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Regnard C, Worthington A, Finlay I. Oregon Death with Dignity Act access: 25 year analysis. BMJ Support Palliat Care 2024:spcare-2023-004292. [PMID: 37788941 DOI: 10.1136/spcare-2023-004292] [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: 03/22/2023] [Accepted: 07/30/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Assisted dying has been legally available in Oregon in the USA for 25 years, since when official reports have been published each year detailing the number of people who have used this option as well as sociodemographic and information about the process. The aim of this study was to examine changes over time in these data. METHODS We collated and reviewed data on 2454 assisted deaths included in annual reports on assisted deaths published by the Oregon Health Authority from 1998 to 2022. Descriptive statistics were used to describe time trends. RESULTS The number of assisted deaths in Oregon increased from 16 in 1998 to 278 in 2022. Over this time, patients' health funding status changed from predominantly private (65%) to predominantly government support (79.5%), and there was an increase in patients feeling a burden and describing financial concerns as reasons for choosing an assisted death. There has been a reduction in the length of the physician-patient relationship from 18 weeks in 2010 to 5 weeks in 2022, and the proportion referred for psychiatric assessment remains low (1%). Data are frequently missing, particularly around complications. CONCLUSIONS The number and characteristics of people accessing assisted deaths, and the process, have changed since data collection started in 1998. Prospective studies are needed to examine the relationship between socioeconomic factors and the desire for an assisted death in Oregon.
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Affiliation(s)
- Claud Regnard
- Honorary Consultant in Palliative Medicine, St Oswald's Hospice, Newcastle upon Tyne, UK
| | | | - Ilora Finlay
- Professor of Palliative Medicine, School of Medicine, Cardiff University School of Medicine, Cardiff, UK
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Trejo-Gabriel-Galán JM. Euthanasia and assisted suicide in neurological diseases: a systematic review. Neurologia 2024; 39:170-177. [PMID: 38272260 DOI: 10.1016/j.nrleng.2024.01.007] [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: 01/06/2021] [Revised: 03/29/2021] [Accepted: 04/04/2021] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE To identify the neurological diseases for which euthanasia and assisted suicide are most frequently requested in the countries where these medical procedures are legal and the specific characteristics of euthanasia in some of these diseases, and to show the evolution of euthanasia figures. METHODS We conducted a systematic literature review. RESULTS Dementia, motor neuron disease, multiple sclerosis, and Parkinson's disease are the neurological diseases that most frequently motivate requests for euthanasia or assisted suicide. Requests related to dementia constitute the largest group, are growing, and raise additional ethical and legal issues due to these patients' diminished decision-making capacity. In some countries, the ratios of euthanasia requests to all cases of multiple sclerosis, motor neuron disease, or Huntington disease are higher than for any other disease. CONCLUSIONS After cancer, neurological diseases are the most frequent reason for requesting euthanasia or assisted suicide.
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Harrawood KA. Medical aid in dying: The role of the nurse practitioner. J Am Assoc Nurse Pract 2024:01741002-990000000-00193. [PMID: 38206106 DOI: 10.1097/jxx.0000000000000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
ABSTRACT Medical aid in dying (MAID) is a practice that has been expanding in the United States over the past few decades. As it becomes a viable option for a growing portion of the American population, nurse practitioners (NPs) need to be prepared to engage in conversation with patients about the practice. Although historically only physicians were able to participate in MAID, the role has recently expanded to include additional advanced practice providers, including NPs. Reviewing the history of MAID and examining how current legislation affects clinical practice can support the NP's ability to educate and counsel patients about the option. Identifying specific areas in which MAID providers report needing additional training and support can help providers work toward delivering the highest quality patient care possible. As MAID becomes accessible to greater numbers of people, NPs need to be prepared to talk to patients who are navigating serious, life-limiting illnesses about the possibility of MAID.
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Affiliation(s)
- Kathryn A Harrawood
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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4
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Scott JD, Bell D, Barry B, Edlund JE. Juror Decision Making and Euthanasia: Exploring the Role of Jury Nullification, Manner of Death, and Defendant-Decedent Relationship. Psychol Rep 2023; 126:3052-3070. [PMID: 35484479 DOI: 10.1177/00332941221093244] [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] [Indexed: 11/17/2022]
Abstract
In cases of euthanasia, determinations of guilt may be influenced by legal and extra-legal factors. This study explores the role that nullification instructions play in juror decision making. A defendant may be viewed as less culpable if the act was done out of mercy and jury nullification may occur as a result. We anticipated that these determinations may be influenced by the manner of death and the relational distance between the defendant and the decedent. It is unknown how euthanasia is viewed when it is performed by a physician compared to a family member or friend. To answer these questions, participants acted as mock jurors in a euthanasia case. The descriptions of the case varied by the presence of nullification instructions, the manner of death, and the defendant's relationship to the decedent. The results revealed significant effects of method of euthanasia and the type of defendant on juror verdicts. Jurors were most likely to acquit in a case that provided nullification instructions and involved a spouse using lethal injection for euthanasia. This finding suggests that different circumstances of a euthanasia case will affect jurors' propensity to focus on personal sympathies and interpretations. Limitations and future directions are discussed.
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Affiliation(s)
- Jason D Scott
- Department of Criminal Justice, Rochester Institute of Technology, Rochester, NY, USA
| | - Daniel Bell
- Department of Psychology, Rochester Institute of Technology, Rochester, NY, USA
| | - Brian Barry
- Department of Sociology and Anthropology, Rochester Institute of Technology, Rochester, NY, USA
| | - John E Edlund
- Department of Psychology, Rochester Institute of Technology, Rochester, NY, USA
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Thabet C, Wheatley-Price P, Moore S. Medical Assistance in Dying in Patients With Cancer. JCO Oncol Pract 2023; 19:819-827. [PMID: 37582243 DOI: 10.1200/op.22.00615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE Medical assistance in dying (MAiD) was legalized in Canada in 2016. To date, patients with cancer account for 69% of MAiD deaths, yet little information is available about these patients. We reviewed disease and treatment characteristics of patients with cancer who underwent MAiD to better understand this population and identify gaps in our current system of care. MATERIALS AND METHODS Patients with cancer who underwent MAiD through the Champlain Regional MAiD Network from June 2016 to November 2020 were reviewed. Baseline demographic, diagnostic, and treatment details were collected by retrospective review. RESULTS During the study period, 255 patients with cancer underwent MAiD. At the time of MAiD, 201 patients (79%) had metastatic disease. Most prevalent solid organ tumors were gastrointestinal (30%), lung (18%) and genitourinary (14%). MAiD was primarily provided in the home (48%) or an acute inpatient facility (40%). One hundred eighty-nine (74%) patients were evaluated by medical oncology, 23 by gynecology oncology (9%), 11 by hematology oncology (4%), and 177 (69%) by radiation oncology. One hundred fifty-eight (62%) patients were not seen by oncology specialists in the 30 days prior to MAiD. One hundred fifty-nine patients (62%) had at least one line of systemic therapy, 138 patients (54%) received radiotherapy, and 61 patients (24%) did not receive cancer-directed treatment. Palliative care assessed at least 213 patients (84%). Common reasons for pursuing MaiD included disease-related symptoms (33%), fear of future suffering or disability (19%), and the ability to control the time and manner of death (17%). In 36% of cases, the reason was not documented. CONCLUSION Although formal oncology consultation is not required before MAiD, with an ever-increasing number of novel cancer therapies, oncologists, cancer centers, and MAiD providers should consider collaborating to ensure a streamlined assessment process for patients.
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Affiliation(s)
- Chloe Thabet
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Wheatley-Price
- Department of Medical Oncology, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute Ottawa, Ontario, Canada
| | - Sara Moore
- Department of Medical Oncology, University of Ottawa, Ottawa, Ontario, Canada
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van Eenennaam RM, Kruithof W, Beelen A, Bakker LA, van Eijk RPA, Maessen M, Baardman JF, Visser-Meily JMA, Veldink JH, van den Berg LH. Frequency of euthanasia, factors associated with end-of-life practices, and quality of end-of-life care in patients with amyotrophic lateral sclerosis in the Netherlands: a population-based cohort study. Lancet Neurol 2023; 22:591-601. [PMID: 37353279 DOI: 10.1016/s1474-4422(23)00155-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis is a progressive and lethal neurodegenerative disease that is at the forefront of debates on regulation of assisted dying. Since 2002, when euthanasia was legally regulated in the Netherlands, the frequency of this end-of-life practice has increased substantially from 1·7% of all deaths in 1990 and 2005 to 4·5% in 2015. We aimed to investigate whether the frequency of euthanasia in patients with amyotrophic lateral sclerosis had similarly increased since 2002, and to assess the factors associated with end-of-life practices and the quality of end-of-life care in patients with this disease. METHODS Using data from the Netherlands ALS registry, we did a population-based cohort study of clinicians and informal caregivers of patients with amyotrophic lateral sclerosis to assess factors associated with end-of-life decision making and the quality of end-of-life care. We included individuals who were diagnosed with amyotrophic lateral sclerosis according to the revised El-Escorial criteria, and who died between Jan 1, 2014, and Dec 31, 2016. We calculated the frequency of euthanasia in patients with amyotrophic lateral sclerosis from reports made to euthanasia review committees (ERCs) between 2012 and 2020. Results were compared with clinic-based survey studies conducted in 1994-2005. End-of-life practices were end-of-life decisions by a clinician when hastening of death was considered as the potential, probable, or definite effect comprising euthanasia, physician-assisted suicide, ending of life without explicit request, forgoing life-prolonging treatment, and intensified alleviation of symptoms. FINDINGS Between Jan 1, 2012, and Dec 31, 2020, 4130 reports of death from amyotrophic lateral sclerosis were made to ERCs, of which 1014 were from euthanasia or physician-assisted suicide (mean frequency 25% [SD 3] per year). Sex and gender data were unavailable from the ERC registry. Of 884 patients with amyotrophic lateral sclerosis who died between Jan 1, 2014, and Dec 31, 2016, their treating clinician was identified for 731 and a caregiver was identified for 741, of whom 356 (49%) and 450 (61%), respectively, agreed to participate in the population-based survey study. According to clinicians, end-of-life practices were chosen by 280 (79%) of 356 patients with amyotrophic lateral sclerosis who died. The frequency of euthanasia in patients with amyotrophic lateral sclerosis in 2014-16 (141 [40%] of 356 deaths in patients with amyotrophic lateral sclerosis) was higher than in 1994-98 (35 [17%] of 203) and 2000-05 (33 [16%] of 209). Median survival of patients with amyotrophic lateral sclerosis from diagnosis was 15·9 months (95% CI 12·6-17·6) for those who chose euthanasia and 16·1 months (13·4-19·1) for those who did not choose euthanasia (hazard ratio 1·07, 95% CI 0·85-1·34; p=0·58). According to caregivers, compared with other end-of-life practices, patients with amyotrophic lateral sclerosis choosing euthanasia commonly reported reasons to hasten death as no chance of improvement (53 [56%] of 94 patients who chose euthanasia vs 28 [39%] of 72 patients who chose other end-of-life practices), loss of dignity (47 [50%] vs 15 [21%]), dependency (34 [36%] vs five [7%]), and fatigue or extreme weakness (41 [44%] vs 14 [20%]). According to caregivers, people with amyotrophic lateral sclerosis-whether they chose euthanasia or did not-were satisfied with the general quality (83 [93%] of 89 patients who chose euthanasia vs 73 [86%] of 85 patients who did not) and availability (85 [97%] of 88 vs 81 [91%] of 90) of end-of-life care. INTERPRETATION The proportion of patients with amyotrophic lateral sclerosis who chose euthanasia in the Netherlands has increased since 2002. The choice of euthanasia was not associated with disease or patient characteristics, depression or hopelessness, or the availability or quality of end-of-life care. The choice of euthanasia had no effect on overall survival. Future studies could focus on the effect of discussing end-of-life options on quality of life as part of multidisciplinary care throughout the course of the disease, to reduce feelings of loss of autonomy and dignity in patients living with amyotrophic lateral sclerosis. FUNDING Netherlands ALS Foundation.
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Affiliation(s)
- Remko M van Eenennaam
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands; Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands; De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Willeke Kruithof
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands; Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands; De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Anita Beelen
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands; Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands; De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Leonhard A Bakker
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands; Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands; De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Ruben P A van Eijk
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands; Biostatistics & Research Support, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Maud Maessen
- University Center for Palliative Care, Inselspital University Hospital Bern, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Joost F Baardman
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands; Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands; De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Jan H Veldink
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands.
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de Araújo AFM. Letter to the Editor: Castling Against Death: A Chess-Based Insight into the Paradox of Physician-Assisted Suicide. J Palliat Med 2023; 26:892. [PMID: 37428969 DOI: 10.1089/jpm.2023.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Affiliation(s)
- Antonio Fábio Medrado de Araújo
- Postgraduate Programme in Medicine and Health (PPGMS), Federal University of Bahia (UFBA) and Expert of the Global Ethics Observatory (GEObs)-UNESCO, Salvador, Brazil
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Vissers S, Dierickx S, Deliens L, Mortier F, Cohen J, Chambaere K. Characteristics and outcomes of peer consultations for assisted dying request assessments: Cross-sectional survey study among attending physicians. Front Public Health 2023; 11:1100353. [PMID: 37064672 PMCID: PMC10090406 DOI: 10.3389/fpubh.2023.1100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/27/2023] [Indexed: 03/31/2023] Open
Abstract
BackgroundIn most jurisdictions where assisted dying practices are legal, attending physicians must consult another practitioner to assess the patient's eligibility. Consequently, in some jurisdictions, they can rely on the expertise of trained assisted dying consultants (trained consultants). However, these peer consultations remain under-researched. We examined the characteristics and outcomes of peer consultations to assess an assisted dying request with trained consultants, and explored how these characteristics influence the performance of assisted dying.MethodsWe conducted a cross-sectional survey in 2019–2020 in Belgium among attending physicians who had consulted a trained consultant for an assisted dying request assessment (N = 904).ResultsThe valid response rate was 56% (502/903). The vast majority of attending physicians (92%) who had consulted a trained consultant were general practitioners. In more than half of the consultations (57%), the patient was diagnosed with cancer. In 66%, the patient was aged 70 or older. Reported as the patients' most important reasons to request assisted dying: suffering without prospect of improving in 49% of the consultations, loss of dignity in 11%, pain in 9%, and tiredness of life in 9%. In the vast majority of consultations (85%), the attending physician consulted the trained consultant because of the expertise, and in nearly half of the consultations (46%) because of the independence. In more than nine out of ten consultations (91%), the consultant gave a positive advice: i.e., substantive requirements for assisted dying were met. Eight out of ten consultations were followed by assisted dying. The likelihood of assisted dying was higher in consultations in which loss of dignity, loss of independence in daily living, or general weakness or tiredness were reasons for the request.ConclusionOur findings indicate that the peer consultation practice with trained consultants is most often embedded in a primary care setting. Moreover, our study corroborates previous research in that assisted dying is performed relatively less frequently in patients with cancer and more often in patients with general deterioration. Our findings suggest that attending physicians hold peer consultations with trained consultants to endorse their own decision-making and to request additional support.
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Affiliation(s)
- Stijn Vissers
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Universiteit Gent, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Ghent, Belgium
- *Correspondence: Stijn Vissers
| | - Sigrid Dierickx
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Universiteit Gent, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Ghent, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Universiteit Gent, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Ghent, Belgium
| | - Freddy Mortier
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Universiteit Gent, Brussels, Belgium
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Universiteit Gent, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Universiteit Gent, Brussels, Belgium
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Universiteit Gent, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Ghent, Belgium
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Dieudonné Rahm N, Pautex S. Determinants of suicidal history before assisted versus self-initiated suicide late in life: an observational study. Swiss Med Wkly 2023; 153:40042. [PMID: 36787459 DOI: 10.57187/smw.2023.40042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Older adults are at risk of assisted and self-initiated suicide. The links between prior attempts and assisted suicide in the elderly have not been investigated. Hence, we aimed to investigate and describe the occurrence, timing and determinants of suicide attempts prior to assisted and self-initiated suicide. METHODS We developed a retrospective study of all assisted and self-initiated suicides among people over 65 years in the canton of Geneva, Switzerland, for a 10-year period (2010-2019). Cases were identified by cross-referencing hospitals' routinely collected electronic data and a forensic report database. Cases were characterised in terms of sociodemographic factors, mental health disorders, main comorbidities, temporal sequence, methods of injury, medical complications and disclosure rates of previous attempts. The study used descriptive statistics. RESULTS A total of 26 of 497 (5.2%) and 20 of 149 (13.4%) older adults had made previous attempts before assisted and self-initiated suicide, respectively. More than half of them had made a single attempt, mostly by medication poisoning, sometimes more than 10 years before dying. Individuals who made two attempts were significantly more represented among the assisted suicide decedents. One self-initiated suicide decedent and half of the assisted suicide cases had disclosed that they had considered suicide. Individual characteristics were similar, except for assisted suicide decedents, who were eight years older than self-initiated suicide decedents. Almost all the individuals had mental disorders. Depression, anxiety and chronic pain were particularly prevalent among decedents of assisted suicide. The substantial representation of women in both groups may be an indication of their vulnerability, possibly related to chronic pain and life stressors. CONCLUSIONS Our results show commonalities between older assisted and self-initiated suicide decedents who made an attempt (s) before suicide. Further research is needed to demonstrate the overlap between the determinants of assisted suicide and other forms of suicidality and to support a suicide prevention strategy applicable to both types of suicide.
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Affiliation(s)
- Nathalie Dieudonné Rahm
- Department of Rehabilitation and Geriatrics, Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Pautex
- Department of Rehabilitation and Geriatrics, Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
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Quah ELY, Chua KZY, Lua JK, Wan DWJ, Chong CS, Lim YX, Krishna L. A Systematic Review of Stakeholder Perspectives of Dignity and Assisted Dying. J Pain Symptom Manage 2023; 65:e123-e136. [PMID: 36244639 DOI: 10.1016/j.jpainsymman.2022.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The debate on assisted dying and its components, euthanasia and physician-assisted suicide has evolved with the emergence of the right to dignity and the wish to hasten death (WTHD). Whilst shaped by local legal and sociocultural considerations, appreciation of how patients, healthcare professionals and lawmakers relate notions of dignity to self-concepts of personhood and the desire for assisted dying will better inform and direct support of patients. METHODS Guided by the Systematic Evidence Based Approach, a systematic scoping review (SSR in SEBA) on perspectives of dignity, WTHD and personhood featured in PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL, Scopus databases and four key Palliative Care journals was conducted. The review hinged on the following questions: "what is the relationship between dignity and the wish to hasten death (WTHD) in the assisted dying debate?", "how is dignity conceptualised by patients with WTHD?" and "what are prevailing perspectives on the role of assisted dying in maintaining a dying patient's dignity?" RESULTS 6947 abstracts were identified, 663 full text articles reviewed, and 88 articles included. The four domains identified include 1) concepts of dignity through the lens of the Ring Theory of Personhood (RToP) including their various definitions and descriptions; 2) the relationship between dignity, WTHD and assisted dying with loss of dignity and autonomy foregrounded; 3) stakeholder perspectives for and against assisted dying including those of patient, healthcare provider and lawmaker; and 4) other dignity-conserving measures as alternatives to assisted dying. CONCLUSION Concepts of dignity constantly evolve throughout the patient's end of life journey. Understanding when and how these concepts of personhood change and trigger the fear of a loss of dignity or intractable suffering could direct timely, individualised and appropriate person-centred dignity conserving measures. We believe an RToP-based tool could fulfil this role and further study into the design of this tool is planned.
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Affiliation(s)
- Elaine Li Ying Quah
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Jun Kiat Lua
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Darius Wei Jun Wan
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Chi Sum Chong
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Yun Xue Lim
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Lalit Krishna
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore; Division of Cancer Education (L.K), National Cancer Centre Singapore Singapore; Division of Supportive and Palliative Care (L.K), National Cancer Centre Singapore (L.K), Singapore; Palliative Care Institute Liverpool (L.K), Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom; Health Data Science (L.K), Liverpool; Duke-NUS Medical School (L.K), Singapore; Centre of Biomedical Ethics (L.K), Singapore; PalC (L.K), The Palliative Care Centre for Excellence in Research and Education, Dover Park Hospice, Singapore.
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Callinan K, Grube D, Ramirez V. Medical Aid in Dying. Cancer Treat Res 2023; 187:347-360. [PMID: 37851240 DOI: 10.1007/978-3-031-29923-0_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
As the nation's 75 million baby boomers enter into a new phase of their life, care for their aging parents, and contemplate their own mortality, many have come to realize that our end-of-life care system is hamstrung by outdated modes of dying. This chapter discusses the current status of medical aid in dying in the United States as a legal and medically recognized medical option for supporting patients at life's end.
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Affiliation(s)
- Kim Callinan
- Compassion and Choices, Portland, Oregon, United States.
| | - David Grube
- Compassion and Choices, Portland, Oregon, United States
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Riley S, Sarbey B. The Unexamined Benefits of the Expansive Legalization of Medical Assistance-in-Dying. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:655-665. [PMID: 36156765 DOI: 10.1007/s11673-022-10211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/17/2022] [Indexed: 06/16/2023]
Abstract
If you slide far enough down the slippery slope envisioned by opponents of medical assistance-in-dying (MAiD), you eventually land in a ghastly society with industrialized euthanasia, rampant suicide, and devalued life. But what if the slippery slope leads us somewhere better? This paper explores the benefits of eliminating nearly all MAiD prohibitions and regulations. We anticipate three positive effects for public health: 1. Expanded access to those currently not qualified from MAiD by removing ineffective access criteria; 2. Harm reduction by making MAiD safer and by rerouting suicidal patients into alternate care; and 3. Improvements to the health system through lowered healthcare costs and increased patient activation in end-of-life care. Safeguards and prohibitions deny those who wish to die the ability to do so to prevent the potential danger of a few being subjected to an undesired early death.
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Affiliation(s)
- Sean Riley
- The Ohio State University Wexner Medical Center, 2050 Kenny Rd, Columbus, OH, 43215, USA.
| | - Ben Sarbey
- Duke University, 1364 Campus Dr., Durham, NC, 27705, USA
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13
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Singer J, Daum C, Shen MJ, Zecha G, Kaplan L, Plakovic K, Blazey M, Arnold M, Silko B, Baker K, Loggers ET. Assessment of Oncology Advanced Practice Professional Willingness to Participate in Medical Aid in Dying. JAMA Netw Open 2022; 5:e2239068. [PMID: 36287559 PMCID: PMC9606841 DOI: 10.1001/jamanetworkopen.2022.39068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE In 2021, New Mexico passed legislation allowing nurse practitioners and physician assistants (referred to herein as advanced practice professionals [APPs]) to prescribe medications for medical aid in dying (MAID). Other US states with existing MAID laws (eg, Washington) are also considering expanding MAID prescribing authority to APPs. There is a lack of research exploring APP knowledge of, willingness to, and comfort with acting as a prescribing or consulting clinician for MAID. OBJECTIVE To assess perspectives of oncology APPs regarding MAID, including their willingness to prescribe and/or consult for MAID and factors associated with willingness. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, self-report survey study used data collected from APPs working at a comprehensive cancer center in Washington State in fall 2021. MAIN OUTCOMES AND MEASURES The primary survey question was whether APPs would be willing to participate in death with dignity, the term used for MAID in Washington. Survey questions evaluated how influential specific factors were on APP views on MAID as well as respondents' knowledge of and comfort with aspects of the MAID process. RESULTS Of 167 eligible APPs, 77 (46.1%) responded to the survey. Most respondents (68 [88.3%]) reported their race and ethnicity as White; 72 (93.5%) identified as a woman. Medical oncology (28 [36.4%]) was the most common field of practice, and 21 respondents (27.3%) reported having practiced as an APP for 6 to 10 years. Of all respondents, 61 (79.2%) reported having at least 1 patient who inquired about MAID; depending on the question, less than a third of respondents (5.0%-27.0%) endorsed feeling knowledgeable or very knowledgeable about any aspect of the MAID process. In this study, 39 APPs (50.6%) endorsed being willing to participate in MAID either as a consulting or prescribing clinician, whereas 31 (40.3%) were uncertain of whether they would participate. Willingness to participate was associated with having had more patients pursue MAID (33 of the 39 willing participants [84.6%] vs 15 of the 31 unsure participants [48.4%] reported having 1 or more patients pursue MAID). Higher knowledge and comfort scores were both significantly associated with increased odds of being willing to participate (odds ratio, 1.14 per 1-point score increase [95% CI, 1.03-1.27]; P = .01) vs unsure (1.18 [95% CI, 1.07-1.30; P = .001). CONCLUSIONS AND RELEVANCE The results of this survey study suggest that oncology APPs may require preparation for the addition of MAID to their scope of practice. This study also raises questions for future research regarding support for APPs who may be considering participation in MAID but question their role or want physician involvement.
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Affiliation(s)
- Jonathan Singer
- Department of Psychological Sciences, Texas Tech University, Lubbock
| | - Courtney Daum
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Megan J. Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Louise Kaplan
- College of Nursing, Washington State University, Vancouver
| | | | | | - Molly Arnold
- Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Kelsey Baker
- Clinical Research Division, Department of Clinical Biostatistics, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Elizabeth T. Loggers
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Division of Oncology, University of Washington, Seattle
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14
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Kozlov E, Nowels M, Gusmano M, Habib M, Duberstein P. Aggregating 23 years of data on medical aid in dying in the United States. J Am Geriatr Soc 2022; 70:3040-3044. [PMID: 35708060 PMCID: PMC9588508 DOI: 10.1111/jgs.17925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/31/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Elissa Kozlov
- Department of Health Behavior, Society and PolicyRutgers School of Public HealthPiscatawayNew JerseyUSA
| | - Molly Nowels
- Department of Health Behavior, Society and PolicyRutgers School of Public HealthPiscatawayNew JerseyUSA
| | - Michael Gusmano
- Department of Community and Population Health; Center for EthicsCollege of Health, Lehigh UniversityBethlehemPennsylvaniaUSA,Research DepartmentThe Hastings CenterGarrisonNew YorkUSA
| | - Muhammed Habib
- Department of Medicine, Division of OncologyRutgers Cancer Institute of New JerseyNew BrunswickNew JersyUSA
| | - Paul Duberstein
- Department of Health Behavior, Society and PolicyRutgers School of Public HealthPiscatawayNew JerseyUSA
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15
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Katz M. Palliative Care and Movement Disorders. Continuum (Minneap Minn) 2022; 28:1520-1529. [DOI: 10.1212/con.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Variath C, Climans SA, Edelstein K, Bell JAH. Neuro-oncology clinicians' perspectives on factors affecting brain cancer patients' access to medical assistance in dying: A qualitative study. DEATH STUDIES 2022; 47:296-306. [PMID: 35442866 DOI: 10.1080/07481187.2022.2063456] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In most jurisdictions where medical assistance in dying (MAiD) is legal, patients must have decision-making capacity. Brain cancer often damages the cognitive networks required to maintain decision-making capacity. Using qualitative methodology guided by a relational ethics conceptual framework, this study explored neuro-oncology clinicians' perspectives on access to and eligibility for MAiD for patients diagnosed with brain cancer. We interviewed 24 neuro-oncology clinicians from 6 countries. Participants described the unique challenges facing brain cancer patients, potentially resulting in their inequitable access to MAiD. The findings highlight the importance of early end-of-life conversations, advance care planning, and access to end-of-life treatment options.
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Affiliation(s)
- Caroline Variath
- Lawrence S Bloomberg School of Nursing, Joint Centre for Bioethics, University of Toronto, Toronto, Canada
| | - Seth A Climans
- Departments of Neurology and Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Kim Edelstein
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jennifer A H Bell
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
- Dalla Lana School of Public Health, Joint Centre for Bioethics, University of Toronto, Toronto, Canada
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17
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Damron L, Bayram E, McGehrin K, Reynolds J, Hess R, Coughlin DG, Litvan I. Physician-Assisted Dying: Access and Utilization in Patients with Movement Disorders. Mov Disord 2022; 37:694-698. [PMID: 35218063 DOI: 10.1002/mds.28964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Lisa Damron
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Ece Bayram
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Kevin McGehrin
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Jane Reynolds
- University of California San Diego, Moores Cancer Center, La Jolla, California, USA
| | - Robert Hess
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - David G Coughlin
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
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18
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Daneault S, Azri M, Ummel D, Vinit F, Côté A, Leclerc-Loiselle J, Laperle P, Gendron S. Non-somatic Suffering in Palliative Care: A Qualitative Study on Patients' Perspectives. J Palliat Care 2022; 37:518-525. [PMID: 35234108 PMCID: PMC9465553 DOI: 10.1177/08258597221083421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Suffering is intimately linked to the experience of
illness, and its relief is a mandate of medicine. Advances in knowledge around
terminal illness have enabled better management of the somatic dimension.
Nevertheless, there is what can be called “non-somatic” suffering which in some
cases may take precedence. Inspired by Paul Ricoeur's thinking on human
suffering, our aim in this qualitative study was to better understand the
experience of non-somatic suffering. Methods: Semi-structured
interviews were conducted with 19 patients. The results were qualitatively
analyzed following a continuous comparative analysis approach inspired by
grounded theory. Results: Three key themes synthesize the
phenomenon: “the being enduring the suffering”, “the being whose agency is
constrained”, and “the being in relationship with others.” The first describes
what patients endure, the shock and fears associated with their own finitude,
and the limits of what can be tolerated. The second refers to the experience of
being restricted and of mourning the loss of their capacity to act. The last
describes a residual suffering related to their interactions with others, that
of loneliness and of abandoning their loved ones, two dimensions that persist
even when they have accepted their own death. Conclusions:
Non-somatic suffering can be multifarious, even when minimized by the patient.
When evaluating suffering, we must keep in mind that patients can reach a
“breaking point” that signals the state of unbearable suffering. In managing it,
we probably need to make more room for family and friends, as well as a posture
of caring based more on presence and listening.
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Affiliation(s)
- Serge Daneault
- Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - Mehdi Azri
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Deborah Ummel
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Canada
| | - Florence Vinit
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Andréanne Côté
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | - Philippe Laperle
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Sylvie Gendron
- Faculty of Nursing Science, Université de Montréal, Montreal, Canada
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19
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Montagna G, Junker C, Elfgen C, Schneeberger A, Güth U. Assisted suicide in patients with cancer. ESMO Open 2022; 7:100349. [PMID: 35066409 PMCID: PMC8789521 DOI: 10.1016/j.esmoop.2021.100349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/14/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background There are limited data on the long-term development and trends of assisted suicide (AS) among cancer patients. Patients and methods Using data of the Swiss Federal Statistical Office, we analyzed AS trends over an 18-year period (1999-2016; total number of cases = 6553). Results Among patients who underwent AS, cancer was the most common underlying disease (n = 2704, 41.3% of all AS cases). The most common cancer types were lung (14.0% of cancer-related AS cases), breast (11.0%) and prostate (10.1%). There was a slight preponderance of men compared with women (51.5% versus 48.5%). The proportion of AS cases within cancer types did not change over time. The ratio of cancer-related AS cases in relationship with all cancer-related deaths increased from 0.3% at the beginning of the study period (1999-2003) to 2.1% from 2014 to 2016 (change of age-standardized rates for men: +488%; for women: +417%). At the end of the study period (2014-2016), there were only minor differences between cancer-specific ratios, highest and lowest range: 1.1% (liver cancer) and 2.8% (breast, esophageal and lip/oral cavity/oropharynx cancer). Individuals who underwent AS because of cancer were considerably younger than those who choose AS on account of other diseases (73 years versus 80 years). The median age of people with cancer-related AS was similar to that of all cancer-related deaths (74 years): for women, the median age of cancer-related AS was 72, whereas for men it was 75. The median age at which AS took place increased over time. Conclusions During the study period, the proportion of people who chose cancer-related AS has approximately sextupled. However, AS among cancer patients remains rare and represents only ∼2% of all cancer-related deaths. Cancer was the most common underlying disease for AS (41.3% of all AS cases). The ratio of cancer-related AS to all cancer-related deaths has sextupled over time: from 0.3% (1991-2003) to 2.1% (2014-2016). There were only minor differences between the cancer-specific ratios; in 2014-2016, ranges were between 1.1% and 2.8%. Individuals with cancer-related AS were younger than those who choose AS due to other diseases (73 vs. 80 years). The median age of people with cancer-related AS (73 years) was similar to that of all cancer-related deaths (74 years).
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20
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Davidson JE, Stokes L, DeWolf Bosek MS, Turner M, Bojorquez G, Lee YS, Upvall M. Nurses' values on medical aid in dying: A qualitative analysis. Nurs Ethics 2022; 29:636-650. [PMID: 35104169 DOI: 10.1177/09697330211051029] [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: 11/17/2022]
Abstract
Aim: Explore nurses' values and perceptions regarding the practice of medical aid in dying. Background: Medical aid in dying is becoming increasing legal in the United States. The laws and American Nurses Association documents limit nursing involvement in this practice. Nurses' values regarding this controversial topic are poorly understood. Methodology: Cross-sectional electronic survey design sent to nurse members of the American Nurses Association. Inductive thematic content analysis was applied to open-ended comments. Ethical Considerations: Approved by the institutional review board (#191046). Participants: 1213 nurses provided 3639 open-ended comments. More than 80% of participants self-identified as white 58% held a graduate degree; and half were of Christian faith. Results: Values ranged on a continuum expressed through four themes: "Honoring Patient Autonomy without Judgment," "Honoring with Limitations," "Not until...," and "Adamantly against." Some felt it was a duty to honor the patients' wishes, set aside own beliefs, and respect patients' choices often with a spiritual connotation. Nurses held concerns about the process, policy, potential psychological harm, legal risk, and the need to learn more about MAID. Nurse who were adamantly against MAID associated the practice with murder/suicide and against religious beliefs. Disparate values were expressed about changing the MAID legislation to allow patient support with taking MAID medications and allowing MAID via advance directive. Conclusions: Nurses desire more education on MAID. There is not one universally held position on the nurse's role during MAID. Healthcare policy/standards need to accommodate the wide variation in nurses' values. Implications: Nurses desire education regarding their role in MAID. Nurses are encouraged to participate in policy discussions as the practice becomes increasingly legal. Managers need to expect that nurses, patients, and families will need psychological support to participate in MAID. Careful construction of policy/standards is needed to minimize conflict, moral distress, and psychological harm amongst nurses. Further research is needed.
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Affiliation(s)
- Judy E Davidson
- Department of Nursing, 315531University of California San Diego, La Jolla, CA, USA
| | - Liz Stokes
- Center for Ethics and Human Rights, 8277American Nurses Association, Silver Spring, MD, USA
| | | | - Martha Turner
- Center for Ethics and Human Rights, 8277American Nurses Association, Silver Spring MD, USA.,School of Nursing, University of Minnesota, SE Minneapolis, MN, USA
| | - Genesis Bojorquez
- Hillcrest Inpatient Medicine Service, 315531University of California San Diego Health, San Diego, CA, USA
| | - Youn-Shin Lee
- School of Nursing, 229133San Diego State University, San Diego, CA, USA
| | - Michele Upvall
- Department of Nursing, 561287VinUniversity, Gia Lam District, Hanoi
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21
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Franke I, Urwyler T, Prüter-Schwarte C. Assisted dying requests from people in detention: Psychiatric, ethical, and legal considerations-A literature review. Front Psychiatry 2022; 13:909096. [PMID: 35966491 PMCID: PMC9374168 DOI: 10.3389/fpsyt.2022.909096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
The principle of equivalence of care states that prisoners must have access to the same standard of health care as the general population. If, as recent court decisions suggest, assisted dying is not limited to people with a terminal physical illness or irremediable suffering, it might also be requested by people with severe mental illness in detention. Some of the countries with legal regulations on assisted dying also have recommendations on how to handle requests from prisoners. However, detention itself can lead to psychological distress and suicidality, so we must consider whether and how people in such settings can make autonomous decisions. Ethical conflicts arise with regard to an individual's free will, right to life, and physical and personal integrity and to the right of a state to inflict punishment. Furthermore, people in prison often receive insufficient mental health care. In this review, we compare different practices for dealing with requests for assisted dying from people in prison and forensic psychiatric facilities and discuss the current ethical and psychiatric issues concerning assisted dying in such settings.
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Affiliation(s)
- Irina Franke
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany.,Psychiatric Services of Grisons, Chur, Switzerland
| | - Thierry Urwyler
- Office of Corrections and Rehabilitation, Department of Research and Development, Zurich, Switzerland.,Faculty of Law, University of Lucerne, Lucerne, Switzerland.,Faculty of Law, University of Zurich, Zurich, Switzerland
| | - Christian Prüter-Schwarte
- Faculty of Medicine and University Hospital Cologne, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany.,Faculty of Health Sciences, Department of Social Philosophy and Ethics in the Health Sciences, University Witten/Herdecke, Witten, Germany.,Department of Forensic Psychiatry and Psychotherapy II, LVR Hospital Cologne, Cologne, Germany
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22
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Cram P. When access to medical aid in dying is difficult: The story of my father. J Am Geriatr Soc 2022; 70:310-312. [PMID: 34590306 PMCID: PMC8742773 DOI: 10.1111/jgs.17482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/25/2021] [Accepted: 09/05/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Peter Cram
- Department of Internal Medicine, UTMB, Galveston, TX,Faculty of Medicine, University of Toronto, Toronto, ON
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23
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Borasio GD, Jox R, Taupitz J, Wiesing U. Yes, This Is the Society in Which We Want to Live. J Palliat Med 2021; 24:659-660. [PMID: 33945324 DOI: 10.1089/jpm.2021.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gian Domenico Borasio
- Palliative and Supportive Care Service, and Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ralf Jox
- Palliative and Supportive Care Service, and Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jochen Taupitz
- Institute for German, European, and International Medical Law, Public Health Law and Bioethics of the Universities of Heidelberg and Mannheim, Mannheim, Germany
| | - Urban Wiesing
- Institute of Ethics and History of Medicine, University of Tuebingen, Tuebingen, Germany
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24
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MAID ready for primetime?: A survey of SGO members regarding medical aid in dying (MAID). Gynecol Oncol Rep 2021; 37:100829. [PMID: 34277920 PMCID: PMC8271105 DOI: 10.1016/j.gore.2021.100829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022] Open
Abstract
MAID (Medical Aid in Dying) is the practice of providing a prescription for a life ending medication to a patient. MAID is an important topic for gynecologic oncologists and their patients. SGO members desire additional education and guidance regarding MAID.
Objectives To assess SGO members’ knowledge, attitudes, and practice patterns regarding Medical Aid In Dying (MAID). Methods SGO members were surveyed via online survey. The survey included questions regarding demographics, knowledge, attitudes, and practice patterns relating to MAID. Descriptive statistics were calculated. Associations between sociodemographic factors and attitudes related to MAID were analyzed utilizing logistic regression. Results Of 1,337 invited members, 225 (17%) responded. Median age was 46. Most were female (58%), white (81%), and in academic practice (64%). Over 50% had heard the term MAID and have had a patient ask about it. Few (20%) reported living in a state where MAID is legal and 61% of these respondents provided MAID. Sixty percent lived in a state that had not legalized MAID and 18% did not know if MAID was legal in their state. 36% of respondents living in a state where MAID was illegal/unknown legality indicated they would provide MAID if it were legal in their state, 30% would not, and 34% were uncertain. The majority (69%) of respondents believed MAID should be legal. Female respondents were more likely to support legalization of MAID (OR 2.44, p=<0.05). Respondents practicing in the southern U.S. were less likely to support legalization of MAID (OR 0.42, p=<0.05). Over 75% of respondents stated an SGO position statement on MAID would be helpful. Conclusions MAID is a highly relevant topic for gynecologic oncologists. Gaps in MAID-related knowledge exist among SGO members and there is a desire for additional education and guidance regarding MAID.
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25
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Hauswirth AG, George HC, Lomen-Hoerth C. ALS patient and caregiver attitudes toward physician-hastened death in California. Muscle Nerve 2021; 64:428-434. [PMID: 34076273 DOI: 10.1002/mus.27343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION/AIMS Since 2016, six states have legalized physician-hastened death (PHD). Neuromuscular disorders, including amyotrophic lateral sclerosis (ALS), are common diagnoses for patients who use PHD, but how patients with ALS view PHD in California has not been systematically studied. We aimed to quantify how many patients with ALS and their caregivers have considered PHD and to assess reasons to consider using or not using it. METHODS This is a cross-sectional study at one ALS center surveying patients with ALS and their caregivers. Data on disease characteristics, demographics, quality of life, and depression were also collected. Descriptive statistics were used to analyze the data. Qualitative data were also collected and analyzed. Patients were followed up longitudinally to assess if they died or if they used PHD. RESULTS A small majority of ALS patients surveyed had considered or would consider using PHD (16/30). Patients most commonly described having intolerable symptoms, being a burden on their loved ones, and losing independence as reasons to consider using PHD. Many patients shared that "their life has purpose" and "they are making the most of their lives" as to why they are not considering PHD. Considering PHD was not related to disease severity or depression. On longitudinal follow-up, 10 of the 30 patients have died, and none have used PHD. DISCUSSION Pursuing PHD is a personal decision for each individual patient. This study shows that considering PHD is relatively common in ALS patients, independent of disease severity or presence of depression.
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Affiliation(s)
- Anna G Hauswirth
- University of California, San Francisco, School of Medicine, San Francisco, California, USA.,Internal Medicine Department, Kaiser San Francisco, San Francisco, California, USA
| | - Hannah C George
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Catherine Lomen-Hoerth
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
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26
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Trejo-Gabriel-Galán JM. Euthanasia and assisted suicide in neurological diseases: a systematic review. Neurologia 2021; 39:S0213-4853(21)00090-6. [PMID: 34090721 DOI: 10.1016/j.nrl.2021.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/29/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To identify the neurological diseases for which euthanasia and assisted suicide are most frequently requested in the countries where these medical procedures are legal and the specific characteristics of euthanasia in some of these diseases, and to show the evolution of euthanasia figures. METHODS We conducted a systematic literature review. RESULTS Dementia, motor neuron disease, multiple sclerosis, and Parkinson's disease are the neurological diseases that most frequently motivate requests for euthanasia or assisted suicide. Claims related to dementia constitute the largest group, are growing, and raise additional ethical and legal issues due to these patients' diminished decision-making capacity. In some countries, the ratios of euthanasia requests to all cases of multiple sclerosis, motor neuron disease, or Huntington disease are higher than for any other disease. CONCLUSIONS After cancer, neurological diseases are the most frequent reason for requesting euthanasia or assisted suicide.
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27
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Suicide Distribution and Trends Among Male Older Adults in the U.S., 1999-2018. Am J Prev Med 2021; 60:802-811. [PMID: 33653647 DOI: 10.1016/j.amepre.2020.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/06/2020] [Accepted: 12/09/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION This study examines the distribution and trends in suicide death rates among male adults aged ≥65 years in the U.S. from 1999 to 2018. METHODS Suicide mortality data were derived from Multiple Cause of Death from the Center for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research database. Suicides were identified from the underlying causes of death. Joinpoint regression examined the distribution and shift in suicide age-adjusted death rates overall and by age groups, race/ethnicity, method of suicide, and urbanicity. Analyses were conducted in 2020. RESULTS Between 1999 and 2018, a total of 106,861 male adults aged ≥65 years died of suicide (age-adjusted rate=31.4 per 100,000 population, 95% CI=31.2, 31.6). Suicide rates showed a V-shaped trend. They were declining annually by 1.8% (95% CI= -2.4, -1.2); however, starting in 2007, there was a shift upward, increasing significantly by 1.7% per year for the next decade (95% CI=1.0, 1.6). Suicide rates were highest among those aged ≥85 years (48.8 per 100,000 population with an upward shift in 2008), Whites (35.3 per 100,000 population with an upward shift in trend in 2007), and the most rural communities (39.0 per 100,000 population). Most suicides were due to firearms (78.3% at a rate of 24.7 per 100,000 population), especially in rural areas, and shifted upward after 2007. CONCLUSIONS Increases in suicide rates among male older adults in the U.S., particularly after the 2007-2008 economic recession, are concerning. Tailored suicide prevention intervention strategies are needed to address suicide-related risk factors.
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[A right to physician-assisted suicide]. Chirurg 2021; 92:535. [PMID: 33974120 DOI: 10.1007/s00104-021-01429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
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Frush BW, Malone JR. Suffering and the moral orientation of presence: lessons from Nazi medicine for the contemporary medical trainee. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106061. [PMID: 32332152 DOI: 10.1136/medethics-2020-106061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
Medical trainees should learn from the actions of Nazi physicians to inform a more just contemporary practice by examining the subtle assumptions, or moral orientations, that led to such heinous actions. One important moral orientation that still informs contemporary medical practice is the moral orientation of elimination in response to suffering patients. We propose that the moral orientation of presence, described by theologian Stanley Hauerwas, provides a more fitting response to suffering patients, in spite of the significant barriers to enacting such a moral orientation for contemporary trainees.
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Affiliation(s)
- Benjamin Wade Frush
- Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jay R Malone
- Department of Pediatrics and Critical Care Medicine, Washington University in St Louis, St Louis, Missouri, USA
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Vilpert S, Borrat-Besson C, Borasio GD, Maurer J. Associations of end-of-life preferences and trust in institutions with public support for assisted suicide: evidence from nationally representative survey data of older adults in Switzerland. PLoS One 2020; 15:e0232109. [PMID: 32324815 PMCID: PMC7179897 DOI: 10.1371/journal.pone.0232109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/07/2020] [Indexed: 11/19/2022] Open
Abstract
The legality of euthanasia and assisted suicide (AS) and nature of regulations of these practices remain controversial and the subject of lively debate among experts and the general public. Our study investigates attitudes and behaviours towards AS among older adults in Switzerland where the practice of AS has a relatively long history and remains rather unregulated. We aim to explore how individuals' preferences regarding their end of life, as well as individuals' trust in institutions involved in the practice or control of AS are associated with attitudes and behaviours towards AS. We analyse nationally representative data of adults aged 55 and over from wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland (n = 2,145). While large majorities supported current legal arrangements around AS in Switzerland (81.7%) and stated that they could consider AS for themselves under certain circumstances (61.0%), only a minority either was a member of a right-to-die organisation already (4.9%) or stated they were likely to become a member of such an organisation (28.2%). Stated preferences for control over the end of life and for maintaining essential capabilities at the end of life showed a positive association with AS-related attitudes and behaviours, whereas preferences for feeling socially and spiritually connected, as well as for not being a burden displayed a negative association with our outcomes. Higher levels of trust in one's relative were positively associated with both support for the legality of AS and potential use of AS. A positive association was also found between trust in the Swiss legal system and support for the legality of AS. By contrast, trust in religious institutions displayed a negative association with all five AS-related attitudes and behaviours. Similarly, trust in healthcare insurance companies was negatively associated with potential use of AS. Taken together, older adults were generally supportive towards current practices regarding AS. This approval appears to be closely related to individuals' preferences and, at different extends, to trust in social and public institutions with regard to end-of-life issues, which is relatively high in Switzerland.
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Affiliation(s)
- Sarah Vilpert
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Swiss Centre of Expertise in the Social Sciences (FORS), University of Lausanne, Lausanne, Switzerland
| | - Carmen Borrat-Besson
- Swiss Centre of Expertise in the Social Sciences (FORS), University of Lausanne, Lausanne, Switzerland
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, University of Lausanne Medical Center, Lausanne, Switzerland
| | - Jürgen Maurer
- Faculty of Business and Economics, University of Lausanne, Lausanne, Switzerland
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Gerson SM, Preston NJ, Bingley AF. Medical Aid in Dying, Hastened Death, and Suicide: A Qualitative Study of Hospice Professionals' Experiences From Washington State. J Pain Symptom Manage 2020; 59:679-686.e1. [PMID: 31678464 DOI: 10.1016/j.jpainsymman.2019.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/11/2019] [Accepted: 10/23/2019] [Indexed: 11/22/2022]
Abstract
CONTEXT Many jurisdictions around the world have passed medical aid in dying (MAID) laws allowing competent eligible individuals facing life-limiting illness to self-administer prescribed medication to control timing of death. These laws do not prevent some patients who are receiving hospice services from dying by suicide without assistance. OBJECTIVES To explore hospice professionals' experiences of patients who die by suicide or intentionally hasten death with or without legal assistance in an area where there is legalized MAID. METHODS Semistructured in-depth qualitative interviews were conducted with 21 home hospice professionals (seven nurses, seven social workers, four physicians, and three chaplains). Thematic analysis was carried out to analyze the data. RESULTS Three primary themes were identified from the interviews: 1) dealing with and differentiating between hastened death and suicide, 2) MAID access and affordability, and 3) how patients have hastened their own deaths. Analysis of these data indicates that there are some patients receiving hospice services who die by suicide because they are not eligible for, have no knowledge of, or lack access to legalized MAID. Hospice professionals do not consistently identify patients' deaths as suicide when they are self-inflicted and sometimes view these deaths as justified. CONCLUSION Suicide and hastened deaths continue to be an unexamined cause of death for some home hospice patients who may have requested MAID. Open communication and increased education and training is needed for palliative care professionals regarding legal options, issues of suicide, and suicide assessment.
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Affiliation(s)
- Sheri Mila Gerson
- Division of Health Research, International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom; School of Interdisciplinary Studies, University of Glasgow, Dumfries, Scotland, United Kingdom.
| | - Nancy J Preston
- Division of Health Research, International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Amanda F Bingley
- Division of Health Research, International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
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Affiliation(s)
- Daniel P Sulmasy
- The Kennedy Institute of Ethics, Departments of Medicine and Philosophy, Georgetown University, Washington, DC
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