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Appel JE, van Wijngaarden E, Dezutter J. Tiredness of Life - Conceptualizing a Complex Phenomenon. Psychol Rep 2024:332941241268815. [PMID: 39054766 DOI: 10.1177/00332941241268815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
A phenomenon referred to as 'tiredness of life' or 'weariness of life' appears in current discussions on the legitimacy of euthanasia for relatively healthy older adults as well as in research on suicidality more broadly. However, a consensus conceptualization of the phenomenon is lacking. In the current paper, we offer such a conceptualization by reviewing and integrating knowledge from terminology, available descriptions, and first qualitative findings. Boredom with life, aversion towards life, meaninglessness, and fatigue are identified as central components of the phenomenon. Per component, we describe how the component was identified, our definition of the component and its foundation in descriptions in the literature, and empirical studies on how the component relates to euthanasia requests and suicidality. Moreover, hypotheses on the structure of the phenomenon are outlined, such as on interactions among and the importance of the different components.
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Affiliation(s)
- Judith E Appel
- Meaning Research Late Life Lab, Faculty of Psychology and Educational Science, University of Leuven, KU Leuven, Leuven, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Els van Wijngaarden
- Meanings of Ageing and Dying Lab, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Jessie Dezutter
- Meaning Research Late Life Lab, Faculty of Psychology and Educational Science, University of Leuven, KU Leuven, Leuven, Belgium
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van den Ende C, Asscher ECA. No (true) right to die: barriers in access to physician-assisted death in case of psychiatric disease, advanced dementia or multiple geriatric syndromes in the Netherlands. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024; 27:181-188. [PMID: 38376767 PMCID: PMC11076306 DOI: 10.1007/s11019-023-10190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 02/21/2024]
Abstract
Even in the Netherlands, where the practice of physician-assisted death (PAD) has been legalized for over 20 years, there is no such thing as a 'right to die'. Especially patients with extraordinary requests, such as a wish for PAD based on psychiatric suffering, advanced dementia, or (a limited number of) multiple geriatric syndromes, encounter barriers in access to PAD. In this paper, we discuss whether these barriers can be justified in the context of the Dutch situation where PAD is legally permitted for those who suffer unbearably and hopelessly as a result of medical conditions. Furthermore, we explore whether there are options to address some of the barriers or their consequences, both within the Dutch legal framework or by adjusting the legal framework, and whether these options are feasible. We conclude that although there are insufficient arguments to overrule the doctor's freedom of conscience in the Netherlands, there are ways to address some of the barriers, mainly by offering support to doctors that would be willing to support a request. Moreover, we believe it is morally required to reduce or mitigate where possible the negative consequences of the barriers for patients, such as the long waiting time for those who suffer from psychiatric disorders, because it is unlikely the adjustments suggested to the system will ensure reasonable access for these patient groups.
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Affiliation(s)
- Caroline van den Ende
- Department of General Practice/Family Medicine, Amsterdam UMC, Amsterdam, The Netherlands.
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Kraak-Steenken FWM, Renckens SC, Pasman HRW, Bosma F, van der Heide A, Onwuteaka-Philipsen BD. Euthanasia and Physician-Assisted Suicide in People With an Accumulation of Health Problems Related to Old Age: A Cross-Sectional Questionnaire Study Among Physicians in the Netherlands. Int J Public Health 2024; 69:1606962. [PMID: 38698912 PMCID: PMC11064696 DOI: 10.3389/ijph.2024.1606962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/27/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives: We explored characteristics of people with an accumulation of health problems related to old age requesting euthanasia or physician-assisted suicide (EAS) and identified characteristics associated with granting EAS requests. Methods: We conducted a cross-sectional questionnaire study among Dutch physicians on characteristics of these people requesting EAS (n = 123). Associations between characteristics and granting a request were assessed using logistic regression analyses. Results: People requesting EAS were predominantly >80 years old (82.4%), female (70.0%), widow/widower (71.7%), (partially) care-dependent (76.7%), and had a life expectancy >12 months (68.6%). The most prevalent health problems were osteoarthritis (70.4%) and impaired vision and hearing (53.0% and 40.9%). The most cited reasons to request EAS were physical deterioration (68.6%) and dependence (61.2%). 44.7% of requests were granted. Granting a request was positively associated with care dependence, disability/immobility, impaired vision, osteoporosis, loss of control, suffering without prospect of improvement and a treatment relationship with the physician >12 months. Conclusion: Enhanced understanding of people with an accumulation of health problems related to old age requesting EAS can contribute to the ongoing debate on the permissibility of EAS in people without life-threatening conditions.
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Affiliation(s)
- Frédérique W. M. Kraak-Steenken
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - Sophie C. Renckens
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - H. Roeline W. Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - Fenne Bosma
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
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Forycka M, Liberacka-Dwojak M, Leppert W, Suchecki P, Suchecka N, Ast B. Psychological Factors Influencing Attitudes towards Euthanasia, Assisted Suicide and Palliative Care among Medical Students and Doctors in Training. Healthcare (Basel) 2024; 12:833. [PMID: 38667594 PMCID: PMC11050125 DOI: 10.3390/healthcare12080833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: This study aimed to analyse the attitudes of medical students, Polish and classical philology students and trainee doctors towards the legalisation and practice of euthanasia and assisted suicide, to explore their beliefs about palliative care and to identify the cognitive, behavioural and emotional factors influencing these attitudes. Methods: An anonymous 22-question survey was sent by email to 670 participants, who comprised students of medicine, students of Polish and classical philology and trainee physicians. Results: Out of the 670 people invited to the survey, 313 (46.72%) responded; 215 (68.69%) and 112 (35.80%) participants supported the legalisation of euthanasia and assisted suicide, respectively. No differences were found between the respondent groups studied. The respondents' attitudes were influenced by religion, place of residence and professed values in the doctor-patient relationship. Among the medical students and trainee doctors surveyed, the declared willingness to perform euthanasia was lower, with 90 (43.7%) people, than the support for its legalisation, with 135 (65.5%) people. Significantly higher support for palliative care was expressed by fifth- and sixth-year medical students and trainee doctors, with 88 respondents (89.89%), less support was expressed by first- and fourth-year medical students, with 74 respondents (68.5%), and the lowest support was observed among Polish and classical philology students, with 63 respondents (58.9%). Conclusions: The legalisation of euthanasia and assisted suicide was supported by more than two-thirds and one-third of all the respondents, respectively, with the majority of medical students and trainee doctors surveyed expressing uncertainty or lack of readiness towards their practice. More than 70% of all the respondents showed a positive opinion towards palliative care, with the lowest support being among Polish and classical philology students.
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Affiliation(s)
- Maria Forycka
- Department of Palliative Medicine, Institute of Medical Sciences, Collegium Medicum, University of Zielona Góra, ul. Zyty 28, 65-046 Zielona Góra, Poland;
| | | | - Wojciech Leppert
- Department of Palliative Medicine, Institute of Medical Sciences, Collegium Medicum, University of Zielona Góra, ul. Zyty 28, 65-046 Zielona Góra, Poland;
- University Hospital in Poznań, Osiedla Rusa 55, 61-245 Poznań, Poland
| | - Paweł Suchecki
- MediCenter Primary Care Physicians, ul. 3 Maja 13, 99-400 Łowicz, Poland; (P.S.); (N.S.)
| | - Natalia Suchecka
- MediCenter Primary Care Physicians, ul. 3 Maja 13, 99-400 Łowicz, Poland; (P.S.); (N.S.)
| | - Bartłomiej Ast
- Department of Care and Treatment Facility, Józef Struś Multispecialist Municipal Hospital, ul. Szwajcarska 3, 61-285 Poznań, Poland;
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Pujol-Fontrodona G, Domínguez-Roldán JM, Valero R. Organic law regulating euthanasia: knowledge and involvement of doctors in Spain one year after its implementation. Rev Clin Esp 2023; 223:596-603. [PMID: 37898356 DOI: 10.1016/j.rceng.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/27/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND AND AIMS The Organic Law Regulating Euthanasia (LORE, for its initials in Spanish) came into force in June 2021. This study aims to examine knowledge of the LORE among physicians licensed in Spain as well as their involvement with and the impact of the law. METHODS This work is a descriptive, cross-sectional study conducted by means of a survey. Information was gathered through a self-administered questionnaire. RESULTS The survey was answered by 1446 physicians licensed in Spain. The samples' demographic characteristics were as follows: 54.7% were women, the mean age was 52 ± 14 years, and 66.0% worked in a hospital. Catalonia was the autonomous community with the most participants (44.6%). Regarding specialties, anesthesiology and resuscitation had the highest number of participants (21.9%), followed by family and community medicine (18.5%). The LORE was known in detail by 24.3% of physicians, 58.0% had a positive opinion of it, and 31.1% had direct experience with the euthanasia procedure. Practitioners working in the hospital setting perceived the law more favorably compared to those in the primary care setting (62.3% vs. 47.3%, p < 0.01). CONCLUSIONS Most doctors did not have in-depth knowledge of the LORE, although a majority supported its existence, particularly those in hospital medicine. Most physicians who viewed the LORE negatively were male, older, and worked in primary care. A minority of physicians considered registering as conscientious objectors.
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Affiliation(s)
- G Pujol-Fontrodona
- Servicio de Anestesiología y Reanimación, Hospital Clínic Barcelona, Barcelona, España
| | - J M Domínguez-Roldán
- Unidad de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Sevilla, España; Departamento de Medicina, Universidad de Sevilla, Sevilla, España
| | - R Valero
- Servicio de Anestesiología y Reanimación, Hospital Clínic Barcelona, Barcelona, España; Departamento de Cirugía y Especialidades Médico quirúrgicas, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Madrid, España.
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Güth U, Junker C, McMillan S, Elfgen C, Schneeberger AR. Long-term experience on assisted suicide in Switzerland: dementia, mental disorders, age-related polymorbidity and the slippery slope argument. Public Health 2023; 223:249-256. [PMID: 37690397 DOI: 10.1016/j.puhe.2023.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/14/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES According to the Swiss medico-ethical guidelines valid between 2004 and 2018, the key criterion for assisted suicide (AS) was that the patients who wished to die suffered with a disease leading to death in the foreseeable future. Critics of AS fears that broadening of the medical indications will lead to an uncontrolled expansion to persons who are not terminally ill (slippery slope argument). We evaluated to what extent this broadening took place in practice over time. STUDY DESIGN Retrospective national cohort study. METHODS By using data of the Swiss Federal Statistical Office, we analyzed the long-term development of AS in Switzerland over a 20-year period (1999-2018; n = 8738 cases). We classified the cases into one of three categories regarding the aforementioned key criterion for AS. RESULTS In 43.6% of AS cases, the criterion 'end of life is near' was met. In 5.3% of cases, this criterion was not met (4.7%: mental disorders; 0.6%: dementia). In 51.1% of cases, the reason underlying AS comprised several, mostly age-related diseases and/or functional impairments; the aforementioned key criterion, however, was probably not met in most of the cases. Over time, the number of cases doubled over each 5-year period; this increase occurred similarly for the three categories. CONCLUSION The fact that many AS cases took place outside the valid medico-ethical guidelines might be interpreted as a development in the idea of the slippery slope argument. The fact that the percentage distribution of these cases remained unchanged over time argues against it.
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Affiliation(s)
- U Güth
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, Zurich CH-8008, Switzerland; University of Basel, Faculty of Medicine, Klingelbergstrasse 61, Basel CH-4056, Switzerland.
| | - C Junker
- Federal Statistical Office, Espace de l'Europe 10, Neuchâtel CH-2010, Switzerland.
| | - S McMillan
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, Zurich CH-8008, Switzerland.
| | - C Elfgen
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, Zurich CH-8008, Switzerland; University of Witten/Herdecke, Faculty of Medicine; Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany.
| | - A R Schneeberger
- University of California San Diego, Department of Psychiatry, 8950 Villa La Jolla Drive, La Jolla, CA 92037, USA.
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Xu H, Stjernswärd S, Glasdam S, Fu C. Circumstances affecting patients' euthanasia or medically assisted suicide decisions from the perspectives of patients, relatives, and healthcare professionals: A qualitative systematic review. DEATH STUDIES 2023; 48:326-351. [PMID: 37390123 DOI: 10.1080/07481187.2023.2228730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
This study aims to explore circumstances affecting patients' euthanasia and medically assisted suicide (MAS) decisions from the perspectives of patients, relatives, and healthcare professionals. A qualitative systematic review was performed following PRISMA recommendations. The review protocol is registered in PROSPERO (CRD42022303034). Literature searches were conducted in MEDLINE, EMBASE, CINAHL Complete, Eric, PsycInfo, and citation pearl search in Scopus from 2012 to 2022. In total, 6840 publications were initially retrieved. The analysis included a descriptive numerical summary analysis and a qualitative thematic analysis of 27 publications, resulting in two main themes-Contexts and factors influencing actions and interactions, and Finding support while dealing with resistance in euthanasia and MAS decisions-and related sub-themes. The results illuminated the dynamics in (inter)actions between patients and involved parties that might both impede and facilitate patients' decisions related to euthanasia/MAS, potentially influencing patients' decision-making experiences, and the roles and experiences of involved parties.
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Affiliation(s)
- Hongxuan Xu
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Sigrid Stjernswärd
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Stinne Glasdam
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Cong Fu
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Katayama O, Lee S, Bae S, Makino K, Chiba I, Harada K, Morikawa M, Tomida K, Shimada H. A simple algorithm to predict disability in community-dwelling older Japanese adults. Arch Gerontol Geriatr 2022; 103:104778. [PMID: 35853274 DOI: 10.1016/j.archger.2022.104778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/27/2022] [Accepted: 07/11/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND With a worldwide aging population, the prevention of disability in older adults has become an important issue. Therefore, the purpose of this study was to develop a model for predicting disability risk in older adults based on multiple factors, using a decision tree analysis. This model may be used with a mobile application when it is difficult to interview older adults, and to obtain individualized information for prioritizing interventions. METHODS We examined the data from a cohort study conducted by the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. We included 12,000 older adults without a disability and performed a decision tree analysis using the Chi-square automatic interaction detection (CHAID) algorithm. RESULTS Among the 12,000 participants without a disability, 11,503 and 497 participants remained disability-free and developed disability, respectively. The CHAID analysis identified 24 end nodes with five levels of partition and 16 partitioning variables for 34 questionnaire variables, with incident disability probabilities ranging from 0.0% to 96.7%. The classification accuracy and area under the curve of the CHAID model were 73.4% and 0.76, respectively. We found that maintaining mental health was important for older adults in their 80s and older, and that lifestyles and geriatric syndromes were important factors for those in their 70s. CONCLUSIONS The magnitude of the influences on the risk of developing a disability differ by age group. The results of this study may provide useful information for the development of mobile applications that predict the risk of developing disability and create tailor-made interventions.
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Affiliation(s)
- Osamu Katayama
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi 474-8511, Japan; Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo 102-0083, Japan.
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi 474-8511, Japan
| | - Seongryu Bae
- Department of Health Care and Science, Dong-A University, 37 Nakdong-daero 550, Saha-gu, Busan 49315, South Korea
| | - Keitaro Makino
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi 474-8511, Japan; Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo 102-0083, Japan
| | - Ippei Chiba
- Tohoku Medical Megabank Organization (ToMMo), Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8573, Japan
| | - Kenji Harada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi 474-8511, Japan
| | - Masanori Morikawa
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi 474-8511, Japan
| | - Kouki Tomida
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi 474-8511, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi 474-8511, Japan
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van Wijngaarden E, Sanders J. 'I want to die on my own terms': Dominant interpretative repertoires of 'a good death' in old age in Dutch newspapers. Soc Sci Med 2022; 311:115361. [PMID: 36108564 DOI: 10.1016/j.socscimed.2022.115361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
RATIONALE There is a paucity of empirical studies exploring how death and dying in old age are actually represented and debated within the Dutch society. OBJECTIVE This study examines the discourse used in Dutch newspapers on the good death and dignified dying. It analyses how different types of social actions and positions are construed, thereby describing how death and dying in old age are portrayed in newspaper media. METHODS 173 newspaper articles between 2010 and 2020 were selected from five Dutch national newspapers. Data were thematically coded and scrutinised for discursive patterns in order to identify interpretative repertoires and their functions. RESULTS Four interpretative repertoires of good death and dying in old age were identified, all drawing on the assisted dying debate: Choice, Risk, Care, and Complexity. Each repertoire constructs a particular image of death and dying, varying from it being a personal choice; a last resort; a joint journey; to a contingent quest. The different repertoires imply distinct identities and actions. The Choice-repertoire construes older people as active subjects who autonomously determine their own death. The Risk- and Care-repertoires both construe older people primarily as passive and acted upon: either threatened by illness, decline and death; or protected and cared for by others and society. The Complexity-repertoire construes older people's situation as an object of reflection. DISCUSSION AND CONCLUSION The strong prevalence of the Choice-repertoire in Dutch newspapers construes good death and dignified dying in old age in a salient way, unrepresentatively highlighting assisted dying as the preferred imagined practice. It is hypothesised that reimaging the Care- and Complexity-repertoires in such a way that they construe older persons in a more active subject role could help depolarise the debate on death and dying in old age.
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Affiliation(s)
- Els van Wijngaarden
- Associate Professor in the Meanings of Ageing and Dying Radboud University Medical Center Nijmegen Geert Grooteplein Zuid, 10 6525, GA, Nijmegen, the Netherlands.
| | - José Sanders
- Professor Communication in Organisations: Narrative Communication, Centre for Language Studies, Radboud University, Erasmusplein 1, 6525 HT, Nijmegen, the Netherlands
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Buturovic Z. Euthanasia and organ donation still firmly connected: reply to Bollen et al. JOURNAL OF MEDICAL ETHICS 2022; 48:488-489. [PMID: 33963068 DOI: 10.1136/medethics-2021-107498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
Bollen et al, replying to my own article, describe, in great detail, administrative and logistical aspects of euthanasia approval and organ donation in the Netherlands. They seem to believe that no useful lessons can be drawn from experiences of related groups such as euthanasia patients (typically patients with cancer) who cannot donate organs; patients who chose assisted suicide as opposed to euthanasia; patients in intensive care units and their relatives and suicidal young people as if we can only learn about organ donation in euthanasia patients by studying this exact group and no other, no matter how closely related and obviously relevant. However, it is not only permissible but also absolutely essential to gather evidence that goes beyond immediate point of interest and carefully study groups that share important features with it. Also, groups eligible for euthanasia are constantly expanding, theoretically, legally and practically, and it would be irresponsible to not foresee what are likely future developments. Finally, myopic focus on the technicalities of the procedure misses psychological reality that drives decisions and behaviours and which rarely mimics administrative timelines. Patients proceeding through euthanasia pipeline already face substantial situational pressure and adding organ donation on top of it can make the whole process work as a commitment device. By allowing euthanasia patients to donate their organs, we are giving them additional reason to end their lives, thus creating an unbreakable connection between the two.
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Requests for euthanasia or assisted suicide of people without (severe) illness. Health Policy 2022; 126:824-830. [PMID: 35710476 DOI: 10.1016/j.healthpol.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Some people request euthanasia or assisted suicide (EAS) even though they are not (severely) ill. In the Netherlands the presence of sufficient medical ground for the suffering is a strict prerequisite for EAS. The desirability of this 'medical ground'-boundary is currently questioned. Legislation has been proposed to facilitate EAS for older persons with "completed life" or "tiredness of life" in the absence of (severe) illness. OBJECTIVES To describe the characteristics and motivations of persons whose requests for EAS in the absence of (severe) illness did not result in EAS and the decision-making process of medical professionals in these types of requests. METHODS Analysis of 237 applicant records of the Dutch Euthanasia Expertise Center. We studied both the perspectives of applicants and medical professionals. FINDINGS The majority of the applicants were women (73%) aged 75 years and older (79%). Applicants most often indicated physical suffering as element of suffering and reason for the request. Medical professionals indicated in 40% of the cases no or insufficient medical ground for the suffering. CONCLUSIONS Physical suffering plays an important role in requests for EAS even for persons who are not (severely) ill. From the presence of physical suffering it does not necessarily follow that for medical professionals there is sufficient medical ground to comply with the 'medical ground'-boundary.
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Yun YH, Sim JA, Choi Y, Yoon H. Attitudes toward the Legalization of Euthanasia or Physician-Assisted Suicide in South Korea: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095183. [PMID: 35564575 PMCID: PMC9105789 DOI: 10.3390/ijerph19095183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/16/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the general South Korean public attitudes toward the legalization of euthanasia or physician-assisted suicide (EAS) and examine the reasons underpinning these attitudes. From March–June 2021, we conducted a cross-sectional survey of a representative national sample of 1000 South Koreans aged 19 years or older. Three in four participants (76.4%) expressed positive attitudes toward the legalization of EAS. Participants who agreed with this legalization reported “meaninglessness of the rest of life” and “right to a good death” as their main reasons. Participants who disagreed with the legalization of EAS reported “respect for life”, “violation of the right to self-determination”, “risk of abuse or overuse”, and “violation of human rights” as theirs. In the multivariate logistic regression analyses, participants with poor physical status (adjusted odds ratio [aOR]: 1.41, 95%; confidence interval [CI]: 1.02–1.93) or comorbidity (aOR: 1.84, 95%; CI: 1.19–2.83) showed positive attitudes toward the legalization of EAS. In summary, most of the general South Korean population regards the legalization of EAS positively, especially participants with poor physical status or comorbidity.
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Affiliation(s)
- Young Ho Yun
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; (Y.C.); (H.Y.)
- Department of Family Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-740-8417
| | - Jin-Ah Sim
- School of AI Convergence, Hallym University, Chuncheon 200160, Korea;
| | - Yeani Choi
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; (Y.C.); (H.Y.)
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Hyejeong Yoon
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; (Y.C.); (H.Y.)
- College of Liberal Studies, Seoul National University, Seoul 03080, Korea
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Groenewoud AS, Leijten E, Oever S, Sommeren J, Boer TA. The ethics of euthanasia in dementia: A qualitative content analysis of case summaries (2012–2020). J Am Geriatr Soc 2022; 70:1704-1716. [PMID: 35187649 PMCID: PMC9306787 DOI: 10.1111/jgs.17707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/03/2022] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Abstract
Background The practice of euthanasia in dementia has thus far been described both in terms of its empirical patient characteristics and its ethical questions. However, 40 new cases have been published since the last study. Methods A qualitative content analysis of all 111 Dutch case summaries of euthanasia in dementia patients between 2012 and 2020, selected from the total of 1117 cases published by the Regional Euthanasia Review Committees (RTE). Our initial analytical framework consists of six due care criteria and five ethical principles. Results 111 case summaries were analyzed, from which we distilled seven recurring ethical questions: (1) How voluntary is a request? (2) Can an incapacitated patient make well‐considered requests? (3) What constitutes “unbearable suffering”? (4) What if the unbearableness of suffering solely consists of “the absence of any prospect of improvement”? (5) What if a euthanasia request is meant to prevent future suffering (now for then)? (6) How (well) can a patient with cognitive limitations be informed? (7) What are “reasonable alternatives” and what if patients decline available alternatives? Conclusions Beyond these questions, however, we also see some serious challenges for the future: (a) narrowing the gap between perceived and real nursing home quality, since many advance euthanasia directives refer to nursing homes as sources of unbearable suffering; (b) making information to incompetent patients and their relatives about end of life options more tailor made, since it is questionable whether patients with dementia currently understand all of the euthanasia procedure; (c) involving patients' own physician as long as possible in a euthanasia request. Training may help physicians to deal better with euthanasia requests by patients suffering from dementia; (d) longitudinal research is required that encompasses all dementia euthanasia cases, not only those selected by the RTE.
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Affiliation(s)
- Antonie Stef Groenewoud
- Radboud University Medical Center, Scientific Center for Quality of Healthcare (IQ Healthcare) Nijmegen the Netherlands
- Protestant Theological University Groningen the Netherlands
| | - Ellen Leijten
- Radboud University Medical Center Nijmegen the Netherlands
| | - Sterre Oever
- Radboud University Medical Center Nijmegen the Netherlands
| | - Julia Sommeren
- Radboud University Medical Center Nijmegen the Netherlands
| | - Theodoor Adriaan Boer
- Protestant Theological University Groningen the Netherlands
- University of Sunderland Sunderland UK
- Health Council of the Netherlands The Hague the Netherlands
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14
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van Wijngaarden E. The Darker Side of Ageing: Towards an Ethics of Suffering that Emphasises the Primacy of Witnessing. JOURNAL OF POPULATION AGEING 2021. [DOI: 10.1007/s12062-021-09331-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractMany older adults succeed in finding meaning in life, even in deep old age. There is, however, a minority of older adults, in particular among the oldest old, who feel that life no longer makes sense: they suffer from the consequences of old age, explicated in feelings of loneliness, social isolation and disconnectedness, and fears for (further) decline and dependency. This article seeks to address this darker side of ageing. It discusses probing questions including: what can we learn from the stories of those who severely struggle with the consequences of old age? And how might these stories guide us in finding ways how we – both as fellow human beings and as a society – can face and respond to suffering in old age? To achieve this, this article first briefly outlines the scholarship on suffering and explores the idea of suffering from life in old age. Secondly, drawing on empirical work, it reflects on the phenomenological question: what is it like to suffer from life in old age? What does it mean to live with a deep sense that life is no longer worth living? Then, thirdly, building on these insights, the aim is to work towards developing an ethics of suffering that emphasises the primacy of witnessing. It is argued that in the confrontation with manifestations of meaninglessness and suffering that cannot be solved or remedied, we need bystanders who are willing to name, to narrate, to give voice and connect to these experiences of suffering.
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15
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Florijn BW, Kaptein AA. Narrative Ethics in Response to Unbearable Suffering-the Dutch Slippery Slope Is Nonexistent. JAMA Intern Med 2021; 181:1016. [PMID: 33749733 DOI: 10.1001/jamainternmed.2021.0198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Barend W Florijn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands
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16
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Bollen J, van Mook W, Vissers K. Narrative Ethics in Response to Unbearable Suffering-the Dutch Slippery Slope Is Nonexistent. JAMA Intern Med 2021; 181:1016-1017. [PMID: 33749750 DOI: 10.1001/jamainternmed.2021.0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Walther van Mook
- Department of Intensive Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, the Netherlands
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17
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Organisierte Sterbehilfe und ärztlich assistierter Suizid bei Alterssyndromen. Dtsch Med Wochenschr 2021. [DOI: 10.1055/a-1392-8839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Guinjoan SM. Expert opinion in Alzheimer disease: The silent scream of patients and their family during coronavirus disease 2019 (COVID-19) pandemic. PERSONALIZED MEDICINE IN PSYCHIATRY 2021. [PMCID: PMC7859695 DOI: 10.1016/j.pmip.2021.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
COVID-19 pandemic is expected to be the greatest challenge for mental health since World War II in general, but the toll exacted on patients with Alzheimer’s disease (AD) and their family is the greatest in several respects. AD patients are at the highest risk for contagion and death from the disease, but also at the very bottom in the list of priorities to access critical care services at times of medical resource scarcity. In this communication we examine the impact of the pandemic on AD patients and their family from the general medical, neurological, and mental health perspectives. We propose that instances of undue restriction of access to care based upon age and diagnosis show that society, governments, and health professionals need to exert maximum care, human compassion, and adherence to original Hippocratic values when addressing the needs of persons with AD and other major neurocognitive disorders during the COVID-19 pandemic, and that psychiatry is called to contribute to societal measures oriented to diminish human burden in this population.
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