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Opinions of medical students regarding prolongation of mechanical ventilation versus unassisted death

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Author(s): Zehra Aqeel Nizami | Neha Aijaz | Khushbakht Nargiza | Ghazal Arif Siddiqui | Ayesha Rida | Omama Shakeel | Iqra Irfan | Anita Ghazal | Maryam Kaukab | Fatima Iqtidar | Javeria Siddiqui | Asna Sultana | Nida Shafi | Masood Abro | Safdar Bhutto

Journal: El Mednifico Journal
ISSN 2307-7301

Volume: 1;
Issue: 2;
Start page: 39;
Date: 2013;
Original page

Keywords: Mechanical ventilation | Unassisted Death | Euthanasia | End of Life Practices

ABSTRACT
Background: Mechanical ventilation is the process of supporting respiration by manual or mechanical means when normal breathing is inefficient or has stopped. The aim of our study was to determine the attitudes, knowledge, and opinions of medical students regarding prolongation of mechanical ventilation versus death without respiratory support.Findings: This was a cross-sectional study carried out at two academic institutions in Karachi for a period of three months. A total of 500 questionnaires were analyzed. The survey consisted of questions about the students' attitudes towards ventilators, their indications, mechanism of action, benefits, ethical issues surrounding their use, definition of brain death, and finally their personal opinion regarding what should be preferred: natural death, or respiratory support in critically ill patients. Majority (76.8%) had a ‘positive’ attitude towards ventilator-assisted life support. 406 (81.2%) students were of the view that ventilator is a machine that provides mechanical ventilation only, whereas 88 (17.6%) considered it to be an absolute life support machine. 219 (43.8%) believed that its usage was in accordance with religious and ethical values, 48 (9.6%) were not in agreement whereas 233 (46.6%) were not sure. 189 (37.8%) said that it was feasible to remove ventilation if the patient was considered brain dead, 232 (46.4%) said that guardian’s consent should be preferred, 29 (5.8%) supported ventilator’s continuation and 50 (10%) were not sure. 126 (25.2%) believed that immediate death would result on the removal of ventilator, 245 (49%) thought that patient would survive but would develop complications, whereas 129 (25.8%) were of the view that the survival would be without complications. Only 315 (63%) were successfully able to distinguished euthanasia from terminal weaning.Conclusion: The results of our survey indicate that most medical students prefer prolongation of mechanical ventilation over natural death. Special educational sessions aimed at increasing awareness regarding end of life practices is needed at college level.
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