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Nissim R, Chu P, Stere A, Tong E, An E, Selby D, Bean S, Isenberg-Grzeda E, Rodin G, Li M, Hales S. "Walk me through the final day": A thematic analysis study on the family caregiver experience of the Medical Assistance in Dying procedure day. Palliat Med 2024; 38:660-668. [PMID: 38720655 PMCID: PMC11158002 DOI: 10.1177/02692163241248725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Legalization of assisted dying is progressively expanding worldwide. In Canada, the Medical Assistance in Dying Act became law in 2016. As assisted dying regulations evolve worldwide, comprehending its subjective impact and broader consequences, especially on family members, becomes pivotal for shaping practice, policy, and training. AIM The goal of this study is to understand the experience of family caregivers on the assisted dying procedure day. DESIGN Qualitative, thematic analysis, research using semi-structured interviews. SETTING/PARTICIPANTS Family caregivers of patients who received assisted dying in two hospitals in Canada were recruited. Interviews were conducted at least 6 months after patient death. Conceptual saturation was achieved after analyzing 18 interviews. RESULTS While caregivers expressed gratitude for the availability of Medical Assistance in Dying, they also described the procedure day as potentially jarring and unsettling. We identified five aspects that shaped their experience: attuned support from the clinical team; preparation for clinical details; congruence between the setting and the importance of the event; active participation and ceremony; and pacing and timing of the procedure. Together, these aspects impacted the level of uneasiness felt by caregivers on the procedure day. CONCLUSIONS This study emphasized the importance of a family-centered approach to delivering Medical Assistance in Dying. It underscored recognizing the needs of family caregivers during the procedure day and offering strategies to ease their experience. Healthcare providers in jurisdictions where assisted dying is legal or deliberated should consider the applicability of these findings to their unique context.
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Affiliation(s)
- Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paige Chu
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Alison Stere
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Eryn Tong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ekaterina An
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Debbie Selby
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sally Bean
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Elie Isenberg-Grzeda
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Laperle P, Achille M, Ummel D. To Lose a Loved One by Medical Assistance in Dying or by Natural Death with Palliative Care: A Mixed Methods Comparison of Grief Experiences. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221085191. [PMID: 35420908 DOI: 10.1177/00302228221085191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The integration of assisted dying into end-of-life care is raising reflections on bereavement. Patients and families may be faced with a choice between this option and natural death assisted by palliative care; a choice that may affect grief. Therefore, this study describes and compares grief experiences of individuals who have lost a loved one by medical assistance in dying or natural death with palliative care. A mixed design was used. Sixty bereaved individuals completed two grief questionnaires. The qualitative component consisted of 16 individual semi-structured interviews. We found no statistically significant differences between medically assisted and natural deaths, and scores did not suggest grief complications. Qualitative results are nuanced: positive and negative imprints may influence grief in both contexts. Hastened and natural deaths are death circumstances that seem to generally help ease mourning. However, they can still, in interaction with other risk factors, produce difficult experiences for some family caregivers.
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Affiliation(s)
- Philippe Laperle
- Department of Psychology, 141639Université de Montréal, Montreal, Canada
| | - Marie Achille
- Department of Psychology, 141639Université de Montréal, Montreal, Canada
| | - Deborah Ummel
- Department of Psychoeducation, 7321Université de Sherbrooke, Longueuil, Canada
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Pronk R, Willems DL, van de Vathorst S. What About Us? Experiences of Relatives Regarding Physician-Assisted Death for Patients Suffering from Mental Illness: A Qualitative Study. Cult Med Psychiatry 2021; 47:237-251. [PMID: 34914019 PMCID: PMC8674522 DOI: 10.1007/s11013-021-09762-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 01/01/2023]
Abstract
Physician-assisted death (PAD) for patients suffering from mental illness is legally permitted in the Netherlands. Although patients' relatives are not entrusted with a legal role, former research revealed that physicians take into account the patient's social context and their well-being, in deciding whether or not to grant the request. However, these studies focussed on relatives' experiences in the context of PAD concerning patients with somatic illness. To date, nothing is known on their experiences in the context of PAD concerning the mentally ill. We studied the experiences of relatives with regard to a PAD request by patients suffering from mental illness. The data for this study were collected through 12 interviews with relatives of patients who have or had a PAD request because of a mental illness. We show that relatives are ambivalent regarding the patient's request for PAD and the following trajectory. Their ambivalence is characterised by their understanding of the wish to die and at the same time hoping that the patient would make another choice. Respondents' experiences regarding the process of the PAD request varied, from positive ('intimate') to negative ('extremely hard'). Some indicated that they wished to be more involved as they believe the road towards PAD should be a joint trajectory. To leave them out during such an important event is not only painful, but also harmful to the relative as it could potentially complicate their grieving process. Professional support during or after the PAD process was wanted by some, but not by all.
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Affiliation(s)
- Rosalie Pronk
- Department of Ethics, Law and Humanities, Amsterdam UMC, Academic Medical Centre, Room J2-126, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - D. L. Willems
- Department of Ethics, Law and Humanities, Amsterdam UMC, Academic Medical Centre, Room J2-126, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - S. van de Vathorst
- Department of Ethics, Law and Humanities, Amsterdam UMC, Academic Medical Centre, Room J2-126, PO Box 22660, 1100 DD Amsterdam, The Netherlands ,Department of Medical Ethics and Philosophy, Erasmus Medical Centre, Rotterdam, The Netherlands
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Philippe A, Touren-Hamonet M. Deuil anticipé chez les proches et demande d’aide active à mourir venant d’un membre de la famille. MÉDECINE PALLIATIVE 2021. [DOI: 10.1016/j.medpal.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Beuthin R, Bruce A, Thompson M, Andersen AEB, Lundy S. Experiences of grief-bereavement after a medically assisted death in Canada: Bringing death to life. DEATH STUDIES 2021; 46:1982-1991. [PMID: 33538647 DOI: 10.1080/07481187.2021.1876790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Medical assistance in dying (MAiD) legislation was passed in Canada in 2016, yet the bereavement experience of family and friends is not well understood. Using interpretive description, we interviewed nine bereaved individuals. The time before the assisted death seems most impactful-an experience of bringing death to life shapes bereavement after death. We identified themes that inform this grieving: (1) certainty of date/time of death-intensifies a parade of lasts, initiates a countdown and affords time to say good-bye; (2) active family engagement as planners supports sense-making; and (3) enacting MAiD as ceremony slows time to "digest" loss.
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Affiliation(s)
- Rosanne Beuthin
- End of Life Care, Vancouver Island Health Authority, Victoria, Canada
| | - Anne Bruce
- School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
| | | | | | - Sarah Lundy
- Faculty of Law, University of Victoria, Victoria, Canada
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Variath C, Peter E, Cranley L, Godkin D, Just D. Relational influences on experiences with assisted dying: A scoping review. Nurs Ethics 2020; 27:1501-1516. [PMID: 32436431 DOI: 10.1177/0969733020921493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Family members and healthcare providers play an integral role in a person's assisted dying journey. Their own needs during the assisted dying journey are often, however, unrecognized and underrepresented in policies and guidelines. Circumstances under which people choose assisted dying, and relational contexts such as the sociopolitical environment, may influence the experiences of family members and healthcare providers. ETHICAL CONSIDERATIONS Ethics approval was not required to conduct this review. AIM This scoping review aims to identify the relational influences on the experiences of family members and healthcare providers of adults who underwent assisted dying and of those unable to access assisted dying due to the loss of capacity to consent. METHODS A literature search was conducted in four databases, including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. The search retrieved 12,074 articles, a number narrowed down to 172 articles for full-text screening. Thirty-six articles met the established inclusion criteria. A feminist relational framework guided the data analysis. RESULTS Five key themes on the influences of family members' and healthcare providers' experiences throughout the assisted dying process were synthesized from the data. They include (1) relationships as central to beginning the process, (2) social and political influences on decision making, (3) complex roles and responsibilities of family members and healthcare providers, (4) a unique experience of death, and (5) varying experiences following death. CONCLUSION The feminist relational lens, used to guide analysis, shed light on the effect of the sociopolitical influences and the relationships among patients, families, and healthcare providers on each other's experiences. Addressing the needs of the family members and healthcare providers is vital to improving the assisted dying process. Including families' and healthcare providers' needs within institutional policies and enhancing collaboration and communication among those involved could improve the overall experience.
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Booker R, Bruce A. Palliative sedation and medical assistance in dying: Distinctly different or simply semantics? Nurs Inq 2019; 27:e12321. [PMID: 31756038 PMCID: PMC9285680 DOI: 10.1111/nin.12321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/17/2019] [Accepted: 08/03/2019] [Indexed: 11/29/2022]
Abstract
Medical assistance in dying (MAiD) and palliative sedation (PS) are both legal options in Canada that may be considered by patients experiencing intolerable and unmanageable suffering. A contentious, lively debate has been ongoing in the literature regarding the similarities and differences between MAiD and PS. The aim of this paper is to explore the propositions that MAiD and PS are essentially similar and conversely that MAiD and PS are distinctly different. The relevance of such a debate is apparent for clinicians and patients alike. Understanding the complex and multi‐faceted nuances between PS and MAiD allows patients and caregivers to make more informed decisions pertaining to end‐of‐life care. It is hoped that this paper will also serve to foster further debate and consideration of the issues associated with PS and MAiD with a view to improve patient care and the quality of both living and dying in Canada.
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Affiliation(s)
- Reanne Booker
- Palliative and End-of-Life Care Services, Calgary, AB, Canada.,Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Anne Bruce
- School of Nursing, University of Victoria, Victoria, BC, Canada
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Andriessen K, Krysinska K, Castelli Dransart DA, Dargis L, Mishara BL. Grief After Euthanasia and Physician-Assisted Suicide. CRISIS 2019; 41:255-272. [PMID: 31657640 DOI: 10.1027/0227-5910/a000630] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Several countries have regulated euthanasia and physician-assisted suicide (PAS). Research has looked at the experiences of patients, family, and professionals. However, little is known of the effects on bereaved individuals. Aims: We aimed to assess (a) what is known about the grief and mental health of people bereaved by euthanasia or PAS and (b) the quality of the research. Method: Systematic review according to PRISMA guidelines with searches in Cinahl, Embase, PsycINFO, Pubmed, and Scopus. Results: The searches identified 10 articles (eight studies), and the study quality was fair. People bereaved by euthanasia/PAS generally had similar or lower scores on measures of disordered grief, mental health, and posttraumatic stress compared with those who died naturally. Lack of social support and secrecy may compound their grief. Being involved in the decision-making process and having the feeling of honoring the deceased's will may facilitate their grief. Limitations: Studies used self-reports from non-random self-selected participants, were retrospective, and were conducted in only three countries. Conclusion: There is little evidence of increased risk of adverse grief or mental health outcomes in people bereaved by euthanasia/PAS. As more countries legalize assisted dying, high-quality studies of the factors that may hinder or facilitate the grief process are needed.
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Affiliation(s)
- Karl Andriessen
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Karolina Krysinska
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Luc Dargis
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices (CRISE), Montréal, Canada
| | - Brian L Mishara
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices (CRISE), Montréal, Canada.,Psychology Department, Université du Québec á Montréal, Canada
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de Boer ME, Depla MFIA, den Breejen M, Slottje P, Onwuteaka-Philipsen BD, Hertogh CMPM. Pressure in dealing with requests for euthanasia or assisted suicide. Experiences of general practitioners. JOURNAL OF MEDICAL ETHICS 2019; 45:425-429. [PMID: 31092632 DOI: 10.1136/medethics-2018-105120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 03/06/2019] [Accepted: 04/16/2019] [Indexed: 06/09/2023]
Abstract
The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide (EAS). This study aimed to explore the content of this pressure as experienced by general practitioners (GP). We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: (1) emotional blackmail, (2) control and direction by others, (3) doubts about fulfilling the criteria, (4) counterpressure by patient's relatives, (5) time pressure around referred patients and (6) organisational pressure. We conclude that the pressure can be attributable to the patient-physician relationship and/or the relationship between the physician and the patient's relative(s), the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account.
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Affiliation(s)
- Marike E de Boer
- Department of General Practice and Old Age Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marja F I A Depla
- Department of General Practice and Old Age Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjolein den Breejen
- Department of General Practice and Old Age Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pauline Slottje
- Department of General Practice and Old Age Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of General Practice and Old Age Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Roest B, Trappenburg M, Leget C. The involvement of family in the Dutch practice of euthanasia and physician assisted suicide: a systematic mixed studies review. BMC Med Ethics 2019; 20:23. [PMID: 30953490 PMCID: PMC6451224 DOI: 10.1186/s12910-019-0361-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/27/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Family members do not have an official position in the practice of euthanasia and physician assisted suicide (EAS) in the Netherlands according to statutory regulations and related guidelines. However, recent empirical findings on the influence of family members on EAS decision-making raise practical and ethical questions. Therefore, the aim of this review is to explore how family members are involved in the Dutch practice of EAS according to empirical research, and to map out themes that could serve as a starting point for further empirical and ethical inquiry. METHODS A systematic mixed studies review was performed. The databases Pubmed, Embase, PsycInfo, and Emcare were searched to identify empirical studies describing any aspect of the involvement of family members before, during and after EAS in the Netherlands from 1980 till 2018. Thematic analysis was chosen as method to synthesize the quantitative and qualitative studies. RESULTS Sixty-six studies were identified. Only 14 studies had family members themselves as study participants. Four themes emerged from the thematic analysis. 1) Family-related reasons (not) to request EAS. 2) Roles and responsibilities of family members during EAS decision-making and performance. 3) Families' experiences and grief after EAS. 4) Family and 'the good euthanasia death' according to Dutch physicians. CONCLUSION Family members seem to be active participants in EAS decision-making, which goes hand in hand with ambivalent feelings and experiences. Considerations about family members and the social context appear to be very important for patients and physicians when they request or grant a request for EAS. Although further empirical research is needed to assess the depth and generalizability of the results, this review provides a new perspective on EAS decision-making and challenges the Dutch ethical-legal framework of EAS. Euthanasia decision-making is typically framed in the patient-physician dyad, while a patient-physician-family triad seems more appropriate to describe what happens in clinical practice. This perspective raises questions about the interpretation of autonomy, the origins of suffering underlying requests for EAS, and the responsibilities of physicians during EAS decision-making.
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Affiliation(s)
- Bernadette Roest
- University of Humanistic Studies, Kromme Nieuwegracht 29, 3512HD Utrecht, The Netherlands
| | - Margo Trappenburg
- University of Humanistic Studies, Kromme Nieuwegracht 29, 3512HD Utrecht, The Netherlands
| | - Carlo Leget
- University of Humanistic Studies, Kromme Nieuwegracht 29, 3512HD Utrecht, The Netherlands
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Televantos A, Talias MA, Charalambous M, Soteriades ES. Attitudes towards euthanasia in severely ill and dementia patients and cremation in Cyprus: a population-based survey. BMC Public Health 2013; 13:878. [PMID: 24060291 PMCID: PMC3852336 DOI: 10.1186/1471-2458-13-878] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 09/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population studies on end-of-life decisions have not been conducted in Cyprus. Our study aim was to evaluate the beliefs and attitudes of Greek Cypriots towards end-of-life issues regarding euthanasia and cremation. METHODS A population-based telephone survey was conducted in Cyprus. One thousand randomly selected individuals from the population of Cyprus age 20 years or older were invited to participate. Beliefs and attitudes on end-of-life decisions were collected using an anonymous and validated questionnaire. Statistical analyses included cross-tabulations, Pearson's chi-square tests and multivariable-adjusted logistic regression models. RESULTS A total of 308 males and 689 females participated in the survey. About 70% of the respondents did not support euthanasia for people with incurable illness and/or elders with dementia when requested by them and 77% did not support euthanasia for people with incurable illness and/or elders with dementia when requested by relatives. Regarding cremation, 78% were against and only 14% reported being in favor. Further statistical analyses showed that male gender, being single and having reached higher educational level were factors positively associated with support for euthanasia in a statistically significant fashion. On the contrary, the more religiosity expressed by study participants, the less support they reported for euthanasia or cremation. CONCLUSIONS The vast majority of Greek Cypriots does not support euthanasia for people with incurable illness and/or elders with dementia and also do not support cremation. Certain demographic characteristics such as age and education have a positive influence towards attitudes for euthanasia and cremation, while religiosity exerts a strong negative influence on the above. Family bonding as well as social and cultural traditions may also play a role although not comprehensively evaluated in the current study.
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Affiliation(s)
- Anastasios Televantos
- Cyprus Institute of Biomedical Sciences (CIBS), Athienitis Strovolos Park, 2A Elia Venezi Street, 2nd Fl, Office 206, 2042, Strovolos, Nicosia, Cyprus.
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Pott M, Dubois J, Currat T, Gamondi C. Les proches impliqués dans une assistance au suicide. ACTA ACUST UNITED AC 2011. [DOI: 10.3917/inka.113.0277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Cherry MJ. UNESCO, "Universal Bioethics," and State Regulation of Health Risks: A Philosophical Critique. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2009; 34:274-95. [DOI: 10.1093/jmp/jhp020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Current Problems of Clinical Ethics: Confidentiality and End-of-Life Decisions – Is Silence Always Golden? HEC Forum 2007; 19:273-6. [DOI: 10.1007/s10730-007-9052-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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