Alipour, Razieh

Rafiei, Hossein

senmar, mojtaba

Qazvin University of Medical Sciences Repository

Vol 6 Issue 4, Oct - Dec 2017                                            www.mintagejournals.com                                                                                           9 Original ArticleMOJTABA SENMAR,  FATEME YOUSEFI,  RAZIE ALIPOUR, NOOSHIN ELIKAEI,  MINA  KESHAVARZ AMANDI, HOSSEIN RAFIEI*1Student Research Committee, Qazvin University Of Medical Sciences, Qazvin, Iran Email: Hosseinr21@gmail.comReceived - 31.08.2017; Reviewed and accepted - 16.09.2017ABSTRACTBackground and Aim: Euthanasia is an important issue in human ethic that medical students may be confronted with this in their clinical courses. Study about attitude of medical students about euthanasia in Iran is very limited. In present study, we examined attitude of Iranian medical student about euthanasia. Methods: Study performed in Qazvin, Iran after obtaining ethic code from medical ethic committee of Qazvin University of medical science. For this study, all medical students who were studying in Qazvin University of medical science in time of study performing invited. Data were collected with using a self-designed demographics characteristics check list and Euthanasia Attitude Scale. Data analysis performed by using SPSS software. P value under 0.05 considered significant in data analysis. Results: Totally 141 students completed questionnaires. Female students in our study were majority (69.5%). Mean age of students in present study were 20.8±1.76 yearEuthanasia Attitude Scale were 59. fs categories were 31.4±4.4, 7.7±1.9, 13.8±1.9 and 5.9±1.3 respectively. We note found and significant relationship and correlation between total score on the Euthanasia Attitude Scale and participants demographics characteristics. Conclusion: Majority of participant in our study have neutral attitude towards euthanasia. It seems that we need to further study in this regards.Key words: Ethical issue, end of life, euthanasia, students, health, Iran   INTRODUCTIONNowadays with increasing end stage patients life span because of medical science improvement in several fields, health care team members confronted with more ethical and moral challenges in time of treatment and caring of this patients [1, 2, 3]. One of this ethical issue is euthanasia [1, 4]. The term of euthanasia derived from Greek words [5, 6]. Based on the how euthanasia is passive and assisted suicide [7, 8, 8]. In active euthanasia, health care members usually physician or nurses have active role in patients dying, in passive euthanasia health care members usually physician and nurses are not active and they not doing any lifesaving action for their patients and in assisted suicide, health care members usually physician or nurses help patients committing a suicide [9, 10]. In the other division, euthanasia divided to voluntary and nonvoluntary types [11]. Nowadays some type of euthanasia is legal in some European and American countries such as Belgium, Luxembourg, Netherlands, Canada, Colombia, and some states of United State [12].Because euthanasia is an important issue in human ethic, several studies in medical and nursing field performed to examine attitude toward euthanasia among health care members [13]. In one study about euthanasia in an Asian country, Malaysia. Sample in Rathor and colleagues study were 192 physicians that work in different health care setting. Most participants in Rathor and colleagues study were Muslims (131 from 192). Majority of participants in Rathor and colleagues study were disagreeing with euthanasia. They also were disagreeing with legalization of euthanasia in their country [13]. In other study in this regards, Terkamo-Moisio and and. A high number of nurses in Terkamo-Moisio and colleagues study were agree with legislation of euthanasia and euthanasia be a part of their healthcare system [14]. In one study in Iran, Naseh and colleagues examined attitude of final years nursing students towards different type of euthanasia.  Sample in their stud were 80 nurse students studying in Islamic Azad University in Shahrekord. Results of Naseh and colleagues study were interesting because about 49% of participant in their study have positive attitude towards euthanasia [15].  future performance in clinical practices.  However study in this regards is limited to few studies. In present study, we examined attitude of medical students studying in Qazvin University of medical science about euthanasia. METHODSPresent descriptive study performed in 2016-2017. Proposal of this study were approved in Qazvin University of medical science, Iran. Study received ethic code from medical ethic committee in this university. All medical students who were studying in Qazvin University of medical science in time of study performing invited to participate in our study. After acceptance to participation, students requested to signed consent form. Students assured that all data that obtained from them in all steps of study remained confidential.Data were collected by researchers in medical college and hospitals affiliated to Qazvin University of medical science. Times need for completing questionnaires was 20 to 40 minute. Students requested to returned questionnaires to researchers after completing these. Data collected with using two instruments. First demographics characteristics collected with using a self-designed check list. This check list incluage, education level, religion, and economical status. Attitude towards euthanasia were measured by using Euthanasia Attitude Scale. This scale developed by Tordella MA, Neutens 1n 1979 [16]. To now, several modifications performed on this scale. Last version of this scale had 21 items that categorized in four categories by Ming-lin Chong & Fok [17]. These four categories are ethical consideration, practical consideration, treasuring life and naturalistic beliefs. The total scores for Euthanasia Attitude Scale are ranged from 21 to 105 and lower scores in this questionnaire indicated a more negative attitude to euthanasia. Valid Persian version of this scale is available and several study used this scale to examine attitude towards euthanasia in Iran [10, 15].For data analysis, we used SPSS software. Analysis performed by one of researchers that were expert in data analysis. Descriptive statistics (mean and frequency), independent t test, one Way ANOVA and Pierson correlation test were used. P value under 0.05 considered significant in data analysis.Vol 6, Issue 4, 2017                                                                                                                                       ISSN: 2320-3315 Mintage Journal of Pharmaceutical & Medical Sciences Rafiei et al                                                                                                               Mintage journal of Pharmaceutical & Medical Sciences 9-11 Vol 6 Issue 4, Oct - Dec 2017                                           www.mintagejournals.com                                                                                           10 RESULTSTotally 141 students completed questionnaires. Female students in our study were majority (69.5%). Mean age of students were 20.8±1.76 years. About 90% of students in our study were single and most of them reported that have moderate level of economic status. All participants in our study were Muslims. Of 141 students, 57.4%, 41.1% and 1.4% have good, moderate and bad relationship with their religion. core on the Euthanasia Attitude Scale were practical consideration, treasuring life and naturalistic beliefs categories showed in graph 1.Graph 1: Mean score of four domains of Euthanasia Attitude ScaleResults of Pierson correlation test showed positive and none significant correlation between students total score on the Euthanasia Attitude Scale and their age (P= 0.362, rr= 0.077). Although the mean score of Euthanasia Attitude Scale werehigher in male students in compared to female students, however this difference between groups were not statistical significant (P= 0.092). Statistical test also not showed correlation and relationship between mean score of Euthanasia Attitude Scale with students economic status, marital status and religiosity (p>0.05).DISCUSSIONMedical students in time of their clinical courses, confronted with different ethical conditions. One of them is euthanasia. In present study, we examined attitude of Muslims medical students towards euthanasia. According to finding of present study, most participants in our study have neutral attitude towards this ethical issue.Most people in Iran are Muslims and according to laws of the Islamic religion, euthanasia is prohibited and in some circumstance its considered as a deliberate murder [1]. However in Iran, we have not clear laws about euthanasia. Previous studies about attitude towards euthanasia among medical students in Iran are very limited. In one study in 2009, Kachoei and colleagues examined attitude of medical students about euthanasia in Qom. Sample in their study were 140 medical students. Half of participants in Kachoei and colleagues study were disagree with all forms of euthanasia. Results of Kachoei and colleagues study also showed that about 30% of their students were agree to patients can choice euthanasia [18]. In other study Tavoosiyan and colleagues examined attitude of 100 medical students about all type of euthanasia. Results of Tavoosiyan and colleagues study revealed that medical students are mostly disagree with all type of euthanasia [19]. Results among medical students in other Asian countries also showed similar findings. In one study in 2006, Ahmed and colleagues examined attitudes of medical students towards euthanasia in India. Sample of their study were 141 final-year students. Results of Ahmed et al., study revealed that Indian medical students are well familiar with the concept of euthanasia and mostly are disagree with this ethical issue. Ahmedand colleagues also reported that religious belief is a determining factor in attitude of medical students toward euthanasia [20]. In other study, Adchalingam and colleagues examined Malaysian -designed instrument.  Similar to finding of present study, participant in Adchalingam and colleagues study were disagree with euthanasia and use of this in clinical practice [21].Although previous studies in Iran and other Asian countries showed similar finding, however study among medical students in European countries showed different finding. In one study in this regards, Mierzecki and colleagues examined attitude toward euthanasia in first year medical students from Szczecin, Germany and Sweden. Majority of medical students in Mierzecki and colleagues study were agreed with euthanasia. In this regards, 3% of German students, 12% of Swedish students and 29% of Poles students were disagree with euthanasia that is difference with finding of our study [22]. This difference could be related to difference in cultural background and religious beliefs between medical students in our study and medical students in Mierzecki and colleagues. It seems that students with strongest religious beliefs are mostly disagreeing with euthanasia. Although we need to further investigation in this regards.CONCLUSIONEuthanasia is multi-dimensional concept that not accepted by Islam laws. Also in Iranian society because of specific cultural situation and lack of clear laws discussion about euthanasia is very difficult. In present study, we examined attitude of medical students about euthanasia. According to finding of our study, most participants in our study have neutral attitude towards this ethical issue. It seems that we need to further study in this regards among medical students with different cultural and religious belief. We also need to further study to determine role of religious belief in attitude towards euthanasia among Muslims medical students.LimitationSampling methods in our study have some limitation. Also most participants in our study were Muslims that should be considered by readers.REFERENCES1. Naseh  L,  Heidari  M.  The  attitudes  of  nursing  students  to euthanasia. Indian J Med Ethics. 2017 Jan-Mar;2(1)NS:20-4.2.tapçio lu G. Turkish Health Professional's Attitude Toward Euthanasia. OMEGA - Journal of Death and Dying. 2008;57(1):93-112.3. Rastegari najaf abadi h, Sedaghat m, Saedi teharani s, Aramesh k. Euthanasia: nurses perspective in teaching hospitals of Tehran University of Medical Sciences. Iranian Journal of Medical Ethics and History of Medicine. 2010;3(5):37-44.4. Hosseinzadeh K, Rafiei H. Nursing Student Attitudes toward Euthanasia: A Cross-Sectional Study. Nursing ethics. 2017:969733017718393.5. Therese MA  , Rukumani  J  , Mano PP , Ponrani  & Nirmala. A study of assess the level of attitude towards euthanasia among health personnel. NUJHS ; 4(4):18-23.6. Singh S, Gupta S, Singh I, Madaan N. Awareness and Attitude of Select Professionals toward Euthanasia in Delhi, India. Indian Journal of Palliative Care. 2016;22(4):485-490.7. Jafari H, Meskini L, Heydari Gorji M, Ahmadi khatir M. Health Care Providers' Attitude towards Performing Euthanasia on the Elderly. Clinical Excellence. 2016;5(2):45-56.8. Aghababi N, Hatami J, Rostami R. The role of individual characteristics and judgment pattern in attitude toward euthanasia. Iranian Journal of Critical Care Nursing. 2011;4(1):23-32.9. Ozcelik H, Tekir O, Samancioglu S, Fadiloglu C, Ozkara E. Nursing students' approaches toward euthanasia. Omega. 2014;69(1):93-103.10. Naseh L, Rafiei H, Heidari M. Nurses' attitudes towards euthanasia: a cross-sectional study in Iran. International journal of palliative nursing. 2015;21(1):43-8.11. Singh S, Sharma D, Aggarwal V, Gandhi P, Rajpurohit S. Attitude of doctors toward euthanasia in Delhi, India. Asian Journal of Oncology. 2015;1(1):49-54.12. Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, Cohen J. Attitudes and Practices of Euthanasia and Physician-Rafiei et al                                                                                                               Mintage journal of Pharmaceutical & Medical Sciences 9-11 Vol 6 Issue 4, Oct - Dec 2017                                           www.mintagejournals.com                                                                                           11 Assisted Suicide in the United States, Canada, and Europe. Jama. 2016;316(1):79-90.13. Rathor MY, Abdul Rani MF, Shahar MA, et al. Attitudes toward Euthanasia and Related Issues among Physicians and Patients in a Multi-cultural Society of Malaysia. Journal of Family Medicine and Primary Care. 2014;3(3):230-237.14. Terkamo-Moisio A, Kvist T, Kangasniemi M, Laitila T, Ryynänen O-P, Pietilä A-euthanasia in conflict with professional ethical guidelines. Nursing ethics. 2016;24(1):70-86.15. Naseh L, Sheykhi R, Rafiei R, Jafari H. Survey of final years Education & Ethics In Nursing. 2014;3(1):49-55.16. Tordella MA, Neutens JJ. An instrument to appraise attitudes of college students toward euthanasia. Journal of School Health. 1979;49(6):351-2.17. Ming-lin Chong A, Fok Sy. Attitudes toward euthanasia in Hong Kong A comparison between physicians and the general public. Death studies. 2004;29(1):29-54.18. Kachoie A, Ahmari Tehran H, Heidari A, Heidarpour A, Euthanasiain Qom in 2009. Qom Univ Med Sci J. 2011;5(3):61-5.19. Tavoosiyan A, Sedaghat M, Aramesh K. Euthanasia: assessment of medical students' perspective. Iranian Journal of Medical Ethics and History of Medicine. 2009;3(1):43-52.20. Ahmed AM, Kheir MM. Attitudes towards euthanasia among final-year Khartoum University medical students. Eastern Mediterranean health journal. 2006;12(3-4):391-7.21. Adchalingam K, Kong WH, Zakiah MA, Zaini M, Wong YL, Lang CC. Attitudes of medical students towards euthanasia in a multicultural setting. The Medical journal of Malaysia. 2005;60(1):46-9.22. Mierzecki A, Rekawek K, Swiatkowski J, Hoelscher M, Yelva L, Wisniewska M, et al. Evaluation of attitude towards euthanasia expressed by first year medical students from Szczecin, Greifswald and Lund medical faculties. Annales Academiae Medicae Stetinensis. 2008;54(1):164-9.© 2017 by the authors; licensee MJPMS, India. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/) 

IRANIAN MEDICAL STUDENT’S ATTITUDE TOWARD EUTHANASIA

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IRANIAN MEDICAL STUDENT’S ATTITUDE TOWARD EUTHANASIA

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