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Text
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Pages
173–180
Issue
3
Volume
48
Dublin Core
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Title
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Nephrologists' subjective attitudes towards end-of-life issues and the conduct of terminal care.
Publisher
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Clinical nephrology
Date
A point or period of time associated with an event in the lifecycle of the resource
1997
1997-09
Subject
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Adult; Humans; Middle Aged; Pilot Projects; *Attitude of Health Personnel; Data Collection; *Attitude to Death; Empirical Approach; *Euthanasia; *Terminal Care; Advance Directive Adherence; Advance Directives; Death and Euthanasia; Nephrology; Withholding Treatment; Ethics; Medical; Active
Creator
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Rutecki G W; Cugino A; Jarjoura D; Kilner J F; Whittier F C
Description
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Decisions which determine the duration and outcome of terminal care should be influenced by patient autonomy. Studies suggest, however, that end-of-life decision-making is more complex than a single principle and that physicians may be responsible for selected aspects of terminal care independent of patient choice. To study how nephrologists' perceptions toward end-of-life issues may affect decision-making, we anonymously surveyed 125 of them. The study employed the straightforward terminology of "hastening death" rather than adopting the ambiguous term "euthanasia" or the narrow term "assisted suicide." Subjective physician profiles demonstrated that nephrologists who are less comfortable with dying patients were significantly less likely to report that they omitted life-prolonging measures (p = 0.02) and more likely to report that they would not initiate measures in order to hasten death even were it legal (p = 0.04). Ninety-eight percent of nephrologists reported omissions in terminal care with patient knowledge and 80% without patient knowledge. In contrast, forty-three percent of the nephrologists said that were it to become legal to initiate measures in order to hasten death, they would "never" do so. The ethical framework utilized for discontinuation of dialysis decisions incorporated medical benefit (cancer as criterion, 48%; multisystem complications, 84%; dementia 79%) and quality of life criteria. Twenty-five percent of nephrologists admitted difficulty with advance directives if the directives clashed with heir beliefs. ESRD end-of-life decision-making in the USA may be altered by the subjective characteristics of nephrologists. In particular, nephrologists' level of discomfort with patient mortality is linked with their reported management of terminal patients.
Rights
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
*Attitude of Health Personnel
*Attitude to Death
*Euthanasia
*Terminal Care
1997
Active
Adult
Advance Directive Adherence
Advance Directives
Clinical nephrology
Cugino A
Data Collection
Death and Euthanasia
Department of Internal Medicine
Empirical Approach
Ethics
Humans
Jarjoura D
Kilner J F
Medical
Middle Aged
NEOMED College of Medicine
Nephrology
Pilot Projects
Rutecki G W
Whittier F C
Withholding Treatment