Survey of Influence

When a group of UVM medical students who had never met each other got together to select a topic for their public health project, currently a graduation requirement for all medical students, they wanted it to have a positive effect on society.

Instead of choosing a simple project that would easily satisfy the requirement, second-year med students Beth Cronin, Alexa Craig, Will Edward, James Metz, Ria Vergara, Logan Murray and Eric Suess took on one of the most controversial topics facing the Vermont State Legislature: a bill that would legalize physician-assisted suicide.

“We knew it would be a lot of work,” Murray says. “But we wanted to do something that would have influence on the outcome of something meaningful.”

The influence of the project, overseen by Gail Rose, a research associate in the department of psychiatry, could be profound after the results of a statewide survey of physicians on assisted suicide are presented at the Vermont Medical Society’s annual meeting on Oct. 17 in Woodstock. The students have been working on the survey since April and believe they have completed the most comprehensive, unbiased research on the topic.

The advocacy groups Death With Dignity Vermont, Inc., and Vermont Alliance for Ethical Health have already completed two physician polls on the subject. The findings of the two polls were drastically different, with the results supporting the positions of each organization.

The alliance sent out questionnaires to 1,489 Vermont physicians and received a total of 325 responses for a response rate of 23 percent. A response postcard was sent asking, “what is your position on the proposed Vermont Death With Dignity Act (physician-assisted suicide) legislation?” with checkboxes for “I oppose” and “I support.” Final results showed that 226 physicians (70 percent) opposed the proposed bill, while 95 (29 percent) supported it, with four undecided.

After writing 74 physicians and following up with phone calls, Death With Dignity found that 45 of them supported the potential legislation. Based on these findings, DWDV decided to poll an additional 1,579 physicians on the subject. After combining the two surveys, the organization found that 242 physicians supported the legislation and 79 opposed it for a 20 percent response rate.

A Broader Poll

The survey conducted by the UVM medical students was more in-depth in terms of the number of questions asked and in the number of responses. Although the results won’t be announced until the Vermont Medical Society meeting, Craig said they were less balanced than she expected. Craig and her collaborators were pleased with the response they received: Of the 2,770 surveys they mailed out, 1,052 were returned, more than tripling the number of respondents of either of the other surveys. They also received 15 typed pages of written comments.

“I think the biggest thing in terms of credibility is the number of responses we received,” Murray said. “It gives our survey some clout.”

Craig said students took the survey one step further by giving physicians seven scenarios in which they were asked if they would support the legal prescription of a dose of medication to a patient. One example asked if they would support physician-assisted suicide for a pulmonary fibrosis patient with less than six months to live. Another scenario asked whether they’d support the procedure for someone with incurable metastatic cancer with pain adequately managed by medication. Physicians could answer the questions by checking the following boxes: definitely not; probably not; uncertain; probably yes; or definitely yes.

Part of the reason for the scenario questions was to give physicians a chance to express how they felt on a number of topics rather than be forced to give a blanket response about physician-assisted suicide that encompasses all illnesses.

“We wanted to know what they thought about different scenarios, because this isn’t a black and white issue for any of us,” Craig said.

The Issue at Hand

The bill currently being considered by the legislature would require that patients wanting physician-assistance to die be at least 18 years old; have been given a diagnosis of less than six months to live; and be mentally competent and not depressed. Craig said that given these limited criteria, students felt like there was room to broaden the discussion using the responses of physicians to the scenario questions, and their remarks in the additional comments section.

The student group said that although they’ve developed some opinions on the subject, they didn’t want the final results to be affected by their views in any way. With this in mind, they modeled their survey after ones conducted in other states by organizations that were generally considered unbiased, with the scenario questions coming before the more politically charged ones.

“We wanted to add information to the conversation,” Suess said. “We weren’t looking for any specific results, we just wanted to have an indirect influence on the discussion. Unfortunately, in this argument people are throwing around facts that are incorrect. We want to provide helpful, factual information.”