Given this confusion, physicians who care for patients near the end of life may be at risk for allegations of euthanasia or formal charges of murder. 3 Finally, empirical studies of patients, their families, the general public, and even clinicians suggest that many people are not clear about the boundaries between legal and illegal health care practices at the end of life. 1, 2 Similarly, a recent legislative effort to reimburse practitioners for advance care planning visits was portrayed by politicians as government-sponsored euthanasia. In 2005, efforts to stop artificial hydration and nutrition for Terry Schiavo, a young woman in a persistent vegetative state, resulted in a public controversy and were depicted in national media reports as murder. O ver the past decade, pundits, advocacy groups, and politicians have publically conflated illegal, active euthanasia with ethically permissible and legal end-of-life care practices. At the time of the survey, none had been found guilty, but they reported experiencing substantial anger and worry. In eight (32%) cases, another member of the health care team had initiated the charges. Overall, 25 physicians (4%) had been formally investigated for hastening a patient's death when that had not been their intention-13 while using opiates for symptom relief and six for using medications while discontinuing mechanical ventilation. Respondents rated palliative sedation and stopping artificial hydration/nutrition as treatments most likely to be misconstrued as euthanasia. One in four stated that at least one friend or family member, or a patient had similarly characterized their treatments. Over half of the respondents had had at least one experience in the last 5 years in which a patient's family, another physician, or another health care professional had characterized palliative treatments as being euthanasia, murder, or killing. The final sample consisted of 663 physicians (response rate 53%).
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