CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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In the second of four articles, the authors discuss the "estimation" approach to interpreting study results. Whereas, in hypothesis testing, study results lead the reader to reject or accept a null hypothesis, in estimation the reader can assess whether a result is strong or weak, definitive or not. A confidence interval, based on the observed result and the size of the sample, is calculated. ⋯ If the lower boundary of a confidence interval is above the threshold considered clinically significant, then the trial is positive and definitive, if the lower boundary is somewhat below the threshold, the trial is positive, but studies with larger samples are needed. Similarly, if the upper boundary of a confidence interval is below the threshold considered significant, the trial is negative and definitive. However, a negative result with a confidence interval that crosses the threshold means that trials with larger samples are needed to make a definitive determination of clinical importance.
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Physician-assisted death includes both euthanasia and assistance in suicide. The CMA urges its members to adhere to the principles of palliative care. It does not support euthanasia and assisted suicide. The following policy summary includes definitions of euthanasia and assisted suicide, background information, basic ethical principles and physician concerns about legalization of physician-assisted death.
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In November, Oregon became one of the first jurisdictions outside the Netherlands to allow physician-assisted suicide. Voters decided by a narrow 51% to 49% margin to pass a Death With Dignity Act, which allows terminally ill patients to receive a fatal prescription from a doctor after they meet several criteria. Observers note that the act's scope is narrow and that it would not have aided Sue Rodriguez, the British Columbia patient who went to court in an attempt to win the right to assisted suicide.
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The growth of an American organization that supports the right to die is proof that the public wants and needs physician-assisted death, says a University of Alberta alumnus who is medical director of the Hemlock Society. Dr. Richard MacDonald says he believes individual patients have the right to decide whether they want to live with a certain quality of life. Both the American Medical Association and the CMA have spoken out against physician-assisted death, but MacDonald says this opposition is out of touch with the opinions of individual physicians and patients.