1
|
Archer M, Willmott L, Chambaere K, Deliens L, White BP. What Domains of Belgian Euthanasia Practice are Governed and by Which Sources of Regulation: A Scoping Review. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231221839. [PMID: 38095044 DOI: 10.1177/00302228231221839] [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: 12/19/2023]
Abstract
BACKGROUND Multiple sources of regulation seek to shape euthanasia practice in Belgium, including legislation and training. This study comprehensively mapped which of these sources govern which domains of euthanasia practice, such health professionals' obligations, or managing patient requests. METHOD Scoping review methodology was used to search for scholarly records which discussed Belgian euthanasia regulation. Template analysis was used to generate themes describing the domains of euthanasia practice governed by sources of regulation. RESULTS Of 1364 records screened, 107 records were included. Multiple sources of regulation govern each domain, which are: the permissible scope of euthanasia; the legal status of a euthanasia death; the euthanasia process; the rights, obligations, and roles of those involved; system workings; and support for health professionals who provide euthanasia. CONCLUSIONS Domains with significant yet fragmented regulation may lead to inconsistent care provision. Policymakers should develop coherent guidance to support health professionals to navigate this regulatory landscape.
Collapse
Affiliation(s)
- Madeleine Archer
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ben P White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
2
|
Archer M, Willmott L, Chambaere K, Deliens L, White BP. Mapping Sources of Assisted Dying Regulation in Belgium: A Scoping Review of the Literature. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231210146. [PMID: 37914208 DOI: 10.1177/00302228231210146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Belgium has over 20 years of experience regulating assisted dying (AD). While much research considers this end-of-life practice, no studies have comprehensively analysed the various sources of regulation that govern it, including law, professional standards, and ethics. A scoping review identified all sources of regulation that guide AD practice, and their regulatory functions. Databases and reference lists were searched for records which met inclusion criteria between 11/2/22 and 25/3/22. Existing scholarship was used to identify sources of regulation, and thematically analyse their functions. Of the initial sample of 1364 records, 107 were included. Six sources of regulation were identified: law, policies, professional standards, training, advisory documents, and system design. Three regulatory functions were identified: prescribing conduct, scaffolding to support practice, and monitoring the system. The Belgian AD regulatory framework is multifaceted, complex, and fragmented. Providers must navigate and reconcile numerous sources of guidance providing this form of end-of-life care.
Collapse
Affiliation(s)
- Madeleine Archer
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, QLD, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
- Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
- Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
| | - Ben P White
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
3
|
Close E, Willmott L, Keogh L, White BP. Institutional Objection to Voluntary Assisted Dying in Victoria, Australia: An Analysis of Publicly Available Policies. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:467-484. [PMID: 37428353 PMCID: PMC10624699 DOI: 10.1007/s11673-023-10271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/21/2022] [Indexed: 07/11/2023]
Abstract
BACKGROUND Victoria was the first Australian state to legalize voluntary assisted dying (elsewhere known as physician-assisted suicide and euthanasia). Some institutions indicated they would not participate in voluntary assisted dying. The Victorian government issued policy approaches for institutions to consider OBJECTIVE: To describe and analyse publicly available policy documents articulating an institutional objection to voluntary assisted dying in Victoria. METHODS Policies were identified using a range of strategies, and those disclosing and discussing the nature of an institutional objection were thematically analysed using the framework method. RESULTS The study identified fifteen policies from nine policymakers and developed four themes: (1) extent of refusal to participate in VAD, (2) justification for refusal to provide VAD, (3) responding to requests for VAD, and (4) appeals to state-sanctioned regulatory mechanisms. While institutional objections were stated clearly, there was very little practical detail in most documents to enable patients to effectively navigate objections in practice. CONCLUSION This study demonstrates that despite having clear governance pathways developed by centralized bodies (namely, the Victorian government and Catholic Health Australia), many institutions' public-facing policies do not reflect this guidance. Since VAD is contentious, laws governing institutional objection could provide greater clarity and regulatory force than policies alone to better balance the interests of patients and non-participating institutions.
Collapse
Affiliation(s)
- Eliana Close
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Ben P White
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| |
Collapse
|
4
|
Ivanitskaya LV, Bjork AE, Taylor MR. Bibliometric Analysis and Visualization of Catholic Health Care Research: 1973-2019. JOURNAL OF RELIGION AND HEALTH 2021; 60:3759-3774. [PMID: 33860402 DOI: 10.1007/s10943-021-01255-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
A multi-dimensional construct of Catholic health care is examined using a bibliometric analysis of 181 scientific studies from the Web of Science database. Medical ethics, religion, and health services research by 418 authors from 26 countries reveals developments in the Catholic health care domain since 1973. Using VOSviewer, we map keyword clusters to reveal the structure of research on Catholic health care that transcends religious and secular literatures. The clusters mostly reflect clinical and ethical issues of reproductive health and the end of life, as well as the essence and the future of the Catholic identity from the theological and empirical perspectives.
Collapse
Affiliation(s)
- Lana V Ivanitskaya
- School of Health Sciences, Central Michigan University, 208D Rowe Hall, Mount Pleasant, MI, 48859, USA.
| | - Anastasia E Bjork
- School of Health Sciences, Central Michigan University, 208D Rowe Hall, Mount Pleasant, MI, 48859, USA
| | - Mark R Taylor
- School of Health Sciences, Central Michigan University, 208D Rowe Hall, Mount Pleasant, MI, 48859, USA
| |
Collapse
|
5
|
Guo Y, Fu B, Xu P, Wang Y, Liu X. Mapping regional differences in payment for ecosystem service policies to inform integrated management: Case study of the Yangtze River Economic Belt. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2021; 278:111396. [PMID: 33113393 DOI: 10.1016/j.jenvman.2020.111396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 07/26/2020] [Accepted: 09/09/2020] [Indexed: 06/11/2023]
Abstract
State and local governments consider payment for ecosystem services (PES) a valuable tool for watershed protection. However, regional differences in PES policies, which significantly influence province-scale cooperation, have been seldom documented. The interrelationships among these policies directly affect overall PES development in the Yangtze River Economic Belt (YREB). Textual analysis was used to categorize the content of PES policies in 11 provinces from 2004 to 2018. Then, we assessed these PES policies with four indicators (i.e., policy intensity, interdepartmental coordination, diversity, and duration). Finally, we analyzed the impact factors of these regional differences. The results showed that the number of PES policies increased yearly, reaching a peak in 2017. Provinces in the upper reaches had the highest policy-intensity score (7.38), followed by downstream provinces (6.39) and provinces in the middle reaches (4.52). Regarding interdepartmental coordination, the downstream areas exhibited the most interdepartment interaction (27.92%), followed by the upstream areas (20.76%) and the middle areas (19.18%). Diversity in the middle reaches was the highest (scored 4.3) while the upstream area exhibited the lowest diversity value (3.25). Downstream provinces issued PES policies the earliest, with a duration 5.52 years, followed by the upstream provinces (4.68) and middle provinces (4.28). Policy intensity was significantly correlated with fixed-asset investment, solid-waste generation, and population. The results suggest that PES in the YREB needs to be strengthened by enhancing policy consistency. In this regard, identifying regional differences in PES policies can help improve the coordination of PES policies for the whole YREB.
Collapse
Affiliation(s)
- Yingman Guo
- Institute of Mountain Hazards and Environment, Chinese Academy of Sciences, Chengdu, Sichuan, 610041, China; University of the Chinese Academy of Sciences, Beijing, 100049, China.
| | - Bin Fu
- Institute of Mountain Hazards and Environment, Chinese Academy of Sciences, Chengdu, Sichuan, 610041, China.
| | - Pei Xu
- Institute of Mountain Hazards and Environment, Chinese Academy of Sciences, Chengdu, Sichuan, 610041, China.
| | - Yukuan Wang
- Institute of Mountain Hazards and Environment, Chinese Academy of Sciences, Chengdu, Sichuan, 610041, China.
| | - Xinmin Liu
- Sichuan Academy of Environmental Sciences, Chengdu, Sichuan610041, China.
| |
Collapse
|
6
|
Verhofstadt M, Van Assche K, Sterckx S, Audenaert K, Chambaere K. Psychiatric patients requesting euthanasia: Guidelines for sound clinical and ethical decision making. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 64:150-161. [PMID: 31122625 DOI: 10.1016/j.ijlp.2019.04.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/28/2019] [Accepted: 04/03/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Since Belgium legalised euthanasia, the number of performed euthanasia cases for psychological suffering in psychiatric patients has significantly increased, as well as the number of media reports on controversial cases. This has prompted several healthcare organisations and committees to develop policies on the management of these requests. METHOD Five recent initiatives that offer guidance on euthanasia requests by psychiatric patients in Flanders were analysed: the protocol of Ghent University Hospital and advisory texts of the Flemish Federation of Psychiatry, the Brothers of Charity, the Belgian Advisory Committee on Bioethics, and Zorgnet-Icuro. These were examined via critical point-by-point reflection, focusing on all legal due care criteria in order to identify: 1) proposed measures to operationalise the evaluation of the legal criteria; 2) suggestions of additional safeguards going beyond these criteria; and 3) remaining fields of tension. RESULTS The initiatives are well in keeping with the legal requirements but are often more stringent. Additional safeguards that are formulated include the need for at least two positive advices from at least two psychiatrists; an a priori evaluation system; and a two-track approach, focusing simultaneously on the assessment of the patient's euthanasia request and on that person's continuing treatment. Although the initiatives are similar in intent, some differences in approach were found, reflecting different ethical stances towards euthanasia and an emphasis on practical clinical assessment versus broad ethical reflection. CONCLUSIONS All initiatives offer useful guidance for the management of euthanasia requests by psychiatric patients. By providing information on, and proper operationalisations of, the legal due care criteria, these initiatives are important instruments to prevent potential abuses. Apart from the additional safeguards suggested, the importance of a decision-making policy that includes many actors (e.g. the patient's relatives and other care providers) and of good aftercare for the bereaved are rightly stressed. Shortcomings of the initiatives relate to the aftercare of patients whose euthanasia request is rejected, and to uncertainty regarding the way in which attending physicians should manage negative or conflicting advices, or patients' suicide threats in case of refusal. Given the scarcity of data on how thoroughly and uniformly requests are handled in practice, it is unclear to what extent the recommendations made in these guidelines are currently being implemented.
Collapse
Affiliation(s)
- Monica Verhofstadt
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Kristof Van Assche
- Research Group Personal Rights and Property Rights, Antwerp University, Stadscampus Venusstraat 23, 2000 Antwerp, Belgium.
| | - Sigrid Sterckx
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Bioethics Institute Ghent, Ghent University, Blandijnberg 2, 9000 Ghent, Belgium.
| | - Kurt Audenaert
- Department of Psychiatry and Medical Psychology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| |
Collapse
|
7
|
Denier Y, de Casterlé BD, De Bal N, Gastmans C. Involvement of Nurses in the Euthanasia Care Process in Flanders (Belgium): An exploration of Two Perspectives. J Palliat Care 2018. [DOI: 10.1177/082585970902500404] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explored nurses’ involvement in the care process for mentally competent, terminally ill patients requesting euthanasia in general hospitals in Flanders, Belgium. In-depth interviews with 18 nurses who had experience in caring for patients requesting euthanasia since May 2002 were analyzed using grounded theory qualitative methods. We found that the involvement of nurses in the care process is influenced by their predominant perspective on it: the procedural, action-focused perspective, from which good practical organization of the care process is essential; or the existential-interpretative perspective, from which it is important to understand the patient's request within a dialogue-focused and communicational atmosphere. Findings show that the two perspectives are not mutually exclusive, but rather complementary dimensions of the euthanasia care process. Hence, sufficient support for nurses to reach a well-balanced integration of both perspectives is essential.
Collapse
Affiliation(s)
- Yvonne Denier
- Y Denier (corresponding author): Centre for Biomedical Ethics and Law, Faculty of Medicine, Catholic University of Leuven, Kapucijnenvoer 35 blok d – bus 7001, 3000 Leuven, Belgium
| | | | - Nele De Bal
- N De Bal, C Gastmans: Centre for Biomedical Ethics and Law, Faculty of Medicine, Catholic University of Leuven
| | - Chris Gastmans
- N De Bal, C Gastmans: Centre for Biomedical Ethics and Law, Faculty of Medicine, Catholic University of Leuven
| |
Collapse
|
8
|
Vanderschaeghe G, Schaeverbeke J, Vandenberghe R, Dierickx K. Amnestic MCI Patients' Perspectives toward Disclosure of Amyloid PET Results in a Research Context. NEUROETHICS-NETH 2017; 10:281-297. [PMID: 28725289 PMCID: PMC5486502 DOI: 10.1007/s12152-017-9313-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/03/2017] [Indexed: 12/19/2022]
Abstract
Background Researchers currently are not obligated to share individual research results (IRR) with participants. This non-disclosure policy has been challenged on the basis of participants’ rights to be aware and in control of their personal medical information. Here, we determined how patients view disclosure of research PET results of brain amyloid and why they believe it is advantageous or disadvantageous to disclose. Method As a part of a larger diagnostic trial, we conducted semi-structured interviews with patients with amnestic Mild Cognitive Impairment (aMCI). Participants had the option to receive their brain amyloid PET scan result (i.e., their IRR). Interviews were conducted before they received their IRR. Results A total of 38 aMCI patients (100% of study participants) wanted to know their IRR. The two most frequently mentioned reasons for choosing IRR disclosure were to better understand their brain health status and to be better able to make informed decisions about future personal arrangements (e.g., inheritance tax, moving into a smaller house, end-of-life decisions, etc.). Emotional risk was mentioned as the primary disadvantage of knowing one’s IRR. On the other hand, non-disclosure was considered to be emotionally difficult also, as patients would be uncertain about their future health condition. Conclusions Many patients diagnosed clinically with aMCI want to know their brain amyloid test results, even though this knowledge may be disadvantageous to them. Knowing what is going on with their health and the ability to make informed decisions about their future were the two principal advantages mentioned for obtaining their amyloid PET results. Because of the overwhelming consensus of aMCI patients was to disclose their brain amyloid PET scan results, researchers should strongly consider releasing this information to research subjects.
Collapse
Affiliation(s)
- Gwendolien Vanderschaeghe
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 Blok D Box 7001, 3000 Leuven, Belgium
| | - Jolien Schaeverbeke
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, 0&N II, Herestraat 49 box 1027, 3000 Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven research Institute for Neurodegenerative Disorders, Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, 0&N II, Herestraat 49 box 1027, 3000 Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven research Institute for Neurodegenerative Disorders, Leuven, Belgium.,Memory Clinic / Neurology, University Hospitals Leuven (UZ Leuven, Campus Gasthuisberg), Leuven, Belgium
| | - Kris Dierickx
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 Blok D Box 7001, 3000 Leuven, Belgium
| |
Collapse
|
9
|
Lemiengre J, Dierckx de Casterlé B, Schotsmans P, Gastmans C. Written institutional ethics policies on euthanasia: an empirical-based organizational-ethical framework. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2014; 17:215-228. [PMID: 24420744 DOI: 10.1007/s11019-013-9524-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
As euthanasia has become a widely debated issue in many Western countries, hospitals and nursing homes especially are increasingly being confronted with this ethically sensitive societal issue. The focus of this paper is how healthcare institutions can deal with euthanasia requests on an organizational level by means of a written institutional ethics policy. The general aim is to make a critical analysis whether these policies can be considered as organizational-ethical instruments that support healthcare institutions to take their institutional responsibility for dealing with euthanasia requests. By means of an interpretative analysis, we conducted a process of reinterpretation of results of former Belgian empirical studies on written institutional ethics policies on euthanasia in dialogue with the existing international literature. The study findings revealed that legal regulations, ethical and care-oriented aspects strongly affected the development, the content, and the impact of written institutional ethics policies on euthanasia. Hence, these three cornerstones-law, care and ethics-constituted the basis for the empirical-based organizational-ethical framework for written institutional ethics policies on euthanasia that is presented in this paper. However, having a euthanasia policy does not automatically lead to more legal transparency, or to a more professional and ethical care practice. The study findings suggest that the development and implementation of an ethics policy on euthanasia as an organizational-ethical instrument should be considered as a dynamic process. Administrators and ethics committees must take responsibility to actively create an ethical climate supporting care providers who have to deal with ethical dilemmas in their practice.
Collapse
Affiliation(s)
- Joke Lemiengre
- Ethos, Expertise Centre of Ethics and Care, Catholic University College Limburg, Oude Luikerbaan 79, 3500, Hasselt, Limburg, Belgium,
| | | | | | | |
Collapse
|
10
|
Andrew EVW, Cohen J, Evans N, Meñaca A, Harding R, Higginson I, Pool R, Gysels M. Social-cultural factors in end-of-life care in Belgium: a scoping of the research literature. Palliat Med 2013; 27:131-43. [PMID: 22143040 DOI: 10.1177/0269216311429619] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As end-of-life (EoL) care expands across Europe and the world, service developments are increasingly studied. The sociocultural context in which such changes take place, however, is often neglected in research. AIM To explore sociocultural factors in EoL care in Belgium as represented by the literature. DESIGN A scoping of the empirical research literature following a systematic search procedure with a focus on thematic analysis based on the literature findings. DATA SOURCES Searches were carried out in eight electronic databases, five journals, reference lists, and grey literature (through September 2010). Articles informing about sociocultural issues in EoL care were included. RESULTS One hundred and fifteen original studies met the inclusion criteria, the majority (107) published between 2000 and 2010. Four major themes were: Setting; Caregivers; Communication; and Medical EoL Decisions (the largest category). Minority Ethnic Groups was an emerging theme. Gaps included: research in Wallonia and Brussels; the role and experiences of informal caregivers; issues of access to palliative care; and experiences of minority ethnic groups. There was a paucity of in-depth qualitative studies. CONCLUSIONS Various sociocultural factors influence the provision of EoL care in Belgium. This country provides a unique opportunity to witness how euthanasia is put into practice when legalized, in a context where palliative care is also highly developed and where many health care institutions have Catholic affiliation, providing an important example to others. Attention to how the sociocultural context affects EoL care adds to the current evidence base of service provision, which is essential in the further development of EoL care.
Collapse
Affiliation(s)
- Erin V W Andrew
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic - Universitat de Barcelona), Barcelona, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Gysels M, Evans N, Meñaca A, Andrew E, Toscani F, Finetti S, Pasman HR, Higginson I, Harding R, Pool R. Culture and end of life care: a scoping exercise in seven European countries. PLoS One 2012; 7:e34188. [PMID: 22509278 PMCID: PMC3317929 DOI: 10.1371/journal.pone.0034188] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/28/2012] [Indexed: 11/18/2022] Open
Abstract
AIM Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence on cultural issues in EoL care generated in the different countries. METHODS We scoped the literature for Germany, Norway, Belgium, The Netherlands, Spain, Italy and Portugal, carrying out electronic searches in 16 international and country-specific databases and handsearches in 17 journals, bibliographies of relevant papers and webpages. We analysed the literature which was unearthed, in its entirety and by type (reviews, original studies, opinion pieces) and conducted quantitative analyses for each country and across countries. Qualitative techniques generated themes and sub-themes. RESULTS A total of 868 papers were reviewed. The following themes facilitated cross-country comparison: setting, caregivers, communication, medical EoL decisions, minority ethnic groups, and knowledge, attitudes and values of death and care. The frequencies of themes varied considerably between countries. Sub-themes reflected issues characteristic for specific countries (e.g. culture-specific disclosure in the southern European countries). The work from the seven European countries concentrates on cultural traditions and identities, and there was almost no evidence on ethnic minorities. CONCLUSION This scoping review is the first comparative exploration of the cultural differences in the understanding of EoL care in these countries. The diverse body of evidence that was identified on socio-cultural issues in EoL care, reflects clearly distinguishable national cultures of EoL care, with differences in meaning, priorities, and expertise in each country. The diverse ways that EoL care is understood and practised forms a necessary part of what constitutes best evidence for the improvement of EoL care in the future.
Collapse
Affiliation(s)
- Marjolein Gysels
- Barcelona Centre for International Health Research, Universitat de Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
D'Haene I, Pasman HRW, Deliens L, Bilsen J, Mortier F, Vander Stichele R. End-of-life care policies in Flemish residential care facilities accommodating persons with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2010; 54:1067-1077. [PMID: 21070425 DOI: 10.1111/j.1365-2788.2010.01335.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE This article aims to describe the presence, content and implementation strategies of written policies on end-of-life decisions in Flemish residential care facilities (RCFs) accommodating persons with intellectual disabilities (ID), and to describe training, education and quality assessments of end-of-life care. METHODS A cross-sectional mail survey was conducted among general directors of all RCFs accommodating persons with ID (n = 140) in Flanders, Belgium. Institutions were asked to provide us with a copy of their end-of-life care policy documents for content analysis. RESULTS Of the 140 institutions, 84 (60%) completed the questionnaire and 25 institutions provided 45 policy documents. Presence of policies on specific end-of-life decisions with a possible life-shortening effect lay between 18% (palliative sedation) and 26% (withdrawing or withholding of life-prolonging treatment). The content analysis showed that the focus in the majority of these policy documents is on palliative care, while end-of-life decisions with a possible life-shortening effect are mentioned but rarely elaborated on. Furthermore, few documents incorporate the distinctive features and needs of persons with ID regarding end-of-life care. On the other hand, half of the institutions trained and educated their professional care providers in some aspects of end-of-life care while one-third assessed the satisfaction of residents and families on several of these aspects. However, more than half reported explicitly that they have no plans for such assessments. CONCLUSIONS The presence of end-of-life care policies is low in Flemish RCFs and their content is not very specific for persons with ID.
Collapse
Affiliation(s)
- I D'Haene
- Ghent University, Heymans Institute of Pharmacology, Gent, Belgium
| | | | | | | | | | | |
Collapse
|
13
|
Denier Y, Gastmans C, De Bal N, Dierckx de Casterlé B. Communication in nursing care for patients requesting euthanasia: a qualitative study. J Clin Nurs 2010; 19:3372-80. [DOI: 10.1111/j.1365-2702.2010.03367.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Dierckx de Casterlé B, Denier Y, De Bal N, Gastmans C. Nursing care for patients requesting euthanasia in general hospitals in Flanders, Belgium. J Adv Nurs 2010; 66:2410-20. [DOI: 10.1111/j.1365-2648.2010.05401.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
15
|
Lemiengre J, Dierckx de Casterlé B, Denier Y, Schotsmans P, Gastmans C. Content analysis of euthanasia policies of nursing homes in Flanders (Belgium). MEDICINE, HEALTH CARE, AND PHILOSOPHY 2009; 12:313-322. [PMID: 19137452 DOI: 10.1007/s11019-008-9176-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 11/28/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To describe the form and content of ethics policies on euthanasia in Flemish nursing homes and to determine the possible influence of religious affiliation on policy content. METHODS Content analysis of euthanasia policy documents. RESULTS Of the 737 nursing homes we contacted, 612 (83%) completed and returned the questionnaire. Of 92 (15%) nursing homes that reported to have a euthanasia policy, 85 (92%) provided a copy of their policy. Nursing homes applied the euthanasia law with additional palliative procedures and interdisciplinary deliberations. More Catholic nursing homes compared to non-Catholic nursing homes did not permit euthanasia. Policies described several phases of the euthanasia care process as well as involvement of caregivers, patients, and relatives; ethical issues; support for caregivers; reporting; and procedures for handling advance directives. CONCLUSION Our study revealed that euthanasia requests from patients are seriously considered in euthanasia policies of nursing homes, with great attention for palliative care and interdisciplinary cooperation.
Collapse
Affiliation(s)
- Joke Lemiengre
- Centre for Biomedical Ethics and Law, Katholieke Universiteit Leuven, Kapucijnenvoer 35, Box 7001, 3000, Leuven, Belgium.
| | | | | | | | | |
Collapse
|