Maltese doctors : views and experiences on end of life decisions and care

Abstract

Background: End of life (EoL) decisions are important and challenging for doctors. Aim: To better understand, describe and quantify this aspect of care. Methodology: A national cross-sectional validated survey was mailed to all doctors of the country. Results: The response rate was 39.3%. The respondents had been practicing for 19.72 years (95% CI: 18.3 – 21.0). 86% of respondents declared that their religion was important in EoL care. 42.9% (25.6% disagreed, 31.5% neutral) agreed with the right of a patient to decide whether or not to hasten the end of life. 48.6% agreed (34% disagreed, 17.4% neutral) that high quality palliative care nearly removes all requests for euthanasia. 60.4% agreed (23.9% disagreed, 15.7% neutral) that physicians should aim to preserve life. Each doctor cared for an average of 10.5 EoL (95%CI: 8.45-12.64) patients in the prior 12 months. 32.1% of doctors withdrew or withheld treatment in the care of these patients. Of the remaining 67.9%, 36.6% agreed with such practices. 50.3% had intensified analgesia at EoL with the possibility of hastening death. Only 6% had sedated patients at EoL. Lastly, 11.9% received request for euthanasia whilst 90.2% of doctors would never consider euthanasia. Significant correlations were observed between considering euthanasia, importance of religion, withdrawing/withholding treatment, doctors’ specialty, preservation of life and request for euthanasia. A thematic analysis of comments highlighted the importance of the topic, feeling uncomfortable in EoL care, the religious aspect of care, lack of legal framework and the challenge of symptom control. Conclusions: The overall majority of doctors is against euthanasia. There is a strong sense of guidance by their religious beliefs when it comes to EoL care. Doctors believe in preserving life as a guiding principle at the end of life, but do not shun intensification of analgesia at the end of life. Different specialties have slightly different views on EoL. Doctors need guidance – legal and moral - on this subject, in the absence of which, their religion and philosophy of life is used to guide them in this rather difficult area of practice.