Assisted dying: resisting the clamour for doctors to engage

Background: To assess the extent to which UK doctors discuss end-of-life decisions (ELDs) with patients, relatives and colleagues, and to assess the degree to which patients' lives are shortened by ELDs. Method: Postal survey of 857 UK medical practitioners. Comparison of UK data with published data from other countries, permissive and not permissive of medical involvement in actively hastening death. Findings: UK doctors, compared with those in permissive and non-permissive countries, are relatively cautious in shortening life by more than a few days. Willingness to discuss ELDs with patients and relatives is relatively high in the UK, but not as high as in permissive countries. UK doctors are highly likely to discuss ELDs with colleagues, and are more likely to do this than doctors in other countries, whether these countries are permissive or not. Interpretation: UK endof-life decision-making is particularly collegiate and reflects caution about actions that significantly shorten life. A culture of sharing decisions with patients and relatives is also evident.

Aims and method To systematically review the prevalence and associated factors of burnout and stress-related psychiatric disorders among UK doctors. An extensive search was conducted of PubMed, EBSCOhost and British medical journals for studies published over a 20-year span measuring the prevalence of psychiatric morbidity (using the General Health Questionnaire) and burnout (using the Maslach Burnout Inventory).Results Prevalence of psychiatric morbidity ranged from 17 to 52%. Burnout scores for emotional exhaustion ranged from 31 to 54.3%, depersonalisation 17.4 to 44.5% and low personal accomplishment 6 to 39.6%. General practitioners and consultants had the highest scores. Factors significantly associated with increase in the prevalence of burnout and psychiatric morbidity include low job satisfaction, overload, increased hours worked and neuroticism.Clinical implications The results indicate a worryingly high rate of burnout and psychiatric morbidity among UK doctors, which could have a huge negative impact on healthcare provision in general. Factors at personal and organisational levels contribute to burnout and psychiatric morbidity, and so efforts made to counter these problems should target both levels.

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