End-of-life care - A survey of US neurologists' attitudes, behavior, and knowledge

Objective: The American Academy of Neurology (AAN) surveyed the attitudes, behavior, and knowledge of its members regarding care at the end of life. T hree groups of AAN members were surveyed: neuro-oncologists, ALS specialist s, and a representative sample of US neurologists.,Methods: The survey pres ented two clinical scenarios involving end-of-life care. Neurologists mere asked a series of questions to assess their knowledge of existing medical, ethical, and legal guidelines; their willingness to participate in physicia n-assisted suicide (PAS) or carry out voluntary euthanasia NE); and their g eneral attitudes regarding end-of-life care. Results: Neurologists support a patient's right to refuse life-sustaining treatment, but many believe tha t they are killing their patients in supporting such refusals. Thirty-seven percent think it is illegal to administer analgesics in doses that risk re spiratory depression to the point of death. Forty percent believe they shou ld obtain legal counsel when considering stopping life-sustaining treatment . One half believe that PAS should be made explicitly legal by statute for terminally ill patients. Under current law, 13% would participate in PAS an d 4% would carry out VE; if those procedures were legalized, 44% would part icipate in PAS and 28% in VE. Approximately one third believe that physicia ns have the same ethical duty to honor a terminally ill patient's request f or PAS as they do to honor a such a patient's refusal of life-sustaining th erapy. Conclusions: There is a gap between established medical, legal, and ethical guidelines for the care of dying patients and the beliefs and pract ices of many neurologists, suggesting a need for graduate and postgraduate education programs in the principles and practices of palliative care medic ine, Many neurologists would participate in PAS and carry out VE if legaliz ed.