INTRODUCTION:

Euthanasia is the practice of intentionally ending of the life to relieve pain and suffering. Every person has right to live and die with dignity. The main objective behind euthanasia is to eliminate unbearable suffering. Many religions do not propagate and support the concept of death with dignity.

They assume that the life is biggest gift from God. If you take away your life or assist someone to enact similar acts then you will be a sinner in the eyes of God. The term euthanasia was used for the first time by Francis Bacon

Euthanasia is defined as the ‘the bringing about of a gentle and easy death for someone suffering from an incurable and painful disease or in an irreversible coma'. (Pearsall and Trumble, 1996)

In 1997, US Supreme Court rules that there is no right to die. In 2001, Netherland legalizes euthanasia. In 2008, Luxembourg legalizes PAS and euthanasia and Washington death with dignity is passed. In 2012, Massachusetts death with dignity ballot measure is defeated.

On 9 March 2018, Supreme Court of India legalized passive euthanasia by means of withdrawal of life support to patients in a persistent vegetative state* (PVS). This decision was made as a part of the verdict* in a case involving Aruna Shanbaug, who had been in persistent vegetative state until her death in 2015. The Supreme Court specified two irreversible conditions to permit passive euthanasia in its 2011 law:-

1) The brain dead for whom the ventilator can be switched off.

2) Those, in the persistent vegetative state (PVS), for whom the feed can be tapered out and pain managing palliatives are added.

Euthanasia is categorized in differnet types which include Voluntary euthanasia, Involuntary euthanasia, Non-voluntary euthanasia. The ways of giving euthanasia:

· Active euthanasia: the use of lethal substances or administration lethal dose of medication to a patient.

· Passive euthanasia: withholding treament necessary for continution of life. For example: withdrawing life-supporting devices from a serious patient.

NEED FOR STUDY:

“Pain demands to be felt” -John Green

The pillar of ethics is preservation of life. Life is a bag of emotions including pain which demands to be felt. From saving the life of patient to giving new life to the patient; doctors and nurses are more close to the patient. So they must feel or show empathy for the pain and suffering of the patient; thus making right decision towards ones ethics.

Here nowadays most controversial topic comes i.e. Euthanasia. Euthanasia is illegal in many countries such as Netherland, Belgium and US state of Oregon. Some countries debated that legalizing the euthanasia cause discourtesy towards public and social moralities. Every health care personnel has different attitude towards euthanasia according to their knowledge. Thus euthanasia becomes the most debated topic towards ones “Right to live and die with dignity”.

In America, the total percentage of medical practitioners who supports euthanasia is 54%, public who supports euthanasia for the terminally ill or on life support is 86%. Average percentage of terminally ill patients who died in pain is 55%, total number who supported euthanasia is 42%.

On July 11, 2012, a meta-analysis study on the practice of euthanasia and end-of-life practices in Netherland published by The Lancet. The study revealed that in 2010, 23% of all euthanasia deaths were a not reported. It is important to realize that the number of reported euthanasia death in Netherland which has been increasing year by year as like 19% in 2010 and 13% in 2009.

Since March 2018, passive euthanasia is legal in India under strict guidelines through a livingwill, and must be either terminally ill or in a vegetative state. In India, euthanasia is a crime. Section 309 of the Indian Penal Code (IPC) deals with the attempt to commit suicide and Section 306 of the IPC deals with abetment of suicide – both actions are punishable.

Thus, the above facts and studies created an insight in the investigators mind that the knowledge and attitudes towards euthanasia among health care professionals will contribute to the core understanding on all the aspects of the euthanasia, which will ultimately contribute to the complete care of terminally ill patient. Here in our study we also distributed booklets regarding euthanasia to fill the gap of knowledge.

PROBLEM STATEMENT:

“A descriptive study to assess the knowledge and attitude towards euthanasia among health care professionals working in selected hospital of Punjab, with a view to develop information booklet”.

OBJECTIVES:

1. To assess the level of knowledge towards euthanasia among health care professionals.

2. To assess the level of attitude towards euthanasia among health care professionals.

3. To determine the relationship between knowledge and attitude towards euthanasia among health care professionals.

4. To find out association of knowledge and attitude towards euthanasia among health care professionals with selected demographic variables.

5. To develop information booklet on euthanasia.

METHODOLOGY:

A Quantitative Non-experimental descriptive research approach and design was used. Total 150 health care professionals were selected by Non-probability purposive sampling technique from Guru Gobind Singh Medical College and Hospital, Faridkot. Structured questionnaire was used to assess knowledge and attitude towards euthanasia among health care professionals. The collected data was analyzed through descriptive and inferential statistics as per objectives of the study.

RESULTS:

Table 1. depicts that maximum 113(75.3%) health care professionals were female and only 37(24.7%) wer male. It was found that majority (62.0%) health care professionals were in age group (21-30 yrs) and only 11(7.3%) were in age group (40-50 yrs). More than half 77(51.3%) of the health care professionals were from nursing profession and 73(48.7%) were from medical profession. The maximum 59(39.3%) health care professionals were Graduate (B.Sc. nursing, MBBS), 50(33.3%) were post graduation and above and only 41(27.3%) health care professionals are Diploma (GNM). All the health care professionals have clinical experience, 12(8%) health care professionals have teaching experience and both clinical and teaching experience. Majority of 86 (57.3%) health care professionals have 2-7 yrs clinical experience and only 2(1.3%) health care professionals have 20 or above clinical experience. Maximum 138(92.0%) of health care professionals have no teaching experience, 7(4.7%) health care professionals have ≤1 yrs experience, only 5(3.3%) health care professionals have 2 yrs experience. The majority 29(19.3%) of health care professionals’ Present working area was medical ward, 23(15.3%) were from gynaecological ward, 15(10.0%) health care professionals are from surgical intensive care unit ,14(9.3%) were from emergency and medical ward, 10(6.7%) health care professionals are from paediatric ward and medical intensive care unit and only 4(2.7%) health care professionals are from paediatric intensive care unit. The Maximum 135(90.0%) health care professionals were not attended conference/ workshop/ training on euthanasia and only 15(10.0%) health care professionals attended.

Table1: Frequency and percentage distribution of health care professionals as per their demographic variables. N=150

S.no	Demographic variables	Frequency (f)	Percentage (%)
1	Gender
	Male	37	24.7
	Female	113	75.3
2	Age (in years)
	21-31	93	62
	31-40	46	30
	40-50	11	7.3
	Types of health care professionals
	Medical	73	48.7
	Nursing	77	51.3
4	Qualification
	Diploma (GNM)	41	27.3
	Graduation (B.Sc. nursing, MBBS)	59	39.3
	Post graduation and above	50	33.3
5	Experience
	Clinical experience	150	100
	Teaching experience	12	8
	Both experience	12	8
6	Total clinical experience (in years)
	≤1	23	15.3
	02-Jul	86	57.3
	Aug-13	27	18
	14-19	12	8
	20 or above	2	1.3
7	Total teaching experience (in years)
	No experience	138	92
	≤1	7	4.7
	2	2	3.3
8	Present working area/ward
	Medical intensive care unit	10	6.7
	Surgical intensive care unit	15	10
	Pediatric intensive care unit	4	2.7
	Neonatal intensive care unit	7	4.7
	Emergency	14	9.3
	Oncology ward	13	8.7
	Psychiatric ward	11	7.3
	Gynecology ward	23	15.3
	Pediatric ward	10	6.7
	Medical ward	29	19.3
	Surgical ward	14	9.3
9	Conference/workshop/training attended on euthanasia
	Yes	15	10
	no	135	90

Table 2: Frequency and percentage distribution of health care professionals depending upon their level of knowledge regarding euthanasia. N=150

Level of knowledge	Frequency	(%)
Excellent (19-24)	57	38.0
Good (13-18)	74	49.3
Average (7-12)	19	12.7

Table 2 reveals that out of 150 health care professionals about half 49.3% have good level of knowledge 38.0% have excellent level of knowledge and only 12.7% have average level of knowledge regarding euthanasia.

Table3: Frequency and percentage distribution of health care professionals depending upon their level of attitude regarding euthanasia. N=150

Level of attitude	Frequency	(%)
Favorable (80-100)	16	10.6
Neutral (51-79)	128	85.3
Unfavorable (20-50)	6	4

Table 3 reveals that majority 85.3% of health care professionals have neutral attitude, 10.6% health care professionals have favorable attitude towards euthanasia, and only 4% health care professionals have unfavorable attitude towards euthanasia.

Table 4: Relationship with level of knowledge and attitude towards euthanasia among health care professionals: N=150

Aspects

Mean

S.D

Level of knowledge

17.02

2.9

+0.98

0.05

Level of attitude

66.4

The above table reveals that the correlation value is +0.98 which shows that there is positive relationship with level of knowledge and attitude of health care professionals regarding euthanasia. It indicates that with the increase in level of knowledge the attitude becomes favorable.

DISCUSSION:

The present study revealed that out of 150 health care professionals about 74(49.3%) respondents were having good knowledge, 57(38.0%) were having excellent knowledge and only 19(12.7%) were having average knowledge regarding euthanasia. Similar study was conducted by Hemalatha M, Rajlakshmi N (2^ndMay 2018), indicated that out of 100 health care professionals, 57(57%) were having adequate knowledge, 22(22%) were having inadequate knowledge and 21(21%) were having moderately adequate knowledge on euthanasia.

The present study revealed that16(10.6%) respondents were having favorable attitude, majority of respondents 128(85.3%) were having neutral attitude towards euthanasia and only 6(4%) were having unfavorable attitude. Similar study was conducted by Mohammad Heidari et al (2015), The study findings revealed that 54%, 3.2% and 39.5% of nurses reported negative, neutral and positive attitude towards euthanasia. The present study revealed that the correlation coefficient value was +0.98 which was significant at the level of +0.05 level (2 tailed). It show positive relationship between attitude and knowledge which indicated that when knowledge level of health care professionals increases the attitude becomes favorable towards euthanasia. The study conducted by Hemalatha M, Rajlakshmi N (2^ndMay 2018), which showed the moderately positive correlation as +0.150, it indicted that when knowledge level of health care professionals increases the attitude becomes favorable on euthanasia.

The analysis was done for the association with knowledge and attitude with selected demographic variables of health care professionals, which revealed that there was statistical significance with knowledge score and the conference/workshop/ attended on euthanasia at 0.05 level of significance. There was statistical significance with level of attitude and age at 0.05 level of significance. The study conducted by Hemalatha M, Rajlakshmi N, (2^nd May 2018), revealed that there was statistical significance between knowledge score and the response to question: Have you heard about euthanasia? However there was no statistical significant association between knowledge score and other demographic variables like age, sex, educational qualification and experience of health care professionals at 0.05 level of significance. There was significant association found between the attitude score and educational qualification of health care professionals at 0.05 level of significance and no statistical association was found with other demographic variables.

Thus the brief discussion and similar study findings gives a clear frame to our study. All the objectives in the research study are achieved at positive level of significance.

CONCLUSION:

The present study concluded that out of 150 health care professionals about 74(49.3%) respondents were having good knowledge, 57(38.0%) were having excellent knowledge and only 19(12.7%) were having average knowledge regarding euthanasia.

The majority 128(85.3%) health care professionals were having neutral attitude towards euthanasia, 16(10.6%) respondents were having favorable attitude, and only 6(4%) were having unfavorable attitude.

Results indicated that positive relationship with level of knowledge and attitude of health care professionals regarding euthanasia.

Under the association of level of knowledge and attitude with selected demographic variables there was significant relationship found with level of knowledge and conference/workshop/training attended on euthanasia demographic variable, which indicates that someone with having prior information about the euthanasia, will have high level of knowledge regarding euthanasia. Similarly, there was significant relationship found with level of attitude and age demographic variable, which indicates that with increase in age the experience to understand certain facts becomes more and it leads to have right attitude towards euthanasia.

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Received on 12.06.2021 Modified on 18.11.2021

Int. J. of Advances in Nur. Management. 2022; 10(1):14-18.

DOI: 10.52711/2454-2652.2022.00004