Background: Due to recent legislations on euthanasia and its current practice in the Netherlands and Belgium, issues of end-of-life
medicine have become very vital in many European countries. In 2002, the Ethics Working Group of the
German Association for Palliative Medicine (DGP) has conducted a survey among its physician members in order to evaluate their attitudes towards different end-of-life medical
practices, such as euthanasia (EUT), physician-assisted suicide (PAS), and terminal sedation (TS).
Methods: An anonymous questionnaire was sent to the 411 DGP physicians, consisting of 14 multiple choice questions on positions that
might be adopted in different hypothetical scenarios on situations of “intolerable suffering” in end-of-life care. For the
sake of clarification, several definitions and legal judgements of different terms used in the German debate on premature
termination of life were included. For statistical analysis
t-tests and Pearson-correlations were used.
Results: The response rate was 61% (
n=251). The proportions of the respondents who were opposed to legalizing different forms of premature termination of life
were: 90% opposed to EUT, 75% to PAS, 94% to PAS for psychiatric patients. Terminal sedation was accepted by 94% of the members.
The main decisional bases drawn on for the answers were personal ethical values, professional experience with palliative care,
knowledge of alternative approaches, knowledge of ethical guidelines and of the national legal frame.
Conclusions: In sharp contrast to similar surveys conducted in other countries, only a minority of 9.6% of the DGP physicians supported
the legalization of EUT. The misuse of medical knowledge for inhumane killing in the Nazi period did not play a relevant role
for the respondents’ negative attitude towards EUT. Palliative care needs to be stronger established and promoted within the
German health care system in order to improve the quality of end-of-life situations which subsequently is expected to lead
to decreasing requests for EUT by terminally ill patients.
Keywords attitudes - euthanasia - German Association for Palliative Medicine - palliative care - physician-assisted suicide - survey - terminal sedation