Facing the end: A survey of medical students on medical decisions in terminal situations

Abstract

Background: Medical decisions concerning the end of life (EOL) are frequently made in our environment. Paradoxically, the topic of death and its circumstances is not developed in the undergraduate and graduate training of Medicine in Argentine universities. The objectives of this study was to know if advanced students of Medicine (EAM), when they become doctors, will agree that people can decide when to end their life in the face of a terminal illness, with a progressive and fatal evolution.
Material and methods: Descriptive observational cross-sectional study in survey format through Google form to EAM [(regular 5th and 6th year students of Medicine from the Faculties of Medicine of the Interamerican University (UAI) and the University of Buenos Aires (UBA )], who signed the informed consent. Demographic information was obtained. The opinion regarding the hypothetical scenario of the voluntary request of a patient suffering from a terminal illness to end their life was questioned; Argentina; degree of knowledge of the concepts of “Euthanasia” and “Dignified death” (Law 26742) and relate the responses to demographic and religious factors.
Results: 101 students answered, mostly Argentinian, with an average age of 27 years and who mostly professed the Christian religion. Approximately half responded that they had a loved one with a terminal illness, with a progressive and fatal evolution. Regarding the question if they agreed that people, faced with a voluntary request, or faced with the impossibility of expressing themselves (involuntarily) through a family member, can decide about when to die in the face of a terminal illness, with a progressive evolution and fatal, if there is legislation that protects the doctor's actions, the majority (87.1%) responded affirmatively. Regarding the question if they would agree that in Argentina there is a Law that regulates this type of clinical situations that protect the will of the patient and the doctor's actions, they also responded affirmatively (93.1%). Finally, when asked if they knew the difference between the terms “Euthanasia” and “Death with dignity”, the latter defined in Law 26742, the vast majority of students responded affirmatively (85.15%). Relating the variables to each other, for question A, a lower affirmative response was observed in non-Argentines and a higher affirmative response in UBA students (p<0.00001). Greater affirmative responses were observed for questions B and C if they reported being atheists/agnostics compared to other religions (p<0.00001). A greater negative response was observed for question D if they reported being atheists/agnostics (p<0.0001).
Conclusion: A survey of 101 students from the last two years of the Medicine Degree at the UAI and UBA, asked them about their position on DFV. As to whether they agreed that people, faced with a voluntary request, or when unable to express themselves (involuntary) through a family member, can decide when to die in the face of a terminal illness, with progressive and fatal evolution, if there is legislation that supports the actions of the doctor, the majority (87.1%) answered affirmatively. As to whether they would agree that in Argentina there is a Law that regulates this type of clinical situations that protects the will of the patient and the actions of the doctor, they also answered affirmatively (93.1%). A greater affirmative response was observed if they reported being atheists/agnostics compared to other religions (p<0.00001). They knew the difference between the terms “Euthanasia” and “Dignified Death” according to Law 26742, the vast majority (85.15%).