亞洲醫師、護理人員、病人與民衆安樂死態度：系統性文獻回顧和統合分析

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.