Medical Decisions at the End of Life That Hasten Death

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Medical decisions at the end of life (MDELs) that have the potential to hasten death are increasingly prevalent in medical practice given (a) an aging population and (b) the increase in medical technology that allows life to be sustained beyond what it could be in the past and sometimes beyond what may be comfortable for the patient. When a decision is made to introduce life-sustaining interventions this may imply a later decision to halt these. Attitudes towards medical decisions that hasten death were explored among Greypower members, 55+ years (N = 595), Psychology students, 29 years and under (N = 205) and General Practitioners, 70 years and under (N = 120) in Auckland, New Zealand. Vignette scenarios were used related to withdrawing and withholding life support and nutrition and hydration, denying dialysis to a requesting patient, increasing medication to address pain at the risk of hastening death, physician supplying information, drugs, physician assisting patient to take drugs and physician giving a lethal injection to a terminally ill patient with intractable pain, on request and physician providing assisted death to a requesting tetraplegic patient. The effect of age of patient and consent on decision-making was also explored. Greypower members and Doctors had similar attitudes towards MDELs that are legal in New Zealand but over three-quarters of the Greypower members judged physician-assisted death for a terminally ill patient as justified compared to only one third of the Doctors. Psychology students were more conservative than either the Greypower members or the Doctors for all judgments related to the justifiability of MDELs. There appear to be underlying philosophical differences in the approaches to end of life decision-making by the three groups with Psychology students favouring a Sanctity of Life position and General Practitioners favouring the Status Quo. Greypower members appear to have a pragmatic approach to end of life care that does not favour one position over another.