亞洲醫師、護理人員、病人與民眾安樂死態度：系統性文獻回顧和統合分析

Attitudes of Physicians, Nurses, Patients, and the Public towards Euthanasia/ PhysicianAssisted Suicide in Asia: A Systematic Literature Review and Meta-Analysis

目的：以系統性文獻回顧和統合分析，了解亞洲醫師、護理人員、病人與民眾安樂死贊成態度百分比，並統整比較四族群贊成態度之相關因素，進而討論台灣安樂死立法的必要。方法：以Medline、PubMed、Web of Science、CINAHL和華藝五電腦資料庫，從1986年1月到2016年12月，搜尋亞洲醫師、護理人員、病人與民眾對於安樂死／醫助自殺態度。本研究依照PRISMA篩選流程，以he Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies評量品質。萃取四族群贊成百分比，以ReviewManager5.3進行分析，並以族群及地區比較。結果：納入17篇亞洲醫師（8）、護理人員（5）、病人（3）與民眾（5）安樂死／醫助自殺態度文獻（篇數重複計算），民眾贊成百分比最高52.83，其次是護理人員50.14、病人33.47、醫師32.03。東北亞，民眾52.83、病人45.70、護理人員22.80、醫師15.17；西亞，護理人員56.50、醫師44.20；南亞，護理人員58.40、醫師45.20、病人9.00。影響四族群贊成態度，以宗教（Religious）及宗教信仰程度（Religiosity）最為顯著。結論：亞洲醫師普遍態度較為謹慎，可能是受道德、法律及臨床實務影響；護理人員較看重病人的需要，願意克服本身宗教信仰，因此贊成態度高於醫師；民眾較病人贊成，可能是病人比民眾了解緩和醫療的選擇。南亞病人贊成態度偏低，可能因當地文化及醫療政策影響。亞洲各地不同醫療政策影響安樂死贊成態度，對台灣而言，應先推廣緩和醫療及病人自主權利法，再考量安樂死立法。

Purpose: Systematic reviews and meta-analysis were to know attitudes of physicians, nurses, patients and the public towards euthanasia (E)/ physician-assisted suicide (PAS) in Asia. By sorting and consolidating all relevant factors associated with agreement, further discussion on potential necessary of legislation against E/ PAS in Taiwan was adopted. Method: Data related to attitudes of physicians, nurses, patients, and the public towards E/ PAS in Asia were searched from 5 database resources of Medline, PubMed, Web of Science, CINAHL, and Airiti Library and focused on the period between January 1986 and December 2016. Following PRISMA flow diagram, evidence was evaluated qualitatively according to The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies. Approved percentage from above-mentioned 4 groups collected before meta-analysis was conducted with Review Manager 5.3 for following cross comparisons by group and/or by region. Results: Total 17 studies for attitudes towards physicians (8), nurses (5), patients (3) and the public (5) were included (Repeated calculation of the number of articles). The percentage approved by the public was the highest 52.83, followed by nurses 50.14, patients'33.47, and physicians 32.03. To distinguish into Asian regions: for Northeast Asia, the public was 52.83, followed by patients 45.70, nurses 22.80, and then physicians 22.80 ; in Western Asia, the percentage approved by nurses was 56.50 in comparison with physicians 44.20 ; in South Asia, the percentage approved by nurses was 58.4, followed by physicians 45.20 and patients 9.00. Factors to influence the attitudes of groups towards E/PAS in Asia were significant, especially the differentiation between religious level and religiosity in each region. Conclusion: In general, physicians are more conservative in Asia and it could be due to ethic, local regulation, and clinical practices in given culture and expectation. Compared to physicians, nurses are often willing to overcome their own religious value and religiosity level to take care of patients' need. In return, the approved percentage is overall higher than that of physicians. The other comparison is that the public approved percentage is higher than that of patients group. It might be because patients understand options of palliative care more than the public. In addition, fewer patients show agreement in South Asia. This could be due to local culture and medical policies. In general, it is medical policies and regulation leading public attitude toward E/ PAS in Asian society. Regarding Taiwan, promoting palliative care and encouraging patients' decision-making power are higher priorities than E/ PAS itself.