Turkey's physicians' attitudes toward euthanasia: a brief research report

Euthanasia and assisted suicide are subject to an ongoing debate and discussed with various aspects. Because physicians are in a profession closely related to euthanasia, their attitudes toward this subject are significant. Thus, research intending to explore their opinions is carried out in many countries. In this study, opinions of the physicians regarding euthanasia's definition, contents, legal aspects, and acceptable conditions for its application are addressed. The questionnaire was given to 949 physicians, more than 1% of the total working in Turkey. Of the physicians who participated in the study, 49.9% agreed with the opinion that euthanasia should be legal in certain circumstances. In addition, 19% had come across a euthanasia request and the majority of physicians (55.9%) believed that euthanasia is applied secretly in the country despite the prohibitory legislation. In conclusion, the authors infer from the study itself and believe that euthanasia should be legal in certain circumstances and that the subject, which is not in the agenda of the Turkish population, should continue to be examined.     

Turkish health professional's attitude toward euthanasia

The cross-sectional study was administrated between April and September 2006. Participants are doctors, nurses, and midwives. Between these dates we met only 750 health staff (doctor, nurse, and midwife). Six hundred thirty-two of them responded to our questionnaire, 122 of them were in Manisa city, and 510 of them in Erciyes. We sought to identify variables that contribute to euthanasia attitude, including demographics, in order to demonstrate Turkish doctors', nurses', and midwives' attitudes toward euthanasia and to compare their attitudes in this regard. The data was collected by a two-part questionnaire. The first part included questions about the health personnel; the second part comprised the euthanasia (Medical Staffs Attitude toward Euthanasia) scale. The scale was developed by the researcher to measure the attitude of healthy staff euthanasia. The SPSS was used to analyze the data. Student t-test, ANOVA, Mann Whitney U, and Kruskal Wallis were used to evaluate the data. Thep value 0.05 (95% confidence interval) was accepted as significant. In our study, professional groups are compared with all the factors but there is a significant difference only between social cost and professional groups.     

Older women and mercy killing

Mercy killing is usually defined as intentional killing, often by family members or friends, with the stated intent to end perceived suffering. International evidence suggests that mercy killing typically involves an older man killing his ailing wife. In this study, we examined U.S. cases of mercy killing recorded by The Hemlock Society for the period 1960-1993. We found that the typical case involved an older woman being killed by a man, often her husband, with her poor health as the justification for the killing. A firearm was often used in these incidents. These patterns of mercy killing are consistent with patterns of homicide-suicide among older adults. Future research should seek to understand why women are typically the targets, and men the agents of mercy killing.     

Power,authority and legitimacy

Management, human resources, organization, control, leadership, etc., all seem to be just so many euphemisms for power, and this suggests a discourse of management and organization that calls things by their proper name. This paper on the contrary stresses the need to resolve the concept of ‘power’ itself into more differentiated notions, and proposes that clarification may be derived from distinctions once explicit in the vocabulary of Classical antiquity, but lost in modern European languages. It argues that nothing but confusion in thinking about organizations, management and legitimation can result from the failure to recognize that the phenomena this vocabulary identifies and distinguishes are irreducibly different.     

Planned euthanasia for old projects

The literature is full of techniques for the evaluation of new projects to ensure that money will be invested at the right time, in the optimun amount and on the best projects. There is, however, a dearth of advice on the evaluation of old projects to guide the withdrawal of resources at the right time and in the right manner from projects nearing the end of their profitable life. The present paper describes a technique for the financial evaluation of the desirability of closing manufacturing activities which are showing declining profitability.     

Physician Utilization of Computers:

This study demonstrates how social network analysis can be used to identify the underlying communication and influence structure that affects the diffusion of the use of a computer-based medical information system among physicians. Interviews, hospital records, and computer system tapes were used to collect data on referrals, consultations, and practice characteristics from 24 physicians who comprise a private group practice. Multidimensional scaling was used to spatially represent the referral and consultation network among the physicans. Also, several indices that measure structural characteristics of the network and practice characteristics of physicians were derived. Four groups of physicians were identified who have similar computer utilization patterns and who perform similar roles within the network. The results indicate that the use of network analytic techniques to study complex physician networks may provide new insights into the diffusion process.     

Physician perspectives on the structure and function of group practice HMOs

This article explores physicians' perspectives regarding how their HMOs function and their satisfaction with and loyalty to HMOs. Three HMOs were studied: a mature (28-year-old) staff model, a 16-year-old staff model, and a 13-year-old group model with both HMO and fee-for-service patients. While these HMOs were found to vary somewhat in terms of emphasis on patient care versus costs, methods used to control costs and degrees of centralization of decision making, they all received high overall satisfaction and loyalty scores. The staff model HMO with a more decentralized decision making structure received the highest satisfaction/loyalty score from its physicians. The degree to which physicians perceive the HMO to be effective and supportive and the use of educational programs and peer review to influence resource use were also found to be significantly related to physician satisfaction and loyalty.     

The spreadsheet and physician productivity.

Friction between medical education faculty members and other physicians at St. Vincent Medical Center, Toledo, Ohio, led to a program to assess both the costs and the contribution of the teaching faculty to the overall goals of the institution. Because the existing information system proved to be unequal to the task, a specially designed spreadsheet system was developed to be used for medical education physicians. The computer-based system that was developed permits a detailed analysis of the productivity of these physicians. More important, it allowed the medical education function to provide solid justification of its efforts on behalf of the medical center.     

Incremental and Average Cost‐Effectiveness Ratios: Will Physicians Make a Distinction?

Physicians are increasingly asked to use cost-effectiveness information when evaluating alternative health care interventions. Little is known about how the way such information is presented can influence medical decision making. We presented physicians with hypothetical screening scenarios with multiple options, varying the type of cost-effectiveness ratios provided as well as whether the scenarios described cancer screening settings that were familiar or unfamiliar. Half the scenarios used average cost-effectiveness ratios, as commonly reported, calculating benefits and costs relative to a no-screening option. The other half used the preferred incremental cost-effectiveness ratios, with each option's benefits and costs calculated relative to the next best alternative. Relative to average cost-effectiveness ratios, incremental cost-effectiveness information significantly reduced preference for the most expensive screening strategies in two of three unfamiliar scenarios. No such difference was found for familiar scenarios, for which physicians likely have established practice patterns. These results suggest that, in unfamiliar settings, average cost-effectiveness ratios as reported in many analyses reported in the literature can hide the often high price for achieving incremental health care goals, potentially causing physicians to choose interventions with poor cost effectiveness.     

An approach to the impaired physician

The 1988 California Administrative Code requiring all acute care medical staffs to provide assistance to impaired physicians has not resulted in an increase in the annual census in the Medical Board of California Diversion Program. In part, this lack of an increase is due to the failure of some hospitals to form physician aid committees and to the poor functioning of such committees in other hospitals. The common reasons for these deficiencies are that the medical staff leadership does not think there are any impaired physicians on staff and that they don't know what the committee would do if it were formed. This attitude demonstrates a lack of appreciation for the prevalence of impaired physicians and the tremendous amount of work required (establishing policies and procedures) to identify and help them. This article discusses the prevalence of the impaired physician, the types of impaired physicians, a "cookbook" approach to managing these physicians, and the success of intervention.     

Physician profiling: trends and implications

Every professional is subject to profiling, and most are profiled more rigorously, more thoroughly, and more dispassionately than are physicians. Profiling occurs when society has the technologies and the economic incentives to perform profiling. In the first of this two-part article, we will consider trends in profiling all professionals and those in profiling physicians. We conclude in the second part of the article with a discussion of the specific methodologies and vendors used in profiling the practice habits of physicians.     

A scale to assess attitudes toward euthanasia

The topic of euthanasia has been a matter of public debate for several decades. Although empirical research should inform policy, scale measurement is lacking. After analyzing shortcomings of previous work, we offer a systematically designed scale to measure attitudes toward euthanasia. We attempt to encompass previously unspecified dimensions of the phenomenon that are central to the euthanasia debate. The results of our pretest show that our attitude towards euthanasia (ATE) scale is both reliable and valid. We delineate active and passive euthanasia, no chance for recovery and severe pain, and patient's autonomy and doctor's authority. We argue that isolating these factors provides a more robust scale capable of better analyzing sample variance. Internal consistency is established with Cronbach's alpha=.871. Construct external consistency is established by correlating the scale with other predictors such as race and spirituality.     

Lonely at the top and loving it: physicians as CEOs

As little as five years ago, most hospital board members scoffed at the idea of hiring physicians as chief executive officers or chief operating officers. Physicians, they maintained, belonged at the bedside, not in the board room. For the most part, physicians didn't take issue with this thinking. Profit and loss statements, strategic planning, and other CEO duties were alien. Besides, being a "suit" was unconscionable, a total fall from the true grace of medicine: patient care. Dramatic changes in health care have wrought dramatic changes in the mindsets of both board members and physicians. Today, both sides have developed a new perspective on physicians in top hospital administrative positions. In this article, the author reports on the experiences of physician executives who have made the trip to the top.     

The evolving role of the primary care physician

In today's climate of health care reform, the title of this article might more appropriately be "Is the Role of the Primary Care Physician Evolving or Going the Way of the Dinosaur?" According to Koop, primary care is in trouble. Whereas only 29 percent of U.S. physicians are primary care physicians, in Great Britain, 72 percent of physicians are primary care physicians and in Europe and Canada the average is 50 percent. Many U.S. primary care physicians are in the later stages of their careers and nearing retirement age. Unless the supply increases, this number will dwindle further. However, in 1992, only 14 percent of U.S. medical school graduates were headed for primary care careers. Even if the supply of primary care graduates were increased to 50 percent of the graduating medical school class, it would be well into the next century before the ratio of primary care physicians to specialists would be equal. Primary care is at a critical juncture and the next few years will decide the fate of the primary care physician. Given the state of primary care today, I believe that a fundamental look at the assumptions regarding the role of primary care physicians is in order. The current health reform movement has placed a major responsibility on primary care to solve many of the problems in health care delivery today, such as cost, utilization, and prevention. Many health care organizations are planning strategies involving primary care providers, and physician executives can play a key role in these decisions.     

Medical decision-making around the time of death of cognitively impaired nursing home residents: a pilot study

The purpose of this article is to describe the end-of-life process in the nursing home for three groups of cognitively-impaired nursing home residents: those who died with a medical decision-making process prior to death; those who died without such a decision-making process; and those who had a status-change event and a medical decision-making process, and did not die prior to data collection. Residents had experienced a medical status-change event within the 24 hours prior to data collection, and were unable to make their own decisions due to cognitive impairment. Data on the decision-making process during the event, including the type of event, the considerations used in making the decisions, and who was involved in making these decisions were collected from the residents' charts and through interviews with their physicians or nurse practitioners. When there was no decision-making process immediately prior to death, a decision-making process was usually reported to have occurred previously, with most decisions calling either for comfort care or limitation of care. When comparing those events leading to death with other status-change events, those who died were more likely to have suffered from troubled breathing than those who remained alive. Hospitalization was used only among those who survived, whereas diagnostic tests and comfort care were used more often with those who died. Those who died had more treatments considered and chosen than did those who remained alive. For half of those who died, physicians felt that they would have preferred less treatment for themselves if they were in the place of the decedents. The results represent preliminary data concerning decision-making processes surrounding death of the cognitively-impaired in the nursing home. Additional research is needed to elucidate the trends uncovered in this study.     

A rational approach to career change

Recently, the number of physicians who have been interested in alternative careers has vastly increased. Many physicians express dissatisfaction with clinical practice, but they are uncertain about which nonclinical options are appropriate for them. Pursuing a different career after many years of studying and practicing medicine can seem like an overwhelming task. In this article, the author briefly outlines a decision-making process that can be used in analyzing career options and suggests some careers that have provided challenging opportunities for physicians.     

Physician executive contracts: negotiating the future

Once viewed as a matter of standard protocol, physician executive contracts have become as complex as the health care industry itself. Historically, hospital administration and physicians negotiated a few key points, then sent the ideas to an attorney for insertion of standard legalize and boilerplate. Today, physician executive contracts are an important part of the changes in health care. They not only cover traditional hospital and physician relations, but increasingly apply to new types of relations (such as employment) between hospitals and physicians, physicians and physicians, and health plans and physicians. In this article, we will explore both the "content" and the "context" of physician executive contracts. Content will deal with the specific provisions typically included in contracts. Context will address issues associated with preparing for and negotiating a contract.     

A protocol for mutual respect and communication

Physicians relating to each other, discussing a patient's problem, needs, and care plans, should be the easiest part of medical practice. Unfortunately, exchanging meaningful information between physicians and their offices is, at times, formidable. This article describes the guiding principles for physician referrals at Hamot Medical Center that were developed to enhance communication between physicians and increase patient care.