A comparison of American and Dutch doctors has found considerable similarity--and some key disagreements--about how they respond when a terminally ill patient asks for help in hastening death.

The study, believed by its authors to be the first of its kind comparing attitudes of doctors from different countries, compared the responses of 67 randomly selected physicians from the Netherlands with those of 152 from Oregon.

Doctors were shown four vignettes about hypothetical patients who were dying. For example, the first vignette described a patient with widespread cancer invading the bones, causing excruciating pain uncontrolled by morphine. Doctors were asked whether it was okay "to increase morphine even if premature death is a likely consequence." In other vignettes, doctors were asked about terminally ill patients, not in pain or depressed, who ask for a life-ending injection because they are debilitated, feel purposeless or fear becoming a burden on their family.

American and Dutch doctors were in general agreement on increased levels of morphine--favoring it almost always for the patient in the first vignette and less often for the others. They also tended to agree on the acceptability of physician-assisted suicide, where a physician helps a terminally ill patient obtain life-ending drugs. In both countries, a majority favored physician-assisted suicide for the patient in excruciating pain, and fewer favored it for the other vignettes.

Dutch doctors, however, were much more likely to support euthanasia, in which the physician directly participates in the death by actually administering the drugs.

"This suggests a resistance by American physicians to perform the final life-ending action, but at the same time a willingness to help patients who want to end their life," researchers concluded.

Dutch doctors were more likely to find it acceptable to participate in physician-assisted suicide with a patient who finds life meaningless than a patient concerned about becoming a burden. There was no such difference among Oregon doctors.

"Importantly, American physicians consider the fear of being a burden as an acceptable justification for assistance with dying more often than their Dutch counterparts," researchers found.

The study was conducted by a team of researchers from Vrije Universiteit in Amsterdam, the Dana-Farber Cancer Institute in Boston and Erasmus University in Rotterdam. Their results appeared last week in the Archives of Internal Medicine.

--Don Colburn


Although many people believe cognitive skills deteriorate with age, older adults can perform certain mental tasks better than young people, researchers say.

Todd Braver and his wife, Deanna Barch, assistant professors of psychology at Washington University in St. Louis, tested 175 people aged 18 to 39 years and 81 people 65 to 85 years old. Each was asked to watch a computer screen on which letters appear one at a time. Participants were instructed to press a "target" button if they saw a letter "X" that had been preceded by an "A" and to press another button under all other circumstances. They were asked to complete the exercise as quickly as possible.

Younger people learned to anticipate pressing the target button when they saw the "A," and made more errors when it was not followed by an "X." Older people had a comparable reaction time but made fewer errors, the researchers found. The older group generally made 2 percent fewer errors than the younger group and 5 percent fewer errors when conditions were made more difficult by adding distracting letters that the participants were told to ignore.

The experiment was based on a computer model designed to look at how behavior is affected by changes in the brain.

Braver said the research does not suggest that the normal shrinkage of brain tissue with age helps people think. But, he added, there may be situations, including the identification of sequences of letters, as in this experiment, in which this decline in memory capacity might be beneficial.

The fact that a computer model predicted this finding also prompts Braver to believe that "computer models will lead the way to helping older adults with memory function."

The research was presented at the November meeting of the Psychonomic Society, a yearly meeting of about 1,000 experimental psychologists and neuroscientists.

--Carrie Donovan


While people with Down syndrome have a high chance of developing childhood leukemia, a new study shows they have only half the normal lifetime risk of getting other kinds of cancer.

Experts already knew about the leukemia risk faced by people with Down, but the study by Danish scientists is the first to estimate their chances of developing other cancers.

The study, published in last week's issue of The Lancet, a British medical journal, suggests that those with the syndrome may be protected because they have an extra copy of a chromosome that contains cancer-fighting genes.

Normally, people have two copies of each chromosome--one from each parent--but those with Down have three copies of chromosome 21, which has at least one gene linked to leukemia.

The findings provide a clue that there may be more protective genes on chromosome 21. Additional studies on these possible genes may help researchers understand how cancer develops in the general population, said the study's leader, Henrik Hasle at Aarhus University in Denmark.

--Associated Press