The
duration
of
the
study
was
one
year.
Considering
a
20
percent
difference
on
a
five
point
Likert
scale
as
clinically
significant,
the
sample
size
needed
was
75
in
each
group
in
order
to
have
a
power
of
80
percent
with
an
alpha
of
0.05.
The
data
were
analyzed
using
a
Mann-Whitney
Rank
Sum
Test
to
determine
if
there
was
a
statistically
significant
difference
in
the
two
cohorts
(PGY1
2000
versus
PGY3
2003).
A
probability
(P)
of
<0.05
was
considered
to
be
statistically
significant.
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Results
Out
of
the
250
questionnaires
mailed
out,
86
completed
and
returned
(34
percent
return
rate).
Demographically,
there
were
54.6
percent
males
and
45.4
percent
females.
Of
the
group,
41.5
percent
considered
themselves
conservative,
35.4
percent
moderate,
18.3
percent
liberal
and
4.9
percent
were
undecided.
The
race/ethnicity
was
57.3
percent
Caucasians,
22
percent
Hispanic,
19.5
percent
Asians
and
1.2
percent
other.
As
to
type
of
practice,
56.1
percent
were
community-based,
41.5
percent
were
university-based,
and
2.4
percent
HMO.
As
the
2003
graduates1
progressed
in
their
residency
training
from
PGY1
to
PGY3
the
following
changes
were
noted:
During
their
first
year
of
training,1
this
cohort
held
liberal
attitudes
toward
euthanasia
and
PAS.
Toward
the
end
of
their
three
years
of
training,
their
attitudes
became
more
conservative.
As
a
group,
the
residents
were
not
in
favor
of
doctors
being
allowed
to
practice
euthanasia
(P<0.021).
They
disagreed
on
providing
specially
trained
physicians
for
euthanasia
(P<0.006),
on
permitting
legislation
for
practicing
active
euthanasia
(P<0.02)
or
allowing
patients
to
ask
for
active
euthanasia
(P<0.026).
However,
they
did
agree
upon
giving
morphine
drip,
even
if
it
meant
hastening
death
(P<0.043).
The
PGY3s
all
agreed
that
paying
close
attention
to
end-of-life
care
would
reduce
requests
for
euthanasia
and
PAS
(P<0.025).
They
also
agreed
that
religious
factors
play
a
part
in
deterring
other
physicians
from
participating
in
acts
of
euthanasia
and
PAS
(P<0.044).
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Conclusion
Residency
training
in
family
medicine
plays
a
large
part
in
molding
the
attitudes
and
changing
the
patterns
of
new
physicians.
Training
helps
attune
new
physicians
to
society
and
its
various
norms
before
they
become
full-fledged
doctors.
As
in
the
2001
study1,
we
see
the
proverbial
“taming
of
the
shrew”
by
residency
training
programs.
Since
euthanasia
has
been
legalized
in
Oregon,
and
other
states
like
Michigan,
Hawaii,
and
California
are
considering
doing
the
same,
it
may
only
be
a
matter
of
a
few
years
before
similar
legislation
is
introduced
in
Texas.
In
that
case,
the
future
family
practitioners
would
be
caught
unprepared,
which
would
be
a
cause
for
alarm.
Both
our
previous
study1
and
this
study
prove
that
the
family
medicine
residents
coming
out
of
training
are
unprepared
to
meet
these
unknown
giants
named
euthanasia
and
PAS.
It
may
be
in
part
due
to
unavailability
of
enough
information
on
the
subjects,
unwillingness
on
the
part
of
our
teachers
to
consider
euthanasia
and
PAS
part
of
routine
training,
or
sheer
ignorance
of
this
quietly
but
surely
growing
situation.
The
overall
conservative
attitude
seen
in
the
graduating
residents
in
this
study
is
similar
to
the
one
seen
in
our
previous
study1.
This
trend
reflects
a
fear
of
the
unknown
that
exists
in
a
training
physician,
which
could
be
detrimental
in
this
rapidly
evolving
and
liberalized
society,
which
is
well
aware
of
its
rights
and
privileges.
Like
any
fear,
fear
of
euthanasia
and
PAS
can
be
curbed
by
proper
education.
If
academia
in
Texas
has
to
arm
the
future
physicians
with
enough
knowledge
about
this
topic,
early
intervention
is
called
for
to
make
euthanasia
and
PAS
a
part
of
our
routine
curriculum.
References
-
Charles
Sponsel,
D.O.,
Brett
Nile,
M.D.
David
M.
Baldwin,
Ph.D.
and
Hormazd
Sanjana,
M.D.
An
examination
of
attitudes
towards
euthanasia
and
physician-assisted
suicide
(PAS)
of
Family
Practice
Residents
in
Texas.
Texas
Family
Physician
2003;
53:58-59
-
Doukas
DJ,
Waterhouse
D,
Gorenflo
DW,
Seid
J.
Attitudes
and
behaviors
on
physician
assisted
death:
a
study
of
Michigan
oncologists.
J
of
Clin
Oncol
1995;
13:1055-1061
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