The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing opinions of physicians and members of the general public on the acceptability of euthanasia in patients with advanced dementia.

Attitudes to questions of whether physician-assisted dying should be legalised in the UK, reflect one of the greatest challenges to moral stance in health care for both individuals and professional bodies, not least as indicated by public opinion. However, public opinion is a seductively deceptive notion, seemingly readily identifiable but in practice multifarious. At best, consensus regarding public opinion and assisted dying is illusory, sometimes transient and what is relevant in this matter is a comprehension of both (...) majority (popular) opinion and vocal dissent, but which do not them selves have a simple relationship with Parliamentary attitudes and legislation. Arguably, an increasingly important consideration to take account of is the influence of increasing population diversity. (shrink)

Many recent events have contributed to the resurgence of the historically cyclical debate over euthanasia. Now, the focus rests on physician-assisted suicide. Many landmark events regarding physician-assisted suicide have occurred within the last year alone. For example, Derek Humphry's Final Exit recently became a best seller, giving people the detailed knowledge of how to “self-deliver” In The New England Journalbf Medicine, Dr. Timothy Quill shared his touching experience of assisting his patient “Diane” after she chose to decline treatment options for (...) leu- kemia. Dr. Jack Kevorkian made use of his highly publicized “death machine” to help Janet Adkins and subsequently, several other women, end their lives. (shrink)

Although euthanasia and assisted suicide in people with psychiatric disorders is relatively rare, the increasing incidence of EAS requests has given rise to public and political debate. This study aimed to explore support of the public and physicians for euthanasia and assisted suicide in people with psychiatric disorders and examine factors associated with acceptance and conceivability of performing EAS in these patients. A survey was distributed amongst a random sample of Dutch 2641 citizens and 3000 physicians. (...) Acceptance and conceivability of performing EAS, demographics, health status and professional characteristics were measured. Multivariable logistic regression analyses were performed. Of the general public 53% were of the opinion that people with psychiatric disorders should be eligible for EAS, 15% was opposed to this, and 32% remained neutral. Higher educational level, Dutch ethnicity, and higher urbanization level were associated with higher acceptability of EAS whilst a religious life stance and good health were associated with lower acceptability. The percentage of physicians who considered performing EAS in people with psychiatric disorders conceivable ranged between 20% amongst medical specialists and 47% amongst general practitioners. Having received EAS requests from psychiatric patients before was associated with considering performing EAS conceivable. Being female, religious, medical specialist, or psychiatrist were associated with lower conceivability. The majority of the psychiatrists were of the opinion that it is possible to establish whether a psychiatric patient’s suffering is unbearable and without prospect and whether the request is well-considered. The general public shows more support than opposition as to whether patients suffering from a psychiatric disorder should be eligible for EAS, even though one third of the respondents remained neutral. Physicians’ support depends on their specialization; 39% of psychiatrists considered performing EAS in psychiatric patients conceivable. The relatively low conceivability is possibly explained by psychiatric patients often not meeting the eligibility criteria. (shrink)

Physicians expressing opinions on medical matters that run contrary to the consensus of experts pose a challenge to licensing bodies and regulatory authorities. While the right to express contrarian views feeds a robust marketplace of ideas that is essential for scientific progress, physicians advocating ineffective or dangerous cures, or actively opposing public health measures, pose a grave threat to societal welfare. Increasingly, a distinction has been made between professional speech that occurs during the physician-patient encounter and (...) class='Hi'>public speech that transpires beyond the clinical setting, with physicians being afforded wide latitude to voice empirically false claims outside the context of patient care. This paper argues that such a bifurcated model does not sufficiently address the challenges of an age when mass communications and social media allow dissenting physicians to offer misleading medical advice to the general public on a mass scale. Instead, a three-tiered model that distinguishes between citizen speech, physician speech and clinical speech would best serve authorities when regulating physician expression. (shrink)

BackgroundExperience with open disclosure and its study are restricted to certain western countries. In addition, there are concerns that open disclosure may be less suitable in non-western countries. The present study explored and compared the in-depth perceptions of the general public and physicians regarding open disclosure in Korea.MethodsWe applied the COREQ checklist to this qualitative study. We conducted 20 in-depth interviews and four focus group discussions with 16 physicians and 18 members of the general public. In-depth (...) interviews and focus group discussions were performed according to semi-structured guidelines developed according to a systematic review of open disclosure. We conducted a directed content analysis by analyzing the verbatim transcripts and field notes in accordance with the predetermined guidelines.ResultsOpen disclosure perceptions were summarized in terms of the “five Ws and one H”. All physician and general public participants acknowledged the normative justifiability of open disclosure. The participants mostly agreed on the known effects of open disclosure, but the physicians had negative opinions on its expected effects, such as decreased intention of the general public to file lawsuits and increased credibility of medical professionals. Generally, the participants thought that open disclosure is required for medical errors causing major harm. However, the physicians and general public had conflicting opinions on the need for open disclosure of near misses. Most physicians did not know how to conduct open disclosure and some physicians had bad experiences due to inappropriate or incomplete open disclosure.ConclusionPhysicians and the general public in Korea acknowledge the need for open disclosure. Guidelines according to the type of patient safety incident are required to encourage physicians to more readily conduct open disclosure. Furthermore, hospitals need to consider organizing a dedicated team and hiring experts for open disclosure. (shrink)

Continuous sedation until death (CSD), the act of reducing or removing the consciousness of an incurably ill patient until death, often provokes medical-ethical discussions in the opinion sections of medical and nursing journals. A content analysis of opinion pieces in medical and nursing literature was conducted to examine how clinicians define and describe CSD, and how they justify this practice morally. Most publications were written by physicians and published in palliative or general medicine journals. Terminal Sedation and Palliative Sedation (...) are the most frequently used terms to describe CSD. Seventeen definitions with varying content were identified. CSD was found to be morally justified in 73 % of the publications using justifications such as Last Resort, Doctrine of Double Effect, Sanctity of Life, Autonomy, and Proportionality. The debate over CSD in the opinion sections of medical and nursing journals lacks uniform terms and definitions, and is profoundly marked by ‘charged language’, aiming at realizing agreement in attitude towards CSD. Not all of the moral justifications found are equally straightforward. To enable a more effective debate, the terms, definitions and justifications for CSD need to be further clarified. (shrink)

BackgroundThere has been no in-depth research of public attitudes on withholding or withdrawing life-prolonging treatment, euthanasia, assisted suicide and physician assisted suicide in Croatia. The aim of this study was to examine these attitudes and their correlation with sociodemographic characteristics, religion, political orientation, tolerance of personal choice, trust in physicians, health status, experiences with death and caring for the seriously ill, and attitudes towards death and dying. MethodsA cross-sectional study was conducted on a three-stage random sample of adult (...) citizens of the Republic of Croatia, stratified by regions, counties, and locations within those counties. In addition to descriptive statistics, ANOVA and Chi-square tests were used to determine differences, and factor analysis, correlation analysis and multiple regression analysis for data analysis.Results38.1% of the respondents agree with granting the wishes of dying people experiencing extreme and unbearable suffering, and withholding life-prolonging treatment, and 37.8% agree with respecting the wishes of such people, and withdrawing life-prolonging treatment. 77% of respondents think that withholding and withdrawing procedures should be regulated by law because of the fear of abuse. Opinions about the practice and regulation of euthanasia are divided. Those who are younger and middle-aged, with higher levels of education, living in big cities, and who have a more liberal worldview are more open to euthanasia. Assisted suicide is not considered to be an acceptable practice, with only 18.6% of respondents agreeing with it. However, 40.1% think that physician assisted suicide should be legalised. 51.6% would support the dying person’s autonomous decisions regarding end-of-life procedures.ConclusionsThe study found low levels of acceptance of withholding or withdrawing life-prolonging treatment, euthanasia, assisted suicide and physician assisted suicide in Croatia. In addition, it found evidence that age, level of education, political orientation, and place of residence have an impact on people’s views on euthanasia. There is a need for further research into attitudes on different end-of-life practices in Croatia. (shrink)

The issue of physician-assisted death is now firmly on the American public agenda. Already legal in five states, it is the subject of intense public opinion battles across the country. Driven by an increasingly aging population, and a baby boom generation just starting to enter its senior years, the issue is not going to go away anytime soon. In this book L.W. Sumner equips readers with everything they need to know to take a reasoned and informed position in (...) this important debate. (shrink)

In many countries, there are health care initiatives to make smokers give up smoking in the peri-operative setting. There is empirical evidence that this may improve some, but not all, operative outcomes. However, it may be feared that some support for such policies stems from ethically questionable opinions, such as paternalism or anti-smoker sentiments. This study aimed at investigating the support for a policy of smoking cessation prior to surgery among Swedish physicians and members of the general public, (...) as well as the reasons provided for this. A random sample of general practitioners and orthopaedic surgeons as well as members of the general public received a mail questionnaire. It contained a vignette case with a smoking 57-year old male farmer with hip osteoarthritis. The patient had been recommended hip replacement therapy, but told that in order to qualify for surgery he needed to give up smoking four weeks prior to and after surgery. The respondents were asked whether making such qualifying demands is acceptable, and asked to rate their agreement with pre-set arguments for and against this policy. Response rates were 58.2% among physicians and 53.8% among the general public. Of these, 83.9% and 86.6%, respectively, agreed that surgery should be made conditional upon smoking cessation. Reference to the peri-operative risks associated with smoking was the most common argument given. However, there was also strong support for the argument that such a policy is mandated in order to achieve long term health gains. There is strong support for a policy of smoking cessation prior to surgery in Sweden. This support is based on considerations of peri-operative risks as well as the general long term risks of smoking. This study indicates that paternalistic attitudes may inform some of the support for peri-operative smoking cessation policies and that at least some respondents seem to favour a “recommendation strategy” vis-à-vis smoking cessation prior to surgery rather than a “requirement strategy”. The normative reasons speak in favour of the “recommendation strategy”. (shrink)

Context Autopsy is a useful tool for understanding the cause and manner of unexpected patient death. However, the attitudes of the general public and physicians in Japan about clinical autopsy are limited. Objective To describe the beliefs of the general public about whether autopsy should be performed and ascertain if they would actually request one given specific clinical situations where patient death occurred with the additional variable of medical error. To compare these attitudes with previously obtained attitudes (...) of physicians practising at Japanese teaching hospitals. Design, setting and participants We conducted a cross-sectional study of the general public. We sent standardised questionnaires in 2010 to a randomly selected non-physician adult population using a survey company for participant selection. Respondents gave their opinions about the necessity of autopsy and how they might act given various clinical scenarios of patient death. We compared these results with those of a previous survey of Japanese physicians conducted in 2009. Results Of the 2300 eligible general adult population, 1575 (68.5%) responded. The majority of the general public indicated they believed an autopsy was necessary. However, in cases of unclear medical error or unclear cause and effect relationship of medical care and patient death, the general public were much less likely to indicate they would actually request an autopsy than were physicians (p<0.0001). Currently in Japan the debate about the role autopsy should play in the case of error related to death is underway. The results from this study will be important in informing related decisions. (shrink)

BackgroundStigma refers to a distinguishing personal trait that is perceived as or actually is physically, socially, or psychologically disadvantageous. Little is known about the opinion of those who have more or less stigmatizing health conditions regarding the need for consent for use of their personal information for health research.MethodsWe surveyed the opinions of people 18 years and older with seven health conditions. Participants were drawn from: physicians' offices and clinics in southern Ontario; and from a cross-Canada marketing panel of (...) individuals with the target health conditions. For each of five research scenarios presented, respondents chose one of five consent choices: (1) no need for me to know; (2) notice with opt-out; (3) broad opt-in; (4) project-specific permission; and (5) this information should not be used. Consent choices were regressed onto: demographics; health condition; and attitude measures of privacy, disclosure concern, and the benefits of health research. We conducted focus groups to discuss possible reasons for observed consent choices.ResultsWe observed substantial variation in the control that people wish to have over use of their personal information for research. However, consent choice profiles were similar across health conditions, possibly due to sampling bias. Research involving profit or requiring linkage of health information with income, education, or occupation were associated with more restrictive consent choices. People were more willing to link their health information with biological samples than with information about their income, occupation, or education.ConclusionsThe heterogeneity in consent choices suggests individuals should be offered some choice in use of their information for different types of health research, even if limited to selectively opting-out. Some of the implementation challenges could be designed into the interoperable electronic health record. However, many questions remain, including how best to capture the opinions of those who are more privacy sensitive. (shrink)

The aim of the present study was to corroborate or undermine a previously presented conjecture that physicians’ estimations of others’ opinions are influenced by their own opinions. We used questionnaire based cross-sectional design and described a situation where an imminently dying patient was provided with alleviating drugs which also shortened life and, additionally, were intended to do so. We asked what would happen to physicians’ own trust if they took the action described, and also what the physician estimated (...) would happen to the general publics’ trust in health services. Decrease of trust was used as surrogate for an undesirable action. The results are presented as proportions with a 95 % Confidence Interval. Statistical analysis was based on inter-rater agreement -test as well as χ2 test and Odds Ratio with 95 % CI. We found a moderate inter-rater agreement between what would happen with the physicians’ own trust in healthcare and their estimations of what would happen with the general population’s trust. We identified a significant difference between being pro et contra the treatment with double intentions and the estimation of the general population’s trust. Focusing on either decreasing or increasing own trust and being pro or contra the action we identified a strong association [OR 79 ]. Although the inter-rater agreement in the present study was somewhat weaker compared to a study about the explicit use of the term ‘physicians assisted suicide’ we found that our hypothesis—physicians’ estimations of others’ opinions are influenced by their own opinions—was corroborated. This might have implications in research as well as in clinical decision-making. We suggest that Merton’s ideal of disinterestedness should be highlighted. (shrink)

BackgroundDebates around euthanasia and physician-assisted suicide are ongoing around the globe. Public support has been mounting in Western countries, while some decline has been observed in the USA and Eastern Europe. Physicians’ support for euthanasia and PAS has been lower than that of the general public, but a trend toward higher acceptance among physicians has been seen in recent years. The aim of this study was to examine the current attitudes of Finnish physicians toward euthanasia (...) and PAS and whether there have been changes in these attitudes over three decades.MethodsA questionnaire survey was conducted with all Finnish physicians of working age in 2020 and the results were compared to previous studies conducted in 1993, 2003 and 2013.ResultsThe proportions of physicians fully agreeing and fully disagreeing with the legalization of euthanasia increased from 1993 to 2020. The number of physicians, who expressed no opinion for or against euthanasia decreased from 19 to 5% during the same period. The proportion of physicians having no opinion of whether a physician should be punished for assisting in a suicide decreased from 20 to 10%.ConclusionsThis study shows that Finnish physicians’ ambivalence toward euthanasia and PAS has decreased. The ongoing debate has probably forced physicians to form more solid opinions on these matters. Our study highlights that attitudes toward euthanasia and PAS are still divided within the medical profession. (shrink)

Debates about end of life decisions should accept that public opinion on these matters is still fluidChanges in the past half century in the attitudes of the American public regarding euthanasia and suicide in the case of incurable disease have been dramatic, and they attest to the success of a social movement that has been in part a phenomenon “of the times” . But they are also in part a consequence of a highly visible social movement and vigorous (...) deliberate actions intended to shape public opinion, moving it in a direction favourable to concrete changes in law, public policy, and precepts of the profession of medicine.During much of this period, a bewildering plethora of polls has been conducted, related in one way or another to the question of how the public has viewed the issues about end of life decisions. End of life decisions have an important bioethical component, especially as they raise questions of who makes choices and how those choices can be made in an ethical manner. Does the individual have complete control of his or her own fate? Who can act as surrogate? What role, if any, should physicians play, and what are the interests of the state in such decisions? Anyone who wants to write a justification for, or promote advocacy of, any kind of policy regarding these issues ought to be seriously acquainted with trends in public attitudes. While public opinion cannot be the final arbiter of what is ethically correct, knowledge of it will help us to address the issues in a way that will best benefit the public discourse. Unfortunately, hardly any presentation of the polls related to the subject has attempted to reconcile the …. (shrink)

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: (...) their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy. (shrink)

BackgroundWhile healthcare professionals’ right to invoke the conscience clause has been recognised as a fundamental human right, it continues to provoke a heated debate in Polish society. Although public discourse is filled with ethical and legal considerations on the conscience clause, much less is known about the attitudes of healthcare professionals regarding that matter. The aim of this study was therefore to describe the attitudes of Polish physicians, nurses and pharmacists towards the ethical and legal aspects of the (...) conscience clause.MethodsWe analysed a group of three hundred healthcare professionals: physicians, nurses and pharmacists in Poznan, Poland, using a standard questionnaire comprising of 29 questions about various ethical and legal aspects of the conscience clause and participants’ personal experiences with the conscience clause. The study was conducted between January and March 2020.ResultsThis research shows that although most Polish healthcare workers support the right to invoke the conscience clause they differ significantly in their opinions on to whom and to what medical procedures the conscience clause should apply to. It also demonstrated that while the conscience clause is rarely invoked in Poland, most healthcare professionals declare that the current legal regulations in that sphere are unclear and inaccurate.ConclusionsWhile there is an urgent need to raise the awareness regarding the conscience clause among medical students and healthcare professionals and educate them about such issues, it is even more important to improve the legal system in regard to the CC so that it protects both HCPs’ right to the CC and safeguards patients’ rights to medical services. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Public Health Ethics: Health by the NumbersMartina Darragh (bio) and Pat Milmoe McCarrick (bio)Hippocrates had nothing to say about public health. Rather, the idea that a government should protect its citizens from disease by maintaining sanitary conditions has its origin in Renaissance humanities texts, and the notion that physicians have public health responsibilities emerged in the works of such Enlightenment authors as Johann Peter Frank, (...) Benjamin Rush, and John Gregory (II, Coughlin and Beauchamp 1996). When the spread of infectious diseases such as typhoid and cholera accompanied the growth of the Industrial Revolution, England was the first to respond by passing the Public Health Act of 1848. The motivation for this reform was not based in humanitarian concerns but in the realization that unsanitary conditions were costly to industry. “... [The] founders of the public health movement were guided by nineteenth century utilitarian moral theories... the greatest good for the greatest number... accompanied by a growing appreciation for the innate value and dignity of mankind... however, the rights and autonomy of individuals have not always been respected in pursuing these important objectives” (I, Coughlin 1995, p. 1).Public health projects have dramatically improved global health status. One measure of their success is that “... most poor people now live longer, on average, than the wealthiest people a century ago” (I, Beaglehole and Bonita 1997, p. 13) These projects are not limited to such activities as disinfecting sewers. “Public health is what we, as a society, do to collectively assure the conditions in which people can be healthy. This requires that continuing and emerging threats to the health of the public be successfully countered. These threats include immediate crises, such as the AIDS epidemic; enduring problems, such as injuries and chronic illness; and impending crises foreshadowed by such developments as the toxic by-products of a modern economy” (I, Institute of Medicine (IOM) 1988, p. 1) The practice of public health has embraced this IOM challenge and includes the subspecialties of epidemiology, health promotion and education, public health administration, international health, maternal and child health, biostatistics, environmental health, and nutrition. This annotated bibliography focuses on epidemiology, [End Page 339] health promotion and education, and public health administration, and includes a wide variety of opinions on each topic.EpidemiologyAt first glance, it is hard to see what ethical issues could arise in population studies of the causes and control of illness. Disclosure of risk information in the clinical encounter is complicated by issues of uncertainty with regard to the data itself. Causation and causal inference may be affected by “wish bias,” leading to studies that use the same data but reach widely varying conclusions (II, Weed 1997). Given the complexity of the statistical calculations used to validate public health recommendations, and mass media’s portrayal of them, the public may be unintentionally deceived by population-based recommendations (V, Seedhouse 1997; II, Lupton 1995). With the addition of genetic screening, another layer of statistical complexity is added to this mix (VI, Stone and Steward 1996).Health Promotion and EducationIncreased life expectancy brought about by advances in public health has raised a new set of problems. With the realization that illness can be promoted in part by individual life-style choices, population-based recommendations about risk factors become important in the clinical encounter. This shift is not without difficulties; one author notes that he has yet to receive any risk information from his physicians, even when he asks “the experts” (V, Dugdale 1998). This may be due in part to the fact that “... public health lacks a vocabulary with which to speak about and identify commonalities among health problems experienced by very different populations” (IV, Mann 1997, p. 8). Furthermore, the mix of disciplines informing health promotion activities (sociology, psychology, recreation medicine, and the like) creates an illusion of shared ethics where none exists, which in turn leads to programs based on value systems that may not be meaningful for the populations they serve (V, Seedhouse 1997).Given these factors, a number of authors are skeptical of introducing public health measures into the clinical encounter. “We might do well to encourage people to live lives of modified hedonism so that they might... (shrink)

BackgroundAlthough the Covid-19 epidemic challenged existing medical care norms and practices, it was no excuse for unlawful conduct. On the contrary, legal compliance proved essential in fighting the pandemic. Within the European legal framework for the pandemic, patients were still entitled to be treated equally, by a specialized physician, with the possibility of seeking a second medical opinion, in a confidential setting, following prior and informed consent. This study examines physicians’ practices regarding patients’ rights during the Covid-19 pandemic and (...) the effects of age, experience, and specialty on physicians’ behavior and preferences. Additionally, it explores the nexus of malpractice complaints, malpractice fear, and legal compliance.MethodsA cross-sectional study was conducted on a convenience sample of attending physicians and general practitioners to assess compliance with patients’ rights regulations. Respondents were physicians practicing in private and public settings in Southwestern Romania from July 2021 to May 2022.Results396 attending physicians and 109 general practitioners participated in the research. Attending physicians acknowledged patients’ rights in 55.7% of statements, while general practitioners showed a slightly higher level of compliance at 59.9%. Emergency and Anesthesia and Intensive Care physicians showed the lowest compliance. There were no significant behavioral differences based on physicians’ age, years in practice, work sector, or location. However, when faced with the question of prioritizing treatment for patients with similar medical conditions, 46.2% of attending physicians reported favoring the younger patients. This preference was common among physicians under 39. Additionally, over half of the attending physicians reported working outside their area of expertise due to staff shortages. Malpractice fear was high among physicians, although unrelated to patients’ claims, legal compliance, or working outside the scope of practice. It resulted in pressure and behavioral changes.ConclusionAdherence to patients’ rights was low during the Covid-19 pandemic. Physicians could benefit from educational and administrative support to ensure better legal compliance. Further research is needed to determine if this behavior persists beyond the pandemic context. (shrink)

The use of voluntary assisted dying as an end‐of‐life option has stimulated concerns and debates over the past decades. Although public attitudes towards voluntary assisted dying (including euthanasia and physician‐assisted suicide) are well researched, there has been relatively little study of the different reasons, normative reasoning and rhetorical strategies that people invoke in supporting or contesting voluntary assisted dying in everyday life. Using a mix of computational textual mining techniques, keyword study and qualitative thematic coding to analyse public (...) submissions to a parliamentary inquiry into voluntary assisted dying in Australia, this study critically examines the different reasons, normative reasoning and rhetorical strategies that people invoke in supporting or contesting voluntary assisted dying in everyday life. The analysis identified complex and potentially contradictory ethical principles being invoked on both sides of the debate. These findings deepen our understanding of the moral basis of public reasoning about end‐of‐life matters and will help to inform future discussions on policy and law reform. The findings underscore the importance of sound normative reasoning and the use of caution when interpreting opinion polls to inform policy. (shrink)

Despite the majority opinion of Muslim jurists that organ donation is permitted in Sharia, surveys indicate continuing resistance by lay Muslims, especially to donating organs following death. Pakistan, a country with 165 million Muslims, currently reliant on live donors, is considering steps to establish deceased donor programs which will require public acceptance and support. This article analyzes the results of in-depth interviews with 105 members of the public focusing on opinions and knowledge about juristic rulings regarding kidney donations, (...) donor-family dynamics in deceased donation decisions, and attitudes towards buying kidneys. The objective was to determine the influence if any of cultural and religious values, and norms of traditional family structures and kinships, on decisions to donate. Study participants view donation of kidneys, particularly from the deceased, through a different lens from that used by jurists and physicians, one that also does not conform to familiar paradigms defining ethical organ donation. A socially modulated understanding of Islam passed down the generations, and longstanding family-centric norms, shape the moral worldview of many rather than academic juristic rulings or non-contextual concepts of autonomy and rights. The results of this study also highlight that medical science may be universal but its application occurs within particularities of cultural and religious values, social constructs of the self and its relationship with others, and different ways in which humans comprehend illness, suffering, and death. These findings are of relevance both to transplant related professionals and bioethicists involved with this field. (shrink)

Despite the majority opinion of Muslim jurists that organ donation is permitted in Sharia, surveys indicate continuing resistance by lay Muslims, especially to donating organs following death. Pakistan, a country with 165 million Muslims, currently reliant on live donors, is considering steps to establish deceased donor programs which will require public acceptance and support. This article analyzes the results of in‐depth interviews with 105 members of the public focusing on opinions and knowledge about juristic rulings regarding kidney donations, (...) donor‐family dynamics in deceased donation decisions, and attitudes towards buying kidneys. The objective was to determine the influence if any of cultural and religious values, and norms of traditional family structures and kinships, on decisions to donate. Study participants view donation of kidneys, particularly from the deceased, through a different lens from that used by jurists and physicians, one that also does not conform to familiar paradigms defining ethical organ donation. A socially modulated understanding of Islam passed down the generations, and longstanding family‐centric norms, shape the moral worldview of many rather than academic juristic rulings or non‐contextual concepts of autonomy and rights. The results of this study also highlight that medical science may be universal but its application occurs within particularities of cultural and religious values, social constructs of the self and its relationship with others, and different ways in which humans comprehend illness, suffering, and death. These findings are of relevance both to transplant related professionals and bioethicists involved with this field. (shrink)

While another von Hagens style public autopsy should not be encouraged, the public should nevertheless be able to experience such events as a public autopsy.During 2002 and 2003 there was considerable discussion about the work of Gunter von Hagens, famed for his Body Worlds exhibition,1 which was publicised extensively and with considerable success. The exhibition is a tribute to, and celebration of, his method of preserving organic life through the process of plastination, developed by von Hagens in (...) the 1980s. The process entails a form of preservation, whereby body parts are dehydrated and filled with polymer resin, making them more robust than conventional formaldehyde does.While it was in the United Kingdom, the exhibit was housed at a back street gallery in Brick Lane, London, though the exhibition has toured throughout the world. Despite many millions having flocked to see the exhibition, the reasons for its success are open to interpretation and have provoked strong opinions from the medical community as to whether this physician ought to be entitled to create exhibits from real bodies. Von Hagens would argue that these works are justifiable because they have artistic merit. Others would claim that viewers are being brought to the gallery by the immense publicity. Alternatively, one might suppose that those who attend the exhibition do so mainly because of a fascination with the extraordinary and with the grotesque. Indeed, such fascination with death, and human remains specifically, was the focus of a meeting hosted by the Institute of Ideas and the Royal College of Physicians in May 2003, which was entitled Morbid Fascinations: the Body and Death in Contemporary Culture.The controversy arising from the Body Worlds exhibition pales in comparison, however, to von Hagens’s most recent performance—the first “public autopsy” in Britain …. (shrink)

Whether the law should permit voluntary euthanasia or physician-assisted suicide is one of the most vital questions facing all modern societies. Internationally, the main obstacle to legalisation has proved to be the objection that, even if they were morally acceptable in certain 'hard cases', voluntary euthanasia and physician-assisted suicide could not be effectively controlled; society would slide down a 'slippery slope' to the killing of patients who did not make a free and informed request, or for whom palliative care would (...) have offered an alternative. How cogent is this objection? This book provides the general reader with a lucid introduction to this central question in the debate, not least by reviewing the Dutch euthanasia experience. It will interest all in any country whether currently for or against legalisation, who wish to ensure that their opinions are better informed. (shrink)

Ethical dilemmas are common in the neonatal intensive care setting. The aim of the present study was to investigate the opinions of Swedish physicians and the general public on treatment decisions regarding a newborn with severe brain damage. We used a vignette-based questionnaire which was sent to a random sample of physicians (n = 628) and the general population (n = 585). Respondents were asked to provide answers as to whether it is acceptable to discontinue ventilator treatment, (...) and when it actually is discontinued whether or not it was acceptable to use drugs which hasten death unintentionally or intentionally. The response rate was 67 % of physicians and 46 % of the general population. A majority of both physicians [56 % (CI 50–62)] and the general population [53 % (CI 49–58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient’s symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. The study indicated that physicians and the general population have similar opinions regarding discontinuing life-sustaining treatment and providing effective drugs which might unintentionally hasten death but seem to have different views on intentions. The results might be helpful to physicians wanting to examine their own intentions when providing adequate treatment at the end of life. (shrink)

When a physician employment relationship terminates, the physician–patient relationship may also be terminated by enforcement of a covenant not to compete, which typically forces the physician to leave the geographic area for a period of time. This gives rise to several ethical dilemmas. The public interest is compromised when enforcement of these covenants contributes to the shortage of physicians in the community, and individual patients are harmed when their physicians are no longer available. The authors undertook a (...) unique study to explore physician perspectives concerning the ethics of banning a physician from practice and the impact of the ban on both the physician and the physician’s patients. The results identified harmful effects that have not been raised in prior scholarly articles or reported court opinions. After reviewing the legal background of covenants not to compete, this paper presents the results of that study and concludes that resorting to the legal system for enforcement of covenants not to compete is not always the ethical course of action. (shrink)

Relationships between physicians and pharmaceutical sales representatives (PSRs) often create conflicts of interest, not least because of the various benefits received by physicians. Many countries attempt to control pharmaceutical industry marketing strategies through legal regulation, and this is true in Poland where efforts are underway to eliminate any practices that might be considered corrupt in medicine. The present research considered Polish medical students’ opinions about domestic laws restricting doctors’ acceptance of expensive gifts from the industry, the idea of (...) compulsory transparency, and the possibility of introducing a Polish Sunshine Law. A qualitative, focus group-based, interview method was used. Data were gathered from nine focus groups involving 92 medical students from three universities located in major Polish cities. The article presents a classification of opposing student views with regard to the consequences of introducing different legal solutions; this should be useful for policy makers deliberating on how to optimally regulate pharmaceutical marketing. The study’s results are discussed in the context of the public bioethical debate in Poland. (shrink)

The quasi-ubiquity of ICT is transforming contemporary politics and seems to deteriorate democracy, for the technologies undermine debates, contest the grounds of reason and truth, and influence people’s votes. Donald Trump’s election and Brexit are good examples of their effects on public opinion. More fundamentally, these technologies cause theoretical problems to the way we traditionally conceive public opinion. Thus, I seek to rethink public opinion beyond conventional approaches. Departing from Deleuze and Guattari’s work, I develop the first (...) steps of a post-representational theory of public opinion as a regime of political truths that has new dimensions of truth production with information and communications technologies. (shrink)

Abstract Building on Philip Converse's understanding of public opinion, John Zaller sees the evidence for the public's ?nonattitudes? as reflecting individuals? ambivalence concerning political issues. Because neither individuals nor the public collectively have what Zaller would call real attitudes, he concludes that the effectiveness of democracy rests on competition among intellectual and political elites. In truth, however, the public has many real attitudes that depend heavily on elite leadership, in ways that Converse did not initially emphasize (...) but that are consistent with both his observations and Zaller's model of mass opinion. The quality of the public's attitudes are, however, a point of serious contention. (shrink)

Generally, public opinion is measured via polls or survey instruments, with a majority of responses in a particular direction taken to indicate the presence of a given ‘public opinion’. However, discursive psychological and related scholarship has shown that the ontological status of both individual opinion and public opinion is highly suspect. In the first part of this article I draw on this body of work to demonstrate that there is currently no meaningful theoretical foundation for the construct (...) of public opinion as it is typically measured in surveys, polls, or focus groups. I then argue that there is a particular sense in which the construct of public opinion does make sense. In deliberative democratic forums participants engage in dialogue with the aim of coming to collective positions on particular issues. Here I draw on examples of deliberative democratic forums conducted on the social and ethical implications of science and technology. Conversation between participants in deliberative democratic forums is ideally characterized by individuals becoming informed about the issues being discussed, respectful interactions between participants, individuals being open to changing their positions, and a convergence towards collective positions in the interest of formulating civic solutions. The end-product of deliberation on a given issue might thus be termed a deliberative public opinion. ‘Deliberative public opinion’ is neither a cognitive nor an aggregate construct, but rather a socio-historical product. Criteria for its legitimacy rely on the inclusiveness of diversity of perspectives and the degree to which collective positions are defensible to a larger society. (shrink)

This major work surveys the historical roots, theoretical foundations, and normative claims of 20th-century conceptualizations of public opinion. It reanalyzes leading traditions, such as those of Lippmann, Dewey, and Noelle-Neumann, and reinvents some unjustly ignored ones, such as Toennies, Harrisson, and Wilson. The book critically examines popular modern research strategies such as polling and the 'spiral of silence' model and looks at the role of mass media in the formation and expression of public opinion.

To understand the prospects for global order and progress in the coming years, we explore the joint implications of three premises: (1) states advantaged by the current international order have stakes in its regularity and predictability, and thus in moving to counter or prevent threats to those stakes; (2) along impure public and club goods lines, they are more likely to make efforts to do so when some private or club benefits result; and (3) public opinion provides a (...) bounded policy acceptance envelope offering incentives and disincentives to national political elites to act as envisioned by the first two premises. We present a mosaic of public opinion in major OECD countries (the US, Japan, and major EU members) on three policy areas that contain international public goods elements. Actual contribution tendencies in those areas found in our previous work largely conform to the public opinion patterns reported here. Within the limits of available data, domestic political incentives as represented by public opinion warrant neither extreme optimism nor pessimism about the prospects for continuing contributions by OECD states to sustaining orderly functioning of the current world system. (shrink)

(1996). Public opinion and democratic culture: The French revolution. The European Legacy: Vol. 1, Fourth International Conference of the International Society for the study of European Ideas, pp. 175-180.

(1996). Public opinion and democratic culture: The French revolution. The European Legacy: Vol. 1, Fourth International Conference of the International Society for the study of European Ideas, pp. 175-180.

Using a recent example from US politics as representative of contemporary liberal democracies, this chapter highlights how public opinion is shaped through the exploitation of our epistemic interdependence and partisan bias. Climate change was an important issue leading into the 2010 US mid-term elections. Public opinion on climate change was subject to a number of willfully disseminated distorting influences, having a significant impact on the election’s outcome and subsequent political discourse surrounding climate change policies. One impact of this (...) type of exploitation is that it has epistemically compromising effects on the electorate, which in turn undermines democratic legitimacy. In the interest of defending democratic legitimacy, this chapter suggests we re-evaluate and update those liberal institutions necessary for informed public opinion surrounding our current political epistemic needs. (shrink)

ABSTRACT George Bishop’s The Illusion of Public Opinion does a superb job of showing how various errors and malfeasances in conducting and interpreting surveys have created illusions about public opinion. It thereby offers a very useful compendium on how to do, and especially how not to do, survey research. Nothing in the book, however, provides persuasive evidence for either of two more troubling “illusion” arguments: that collective public preferences on policy issues do not exist; or that surveys (...) cannot measure them. Instead, Bishop’s examples show that even in obscure, low‐information situations, well‐designed survey questions generally reveal meaningful collective policy preferences that are coherent, well differentiated, and reflective of citizens’ basic interests and values. (shrink)

This paper considers the relation between philosophical discussions of, and social-scientific research into popular beliefs about, distributive justice. The first part sets out the differences and tensions between the two perspectives, identifying considerations which tend to lead adherents of each discipline to regard the other as irrelevant to its concerns. The second discusses four reasons why social scientists might benefit from philosophy: problems in identifying inconsistency, the fact that non-justice considerations might underlie distributive judgments, the way in which different principles (...) of justice can yield the same concrete distributive judgments, and the ambiguity of key terms. The third part distinguishes and evaluates three versions of the claim that normative theorising about justice can profit from empirical research into public opinion: that its findings are food for thought, that they amount to feasibility constraints, and that they are constitutive of normatively justified principles of justice. The view that popular opinion about justice has a strongly constitutive role to play in justifying principles of distributive justice stricto sensu is rejected, but it is argued that what the people think (and what they can reasonably be expected to come to think) on distributive matters can be an important factor for the political theorist to take into account, for reasons of legitimacy, or feasibility, or both. (shrink)

In bioethics as in other areas of health policy, historical institutional factors can shape policy independently of interests or public opinion. This article finds policy divergence among countries with similar national moral views of stem cell research, and explains that divergence as the product of path-dependency.

Are there significant variations across major religious faiths about the proper political roles of religion? Using recent WorldValues/EuropeanValues data from 63 countries we study the attitudes of mass publics on two separate aspects of this question. First, should religious beliefs be used as a criterion for selecting political leaders (dimension I)? Second, should religious leaders use their position for political influence (dimension II)? For dimension I we find that Muslims are somewhat more likely than followers of other faiths and denominations (...) to say that religious beliefs are important in selecting leaders. The remaining results of our investigation somewhat weaken or modify this result. On dimension II we find that Muslims do not stand out as comparatively favorable towards the view that religious leaders shall use their position for political influence. Finally, we find a negative, albeit weak and somewhat irregular effect of education on attitudes towards a close link between religion and political leadership (dimension I). However, this effect holds up equally well for Muslims as for other denominations, suggesting that Muslims are not immune to the effects of secularization. (shrink)

In 1992, Bill Clinton won the presidency committed to an ambitious program of “public investment.” Yet the plan Clinton submitted to the Democrat-controlled Congress in early 1993 was sharply scaled back in favor of an emphasis on reducing the federal budget deficit. Congress then made further deep cuts in Clinton's plan. This Democratic retreat from public investment would continue throughout the remainder of Clinton's presidency. In this article, I argue that the fate of “Clintonomics” was due mainly to (...) public opinion and electoral politics. In an epilogue, I examine the implications of this episode for the new intra-Democratic debate over public investment. (shrink)

Media has paid more attention recently on environmental issues caused by construction companies which imposes public opinion pressure on construction companies and could potentially impact their decision-making processes for green innovations. However, research on the relationship between public opinions pressure and construction company green innovation behavior is still limited. To understand how such public opinions pressure can impact construction companies' green transition and formulate advice accordingly, it is necessary to use empirical data to find the correlations. Therefore, (...) this research has gathered questionnaire data of the construction companies in Chengdu-Chongqing economic circle of China to study the influencing mechanism of environmental public opinion pressure on enterprise green innovation behavior, analyzes the realization path of leaders' environmental intention as a mediating variable in the impact of environmental public opinion pressure on enterprise green innovation behavior, and reveals the role boundary of environmental regulation as a moderating variable in the impact of environmental public opinion pressure on enterprise green innovation behavior. The results show that environmental public opinion pressure has a significant positive impact on enterprise green innovation behavior. More specifically, enterprise green innovation behavior is affected by leaders' environmental intention and the latter plays a partial mediating role between environmental public opinion pressure and enterprise green innovation behavior. Environmental regulation also enhances the sensitivity of companies to environmental public opinion pressure, and therefore can significantly strengthen the relationship between environmental public opinion pressure and enterprise green innovation behavior. Further research find that, compared with incentive-based environmental regulations, mandatory environmental regulations make companies more sensitive to environmental public opinion pressure and has a more significant positive moderating effect. The research conclusions could be used to provide theoretical reference with empirical data for accelerating the green innovation transformation and promoting the high-quality development in the construction industry. (shrink)

ABSTRACT Benjamin Page's thoughtful critique of my book, The Illusion of Public Opinion, strives to reassure readers that all is well—despite the book's extensive documentation of measurement‐error artifacts in numerous public opinion surveys. Page's own careful polling practices are not followed outside of elite academic survey centers. Moreover, even in such well‐run surveys, the respondents are often ignorant of the issues being probed. The fact that nonrandom reasons of some sort must be determining on‐the‐spot survey responses may allow (...) us to call the respondents “rational” in a loose sense. But the responses still don't represent actual opinions about the specific policy issues being probed—let alone well‐informed answers. Finally, while Page argues that measurement errors are most likely random, and should cancel out in the aggregate, the “miracle of aggregation” doesn't occur when the form, wording, and context of questions varies from survey to survey. And even when wording and context are held constant, the respondents' understanding of the same words can vary dramatically or subtly over time, due to new political events and their changing interpretation. (shrink)