51
|
Moshe S, Gershfeld-Litvin A. Old and Depressed? What We Think About Ending Their Suffering—Attitudes Toward Euthanasia for Elderly Suffering From Physical Versus Mental Illness. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:1026-1041. [DOI: 10.1177/0030222820961241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aims to extend our knowledge regarding attitudes toward euthanasia. Specifically, the effect of patient’s age and illness type. 123 participants were randomly assigned to 1 of 4 groups completed the Assessing Right to Die Attitudes (ARDA) questionnaire after reading a patients age (79 vs. 29 year old) and illness type (cancer vs. depression) description. Findings revealed more positive attitudes toward euthanasia when the patient was physically ill, as opposed to mentally ill. Participants’ attitude towards euthanasia was more positive when the patient was elderly. Illness type as a function of the patient’s age did not significantly influence attitudes towards euthanasia. The results of the current study reinforce the individual influence of illness type and of patient age on attitudes toward euthanasia, and suggest additional avenues for further research regarding their combined influence.
Collapse
Affiliation(s)
- Shir Moshe
- Academic College of Tel Aviv–Yaffo, Yaffo, Israel
| | | |
Collapse
|
52
|
Attia JR, Jorm C, Kelly B. Medical assistance in dying: the downside. BMJ Support Palliat Care 2020; 10:259-261. [DOI: 10.1136/bmjspcare-2020-002350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 11/04/2022]
|
53
|
Ahlzen R. Suffering, authenticity, and physician assisted suicide. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:353-359. [PMID: 32661805 PMCID: PMC7426309 DOI: 10.1007/s11019-019-09929-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- R Ahlzen
- Karlstads Universitet, Karlstads, Sweden.
| |
Collapse
|
54
|
Pentaris P, Jacobs L. UK Public's Views and Perceptions About the Legalisation of Assisted Dying and Assisted Suicide. OMEGA-JOURNAL OF DEATH AND DYING 2020; 86:203-217. [PMID: 32746764 DOI: 10.1177/0030222820947254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Current debates about assisted dying and assisted suicide cover a series of medical, legal, moral, ethical and religious aspects. Yet, public views on the subject remain underexplored and, therefore, not always accounted for in the formation of public policy. This paper reports on empirical data from a cross-sectional study in the UK in 2019, which examines public views about the legalisation of assisted dying and assisted suicide, by means of a self-administered Qualtrics-based survey (self-devised vignettes). A combination of simple random and convenience sampling was used. Participants (n = 297) state their preference that both assisted dying and assisted suicide should be legalised in the UK (n = 70%), while doctors should be legally allowed to support such wishes of patients with an incurable and painful illness from which they will die (n = 62.22%). The paper concludes that public opinion needs to be further accounted for in policymaking and discourses regarding patient autonomy and dignity of care.
Collapse
Affiliation(s)
- Panagiotis Pentaris
- School of Human Sciences & Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Lucy Jacobs
- Social Work Alumni, School of Human Sciences, University of Greenwich, London, UK
| |
Collapse
|
55
|
Dorman JD, Raffin Bouchal S. Moral distress and moral uncertainty in medical assistance in dying: A simultaneous evolutionary concept analysis. Nurs Forum 2020; 55:320-330. [PMID: 31957042 DOI: 10.1111/nuf.12431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM To develop a simultaneous, evolutionary concept analysis of moral distress and moral uncertainty in the context of medical assistance in dying (MAiD). BACKGROUND Moral distress is well represented in nursing literature but disagreement persists in how the concept is defined and understood. Moral uncertainty has not been investigated in-depth. Further definition and conceptual clarity is required to understand these concepts within the context of MAiD. DESIGN Simultaneous concept analysis. DATA SOURCES Cumulative Index of Nursing and Allied Health Literature, Google Scholar, and PubMed databases were searched for articles in English. The final sample consisted of 44 documents published from 1984 to 2019. METHOD An adapted combination of Rodgers's Evolutionary Model and Haase et al's Simultaneous Concept Analysis method. RESULTS Despite the significant overlap, moral distress and moral uncertainty have subtle distinguishing differences. Attributes of moral distress in the context of MAiD focus on knowing the right course of action but being unable to act, especially when conflict or suffering occurs. Attributes of moral uncertainty center on an inability to decide on which course of action to take or knowing what outcome is preferable. CONCLUSION More research is required to bring further clarity to these concepts and develop interventions to support nurses who receive requests for or participate in MAiD.
Collapse
|
56
|
Van Rickstal R, De Vleminck A, Morrison SR, Koopmans RT, van der Steen JT, Engelborghs S, Neugroschl J, Aldridge MD, Sano M, Van den Block L. Comparing Advance Care Planning in Young-Onset Dementia in the USA vs Belgium: Challenges Partly Related to Societal Context. J Am Med Dir Assoc 2020; 21:851-857. [DOI: 10.1016/j.jamda.2020.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 10/24/2022]
|
57
|
Gerson SM, Koksvik GH, Richards N, Materstvedt LJ, Clark D. The Relationship of Palliative Care With Assisted Dying Where Assisted Dying is Lawful: A Systematic Scoping Review of the Literature. J Pain Symptom Manage 2020; 59:1287-1303.e1. [PMID: 31881289 PMCID: PMC8311295 DOI: 10.1016/j.jpainsymman.2019.12.361] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 11/28/2019] [Accepted: 12/13/2019] [Indexed: 01/21/2023]
Abstract
CONTEXT A central approach of palliative care has been to provide holistic care for people who are dying, terminally ill, or facing life-limiting illnesses while neither hastening nor postponing death. Assisted dying laws allow eligible individuals to receive medically administered or self-administered medication from a health provider to end their life. The implementation of these laws in a growing number of jurisdictions therefore poses certain challenges for palliative care. OBJECTIVES To analyze the research literature about the relationship of assisted dying with palliative care, in countries where it is lawful. METHODS A five-stage scoping review process was adapted from the Joanna Briggs Institute. Data sources searched through October 2018 were MEDLINE, CINAHL, PsychINFO, SCOPUS, and ProQuest dissertations and theses, with additional material identified through hand searching. Research studies of any design were included, but editorials or opinion articles were excluded. RESULTS After reviewing 5778 references from searches, 105 were subject to full-text review. About 16 studies were included: from Belgium (n = 4), Canada (n = 1), Switzerland (n = 2), and the U.S. (n = 9). We found that the relationship between assisted dying and palliative care practices in these locations took varied and sometimes combined forms: supportive, neutral, coexisting, not mutually exclusive, integrated, synergistic, cooperative, collaborative, opposed, ambivalent, and conflicted. CONCLUSION The studies in this review cast only partial light on challenges faced by palliative care when assisted dying is legal. There is pressing need for more research on the involvement of palliative care in the developing practices of assisted dying, across a growing number of jurisdictions.
Collapse
Affiliation(s)
- Sheri Mila Gerson
- School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Scotland, United Kingdom.
| | - Gitte H Koksvik
- School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Scotland, United Kingdom
| | - Naomi Richards
- School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Scotland, United Kingdom
| | - Lars Johan Materstvedt
- School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Scotland, United Kingdom; Faculty of Humanities, Department of Philosophy and Religious Studies, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - David Clark
- School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Scotland, United Kingdom
| |
Collapse
|
58
|
Solari A, Giordano A, Sastre-Garriga J, Köpke S, Rahn AC, Kleiter I, Aleksovska K, Battaglia MA, Bay J, Copetti M, Drulovic J, Kooij L, Mens J, Meza Murillo ER, Milanov I, Milo R, Pekmezovic T, Vosburgh J, Silber E, Veronese S, Patti F, Voltz R, Oliver D. EAN guideline on palliative care of people with severe, progressive multiple sclerosis. Eur J Neurol 2020; 27:1510-1529. [PMID: 32469447 DOI: 10.1111/ene.14248] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Patients with severe, progressive multiple sclerosis (MS) have complex physical and psychosocial needs, typically over several years. Few treatment options are available to prevent or delay further clinical worsening in this population. The objective was to develop an evidence-based clinical practice guideline for the palliative care of patients with severe, progressive MS. METHODS This guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Formulation of the clinical questions was performed in the Patients-Intervention-Comparator-Outcome format, involving patients, carers and healthcare professionals (HPs). No uniform definition of severe MS exists: in this guideline, constant bilateral support required to walk 20 m without resting (Expanded Disability Status Scale score > 6.0) or higher disability is referred to. When evidence was lacking for this population, recommendations were formulated using indirect evidence or good practice statements were devised. RESULTS Ten clinical questions were formulated. They encompassed general and specialist palliative care, advance care planning, discussing with HPs the patient's wish to hasten death, symptom management, multidisciplinary rehabilitation, interventions for caregivers and interventions for HPs. A total of 34 recommendations (33 weak, 1 strong) and seven good practice statements were devised. CONCLUSIONS The provision of home-based palliative care (either general or specialist) is recommended with weak strength for patients with severe, progressive MS. Further research on the integration of palliative care and MS care is needed. Areas that currently lack evidence of efficacy in this population include advance care planning, the management of symptoms such as fatigue and mood problems, and interventions for caregivers and HPs.
Collapse
Affiliation(s)
- A Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - A Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Psychology, University of Turin, Turin, Italy
| | - J Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Köpke
- Institute of Clinical Nursing Science, University of Cologne, Cologne, Germany.,Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A C Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | | | - M A Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
| | - J Bay
- Multiple Sclerosis International Federation, People with MS Advisory Committee, Copenhagen, Denmark
| | - M Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - J Drulovic
- Clinic of Neurology, CCS, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - L Kooij
- Nieuw Unicum, Zandvoort, The Netherlands
| | - J Mens
- Nieuw Unicum, Zandvoort, The Netherlands
| | - E R Meza Murillo
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Milanov
- Medical University of Sofia, Sofia, Bulgaria
| | - R Milo
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - T Pekmezovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - J Vosburgh
- Israel Multiple Sclerosis Society, Tel-Aviv, Israel
| | - E Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - S Veronese
- FARO Charitable Foundation, Turin, Italy
| | - F Patti
- Neurology Clinic, Multiple Sclerosis Centre, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - R Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Center for Health Services Research (ZVFK), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - D Oliver
- The Tizard Centre, University of Kent, Canterbury, UK
| | | |
Collapse
|
59
|
Colburn B. Autonomy, voluntariness and assisted dying. JOURNAL OF MEDICAL ETHICS 2020; 46:316-319. [PMID: 31719156 DOI: 10.1136/medethics-2019-105720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/03/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
Ethical arguments about assisted dying often focus on whether or not respect for an individual's autonomy gives a reason to offer them an assisted death if they want it. In this paper, I present an argument for legalising assisted dying which appeals to the autonomy of people who don't want to die. Adding that option can transform the nature of someone's choice set, enabling them to pursue other options voluntarily where that would otherwise be harder or impossible. This does not contradict the more familiar arguments for legalising assisted dying based on the autonomy of those who seek to die. But it does suggest that a wider constituency of support for that legislative change might be created by emphasising that one need not be in that position to be benefited by the change.
Collapse
Affiliation(s)
- Ben Colburn
- Department of Philosophy, University of Glasgow, Glasgow G12 8QQ, UK
| |
Collapse
|
60
|
Salas SP, Salinas RA, Besio M, Micolich C, Arriagada A, Misseroni Raddatz A, Valenzuela CY, Novoa F, BÓrquez EstefÓ G. [Ethical arguments for and against the participation of the medical profession in assisted death: analysis of the Ethics Department of the Chilean Medical Association]. Rev Med Chil 2020; 148:542-547. [PMID: 32730464 DOI: 10.4067/s0034-98872020000400542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/03/2020] [Indexed: 11/17/2022]
Affiliation(s)
- SofÍa P Salas
- Departamento de Ética, Colegio Médico de Chile A.G, Santiago, Chile
| | | | - Mauricio Besio
- Departamento de Ética, Colegio Médico de Chile A.G, Santiago, Chile
| | | | | | | | | | - Fernando Novoa
- Departamento de Ética, Colegio Médico de Chile A.G, Santiago, Chile
| | | |
Collapse
|
61
|
Pesut B, Thorne S, Schiller CJ, Greig M, Roussel J. The rocks and hard places of MAiD: a qualitative study of nursing practice in the context of legislated assisted death. BMC Nurs 2020; 19:12. [PMID: 32095114 PMCID: PMC7025406 DOI: 10.1186/s12912-020-0404-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 01/31/2020] [Indexed: 11/10/2022] Open
Abstract
Background Medical Assistance in Dying (MAiD) was legalized in Canada in June, 2016. The Canadian government's decision to legislate assisted dying, an approach that requires a high degree of obligation, precision, and delegation, has resulted in unique challenges for health care and for nursing practice. The purpose of this study was to better understand the implications of a legislated approach to assisted death for nurses' experiences and nursing practice. Methods The study used a qualitative approach guided by Interpretive Description. Semi-structured interviews were conducted with 59 registered nurses and nurse practitioners. Interviews were audio-recorded, transcribed, and managed using qualitative analysis software. Analysis followed a procedure of data immersion, open coding, constant comparative analysis, and the construction of a thematic and interpretive account. Results Nurses in this study described great variability in how MAiD had been enacted in their work context and the practice supports available to guide their practice. The development of systems to support MAiD, or lack thereof, was largely driven by persons in influential leadership positions. Workplaces that supported a range of nurses' moral responses to MAiD were most effective in supporting nurses' well-being during this impactful change in practice. Participants cited the importance of teamwork in providing high quality MAiD-related care; although, many worked without the benefit of a team. Nursing work related to MAiD was highly complex, largely because of the need for patient-centered care in systems that were not always organized to support such care. In the absence of adequate practice supports, some nurses were choosing to limit their involvement in MAiD. Conclusions Data obtained in this study suggested that some workplace contexts still lack the necessary supports for nurses to confidently meet the precision required of a legislated approach to MAiD. Without accessible palliative care, sufficient providers, a supportive team, practice supports, and a context that allowed nurses to have a range of responses to MAiD, nurses felt they were legally and morally at risk. Nurses seeking to provide the compassionate care consistent with such a momentous moment in patients' lives, without suitable supports, find themselves caught between the proverbial rock and hard place.
Collapse
Affiliation(s)
- Barbara Pesut
- 1Canada Research Chair in Health, Ethics, and Diversity, University of British Columbia Okanagan, 1147 Research Road, Okanagan, Kelowna, BC V1V 1V7 Canada
| | - Sally Thorne
- 2University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | | | - Madeleine Greig
- 1Canada Research Chair in Health, Ethics, and Diversity, University of British Columbia Okanagan, 1147 Research Road, Okanagan, Kelowna, BC V1V 1V7 Canada
| | - Josette Roussel
- 4Policy, Advocacy and Strategy, Canadian Nurses Association, 50 Driveway, Ottawa, Ontario K2P 1E2 Canada
| |
Collapse
|
62
|
Fontalis A, Prousali E, Kulkarni K. Euthanasia and assisted dying: what is the current position and what are the key arguments informing the debate? J R Soc Med 2019; 111:407-413. [PMID: 30427291 DOI: 10.1177/0141076818803452] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Assisted dying is a highly controversial moral issue incorporating both physician-assisted dying (PAD) and voluntary active euthanasia. End-of-life practices are debated in many countries, with assisted dying receiving different consideration across various jurisdictions. In this paper, we provide an analytic framework of the current position and the main arguments related to the rights and moral principles concerning assisted dying. Assisted dying proponents focus on the respect of autonomy, self-determination and forestalling suffering. On the other hand, concerns are raised regarding the interpretation of the constitutional right to life and balancing this with the premise of assisted dying, alongside the impacts of assisted dying on the doctor-patient relationship, which is fundamentally based on trust, mutual respect and the premise of 'first do no harm'. Our review is underpinning the interpretation of constitutional rights and the Hippocratic Oath with the premise of assisted dying, alongside the impacts of assisted dying on the doctor-patient relationship. Most clinicians remain untrained in such decision making, with fears against crossing key ethical divides. Due to the increasing number of cases of assisted dying and lack of consensus, our review enables the integration of ethical and legal aspects and facilitates decision making.
Collapse
Affiliation(s)
- Andreas Fontalis
- 1 St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | | | - Kunal Kulkarni
- 3 University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK
| |
Collapse
|
63
|
[Looking into international journals]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 65:304-306. [PMID: 31476989 DOI: 10.13109/zptm.2019.65.3.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
64
|
Gamondi C, Fusi-Schmidhauser T, Oriani A, Payne S, Preston N. Family members' experiences of assisted dying: A systematic literature review with thematic synthesis. Palliat Med 2019; 33:1091-1105. [PMID: 31244384 DOI: 10.1177/0269216319857630] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Families' experiences of assisted dying are under-investigated and families are rarely considered in clinical guidelines concerning assisted dying. AIM To systematically review family experiences of assisted dying. DESIGN A systematic literature review using thematic synthesis. DATA SOURCES MEDLINE, Embase, CINAHL, AMED (Allied and Complementary Medicine) and PsycINFO databases (January 1992 to February 2019). Studies investigating families' experiences on the practice of legalised assisted dying were included. We excluded studies prior to legalisation within the jurisdiction, secondary data analysis and opinion papers. RESULTS Nineteen articles met the inclusion criteria. Publications were derived from four countries: The Netherlands, United States (Oregon, Washington and Vermont), Canada and Switzerland. Dutch studies predominately investigated family involvement in euthanasia, while Swiss and American studies only reported on assisted suicide. Eleven studies had a qualitative design, using predominately in-depth interviews; seven were retrospective surveys. Five analytical themes represented families' experiences in assisted dying: (1) context of the decision, (2) grounding the decision, (3) cognitive and emotional work, (4) experiencing the final farewell and (5) grief and bereavement. The results showed that families can be very involved in supporting patients seeking assisted dying, where open communication is maintained. Family involvement appeared to be influenced by the type of legislation in their country and the families' perception of the social acceptability of assisted dying. CONCLUSION Our data confirm that families across all jurisdictions are involved in assisted suicide decision and enactment. Family needs are under-researched, and clinical guidelines should incorporate recommendations about how to consider family needs and how to provide them with evidence-based tailored interventions.
Collapse
Affiliation(s)
- Claudia Gamondi
- 1 Palliative and Supportive Care Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,2 Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Tanja Fusi-Schmidhauser
- 2 Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Anna Oriani
- 2 Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Sheila Payne
- 3 International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- 3 International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| |
Collapse
|
65
|
Gerson SM, Bingley A, Preston N, Grinyer A. When is hastened death considered suicide? A systematically conducted literature review about palliative care professionals' experiences where assisted dying is legal. BMC Palliat Care 2019; 18:75. [PMID: 31472690 PMCID: PMC6717643 DOI: 10.1186/s12904-019-0451-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/26/2019] [Indexed: 11/18/2022] Open
Abstract
Background Laws allowing assisted suicide and euthanasia have been implemented in many locations around the world but some individuals suffering with terminal illness receiving palliative care services are hastening death or die by suicide without assistance. This systematic review aims to summarise evidence of palliative care professionals’ experiences of patients who died by suicide or hastened death in areas where assisted dying is legal and to understand when hastened death is considered to be a suicide. Methods AMED, CINAHL Complete, PsycINFO, PubMED, and Academic Search Ultimate were searched for articles from inception through June 2018. Quality assessment used the Hawker framework. Results A total of 1518 titles were screened resulting in thirty studies meeting eligibility criteria for this review. Published studies about professionals’ experiences from areas with legalised assisted dying includes limited information about patients who hasten death outside legal guidelines, die by suicide without assistance, or if the law impacts suicide among palliative care patients. Conclusion There are a range of experiences and emotions professionals’ experience with patients who die by euthanasia, assisted suicide, or hasten death without assistance. The included literature suggests improved communication among professionals is needed but does not explicitly identify when a hastened death is deemed a suicide in areas where assisted dying is practiced. More research is needed to help clarify what hastened death means in a palliative care context and identify how and if assisted dying impacts issues of suicide in palliative care settings. Electronic supplementary material The online version of this article (10.1186/s12904-019-0451-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sheri Mila Gerson
- School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Dumfries, Scotland, DG1 4ZL, UK. .,Division of Health Research, Lancaster University, Lancaster, UK.
| | - Amanda Bingley
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Bailrigg, Lancaster, LA1 4YG, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Bailrigg, Lancaster, LA1 4YG, UK
| | - Anne Grinyer
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Bailrigg, Lancaster, LA1 4YG, UK
| |
Collapse
|
66
|
Bos DC, de Graaf E, de Graeff A, Teunissen SCCM. Determinants of unbearable suffering in hospice patients who died due to Euthanasia: A retrospective cohort study. DEATH STUDIES 2019; 45:451-458. [PMID: 31390320 DOI: 10.1080/07481187.2019.1648338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this retrospective study, determinants of unbearable suffering in hospice patients who died due to euthanasia were analyzed. The four dimensions of suffering (physical, psychological, social, and existential) were used as a framework. 28 patients (5% of all admitted patients in nine years) were included. Most patients indicated 3-5 determinants, predominantly a combination of physical (96% of patients) and existential determinants (89%). Fatigue, anorexia, and dry mouth were the most prevalent and severe symptoms. Psychological (21%) and social determinants (4%) were much less often described. The results of this study may be used to assess determinants playing a role in euthanasia requests.
Collapse
Affiliation(s)
- Dieuwke C Bos
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Everlien de Graaf
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Academic Hospice Demeter, De Bilt, The Netherlands
| | - Saskia C C M Teunissen
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Academic Hospice Demeter, De Bilt, The Netherlands
| |
Collapse
|
67
|
Fujioka JK, Mirza RM, Klinger CA, McDonald LP. Medical assistance in dying: implications for health systems from a scoping review of the literature. J Health Serv Res Policy 2019; 24:207-216. [DOI: 10.1177/1355819619834962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective Medical assistance in dying (MAiD) is the medical provision of substances to end a patient’s life at their voluntary request. While legal in several countries, the implementation of MAiD is met with ethical, legislative and clinical challenges, which are often overshadowed by moral discourse. Our aim was to conduct a scoping review to explore key barriers for the integration of MAiD into existing health systems. Methods We searched electronic databases (CINAHL, Embase, MEDLINE, and PsycINFO) and grey literature sources from 1990 to 2017. Studies discussing barriers and/or challenges to implementing MAiD from a health system’s perspective were included. Full-text papers were screened against inclusion/exclusion criteria for article selection. A thematic content analysis was conducted to summarize data into themes to highlight key implementation barriers. Results The final review included 35 articles (see online Appendix 1). Six categories of implementation challenges emerged: regulatory (n = 26), legal (n = 15), social (n = 9), logistical (n = 9), financial (n = 3) and compatibility with palliative care (n = 3). Within four of the six identified implementation barriers (regulatory, legal, social and logistical) were subthemes, which described barriers related to legalizing MAiD in more detail. Conclusion Despite multiple challenges related to its implementation, MAiD remains a requested end-of-life option, requiring careful examination to ensure adequate integration into existing health services. Comprehensive models of care incorporating multidisciplinary teams and regulatory oversight alongside improved clinician education may be effective to streamline MAiD services.
Collapse
Affiliation(s)
- Jamie K. Fujioka
- Researcher, Factor-Inwentash Faculty of Social Work, Institute for Life Course and Aging, University of Toronto, Canada
- Researcher, National Initiative for the Care of the Elderly, Canada
- Researcher, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Raza M. Mirza
- Senior Research Associate, Factor-Inwentash Faculty of Social Work, Institute for Life Course and Aging, University of Toronto, Canada
- Senior Research Associate, National Initiative for the Care of the Elderly, Canada
| | - Christopher A. Klinger
- Senior Research Associate, Factor-Inwentash Faculty of Social Work, Institute for Life Course and Aging, University of Toronto, Canada
- Senior Research Associate, National Initiative for the Care of the Elderly, Canada
| | - Lynn P. McDonald
- Professor, Factor-Inwentash Faculty of Social Work, Institute for Life Course and Aging, University of Toronto, Canada
- Scientific Director, National Initiative for the Care of the Elderly, Canada
| |
Collapse
|
68
|
Selby D, Bean S, Isenberg-Grzeda E, Bioethics BHD, Nolen A. Medical Assistance in Dying (MAiD): A Descriptive Study From a Canadian Tertiary Care Hospital. Am J Hosp Palliat Care 2019; 37:58-64. [PMID: 31256607 DOI: 10.1177/1049909119859844] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In June 2016, the Government of Canada passed Bill C-14 decriminalizing medically assisted death. Increasing numbers of Canadians are accessing medical assistance in dying (MAiD) each year, but there is limited information about this population. OBJECTIVE To describe the characteristic outcomes of MAiD requests in a cohort of patients at an academic tertiary care center in Toronto, Ontario, Canada. METHODS A retrospective chart review of patients making a formal request for a MAiD eligibility assessment from July 16 to September 18. Data extracted included demographics, diagnosis, psychosocial characteristics, information relating to the MAiD request, and clinical outcome. RESULTS We received 107 formal requests for MAiD assessment. Ninety-seven patients were found eligible, of whom 80 received MAiD. Cancer was the primary diagnosis for 78% and median age was 74 years. The majority of patients (64%) cited "functional decline or inability to participate in meaningful activities" as the main factor motivating their request for MAiD. Half of patients who received MAiD (46%) described their request as consistent with a long-standing, philosophical view predating their illness. The 10-day reflection period was reduced for 39% of provisions due to impending loss of capacity. Our cohort was very similar demographically to those described both nationally and internationally. CONCLUSION Patients seeking MAiD at our institution were similar to those described in other jurisdictions where assisted dying is legal and represent a group for whom autonomy and independence is critical. We noted a very high rate of risk of loss of capacity, suggesting a need for both earlier assessments and regular monitoring.
Collapse
Affiliation(s)
- Debbie Selby
- Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sally Bean
- Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elie Isenberg-Grzeda
- Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Amy Nolen
- Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
69
|
Safarpour H, Keykha R, Varasteh S, Sargazi V, Mirmortazavi M, Tavakolian N. Attitude of nurses towards euthanasia: a cross-sectional study in Iran. Int J Palliat Nurs 2019; 25:274-282. [DOI: 10.12968/ijpn.2019.25.6.274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Nurses play a major role in providing end-of-life care, and euthanasia is considered to be one of the most important ethical challenges that care providers can face. Aim: To assess the nurses' attitude towards euthanasia in Iran. Methods: The cross-sectional study included nurses who worked in intensive and critical care, as well as dialysis units of a teaching hospital affiliated to Zahedan University of Medical Sciences, who were selected by the census sampling technique. Data were collected using a two-part questionnaire encompassing the demographic characteristics of nurses and the 20-item Euthanasia Attitude Scale. Results: The overall score of nurses' attitudes towards euthanasia, ranging from one to five, was 2.71±0.45, indicating a negative attitude and opposition towards euthanasia. Alongside this, the results demonstrated that there was no significant relationship between demographic characteristics and nurses' attitudes toward euthanasia. Conclusion: In general, nurses in Iran oppose euthanasia. This can be attributed to the context of religious beliefs and culture in Iran as an Islamic country.
Collapse
Affiliation(s)
- Hamid Safarpour
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Roghayeh Keykha
- Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Saeideh Varasteh
- Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Venus Sargazi
- Student Research Committee, Nursing and Midwifery School, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mahan Mirmortazavi
- Student Research Committee, Khorasgan Branch, Islamic Azad University, Isfahan, Iran
| | - Najmeh Tavakolian
- Student Research Committee, Nursing and Midwifery School, Zahedan University of Medical Sciences, Zahedan, Iran
| |
Collapse
|
70
|
Affiliation(s)
- Nancy Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| |
Collapse
|
71
|
Blaschke SM, Schofield P, Taylor K, Ugalde A. Common dedication to facilitating good dying experiences: Qualitative study of end-of-life care professionals' attitudes towards voluntary assisted dying. Palliat Med 2019; 33:562-569. [PMID: 30688145 DOI: 10.1177/0269216318824276] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Debate about appropriate and ethically acceptable end-of-life choices is ongoing, which includes discussion about the legalization of voluntary assisted dying. Given health professionals' role in caring for patients at the end life, their stance towards assisting a person with dying can have implications for policy development and implementation in jurisdictions where law changes are being considered. AIM To explore end-of-life care professionals' attitudes towards voluntary assisted dying 6 months prior to vote on legalization. DESIGN Qualitative study using textual data collected through semi-structured interviews. Purposive sampling strategy used to collect a broad representation of perspectives. Audio-recorded interviews were transcribed verbatim and subjected to qualitative descriptive analysis techniques. PARTICIPANTS A total of 16 health professionals with experience in caring for people with life-limiting illness. RESULTS Participants reported two overarching positions grounded in differing moral philosophies with compelling arguments both for and against legalization of voluntary assisted dying. A third and common line of argument emerged from areas of shared concern and uncertainty about the practical consequences of introducing voluntary assisted dying. While a diversity of opinion was evident, all participants advocated for more public education and funding into end-of-life care services to make high-quality care equitable and widely available. CONCLUSION Common dedication to reducing suffering and facilitating good dying experiences exists among experts despite their divergent views on voluntary assisted dying. Ongoing engagement with stakeholders is needed for practical resolution in the interest of developing health policy for best patient care.
Collapse
Affiliation(s)
| | | | - Keryn Taylor
- 3 St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Anna Ugalde
- 4 Faculty of Health, Deakin University, Burwood, VIC, Australia
| |
Collapse
|
72
|
Loizeau AJ, Cohen SM, Mitchell SL, Theill N, Eicher S, Martin M, Riese F. Physician and Surrogate Agreement with Assisted Dying and Continuous Deep Sedation in Advanced Dementia in Switzerland. NEURODEGENER DIS 2019; 19:4-11. [PMID: 31013507 PMCID: PMC6692213 DOI: 10.1159/000499113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 02/18/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Assisted dying and continuous deep sedation (CDS) are controversial practices. Little is known about the perceptions of physicians and surrogates about these practices for patients with advanced dementia. OBJECTIVES To describe and compare physician and surrogate agreement with the use of assisted dying and CDS in advanced dementia. DESIGN, SETTING, SUBJECTS Physicians (n = 64) and surrogates (n = 168) of persons with advanced dementia were recruited as part of a randomized controlled trial in Switzerland that tested decision support tools in this population. METHODS At baseline, the participants were asked about their agreement with assisted dying and CDS in advanced dementia using the following response options: "completely agree," "somewhat agree," "somewhat disagree," "completely disagree," and "do not know." Multivariable logistic regressions compared the likelihood that surrogates versus physicians would completely or somewhat agree (vs. completely or somewhat disagree) with these practices. RESULTS The physicians and surrogates, respectively, had a mean age (SD) of 50.6 years (9.9) and 57.4 years (14.6); 46.9% (n = 30/64) and 68.9% (n = 115/167) were women. A total of 20.3% (n = 13/64) of the physicians and 47.0% (n = 79/168) of the surrogates agreed with assisted dying in advanced dementia. Surrogates were significantly more likely to agree with this practice than physicians (adjusted odds ratio, 3.87; 95% CI: 1.94, 7.69). With regard to CDS, 51.6% (n = 33/64) of the physicians and 41.9% (n = 70/169) of the surrogates agreed with this practice, which did not differ significantly between the groups. CONCLUSIONS The surrogates were more agreeable to considering assisted dying in the setting of advanced dementia than the physicians, and about half of the participants in both groups reported CDS to be an appropriate option for this population.
Collapse
Affiliation(s)
- Andrea Jutta Loizeau
- University Research Priority Program "Dynamics of Healthy Aging," University of Zurich, Zurich, Switzerland,
- Center for Gerontology, University of Zurich, Zurich, Switzerland,
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts, USA,
| | - Simon M Cohen
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts, USA
| | - Susan L Mitchell
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Nathan Theill
- University Research Priority Program "Dynamics of Healthy Aging," University of Zurich, Zurich, Switzerland
- Center for Gerontology, University of Zurich, Zurich, Switzerland
- Division of Psychiatry Research and Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Stefanie Eicher
- University Research Priority Program "Dynamics of Healthy Aging," University of Zurich, Zurich, Switzerland
- Center for Gerontology, University of Zurich, Zurich, Switzerland
| | - Mike Martin
- University Research Priority Program "Dynamics of Healthy Aging," University of Zurich, Zurich, Switzerland
- Center for Gerontology, University of Zurich, Zurich, Switzerland
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Florian Riese
- University Research Priority Program "Dynamics of Healthy Aging," University of Zurich, Zurich, Switzerland
- Division of Psychiatry Research and Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| |
Collapse
|
73
|
Miccinesi G, Caraceni A, Garetto F, Zaninetta G, Bertè R, Broglia CM, Farci B, Aprile PL, Luzzani M, Marzi AM, Mercadante S, Montanari L, Moroni M, Piazza E, Pittureri C, Tassinari D, Trentin L, Turriziani A, Zagonel V, Maltoni M. The Path of Cicely Saunders: The “Peculiar Beauty” of Palliative Care. J Palliat Care 2019; 35:3-7. [DOI: 10.1177/0825859719833659] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This paper is aimed at focusing on the writings and the experience of the Hospice movement Founder, Dame Cicely Saunders. The in-depth analysis carried out had the objective of verifying if “the way” of Cicely to understand, live and propose palliative care was still current and “beautiful”, so that we can nowadays refer to her fascinating “Original Palliative Care”. With “beauty” we mean, on the one hand, a way able to allow a personal path of research of the meaning of the disease and of the care, both for those who care and for those who are cared for. On the other hand, it seems to us that Cicely strongly suggests how this path can not be carried out alone, but is only possible within the context of a network of relationships and support, in a so called “relational autonomy”, for the patient, included in a “care ethics”. The authors believe that the work extensively documents as the overall approach of Cicely, traditional but always to be rediscovered, is still today the most convincing way of conception and action of palliative care.
Collapse
Affiliation(s)
- Guido Miccinesi
- Clinical Epidemiology Unit, Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Firenze, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, National Tumor Institute (INT) IRCCS Foundation, Milano, Italy
| | - Ferdinando Garetto
- FARO ONLUS Foundation & Palliative Care Unit, Humanitas Gradenigo Hospital, Torino, Italy
| | | | - Raffaella Bertè
- Oncology Department, Palliative Care, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Chiara M. Broglia
- Oncology Unit, Policlinico San Matteo IRCCS Foundation, Pavia, Italy
| | | | - P. Lora Aprile
- Italian College of General Practitioners and Primary Care, Desenzano del Garda, Italy
| | - Massimo Luzzani
- Palliative Care, Department of Geriatrics, Orthogeriatrics and Rehabilitation Frailty Area, E.O. Galliera Hospital, Genova, Italy
| | - Annamaria M. Marzi
- Modena and Reggio Emilia University & Casa Madonna dell’Uliveto Hospice, Albinea, Italy
| | - Sebastiano Mercadante
- Anesthesia & Intensive Care and Pain Relief & Palliative Care Unit, La Maddalena Cancer Center & Palermo University, Palermo, Italy
| | - Luigi Montanari
- Palliative Care Unit, AUSL Romagna (Local Health Authority), Lugo, Italy
| | - Matteo Moroni
- Maria Teresa Chiantore Seragnoli Hospice ONLUS Foundation, Bentivoglio, Italy
| | - Elena Piazza
- Medical Oncology, Luigi Sacco University Hospital, Milano, Italy
| | - Cristina Pittureri
- Palliative Care and Hospice Unit, AUSL Romagna (Local Health Authority), Savignano sul Rubicone, Italy
| | - Davide Tassinari
- Department of Oncology & Hospice and Palliative Care Unit, Degli Infermi Hospital, Rimini, Italy
| | - Leonardo Trentin
- Palliative Care and Pain Therapy Unit, Veneto Institute of Oncology (IOV) IRCCS, Padova, Italy
| | | | - Vittorina Zagonel
- Medical Oncology Unit 1, Veneto Institute of Oncology (IOV) IRCCS, Padova, Italy
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| |
Collapse
|
74
|
Evenblij K, Pasman HRW, van der Heide A, Hoekstra T, Onwuteaka-Philipsen BD. Factors associated with requesting and receiving euthanasia: a nationwide mortality follow-back study with a focus on patients with psychiatric disorders, dementia, or an accumulation of health problems related to old age. BMC Med 2019; 17:39. [PMID: 30777057 PMCID: PMC6379969 DOI: 10.1186/s12916-019-1276-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/31/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recently, euthanasia and assisted suicide (EAS) in patients with psychiatric disorders, dementia, or an accumulation of health problems has taken a prominent place in the public debate. However, limited is known about this practice. The purpose of this study was threefold: to estimate the frequency of requesting and receiving EAS among people with (also) a psychiatric disorder, dementia, or an accumulation of health problems; to explore reasons for physicians to grant or refuse a request; and to describe differences in characteristics, including the presence of psychiatric disorders, dementia, and accumulation of health problems, between patients who did and did not request EAS and between patients whose request was or was not granted. METHODS A nationwide cross-sectional survey study was performed. A stratified sample of death certificates of patients who died between 1 August and 1 December 2015 was drawn from the central death registry of Statistics Netherlands. Questionnaires were sent to the certifying physician (n = 9351, response 78%). Only deceased patients aged ≥ 17 years and who died a non-sudden death were included in the analyses (n = 5361). RESULTS The frequency of euthanasia requests among deceased people who died non-suddenly and with (also) a psychiatric disorder (11.4%), dementia (2.1%), or an accumulation of health problems (8.0%) varied. Factors positively associated with requesting euthanasia were age (< 80 years), ethnicity (Dutch/Western), cause of death (cancer), attending physician (general practitioner), and involvement of a pain specialist or psychiatrist. Cause of death (neurological disorders, another cause) and attending physician (general practitioner) were also positively associated with receiving euthanasia. Psychiatric disorders, dementia, and/or an accumulation of health problems were negatively associated with both requesting and receiving euthanasia. CONCLUSIONS EAS in deceased patients with psychiatric disorders, dementia, and/or an accumulation of health problems is relatively rare. Partly, this can be explained by the belief that the due care criteria cannot be met. Another explanation is that patients with these conditions are less likely to request EAS.
Collapse
Affiliation(s)
- Kirsten Evenblij
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - H. Roeline W. Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Trynke Hoekstra
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| |
Collapse
|
75
|
Inbadas H, Carrasco JM, Clark D. Representations of palliative care, euthanasia and assisted dying within advocacy declarations. MORTALITY (ABINGDON, ENGLAND) 2019; 25:138-150. [PMID: 32256200 PMCID: PMC7077361 DOI: 10.1080/13576275.2019.1567484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
It is well known that there are disagreements between the proponents of palliative care and of euthanasia or assisted dying, often with little common ground,shaping the end of life discourse internationally. Advocacy documents or 'declarations'constitute a significant feature of this discourse. The aim of this study was to explore the content of such declarations and to focus on what they can tell us about palliative care and assisted dying and their dispositions towards one another. 104 declarations were identified and included in the study, covering the period 1974 to 2017. These declarations were analysed following the principles of thematic content analysis. We classified them based on their primary purpose: those with the goal of advocating for palliative care services, education and research were grouped under 'palliative care declarations'; those with the primary objective of advocating for or against euthanasia/assisted dying were classified as "euthanasia/assisted dying declarations". Our analysis revealed that the content of the declarations could be broadly categorised into three dimensions: framing, claiming and demanding. We demonstrate that these declarations reveal a struggle over the construction of meanings relating to palliative care and assisted dying and constitute a valuable resource for the analysis of an unfolding debate.
Collapse
Affiliation(s)
- Hamilton Inbadas
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK
- Scottish Episcopal Church, Forres, UK
| | - José Miguel Carrasco
- APLICA Investigación y traslación, Madrid, Spain
- Glasgow End of Life Studies Group, University of Glasgow, Dumfries, UK
- ATLANTES Research Programme, Institute for Culture and Society, Universidad de Navarra, Pamplona, Spain
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK
| |
Collapse
|
76
|
Sainton J. Le dispositif Leonetti-Claeys : sédation palliative ou terminale ? MÉDECINE PALLIATIVE 2019. [DOI: 10.1016/j.medpal.2018.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
77
|
Lindblad A, Helgesson G, Sjöstrand M. Towards a palliative care approach in psychiatry: do we need a new definition? JOURNAL OF MEDICAL ETHICS 2019; 45:26-30. [PMID: 30266796 DOI: 10.1136/medethics-2018-104944] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/28/2018] [Accepted: 09/01/2018] [Indexed: 06/08/2023]
Abstract
Psychiatry today is mainly practised within a curative framework. However, many mental disorders are persistent and negatively affect quality of life as well as life expectancy. This tension between treatment goals and the actual illness trajectory has evoked a growing academic interest in 'palliative psychiatry', namely the application of a palliative care approach in patients with severe persistent mental illness. Recently, Trachsel et al presented a working definition of palliative psychiatry. This first official attempt to capture the concept is based on WHO's widely accepted definition of palliative care but modified and limited to include only severe persistent psychiatric illness. While this is a welcome step in the discussion on palliative care approaches in psychiatry, it also opens up for new questions. One of the most evident is whether psychiatry actually needs its own definition of palliative care or, put differently, whether there is something about mental disorders that differs so radically from other medical conditions that it calls for a separate definition. We acknowledge the need to discuss the goals of psychiatric care in patients with severe persistent psychiatric illness. However, we question whether a separate definition of palliative care exclusive to psychiatry is the right way to go. In this paper, we discuss why.
Collapse
Affiliation(s)
- Anna Lindblad
- Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Gert Helgesson
- Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Manne Sjöstrand
- Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
78
|
Bélanger E, Towers A, Wright DK, Chen Y, Tradounsky G, Macdonald ME. Of dilemmas and tensions: a qualitative study of palliative care physicians' positions regarding voluntary active euthanasia in Quebec, Canada. JOURNAL OF MEDICAL ETHICS 2019; 45:48-53. [PMID: 30377217 DOI: 10.1136/medethics-2017-104339] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/22/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES In 2015, the Province of Quebec, Canada passed a law that allowed voluntary active euthanasia (VAE). Palliative care stakeholders in Canada have been largely opposed to euthanasia, yet there is little research about their views. The research question guiding this study was the following: How do palliative care physicians in Quebec position themselves regarding the practice of VAE in the context of the new provincial legislation? METHODS We used interpretive description, an inductive methodology to answer research questions about clinical practice. A total of 18 palliative care physicians participated in semistructured interviews at two university-affiliated hospitals in Quebec. RESULTS Participants positioned themselves in opposition to euthanasia. Their justifications were framed within their professional commitment to not hasten death, which sat in tension with the value of patients' autonomy to choose how to die. Participants described VAE as unacceptable if it impeded opportunities to evaluate and alleviate suffering. Further, they contested government rhetoric that positioned VAE as a way to improve end-of-life care. Participants felt that VAE would diminish the potential of palliative care to relieve suffering. Dilemmas were apparent in their narratives, about reconciling respect for patient autonomy with broader palliative care values, and the value of accompanying and not abandoning patients who make requests for VAE while being committed to neither prolonging nor hastening death. CONCLUSIONS This study provides insight into nuanced positions of experienced palliative care physicians in Quebec and confirms expected tensions between an important stakeholder and the practice of VAE as guided by the new legislation.
Collapse
Affiliation(s)
- Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Anna Towers
- Department of Oncology, McGill University, Montreal, Quebec, Canada
| | | | - Yuexi Chen
- Palliative Care McGill, McGill University Montreal, Montreal, Quebec, Canada
| | - Golda Tradounsky
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | | |
Collapse
|
79
|
Mercadante S, Masedu F, Degan G, Marinangeli F, Aielli F. Physicians' Attitudes Toward Euthanasia and Assisted Suicide in Italy. J Pain Symptom Manage 2018; 56:e1-e3. [PMID: 30236790 DOI: 10.1016/j.jpainsymman.2018.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy
| | - Giulia Degan
- Anesthesiology and Pain Medicine, Department of Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Franco Marinangeli
- Anesthesiology and Pain Medicine, Department of Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federica Aielli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | |
Collapse
|
80
|
Gilbert J, Boag J. ‘To die, to sleep’ – assisted dying legislation in Victoria: A case study. Nurs Ethics 2018; 26:1976-1982. [DOI: 10.1177/0969733018806339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Assisted dying remains an emotive topic globally with a number of countries initiating legislation to allow individuals access to assisted dying measures. Victoria will become the first Australian state in over 13 years to pass Assisted Dying Legislation, set to come into effect in 2019. Objectives: This article sought to evaluate the impact of Victorian Assisted Dying Legislation via narrative view and case study presentation. Research design: Narrative review and case study. Participants and research context: case study. Ethical considerations: This legislation will provide eligible Victorian residents with the option to request access to assisted dying measures as a viable alternative to a potentially painful, protracted death. Findings: This legislation, while conservative and inclusive of many safeguards at present, will form the basis for further discussion and debate on assisted dying across Australia in time to come. Discussion: The passing of this legislation by the Victorian parliament was prolonged, emotive and divided not only the parliament but Australian society. Conclusion: Many advocates for this legislation proclaimed it was well overdue and will finally meet the needs of contemporary society. Protagonists claim that medical treatment should not provide a means of ending life, despite palliative care reportedly often failing to relieve the pain and suffering of individuals living with a terminal illness.
Collapse
Affiliation(s)
| | - Jane Boag
- Federation University Australia, Australia
| |
Collapse
|
81
|
Maeda S, Morita T, Ikenaga M, Abo H, Kizawa Y, Tsuneto S. Changes in opinions on palliative sedation of palliative care specialists over 16 years and their effects on clinical practice. Support Care Cancer 2018; 27:2211-2219. [DOI: 10.1007/s00520-018-4497-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/03/2018] [Indexed: 11/30/2022]
|
82
|
Abstract
Palliative sedation (PS) is performed in the terminally ill patient to manage one or more refractory symptoms. Proportional PS, which means that drugs can be titrated to the minimum effective dose, is the form most widely used. From a quarter to a third of all terminally ill patients undergo PS, with a quarter of these requiring continuous deep sedation. The prevalence of PS varies according to the care setting and case mix. The most frequent refractory physical symptoms are delirium and dyspnea, but PS is also considered for existential suffering or psychological distress, which is an extremely difficult and delicate issue to deal with. Active consensus from the patient and advanced care planning is recommended for PS. The decision-making process concerning the continuation or withdrawal of other treatments is not the same as that used for PS. The practice differs totally from euthanasia in its intentions, procedures, and results. The most widely used drugs are midazolam and haloperidol for refractory delirium, but chlorpromazine and other neuroleptics are also effective. In conclusion, some patients experience refractory symptoms during the last hours or days of life and PS is a medical intervention aimed at managing this unbearable suffering. It does not have a detrimental effect on survival.
Collapse
Affiliation(s)
| | | | - Romina Rossi
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
| |
Collapse
|
83
|
Yun YH, Kim KN, Sim JA, Yoo SH, Kim M, Kim YA, Kang BD, Shim HJ, Song EK, Kang JH, Kwon JH, Lee JL, Nam EM, Maeng CH, Kang EJ, Do YR, Choi YS, Jung KH. Comparison of attitudes towards five end-of-life care interventions (active pain control, withdrawal of futile life-sustaining treatment, passive euthanasia, active euthanasia and physician-assisted suicide): a multicentred cross-sectional survey of Korean patients with cancer, their family caregivers, physicians and the general Korean population. BMJ Open 2018; 8:e020519. [PMID: 30206075 PMCID: PMC6144336 DOI: 10.1136/bmjopen-2017-020519] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study determined attitudes of four groups-Korean patients with cancer, their family caregivers, physicians and the general Korean population-towards five critical end-of-life (EOL) interventions-active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide. DESIGN AND SETTING We enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a 'good death' with critical interventions at EoL care. RESULTS All participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling 'life was meaningful' (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing 'freedom from pain' negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, 'not being a burden to the family' was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89). CONCLUSION Groups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.
Collapse
Affiliation(s)
- Young Ho Yun
- Department of Biomedical Science, College of Medicine, Seoul National University, Seoul, Korea
- Department of Biomedical Informatics, College of Medicine, Seoul National University, Seoul, Korea
| | - Kyoung-Nam Kim
- Public Health Medical Service, Seoul National University Hospital, Seoul, Korea
| | - Jin-Ah Sim
- Department of Biomedical Science, College of Medicine, Seoul National University, Seoul, Korea
| | - Shin Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ae Kim
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Beo Deul Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun-Jeong Shim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, School of Medicine, Chonbuk National University, Jeonju, Korea
| | - Eun-Kee Song
- Division of Hematology/Oncology, Chonbuk National University Medical School, Jeonju, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Postgraduate Medical School, Gyeongsang National University, Jinju, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jung Lim Lee
- Department of Hemato-oncology, Daegu Fatima Hospital, Daegu, Korea
| | - Eun Mi Nam
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Chi Hoon Maeng
- Department of Medical Oncology and Hematology, Kyung Hee University Hospital, Seoul, Korea
| | - Eun Joo Kang
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Rok Do
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yoon Seok Choi
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
84
|
Demedts D, Roelands M, Libbrecht J, Bilsen J. The attitudes, role & knowledge of mental health nurses towards euthanasia because of unbearable mental suffering in Belgium: A pilot study. J Psychiatr Ment Health Nurs 2018; 25:400-410. [PMID: 29802774 DOI: 10.1111/jpm.12475] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 05/16/2018] [Accepted: 05/23/2018] [Indexed: 12/20/2022]
Abstract
UNLABELLED WHAT IS KNOWN ABOUT THE SUBJECT?: Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002 under strict conditions of careful practice. UMS euthanasia occurs fairly rarely in Belgium, but the frequency has increased substantially over the past few years. Although most mental health nurses play an important role and are supportive of euthanasia in general, their role, attitude and knowledge when it comes to UMS euthanasia were unknown until now. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Most mental health nurses in Belgium appear to be supportive towards UMS euthanasia and where UMS euthanasia is carried out, mental health nurses are often involved in the preceding decision-making process. Mental health nurses critically reflect on the interpretation and application of the legal euthanasia criteria as experienced in their daily work with their patients, and identify several problems. After a rather quiet period in Belgium, the public ethical debate regarding UMS euthanasia has recently been reopened and intensified. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia. This applies at several levels: legal, healthcare policy, bedside care and education. Specific attention must be paid within the UMS euthanasia process to ensure adequate cooperation between physicians, nurses and patients. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions. ABSTRACT Introduction Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002, under certain circumstances that govern careful practice. Despite the legal framework, there are specific difficulties and concerns regarding UMS euthanasia. Mental health nurses are often involved in the process, but little is known about their attitudes towards UMS euthanasia, their role and their knowledge. Aim To determine the attitudes, role and knowledge of mental health nurses regarding UMS euthanasia. Methods A cross-sectional survey was performed at a convenience sample of four psychiatric hospitals in Belgium (n = 133) as a pilot study. Self-administered questionnaires were provided to mental health nurses. Results Half the nurses in our sample had been involved at least once in the process of UMS euthanasia. A large majority of mental health nurses were supportive of UMS euthanasia. Nurses show differences in attitudes related to the different psychiatric pathologies of the patients, and in whether or not minors are involved. In some cases, they believed that the mental suffering of psychiatric patients can be unbearable and irreversible and that psychiatric patients can be competent to voluntarily request UMS euthanasia. Nurses stated that they have an important role in the UMS euthanasia process, but also demanded more knowledge and clear guidelines to implement the procedure. Discussion Nurses have a key role regarding UMS euthanasia but face several challenges: the recent process, resistance to a multidisciplinary approach by psychiatrists and an unclear role defined by the legal framework. Nurses do not appear to have a common voice on the topic and the development of clear guidelines appears to be essential. Social recovery can offer a way out of an UMS euthanasia request, but it will not always offer a solution. Implications for Practice Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia at various levels: bedside practice, healthcare management, education and policy. A form of systematic cooperation between nurses, physicians and patients can contribute to the utmost careful decision-making process needed in these cases. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions.
Collapse
Affiliation(s)
- Dennis Demedts
- Research group Mental Health and Wellbeing, Vrije Universiteit Brussels (VUB), Brussels, Belgium.,Department of Health and Landscape Architecture, Erasmus University College Brussels (EhB), Brussels, Belgium.,Knowledge Center Brussels Integrated Care, Erasmus University College Brussels, Brussels, Belgium
| | - Marc Roelands
- Research group Mental Health and Wellbeing, Vrije Universiteit Brussels (VUB), Brussels, Belgium
| | - Julien Libbrecht
- Department of Health and Landscape Architecture, Erasmus University College Brussels (EhB), Brussels, Belgium
| | - Johan Bilsen
- Research group Mental Health and Wellbeing, Vrije Universiteit Brussels (VUB), Brussels, Belgium
| |
Collapse
|
85
|
Wales J, Isenberg SR, Wegier P, Shapiro J, Cellarius V, Buchman S, Husain A, Khoshnood N. Providing Medical Assistance in Dying within a Home Palliative Care Program in Toronto, Canada: An Observational Study of the First Year of Experience. J Palliat Med 2018; 21:1573-1579. [PMID: 30095328 DOI: 10.1089/jpm.2018.0175] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Medical Assistance in Dying (MAiD) was legalized in Canada in June 2016. There are no documented experiences of MAiD provision within a home palliative care program. The majority of palliative care physicians in Canada object to MAiD. As one of the largest home-based palliative care providers in Canada, the Temmy Latner Centre for Palliative Care (TLCPC) developed processes to implement MAiD provision within a home palliative care team with diverse attitudes toward MAiD. OBJECTIVE To demonstrate the feasibility of providing MAiD within a home palliative care setting and describe the population that received MAiD in the first year of legalization. DESIGN A retrospective chart review identified patients who received or were assessed for MAiD and had a known outcome between June 17, 2016 and June 30, 2017. SETTING/SUBJECTS Patients receiving home-based palliative care. MEASUREMENTS Data extracted included age, gender, primary diagnosis, length of time receiving home-based palliative care, and final clinical outcome. RESULTS Of the 45 patients who were assessed for MAiD, 27 (60%) received MAiD and 18 (40%) did not. The mean age was 74 (range 20-95), 24 (53%) were male, and 33 (73%) had cancer as a primary diagnosis. These 27 patients represent 1.2% of our total patient population during this time period. CONCLUSIONS MAiD was accessed by 1.2% of the patients within a home palliative care center in the first year of legalization. Patient demographics were consistent with those documented elsewhere. The TLCPC process accommodates the diverse viewpoints of clinicians and emphasizes continuity of palliative care provision.
Collapse
Affiliation(s)
- Joshua Wales
- 1 Temmy Latner Centre for Palliative Care , Sinai Health System, Toronto, Ontario, Canada .,2 Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Sarina R Isenberg
- 1 Temmy Latner Centre for Palliative Care , Sinai Health System, Toronto, Ontario, Canada .,2 Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada .,3 Lunenfeld-Tanenbaum Research Institute , Sinai Health System, Toronto, Ontario, Canada
| | - Pete Wegier
- 1 Temmy Latner Centre for Palliative Care , Sinai Health System, Toronto, Ontario, Canada .,2 Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada .,3 Lunenfeld-Tanenbaum Research Institute , Sinai Health System, Toronto, Ontario, Canada
| | - Jennifer Shapiro
- 1 Temmy Latner Centre for Palliative Care , Sinai Health System, Toronto, Ontario, Canada
| | - Victor Cellarius
- 1 Temmy Latner Centre for Palliative Care , Sinai Health System, Toronto, Ontario, Canada .,2 Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Sandy Buchman
- 1 Temmy Latner Centre for Palliative Care , Sinai Health System, Toronto, Ontario, Canada .,2 Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Amna Husain
- 1 Temmy Latner Centre for Palliative Care , Sinai Health System, Toronto, Ontario, Canada .,2 Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada .,3 Lunenfeld-Tanenbaum Research Institute , Sinai Health System, Toronto, Ontario, Canada
| | - Narges Khoshnood
- 1 Temmy Latner Centre for Palliative Care , Sinai Health System, Toronto, Ontario, Canada .,2 Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada
| |
Collapse
|
86
|
Friedel M, Terwangne BD, Brichard B, Ruysseveldt I, Renard M. The Belgian euthanasia law and its impact on the practises of Belgian paediatric palliative care teams. Int J Palliat Nurs 2018; 24:333-337. [PMID: 30044700 DOI: 10.12968/ijpn.2018.24.7.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marie Friedel
- PhD student and research assistant, REsearch Institute for Health and Society, Université Catholique de Louvain; Lecturer, Institut Parnasse-ISEI, Haute Ecole Léonard de Vinci, Brussels, Belgium
| | - Brigitte de Terwangne
- Paediatric Liason Nurse, Interface Pédiatrique, Cliniques Universitaires St Luc, Brussels, Belgium
| | - Bénédicte Brichard
- Oncopediatrician and Head of Department, Department of Pediatric Hemato-oncology, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Marleen Renard
- Oncopediatrician, Department of Paediatric Hemato-oncology, University Hospital Leuven, Belgium
| |
Collapse
|
87
|
Sprung CL, Somerville MA, Radbruch L, Collet NS, Duttge G, Piva JP, Antonelli M, Sulmasy DP, Lemmens W, Ely EW. Physician-Assisted Suicide and Euthanasia. J Palliat Care 2018; 33:197-203. [DOI: 10.1177/0825859718777325] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medical professional societies have traditionally opposed physician-assisted suicide and euthanasia (PAS-E), but this opposition may be shifting. We present 5 reasons why physicians shouldn’t be involved in PAS-E. 1. Slippery slopes: There is evidence that safeguards in the Netherlands and Belgium are ineffective and violated, including administering lethal drugs without patient consent, absence of terminal illness, untreated psychiatric diagnoses, and nonreporting; 2. Lack of self-determination: Psychological and social motives characterize requests for PAS-E more than physical symptoms or rational choices; many requests disappear with improved symptom control and psychological support; 3. Inadequate palliative care: Better palliative care makes most patients physically comfortable. Many individuals requesting PAS-E don’t want to die but to escape their suffering. Adequate treatment for depression and pain decreases the desire for death; 4. Medical professionalism: PAS-E transgresses the inviolable rule that physicians heal and palliate suffering but never intentionally inflict death; 5. Differences between means and ends: Proeuthanasia advocates look to the ends (the patient’s death) and say the ends justify the means; opponents disagree and believe that killing patients to relieve suffering is different from allowing natural death and is not acceptable. Conclusions: Physicians have a duty to eliminate pain and suffering, not the person with the pain and suffering. Solutions for suffering lie in improving palliative care and social conditions and addressing the reasons for PAS-E requests. They should not include changing medical practice to allow PAS-E.
Collapse
Affiliation(s)
- Charles L. Sprung
- General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Margaret A. Somerville
- Professor of Bioethics, School of Medicine, The University of Notre Dame Australia, Sydney, Australia; Samuel Gale Professor of Law Emerita, Professor Faculty of Medicine Emerita, Founding Director of the Centre for Medicine, Ethics and Law Emerita, McGill University Montreal, Canada
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Gunnar Duttge
- Center for Medical Law, Georg-August-University Göttingen, Göttingen, Germany
| | - Jefferson P. Piva
- Federal University of Rio Grande do Sul (Brazil), Medical Director-Pediatric Emergency and Critical Care, Department H Clinicas P. Alegre, Brazil
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore—Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Daniel P. Sulmasy
- Kennedy Institute of Ethics and Pellegrino Center, Departments of Medicine and Philosophy, Georgetown University, Washington D.C., United States
| | - Willem Lemmens
- Department of Philosophy, Centre for Ethics, University of Antwerp, Belgium
| | - E. Wesley Ely
- Department of Medicine, Vanderbilt University Medical Center and Veteran’s Affair TN Valley Geriatric Research Education Clinical Center (GRECC), Nashville, TN, United States
| |
Collapse
|
88
|
Piili RP, Metsänoja R, Hinkka H, Kellokumpu-Lehtinen PLI, Lehto JT. Changes in attitudes towards hastened death among Finnish physicians over the past sixteen years. BMC Med Ethics 2018; 19:40. [PMID: 29843682 PMCID: PMC5975714 DOI: 10.1186/s12910-018-0290-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 05/16/2018] [Indexed: 02/06/2023] Open
Abstract
Background The ethics of hastened death are complex. Studies on physicians’ opinions about assisted dying (euthanasia or assisted suicide) exist, but changes in physicians’ attitudes towards hastened death in clinical decision-making and the background factors explaining this remain unclear. The aim of this study was to explore the changes in these attitudes among Finnish physicians. Methods A questionnaire including hypothetical patient scenarios was sent to 1182 and 1258 Finnish physicians in 1999 and 2015, respectively. Two scenarios of patients with advanced cancer were presented: one requesting an increase in his morphine dose to a potentially lethal level and another suffering a cardiac arrest. Physicians’ attitudes towards assisted death, life values and other background factors were queried as well. The response rate was 56%. Results The morphine dose was increased by 25% and 34% of the physicians in 1999 and 2015, respectively (p < 0.001). Oncologists approved the increase most infrequently without a significant change between the study years (15% vs. 17%, p = 0.689). Oncological specialty, faith in God, female gender and younger age were independent factors associated with the reluctance to increase the morphine dose. Euthanasia, but not assisted suicide, was considered less reprehensible in 2015 (p = 0.008). In both years, most physicians (84%) withheld cardiopulmonary resuscitation. Conclusion Finnish physicians accepted the risk of hastening death more often in 2015 than in 1999. The physicians’ specialty and many other background factors influenced this acceptance. They also regarded euthanasia as less reprehensible now than they did 16 years ago.
Collapse
Affiliation(s)
- Reetta P Piili
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland. .,Department of Oncology, Palliative Care Unit, Tampere University Hospital, Teiskontie 35, R-building, 33520, Tampere, Finland.
| | - Riina Metsänoja
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | | | - Pirkko-Liisa I Kellokumpu-Lehtinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Oncology, Palliative Care Unit, Tampere University Hospital, Teiskontie 35, R-building, 33520, Tampere, Finland
| | - Juho T Lehto
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Oncology, Palliative Care Unit, Tampere University Hospital, Teiskontie 35, R-building, 33520, Tampere, Finland
| |
Collapse
|
89
|
Regan L, Preston NJ, Eccles FJR, Simpson J. The views of adults with Huntington's disease on assisted dying: A qualitative exploration. Palliat Med 2018; 32:708-715. [PMID: 29139332 DOI: 10.1177/0269216317741850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Assisted dying is frequently debated publicly and research often includes the views of health professionals on this issue. However, the views of people with life-limiting conditions, for whom this issue is likely to have a different resonance, are less well represented. AIM The purpose of this study was to explore the views of people who live with the inevitability of developing Huntington's disease, a genetically transmitted disease which significantly limits life, on assisted dying. DESIGN Using thematic analysis methodology, individual semi-structured interviews were conducted. SETTING/PARTICIPANTS Seven participants (five women and two men) who were gene positive for Huntington's disease took part in the study. RESULTS Four themes were extracted: (1) autonomy and kindness in assisted dying: the importance of moral principles; (2) Huntington's disease threatens life and emphasises issues relating to death; (3) dilemmas in decision-making on assisted dying: "There are no winners" and (4) the absence of explicit discussion on dying and Huntington's disease: "Elephants in the room". CONCLUSIONS Our findings suggest that talking to patients about assisted death may not cause harm and may even be invited by many patients with Huntington's disease. The perspectives of those who live with Huntington's disease, especially given its extended effects within families, add significant clinical and theoretical insights.
Collapse
Affiliation(s)
- Laurence Regan
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Nancy J Preston
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Fiona J R Eccles
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, UK
| |
Collapse
|
90
|
Gamondi C, Pott M, Preston N, Payne S. Family Caregivers' Reflections on Experiences of Assisted Suicide in Switzerland: A Qualitative Interview Study. J Pain Symptom Manage 2018; 55:1085-1094. [PMID: 29288877 DOI: 10.1016/j.jpainsymman.2017.12.482] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 02/08/2023]
Abstract
CONTEXT Thousands of family members worldwide are annually involved in assisted dying. Family participation in assisted dying has rarely been investigated and families' needs typically are not considered in assisted dying legislation and clinical guidelines. OBJECTIVES To explore family caregivers' reflections on experiences of assisted suicide in Switzerland. METHODS A cross-sectional qualitative interview study conducted in the Italian- and French-speaking regions of Switzerland. Interpretation and analysis were performed using qualitative content analysis. RESULTS Twenty-eight close relatives and family carers of 18 patients who died by assisted suicide in Switzerland were interviewed. Family members perceived their involvement in assisted suicide as characterized by five phases; 1) contemplation, 2) gaining acceptance, 3) gaining permission, 4) organization, and 5) aftermath. Families can participate in these phases at diverse levels and with varying degrees of involvement. Important triggers for families and patients for transition between phases include patients' experiences of their life-threatening illnesses and related treatments, their increasing awareness of approaching death, and family member recognition of their loved one's unbearable suffering. Participating in assisted suicide created further demanding tasks for families in addition to their role of caregivers. CONCLUSION Families appeared to be involved in the preparation of assisted suicide along with patients, irrespective of their personal values regarding assisted dying. Support for family members is essential if they are involved in tasks preparatory to assisted suicide. Clinical guidelines and policies concerning assisted dying should acknowledge and address family needs.
Collapse
Affiliation(s)
- C Gamondi
- Service de Soins Palliatifs et de Support, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | - Murielle Pott
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Nancy Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Sheila Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| |
Collapse
|
91
|
Catford J. Healthy dying: time for health promotion to get serious. Health Promot Int 2018; 33:183-186. [DOI: 10.1093/heapro/day019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John Catford
- Chair, Editorial Board Health Promotion International Executive Deans Office, Faculty of Health, Deakin University, Geelong Waurn Ponds Campus, Locked Bag 20000, Geelong, Victoria 3220, Australia
| |
Collapse
|
92
|
Tuffrey-Wijne I, Curfs L, Finlay I, Hollins S. Euthanasia and assisted suicide for people with an intellectual disability and/or autism spectrum disorder: an examination of nine relevant euthanasia cases in the Netherlands (2012-2016). BMC Med Ethics 2018; 19:17. [PMID: 29506512 PMCID: PMC5838868 DOI: 10.1186/s12910-018-0257-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/21/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Euthanasia and assisted suicide (EAS) have been legally possible in the Netherlands since 2001, provided that statutory due care criteria are met, including: (a) voluntary and well-considered request; (b) unbearable suffering without prospect of improvement; (c) informing the patient; (d) lack of a reasonable alternative; (e) independent second physician's opinion. 'Unbearable suffering' must have a medical basis, either somatic or psychiatric, but there is no requirement of limited life expectancy. All EAS cases must be reported and are scrutinised by regional review committees (RTE). The purpose of this study was to investigate whether any particular difficulties arise when the EAS due care criteria are applied to patients with an intellectual disability and/or autism spectrum disorder. METHODS The 416 case summaries available on the RTE website (2012-2016) were searched for intellectual disability (6) and autism spectrum disorder (3). Direct content analysis was used on these nine cases. RESULTS Assessment of decisional capacity was mentioned in eight cases, but few details given; in two cases, there had been uncertainty or disagreement about capacity. Two patients had progressive somatic conditions. For most, suffering was due to an inability to cope with changing circumstances or increasing dependency; in several cases, suffering was described in terms of characteristics of living with an autism spectrum disorder, rather than an acquired medical condition. Some physicians struggled to understand the patient's perspective. Treatment refusal was a common theme, leading physicians to conclude that EAS was the only remaining option. There was a lack of detail on social circumstances and how patients were informed about their prognosis. CONCLUSIONS Autonomy and decisional capacity are highly complex for patients with intellectual disabilities and difficult to assess; capacity tests in these cases did not appear sufficiently stringent. Assessment of suffering is particularly difficult for patients who have experienced life-long disability. The sometimes brief time frames and limited number of physician-patient meetings may not be sufficient to make a decision as serious as EAS. The Dutch EAS due care criteria are not easily applied to people with intellectual disabilities and/or autism spectrum disorder, and do not appear to act as adequate safeguards.
Collapse
Affiliation(s)
- Irene Tuffrey-Wijne
- Kingston University & St George’s, University of London, Cranmer Terrace, London, SW7 0RE UK
| | - Leopold Curfs
- Governor Kremers Centre, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Ilora Finlay
- Cardiff University, Velindre NHS Trust, Cardiff, CF14 2TL UK
| | - Sheila Hollins
- St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
| |
Collapse
|
93
|
Religiosity and the Wish of Older Adults for Physician-Assisted Suicide. RELIGIONS 2018. [DOI: 10.3390/rel9030066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
94
|
Radbruch L, Ling J, Hegedus K, Larkin P. European Association for Palliative Care: Forging a Vision of Excellence in Palliative Care in Central and Eastern European and Former Soviet Union Countries. J Pain Symptom Manage 2018; 55:S117-S120. [PMID: 28797853 DOI: 10.1016/j.jpainsymman.2017.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/02/2017] [Indexed: 11/19/2022]
Abstract
The European Association for Palliative Care (EAPC) represents many thousands of health care workers and volunteers working in or with an interest in palliative care. In 2016, the EAPC has individual members from 48 nations across the world, and collective members from 57 national palliative care associations in 32 European countries. Throughout its history, the EAPC has produced guidance on a range of palliative care issues. The biennial congresses and research congresses and the comprehensive Web site (www.eapcnet.eu) are renowned and well utilized platforms for dissemination and exchange of palliative care information. The EAPC has also published a newsletter specifically for Eastern European and Central Asian countries that has been available in both English and Russian from 2005 to 2012. In addition, for a period of time, a Russian Web site (www.eapcspeaksrussian.eu) was also available. A survey of palliative care in Central and Eastern European nations sponsored by Open Society Foundation's International Palliative Care Initiative found that in most countries, the national language is preferred rather than using English or Russian for the provision of information. Accordingly, the EAPC Web site provides translations of white papers, position papers, and blog posts in a number of languages.
Collapse
Affiliation(s)
- Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany; Center for Palliative Care, Malteser Hospital Bonn, Bonn, Germany.
| | - Julie Ling
- European Association for Palliative Care, Milan, Italy
| | - Katalin Hegedus
- Semmelweis University, Institute of Behavioral Sciences, Budapest, Hungary
| | - Philip Larkin
- Our Lady's Hospice & Care Services, Dublin, Ireland; UCD College of Health Sciences, Dublin, Ireland
| |
Collapse
|
95
|
Prado BL, Gomes DBD, Usón Júnior PLS, Taranto P, França MS, Eiger D, Mariano RC, Hui D, Del Giglio A. Continuous palliative sedation for patients with advanced cancer at a tertiary care cancer center. BMC Palliat Care 2018; 17:13. [PMID: 29301574 PMCID: PMC5755023 DOI: 10.1186/s12904-017-0264-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 12/12/2017] [Indexed: 11/10/2022] Open
Abstract
Background Palliative sedation (PS) is an intervention to treat refractory symptoms and to relieve suffering at the end of life. Its prevalence and practice patterns vary widely worldwide. The aim of our study was to evaluate the frequency, clinical indications and outcomes of PS in advanced cancer patients admitted to our tertiary comprehensive cancer center. Methods We retrospectively studied the use of PS in advanced cancer patients who died between March 1st, 2012 and December 31st, 2014. PS was defined as the use of continuous infusion of midazolam or neuroleptics for refractory symptoms in the end of life. This study was approved by the Research Ethics Committee of our institution (project number 2481–15). Results During the study period, 552 cancer patients died at the institution and 374 met the inclusion criteria for this study. Main reason for exclusion was death in the Intensive Care Unit. Among all included patients, 54.2% (n = 203) received PS. Patients who received PS as compared to those not sedated were younger (67.8 vs. 76.4 years-old, p < 0.001) and more likely to have a diagnosis of lung cancer (23% vs. 14%, p = 0.028). The most common indications for sedation were dyspnea (55%) and delirium (19.7%) and the most common drugs used were midazolam (52.7%) or midazolam and a neuroleptic (39.4%). Median initial midazolam infusion rate was 0.75 mg/h (interquartile range – IQR - 0.6-1.5) and final rate was 1.5 mg/h (IQR 0.9–3.0). Patient survival (length of hospital stay from admission to death) of those who had PS was more than the double of those who did not (33.6 days vs 16 days, p < 0.001). The palliative care team was involved in the care of 12% (n = 25) of sedated patients. Conclusions PS is a relatively common practice in the end-of-life of cancer patients at our hospital and it is not associated with shortening of hospital stay. Involvement of a dedicated palliative care team is strongly recommended if this procedure is being considered. Further research is needed to identify factors that may affect the frequency and outcomes associated with PS. Electronic supplementary material The online version of this article (10.1186/s12904-017-0264-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Bernard Lobato Prado
- Oncology Department, Hospital Israelita Albert Einstein, 627 Albert Einstein Av., Sao Paulo, 05652-900, Brazil.
| | - Diogo Bugano Diniz Gomes
- Oncology Department, Hospital Israelita Albert Einstein, 627 Albert Einstein Av., Sao Paulo, 05652-900, Brazil
| | | | - Patricia Taranto
- Oncology Department, Hospital Israelita Albert Einstein, 627 Albert Einstein Av., Sao Paulo, 05652-900, Brazil
| | - Monique Sedlmaier França
- Oncology Department, Hospital Israelita Albert Einstein, 627 Albert Einstein Av., Sao Paulo, 05652-900, Brazil
| | - Daniel Eiger
- Oncology Department, Hospital Israelita Albert Einstein, 627 Albert Einstein Av., Sao Paulo, 05652-900, Brazil
| | - Rodrigo Coutinho Mariano
- Oncology Department, Hospital Israelita Albert Einstein, 627 Albert Einstein Av., Sao Paulo, 05652-900, Brazil
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, USA
| | - Auro Del Giglio
- Faculdade de Medicina do ABC, 821 Principe de Gales Av, Santo André, Brazil
| |
Collapse
|
96
|
Dierickx S, Deliens L, Cohen J, Chambaere K. Involvement of palliative care in euthanasia practice in a context of legalized euthanasia: A population-based mortality follow-back study. Palliat Med 2018; 32:114-122. [PMID: 28849727 PMCID: PMC5758933 DOI: 10.1177/0269216317727158] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In the international debate about assisted dying, it is commonly stated that euthanasia is incompatible with palliative care. In Belgium, where euthanasia was legalized in 2002, the Federation for Palliative Care Flanders has endorsed the viewpoint that euthanasia can be embedded in palliative care. AIM To examine the involvement of palliative care services in euthanasia practice in a context of legalized euthanasia. DESIGN Population-based mortality follow-back survey. SETTING/PARTICIPANTS Physicians attending a random sample of 6871 deaths in Flanders, Belgium, in 2013. RESULTS People requesting euthanasia were more likely to have received palliative care (70.9%) than other people dying non-suddenly (45.2%) (odds ratio = 2.1 (95% confidence interval, 1.5-2.9)). The most frequently indicated reasons for non-referral to a palliative care service in those requesting euthanasia were that existing care already sufficiently addressed the patient's palliative and supportive care needs (56.5%) and that the patient did not want to be referred (26.1%). The likelihood of a request being granted did not differ between cases with or without palliative care involvement. Palliative care professionals were involved in the decision-making process and/or performance of euthanasia in 59.8% of all euthanasia deaths; this involvement was higher in hospitals (76.0%) than at home (47.0%) or in nursing homes (49.5%). CONCLUSION In Flanders, in a context of legalized euthanasia, euthanasia and palliative care do not seem to be contradictory practices. A substantial proportion of people who make a euthanasia request are seen by palliative care services, and for a majority of these, the request is granted.
Collapse
Affiliation(s)
- Sigrid Dierickx
- 1 End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Luc Deliens
- 1 End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,2 Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Joachim Cohen
- 1 End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Kenneth Chambaere
- 1 End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| |
Collapse
|
97
|
Symptomlinderung. Palliat Care 2018. [DOI: 10.1007/978-3-662-56151-5_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
98
|
Jox RJ, Black I, Borasio GD, Anneser J. Voluntary stopping of eating and drinking: is medical support ethically justified? BMC Med 2017; 15:186. [PMID: 29052518 PMCID: PMC5649087 DOI: 10.1186/s12916-017-0950-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physician-assisted dying has been the subject of extensive discussion and legislative activity both in Europe and North America. In this context, dying by voluntary stopping of eating and drinking (VSED) is often proposed, and practiced, as an alternative method of self-determined dying, with medical support for VSED being regarded as ethically and legally justified. ARGUMENT In our opinion, this view is flawed. First, we argue that VSED falls within the concept of suicide, albeit with certain unique features (non-invasiveness, initial reversibility, resemblance to the natural dying process). Second, we demonstrate, on the basis of paradigmatic clinical cases, that medically supported VSED is, at least in some instances, tantamount to assisted suicide. This is especially the case if a patient's choice of VSED depends on the physician's assurance to provide medical support. CONCLUSION Thus, for many jurisdictions worldwide, medically supported VSED may fall within the legal prohibitions on suicide assistance. Physicians, lawmakers, and societies should discuss specific ways of regulating medical support for VSED in order to provide clear guidance for both patients and healthcare professionals. Please see related article: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0951-0 .
Collapse
Affiliation(s)
- Ralf J Jox
- Institute for Ethics, History and Theory of Medicine, University of Munich, Lessingstr. 2, D-80336, Munich, Germany. .,Geriatric Palliative Care, University of Lausanne, Lausanne, Switzerland.
| | - Isra Black
- York Law School, The University of York, York, UK.,Palliative Care Service, Technical University Munich, Munich, Germany
| | - Gian Domenico Borasio
- Service de Soins Palliatifs et de Support, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Johanna Anneser
- Palliative Care Service, Technical University Munich, Munich, Germany
| |
Collapse
|
99
|
Medikamente und toxische Substanzen in der Sterbehilfe. Rechtsmedizin (Berl) 2017. [DOI: 10.1007/s00194-017-0207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
100
|
De Lima L, Wenk R, Pettus K, Radbruch L. No Occultation in the International Association for Hospice and Palliative Care Position Statement on Palliative Care and Assisted Suicide. J Palliat Med 2017; 20:1309-1310. [PMID: 28885091 DOI: 10.1089/jpm.2017.0364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Liliana De Lima
- 1 International Association for Hospice and Palliative Care , Houston, Texas
| | - Roberto Wenk
- 1 International Association for Hospice and Palliative Care , Houston, Texas.,2 Fundacion FEMEBA , San Nicolas, Argentina
| | - Katherine Pettus
- 1 International Association for Hospice and Palliative Care , Houston, Texas
| | - Lukas Radbruch
- 1 International Association for Hospice and Palliative Care , Houston, Texas.,3 Department of Palliative Medicine, Malteser Hospital , Bonn, Germany .,4 Palliative Care Centre, Malteser Hospital Bonn/Rhein-Sieg , Bonn, Germany
| |
Collapse
|