Evaluating physicians' knowledge of assisted suicide and palliative sedation therapy in Austria: An exploratory survey study

BACKGROUND: Since January 2022, assisted suicide (AS) has been legal in Austria under specific conditions, allowing medical AS for individuals with incurable, life-ending diseases or severe, enduring illnesses that significantly impact their lives. Palliative sedation therapy (PST) involves the controlled use of drugs to induce unconsciousness and alleviate otherwise untreatable suffering. This study evaluates Austrian physicians' knowledge of AS and PST, comparing the knowledge levels of palliative care (PC) and non-PC physicians.

METHODS: In this explorative study, an online survey was distributed primarily to physicians in Lower Austria through the State Healthcare Agency Lower Austria (Landesgesundheitsagentur Niederösterreich, LGA) and to PC physicians across Austria via the Austrian Association for Palliative Care (Österreichische Palliativgesellschaft, OPG). Questions in this survey focused on basic knowledge of the principles of AS and PST. Participants included physicians who have expertise in PC and physicians from other medical specialties.

RESULTS: In this study, 223 physicians completed the survey. The PC physicians displayed significantly more specialized training, with 74.2% holding a PC diploma compared to 17.9% of non-PC physicians (p < 0.001). Regarding PST, PC physicians were more likely to follow guidelines, using midazolam (97.8% vs. 77.6%, p < 0.001), propofol (56.2% vs. 38.1%, p = 0.009), and levomepromazine (23.6% vs. 11.2%, p = 0.016). In AS, PC physicians emphasized the decision-making capacity more frequently (p = 0.006) and were better informed about the legal requirements.

CONCLUSION: Overall, Austrian physicians demonstrate insufficient knowledge of AS and PST, underlining the need for enhanced education on PC principles to ensure informed practice post-AS legalization. Nonetheless, PC physicians in Austria demonstrate superior adherence to guidelines in managing life-limiting conditions, PST and AS compared to non-PC physicians, highlighting the importance of specialized PC education.