Selected problems of palliative care and euthanasia in physicians and medical students views

Background . The increasing number of patients demanding palliative care in Poland indicates the necessity of gaining by physicians’ basic knowledge concerning palliative care and end-of-life ethical issues. The aim of this study was to evaluate basic knowledge of the end-of-life ethical issues of the 3 rd year medical students and trainees at the department of internal medicine and to assess their attitude towards euthanasia. Material and methods . A questionnaire survey with participation of 401 students and 217 physicians was filled after lectures for students concerning medical ethics, including the lecture “Physician facing dying patient” and after the theoretical course comprising basic palliative medicine for physicians during internal medicine specialty training. Results . Outcome of the study indicates comparable difficulties in breaking bad news concerning the disease and prognosis in students and physicians. 28% of students and 24% of physicians were ready to reveal full information but the number of surveyed who wanted to be fully informed of their situation was 84% of students and 80% of physicians. 1/3 of the surveyed both students and doctors were able to give appropriate definition of euthanasia, 82% of students and 90% of physicians would not perform euthanasia, 67% students and 75% physicians were against legalization of euthanasia. Regarding the doctrine of double effect 47% doctors and 88% of students gave no response. The most frequent answer for the request of giving the definition and the difference between pain and suffering was “unpleasant feeling, discomfort” without recognizing the difference (students 21%, doctors 14%). For the half of surveyed (51% of students, 49% physicians), the term palliative care meant „care for the non curable people improving their quality of life”. 37% of students and 35% of physicians treat hospice as a „place of stay of incurable patients”. 70% of doctors and 23% of students indicated oral as the most preferable route of morphine administration. 74% of physicians and 43% of students chose the appropriate statement that there is no maximal dose of morphine and 64% doctors and 6% of students indicated appropriate answer i.e. constipation is a constant side effect of morphine. Conclusions . Breaking bad news concerning cancer diagnosis and prognosis is a significant difficulty for both students and physicians. This study indicates that there is a significant lack of knowledge of bioethics, small percentage of respondents were tending to practice euthanasia and bigger accepting its legalization. In contrast to students the majority of physicians posses knowledge concerning the route of administration and side effects of morphine in cancer pain treatment.