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Marcoux I, Onwuteaka-Philipsen BD, Jansen-van der Weide MC, van der Wal G. Withdrawing an explicit request for euthanasia or physician-assisted suicide: a retrospective study on the influence of mental health status and other patient characteristics. Psychol Med 2005; 35:1265-1274. [PMID: 16168149 DOI: 10.1017/s0033291705005465] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Mental health status may be closely related to an instability of intentions toward a premature death, but little is known about such instability following an explicit request for euthanasia or physician-assisted suicide (EAS) and patient characteristics associated with a change of mind. METHOD A questionnaire was sent to 6596 general practitioners in The Netherlands (response rate 60%). Of these, 1681 provided descriptions of the most recent explicit request for EAS they had received in the preceding 18 months. RESULTS Symptoms of depression and anxiety were related to a change of mind, but no relationship was found with the total score of the NOSGER Mood Dimension. Multinomial regression analysis revealed that patients who changed their mind had more mental health problems and less mental clarity than those who died by EAS. They also had fewer general health problems, had less unbearable and pointless suffering (according to the physician), were less concerned about loss of dignity and alternative treatment options were more frequently available. A further analysis revealed that mental health problems were more prevalent among patients whose requests were refused than among those who changed their mind. The physicians' evaluations of the reasons why a patient requested EAS were similar to a more objective measure of the patient characteristics. CONCLUSIONS These findings suggest that mental health status must be carefully assessed, and possible instability of desire must be taken into account in the course of a request for EAS. These results require replication, and future studies should adopt a prospective method.
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Abstract
The clinical status of terminal cancer patients is very complex and is affected by several severe symptoms, of extended duration, changing with time and of multifactorial origin. When there are no reasonable cancer treatments specifically able to modify the natural history of the disease, symptom control acquires priority and favours the possible better adaptation to the general inexorable deterioration related to the neoplasic progression. Despite the important advances in Palliative Medicine, symptoms are frequently observed that are intolerable for the patient and which do not respond to usual palliative measures. This situation, characterised by rapid deterioration of the patient, very often heralds, implicitly or explicitly, approaching death. The intolerable nature and being refractory to treatment indicates to the health-care team, on many occasions, the need for sedation of the patient. The requirement for sedation of the cancer patient is a situation that does not allow for an attitude of doubt regarding maintenance of the patient in unnecessary suffering for more than a reasonable time. Given the undoubted clinical difficulty in its indication, it is important to have explored at an earlier stage all usual treatments possible and the grade of response, commensurate with the patient's values and desires. Sedation consists of the deliberate administration of drugs in minimum doses and combinations required not only to reduce the consciousness of the patients but also to achieve adequate alleviation of one or more refractory symptoms, and with the prior consent given by the patient explicitly, or implicitly or delegated. Sedation is accepted as ethically warranted when considering the imperative of palliation and its administration and, whenever contemplated, the arguments that justify them are clear recorded in the clinical history. It is not an easy decision for the physician since, traditionally, the training has been "for the fight to save life". Nevertheless, it seems necessary to make some preparations regarding these problems that have a central affect on the clinical oncologist in his daily function.
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McQuoid-Mason D. Pacemakers and end-of-life decisions. S Afr Med J 2005; 95:566, 568. [PMID: 16200998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
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Laane HM. [Deliberate termination of life in newborns in The Netherlands; review of all 22 reported cases between 1997 and 2004]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2005; 149:1713; author reply 1713. [PMID: 16104122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Abstract
The Right to Die is a debatable issue and some basic notions need to be clarified to discuss it. Death needs to be recognized as part of human life. The goal of medicine is to avoid pain and alleviate suffering, to prevent premature death and when this is not possible, to let it occur peacefully. The concept of euthanasia is unclear, which increases the confusion on end-of-life topics. The term euthanasia should be used only when referring to medical acts performed to produce the patient's death, with the intention of terminating his/her suffering. It is what is usually called "active" euthanasia, which can be voluntary or involuntary. It is essential to understand the difference between producing and allowing death. This will permit timely decisions about limiting or withdrawing treatments, that can be disproportionate or that are only prolonging suffering. Limiting treatments does not mean to abandon the patient but rather to redefine his needs, such as pain treatment, prevention of complications, and relief of suffering. The ethic rationale for these decisions is the respect to the dignity of human life, and the estimation of proportionality or futility of each treatment. The physician's duty with the patient at the end of his life is to assist him in dying according to his values and to minimize his distress.
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Abstract
As the New England Journal of Medicine publishes the Groningen protocol for euthanasia in severely ill newborn babies, Tony Sheldon talks to its author, Eduard Verhagen
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Keizer AA, Swart SJ. [Palliative sedation, the sympathetic alternative for euthanasia?]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2005; 149:449-51. [PMID: 15771337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Palliative sedation is given to relieve refractory discomfort (pain, shortness of breath, agitation) during the phase when life expectancy is estimated to be a week or less. It is a medical intervention which, although not expressly meant to shorten life, may well do so. There is an inherent uncertainty here which is the cause of considerable ethical unease. Figures show that in a limited number of cases palliative sedation is actually applied with the intention to hasten death. It may well be impossible to rid ourselves ofthis uncertainty conclusively.
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Ponsioen BP. [Euthanasia and other medical decisions at the end of life in the Netherlands in 1990, 1995 and 2001]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2004; 148:49; author reply 49-50. [PMID: 14750456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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Gigli GL, Valente M. The withdrawal of nutrition and hydration in the vegetative state patient: societal dimension and issues at stake for the medical profession. NeuroRehabilitation 2004; 19:315-28. [PMID: 15671586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The withdrawal of assisted nutrition and hydration (ANH) is increasingly supported by scientific societies, by hospitals and by some families, once the condition of vegetative state could be considered permanent. In the first part of this article, the authors present the factors used to support the decision to withdraw ANH: a) the prognostic evaluation about outcome transformed into a clinical diagnosis of permanency; b) basic health care transformed into a medical treatment, subject to refusal by the patient; c) the human life (an undisposable good) transformed into a disposable one, open to decisions made by surrogates; d) the evaluations about quality of life transformed into judgments about the indignity of human life to be lived. In the second part, the authors outline the changes that this attitude can provoke in the integrity and the juridical status of the medical and nursing professions, and its potential impact on the society at large.
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Tuffs A. German doctor is investigated for killing 76 patients with morphine. BMJ 2003; 327:830. [PMID: 14551077 PMCID: PMC1140381 DOI: 10.1136/bmj.327.7419.830-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Saliga CM. Was this a case of euthanasia? THE NATIONAL CATHOLIC BIOETHICS QUARTERLY 2003; 2:687-94. [PMID: 12854612 DOI: 10.5840/ncbq2002249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bartmann P. Physician-assisted suicide and euthanasia: German Protestantism, conscience, and the limits of purely ethical reflection. CHRISTIAN BIOETHICS 2003; 9:203-225. [PMID: 15254991 DOI: 10.1076/chbi.9.2.203.30286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In this essay I shall describe and analyse the current debate on physician assisted suicide in contemporary German Protestant church and theology. It will be shown that the Protestant (mainly Lutheran) Church in Germany together with her Roman Catholic sister church has a specific and influential position in the public discussion: The two churches counting the majority of the population in Germany among their members tend to "organize" a social and political consensus on end-of-life questions. This cooperation is until now very successful: Speaking with one voice on end-of-life questions, the two churches function as the guardians of a moral consensus which is appreciated even by many non-believers. Behind this joint service to society the lines of the theological debate have to be ree-discovered. First it will be argued that a Protestant reading of the joint memoranda has to be based on the concept of individual conscience. The crucial questions are then: Whose conscience has the authority to decide? and: Can the physician assisted suicide be desired faithfully? Prominent in the current debate are Ulrich Eibach as a strict defender of the sanctity of life, and on the other side Walter Jens and Hans Kung, who argue for a right to physician assisted suicide under extreme conditions. I shall argue that it will be necessary to go beyond this actual controversy to the works of Gerhard Ebeling and Karl Barth for a clear and instructive account of conscience and a theological analysis of the concepts of life and suicide. On the basis of their considerations, a conscience-related approach to physician assisted suicide is developed.
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Kirk EP. To kill or let die? J Paediatr Child Health 2003; 39:480; author reply 480. [PMID: 12919508 DOI: 10.1046/j.1440-1754.2003.00195.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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McNeil DG. First study on patients who fast to end lives. THE NEW YORK TIMES ON THE WEB 2003:A23. [PMID: 14515848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Gherardi CR. [Euthanasia]. Medicina (B Aires) 2003; 63:63-9. [PMID: 12673965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Technological progress in medicine regarding the application of life-sustaining treatment in the critical patient and the cultural changes that have taken place in contemporary society with respect to the patients' right to decide over the end of their lives, demand the existence of a definition of euthanasia that will acknowledge this new scenario. The concept of euthanasia would be very specifically limited by the exclusion of so-called passive forms of euthanasia and of omission as a possible procedure to cause death and the need for the explicit request of the patient involved. Likewise, the definition of euthanasia should include a specific reference to the means through which death is to be achieved. Euthanasia would thus be defined basically as causing the death of a patient suffering from a mortal disease, upon his or her request and for his or her own benefit, by administering a toxic or poisonous substance in mortal doses. This restrictive definition would differentiate euthanasia from cases of refusal to receive treatment, even if death is the consequence of such refusal, and also from cases in which life-sustaining treatment is withheld or withdrawn to enable the occurrence of death.
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Clark PA. Morphine vs. ABT-594: A Reexamination by the Principle of Double Effect. Linacre Q 2003; 70:109-20. [PMID: 14682326 DOI: 10.1080/20508549.2003.11877668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Thunder JM. Quiet killings in medical facilities: detection & prevention. ISSUES IN LAW & MEDICINE 2003; 18:211-237. [PMID: 12693179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Mendelson D, Jost TS. A comparative study of the law of palliative care and end-of-life treatment. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2003; 31:130-143. [PMID: 12762106 DOI: 10.1111/j.1748-720x.2003.tb00063.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Since the Supreme Court of New Jersey decided the Quinlan case a quarter of a century ago, three American Supreme Court decisions and a host of state appellate decisions have addressed end-of-life issues. These decisions, as well as legislation addressing the same issues, have prompted a torrent of law journal articles analyzing every aspect of end-of-life law. In recent years, moreover, a number of law review articles, many published in this journal, have also specifically addressed legal issues raised by palliative care. Much less is known in the United States, however, as to how other countries address these issues. Reflection on the experience and analysis of other nations may give Americans a better understanding of their own experience, as well as suggest improvements to their present way of dealing with the difficult problems in this area.This article offers a conceptual and comparative analysis of major legal issues relating to end-of-life treatment and to the treatment of pain in a number of countries. In particular, it focuses on the law of Australia, Canada, the United Kingdom, Poland, France, the Netherlands, Germany, and Japan.
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Johnson SH. End-of-life decision making: what we don't know, we make up; what we do know, we ignore. INDIANA LAW REVIEW 2002; 31:13-47. [PMID: 12199229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Vehmas S. Newborn infants and the moral significance of intellectual disabilities. THE JOURNAL OF THE ASSOCIATION FOR PERSONS WITH SEVERE HANDICAPS : OFFICIAL PUBLICATION OF THE ASSOCIATION FOR PERSONS WITH SEVERE HANDICAPS 2002; 24:111-21. [PMID: 11700686 DOI: 10.2511/rpsd.24.2.111] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This article presents moral philosophical arguments regarding life-saving medical treatment that may be more available to infants without disabilities than to infants with intellectual disabilities. The ideas are that children with disabilities are a burden to their families and to society and that a happy life may not be attainable for these children and their families. I argue that human well-being is not based merely on individual characteristics, but is a result of the individual's relation to other people. Further, children with disabilities are not inevitably a burden to their families or society. Accordingly, intellectual disability is not a sufficient reason for withholding life-saving treatment.
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Hawryluck LA, Harvey WRC, Lemieux-Charles L, Singer PA. Consensus guidelines on analgesia and sedation in dying intensive care unit patients. BMC Med Ethics 2002; 3:E3. [PMID: 12171602 PMCID: PMC122088 DOI: 10.1186/1472-6939-3-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2002] [Accepted: 08/12/2002] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. METHODS Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1) Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9); 2) Deputy chief provincial coroners (N = 5); 3) Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12). RESULTS After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. CONCLUSION Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.
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Coulter DL. Beyond Baby Doe: does infant transplantation justify euthanasia? THE JOURNAL OF THE ASSOCIATION FOR PERSONS WITH SEVERE HANDICAPS : OFFICIAL PUBLICATION OF THE ASSOCIATION FOR PERSONS WITH SEVERE HANDICAPS 2002; 13:71-5. [PMID: 12085930 DOI: 10.1177/154079698801300203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent advances in medical technology have made it possible to transplant organs into infants with severe heart and kidney disease, but the need for these organs exceeds the presently available supply. Some have suggested that infants born with the severe neurological defect of anencephaly might be used as organ donors, even if these infants do not meet the criteria for brain death. Current criteria for brain death are reviewed and it is concluded that this proposal represents active euthanasia or medical killing of infants with anencephaly. Justification of active euthanasia is discussed in medical, ethical, and historical terms. Recently developed protocols to obtain organs for transplantation from infants with anencephaly after brain death has been determined are described and their ethical implications are discussed. It is argued that active euthanasia of infants with anencephaly is undesirable and should be prohibited in order to safeguard the rights of all persons with severe neurological disabilities.
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DiCamillo JA. A comparative analysis of the right to die in the Netherlands and the United States after Cruzan: reassessing the right of self-determination. THE AMERICAN UNIVERSITY JOURNAL OF INTERNATIONAL LAW AND POLICY 2002; 7:807-42. [PMID: 12091922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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