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Lopez V, van der Keylen P, Kühlein T, Sebastião M. Psychological stress of general practitioners in the care of patients with palliative care needs: an exploratory study. BMC Palliat Care 2024; 23:197. [PMID: 39097720 PMCID: PMC11297742 DOI: 10.1186/s12904-024-01529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND In Germany, general practitioners play a pivotal role in palliative care provision. Caring for patients with palliative care needs can be a burden for general practitioners, highlighting the importance of self-care and mental health support. This study aimed to explore the role of palliative care in general practitioners' daily work, the stressors they experience, their coping mechanisms, and the potential benefits of Advance Care Planning in this context. METHODS An exploratory approach was employed, combining a short quantitative survey with qualitative interviews. The analysis was based on a structuring qualitative content analysis, following a deductive-inductive procedure and integrating the Stress-Strain Model and Lazarus' Transactional Model of Stress and Coping. We recruited eleven general practitioners to take part in the study. RESULTS General practitioners viewed palliative care as integral to their practice but faced challenges such as time constraints and perceived expertise gaps. Societal taboos often hindered conversations on the topic of death. Most general practitioners waited for their patients to initiate the topic. Some general practitioners viewed aspects of palliative care as potentially distressing. They used problem-focused (avoiding negative stressors, structuring their daily schedules) and emotion-focused (discussions with colleagues) coping strategies. Still, general practitioners indicated a desire for specific psychological support options. Advance Care Planning, though relatively unfamiliar, was acknowledged as valuable for end-of-life conversations. CONCLUSIONS Palliative care can be associated with negative psychological stress for general practitioners, often coming from external factors. Despite individual coping strategies in place, it is advisable to explore concepts for professional psychological relief. TRIAL REGISTRATION Not registered.
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Affiliation(s)
- Verena Lopez
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Universitätsstr. 29, 91054, Erlangen, Germany
| | - Piet van der Keylen
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Universitätsstr. 29, 91054, Erlangen, Germany
- Lutheran University of Applied Sciences, Nürnberg, Germany
| | - Thomas Kühlein
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Universitätsstr. 29, 91054, Erlangen, Germany
| | - Maria Sebastião
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Universitätsstr. 29, 91054, Erlangen, Germany.
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Piili RP, Hökkä M, Vänskä J, Tolvanen E, Louhiala P, Lehto JT. Facing a request for assisted death - views of Finnish physicians, a mixed method study. BMC Med Ethics 2024; 25:50. [PMID: 38702731 PMCID: PMC11067268 DOI: 10.1186/s12910-024-01051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/28/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Assisted death, including euthanasia and physician-assisted suicide (PAS), is under debate worldwide, and these practices are adopted in many Western countries. Physicians' attitudes toward assisted death vary across the globe, but little is known about physicians' actual reactions when facing a request for assisted death. There is a clear gap in evidence on how physicians act and respond to patients' requests for assisted death in countries where these actions are not legal. METHODS A survey including statements concerning euthanasia and PAS and an open question about their actions when facing a request for assisted death was sent to all Finnish physicians. Quantitative data are presented as numbers and percentages. Statistical significance was tested by using the Pearson chi-square test, when appropriate. The qualitative analysis was performed by using an inductive content analysis approach, where categories emerge from the data. RESULTS Altogether, 6889 physicians or medical students answered the survey, yielding a response rate of 26%. One-third of participants agreed or partly agreed that they could assist a patient in a suicide. The majority (69%) of the participants fully or partly agreed that euthanasia should only be accepted due to difficult physical symptoms, while 12% fully or partly agreed that life turning into a burden should be an acceptable reason for euthanasia. Of the participants, 16% had faced a request for euthanasia or PAS, and 3033 answers from 2565 respondents were achieved to the open questions concerning their actions regarding the request and ethical aspects of assisted death. In the qualitative analysis, six main categories, including 22 subcategories, were formed regarding the phenomenon of how physicians act when facing this request. The six main categories were as follows: providing an alternative to the request, enabling care and support, ignoring the request, giving a reasoned refusal, complying with the request, and seeing the request as a possibility. CONCLUSIONS Finnish physicians' actions regarding the requests for assisted death, and attitudes toward euthanasia and PAS vary substantially. Open discussion, education, and recommendations concerning a request for assisted death and ethics around it are also highly needed in countries where euthanasia and PAS are not legal.
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Affiliation(s)
- Reetta P Piili
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Palliative Care Centre, Tampere University Hospital, Palliative Care Unit, Sädetie 6, R-building, Tampere, 33520, Finland.
| | - Minna Hökkä
- Diaconia University of Applied Sciences, Helsinki, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | | | - Elina Tolvanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Tampere University Hospital, Palliative Care Unit, Sädetie 6, R-building, Tampere, 33520, Finland
| | - Pekka Louhiala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Tampere University Hospital, Palliative Care Unit, Sädetie 6, R-building, Tampere, 33520, Finland
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Lyon C. Words matter: 'enduring intolerable suffering' and the provider-side peril of Medical Assistance in Dying in Canada. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109555. [PMID: 38443165 DOI: 10.1136/jme-2023-109555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
Enduring intolerable suffering, an essential eligibility criterion in Medical Assistance in Dying (MAiD) in Canada and elsewhere, is a contradiction in terms, in that suffering must be tolerable to be endured. Cases of people who were approved for MAiD but who elected to die naturally, thus tolerating their suffering, bear out the unreliability of this central safeguard. The clinical assessment of intolerable suffering may be strengthened by adopting a definition of intolerable suffering centred on clinically evidenced physical and psychological decompensation. This argument also raises important questions about the risks of MAiD clinicians subjectively defining, approving and providing MAiD in ways that deviate from accepted legal and clinical concepts and ethics. Examples show some prolific clinicians describe MAiD in terminology that differs from such norms, as a personal mission, as personally pleasurable, and as a rights-based service. These alternative views are explored for their risks in assessing and providing MAiD for intolerable suffering. This further demonstrates the need for conceptual clarity in legislation, improved vetting and monitoring of clinicians, and a different assessment process to protect patients and clinicians.
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Affiliation(s)
- Christopher Lyon
- Leverhulme Centre for Anthropocene Biodiversity, University of York, York, UK
- Department of Environment and Geography, University of York, York, UK
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Verdaguer M, Beroiz-Groh P, Busquet-Duran X, Moreno-Gabriel E, Arreciado Marañón A, Feijoo-Cid M, Domènech M, Íñiguez-Rueda L, Vallès-Peris N, Cantarell-Barella G, Toran-Monserrat P. [The euthanasia law and professional experiences: tensions in clinical practice]. GACETA SANITARIA 2024:S0213-9111(24)00020-7. [PMID: 38472012 DOI: 10.1016/j.gaceta.2024.102373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To analyze the process of assisted death provision in Catalonia and identify the main tensions, difficulties, and/or sources of discomfort related to professional practice. METHOD A qualitative study was conducted based on interviews (n=29) and focus groups (n=19) with professionals who participated in the euthanasia process. The selection of participants combined the snowball and maximization of variability procedures, taking into account the variables of professional profile, setting, gender, age and territoriality. Intentional and theoretical sampling process. RESULTS The assisted death process is divided into four main moments: 1) reception of the request, 2) medical-bureaucratic procedure, 3) the actual procedure, and 4) closure. At each of these moments, difficulties arise that can be a source of discomfort and have to do with the limits and tensions between the legal and moral, the conception of one's own professional role, the lack of recognition of some professional roles, stress and overload, the lack of formal and informal support, and the relationship with the patient and his/her family. The bureaucratic-administrative stress derived from a protective law, with both prior and subsequent verifying control, stands out, given that it stresses the professionals immersed in a healthcare system already under high pressure after budget cuts and the COVID-19 epidemic. CONCLUSIONS Throughout the assisted death process, the sources of distress are diverse and of a psychological, psychosocial, and structural nature. These results may lead to interventions for psychological and peer support, information, training, institutional involvement, and burden reduction.
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Affiliation(s)
- Maria Verdaguer
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina, Mataró (Barcelona), España; Departament de Psicologia Social, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España.
| | - Patricia Beroiz-Groh
- Hospital Germans Trias i Pujol, Badalona (Barcelona), España; Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Xavier Busquet-Duran
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina, Mataró (Barcelona), España; Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España; Programa d'Atenció Domiciliària Equip de Suport, Servei d'Atenció Primària Vallès Oriental, Institut Català de la Salut, Granollers (Barcelona), España
| | - Eduard Moreno-Gabriel
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina, Mataró (Barcelona), España; Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España
| | - Antonia Arreciado Marañón
- Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España; Departament d'Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Maria Feijoo-Cid
- Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España; Departament d'Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Miquel Domènech
- Departament de Psicologia Social, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Lupicinio Íñiguez-Rueda
- Departament de Psicologia Social, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Núria Vallès-Peris
- Institut d'investigació en Intel·ligència Artificial, Consejo Superior de Investigaciones Científicas (IIIA-CSIC), Bellaterra (Cerdanyola del Vallès, Barcelona), España; Barcelona Science and Technology Studies Group (STS-b), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | | | - Pere Toran-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina, Mataró (Barcelona), España; Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España
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Ristic I, Ignjatovic-Ristic D, Gazibara T. Personality traits and attitude towards euthanasia among medical students in Serbia. Int J Psychiatry Med 2024; 59:232-247. [PMID: 37503904 DOI: 10.1177/00912174231191963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Various factors may influence the attitudes of medical students towards euthanasia, including personal values, beliefs, and personality traits. The objective of this study was to examine the attitudes of 2nd and 5th year medical students about euthanasia and the relationship between these attitudes and students' personality traits. METHODS Medical students from the Universities of Kragujevac and Belgrade, Serbia, participated in this study. A questionnaire was administered assessing attitudes toward euthanasia and student personality traits (honesty-humility, emotionality, extraversion, agreeableness, conscientiousness, and openness using the HEXACO-60). RESULTS More than 50% of students in the second year and 60% of students in the fifth year were supportive of euthanasia. Students in the 5th year were 2.5 times more likely to express a concern that euthanasia needs to be clearly regulated by law compared to students in the second year. Adjusted analyses indicated that lower levels of honesty-humility and emotionality were positively correlated with students' belief that euthanasia should be legalized. CONCLUSION Many medical students in Serbia have a positive attitude towards euthanasia. It is important to consider the possible influences of culture, religion, and the law on attitudes towards euthanasia. Undergraduate medical training should include more hours dedicated to palliative care and end-of-life topics to raise awareness of patients' preferences in this regard.
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Affiliation(s)
- Ivan Ristic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Shenouda J, Haslam J. Is medical assistance in dying just medically-administered death? Br J Hosp Med (Lond) 2023; 84:1-3. [PMID: 38153012 DOI: 10.12968/hmed.2023.0262] [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: 12/29/2023]
Abstract
As medical assistance in dying seemingly gains traction, this editorial discusses the arguments for and against it, looking at the balance of patient autonomy and alleviation of suffering vs the potentially far-reaching and unintended consequences. The authors hope that this provides a platform for further debate and education around assisted dying.
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Affiliation(s)
- John Shenouda
- Department of Anaesthesia, The Royal Marsden Hospital, London, UK
| | - James Haslam
- Department of Anaesthesia and Intensive Care Medicine, Salisbury NHS Foundation Trust, Salisbury, UK
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Worthington A, Finlay I, Regnard C. Assisted dying and medical practice: questions and considerations for healthcare organisations. BMJ Support Palliat Care 2023; 13:438-441. [PMID: 35473754 DOI: 10.1136/bmjspcare-2022-003652] [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: 03/21/2022] [Accepted: 04/05/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Most clinical teams and organisations have not openly or formally discussed how they would react if physician-assisted suicide were to be legalised. This paper aims to discuss some of the potential challenges of introducing 'assisted dying' into medical care and produces a table of questions and considerations in light of such evidence so as to promote necessary discussion. METHODS An analysis of recent quantitative and qualitative studies from jurisdictions where 'assisted dying' is practised was conducted, with particular attention paid to studies which focus on the impact of legalising 'assisted dying' on clinical care. RESULTS 'Assisted dying' can have a significant impact on clinical practice by complicating patient care and increasing clinician workload, potentially causing stress on patient care. CONCLUSIONS If physician-assisted suicide was to be legalised as part of existing healthcare, there are many questions that healthcare organisations must consider. Such considerations are tabulated in order to encourage awareness and discussion on the topic.
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Affiliation(s)
- Ana Worthington
- Department of Theology and Religion, University of Oxford, Oxford, UK
| | - Ilora Finlay
- Professor of Palliative Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Claud Regnard
- Honorary Consultant of Palliative Medicine, St. Oswald's Hospice, Newcastle-upon-Tyne, UK
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Boven C, Dillen L, Dierickx S, Van den Block L, Piers R, Van Den Noortgate N, Van Humbeeck L. Relatives' Experiences of Being Involved in Assisted Dying: A Qualitative Study. QUALITATIVE HEALTH RESEARCH 2023; 33:1154-1164. [PMID: 37791685 PMCID: PMC10626978 DOI: 10.1177/10497323231196827] [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] [Indexed: 10/05/2023]
Abstract
Recent literature demonstrates an interdependence between relatives and healthcare providers throughout euthanasia processes. Yet, current guidelines and literature scarcely specify the interactions between healthcare providers and bereaved relatives. The aim of this work consisted of providing an insight into bereaved relatives' experiences (1) of being involved in euthanasia processes and (2) of their interactions with healthcare providers before, during, and after the euthanasia. The research process was guided by the principles of constructivist grounded theory. Nineteen Dutch-speaking bereaved relatives of oncological patients, who received euthanasia at home or in a hospital less than 24 months ago, participated via semi-structured interviews. These interviews were conducted between May 2021 and June 2022. Due to the intensity of euthanasia processes, relatives wanted to be involved as early as possible, in order to receive time, space, and access to professionals' support whilst preparing themselves for the upcoming loss of a family member with cancer. Being at peace with the euthanasia request facilitated taking a supportive attitude, subsequently aiding in achieving a serene atmosphere. A serene atmosphere facilitated relatives' grief process because it helped them in creating and preserving good memories. Relatives appreciated support from healthcare providers, as long as overinvolvement on their part was not occurring. This study advocates for a relational approach in the context of euthanasia and provides useful complements to the existing euthanasia guidelines.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
| | - Sigrid Dierickx
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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Kirchhoffer DG, Lui CW, Ho A. Moral uncertainty and distress about voluntary assisted dying prior to legalisation and the implications for post-legalisation practice: a qualitative study of palliative and hospice care providers in Queensland, Australia. BMJ Open 2023; 13:e065964. [PMID: 37160397 PMCID: PMC10410955 DOI: 10.1136/bmjopen-2022-065964] [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] [Received: 06/23/2022] [Accepted: 04/04/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVES There is little research on moral uncertainties and distress of palliative and hospice care providers (PHCPs) working in jurisdictions anticipating legalising voluntary assisted dying (VAD). This study examines the perception and anticipated concerns of PHCPs in providing VAD in the State of Queensland, Australia prior to legalisation of the practice in 2021. The findings help inform strategies to facilitate training and support the health and well-being of healthcare workers involved in VAD. DESIGN The study used a qualitative approach to examine and analyse the perception and anticipated concerns of PHCPs regarding challenges of providing assisted dying in Queensland. Fourteen PHCPs were recruited using a purposive sampling strategy to obtain a broad representation of perspectives including work roles, geographical locations and workplace characteristics. Data were collected via one in-depth interview per participant. The transcripts were coded for patterns and themes using an inductive analysis approach following the tradition of Grounded Theory. SETTING The study was conducted in hospital, hospice, community and residential aged care settings in Queensland, Australia. These included public and private facilities, secular and faith-based facilities, and regional/rural and urban facilities. PARTICIPANTS Interviews were conducted with fourteen PHCPs: 10 nurses and 4 physicians; 11 female and 3 male. The median number of years of palliative care practice was 17, ranging from 2 to 36 years. For inclusion, participants had to be practising palliative and hospice care providers. RESULTS PHCPs are divided on whether VAD should be considered part of palliative care. Expectations of moral distress and uncertainty about practising VAD were identified in five areas: handling requests, assessing patient capacity, arranging patient transfers and logistical issues, managing unsuccessful attempts, and dealing with team conflicts and stigma. CONCLUSIONS The possibility of having to practise VAD causes moral distress and uncertainty for some PHCPs. Procedural clarity can address some uncertainties; moral and psychological distress, however, remains a source of tension that needs support to ensure ongoing care of both patients and PHCPs. The introduction of VAD post-legalisation may present an occasion for further moral education and development of PHCPs.
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Affiliation(s)
- David G Kirchhoffer
- Queensland Bioethics Centre, Australian Catholic University, Brisbane, Queensland, Australia
| | - Chi-Wai Lui
- Queensland Bioethics Centre, Australian Catholic University, Brisbane, Queensland, Australia
| | - Anita Ho
- Centre for Applied Ethics, University of British Columbia, Vancouver, British Columbia, Canada
- Bioethics Program, University of California, San Francisco (UCSF), San Francisco, California, USA
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Boven C, Van Humbeeck L, Van den Block L, Piers R, Van Den Noortgate N, Dillen L. Bereavement care and the interaction with relatives in the context of euthanasia: A qualitative study with healthcare providers. Int J Nurs Stud 2023; 140:104450. [PMID: 36796117 DOI: 10.1016/j.ijnurstu.2023.104450] [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: 06/09/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND A recent review shows an interdependence between healthcare providers and relatives in the context of euthanasia. Belgian guidelines do focus on the role of certain healthcare providers (physicians, nurses, and psychologists), yet they hardly specify bereavement care services before, during and after the euthanasia. PURPOSE A conceptual model showing underlying mechanisms of healthcare providers' experiences regarding the interaction with and the provision of bereavement care to relatives of cancer patients throughout a euthanasia process. METHODS 47 semi-structured interviews with Flemish physicians, nurses and psychologists working in hospitals and/or homecare, conducted from September 2020 to April 2022. Transcripts were analyzed using the Constructivist Grounded Theory Approach. RESULTS Participants experienced the interaction with relatives as very diverse, which can be visualized as a continuum ranging from negative to positive, depending on each unique case. The achieved degree of serenity was the main contributor in determining their position on the aforementioned continuum. To create this serene atmosphere, healthcare providers undertook actions underpinned by two attitudes (wariness and meticulousness), which are guided by different considerations. These considerations can be categorized into three groups: 1) ideas about a good death and its importance, 2) having the situation well under control and 3) self-reassurance. CONCLUSIONS If relatives were not at peace, most participants said that they deny a request or formulate additional requirements. Moreover, they wanted to ensure relatives can cope with the loss, which was often experienced as intense and time-consuming. Our insights shape needs-based care from healthcare providers' perspective in the context of euthanasia. Future research should explore the relatives' perspective regarding this interaction and the provision of bereavement care. TWEETABLE ABSTRACT Professionals strive for a serene atmosphere throughout a euthanasia process to ensure relatives can cope with the loss, and the way in which the patient died.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium.
| | - Liesbeth Van Humbeeck
- Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels Health Campus, Laarbeeklaan 103, 1090 Brussels, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
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Mroz S, Deliens L, Cohen J, Chambaere K. Developments after the liberalization of laws concerning assisted dying—experience from Belgium and other countries. DEUTSCHES ÄRZTEBLATT INTERNATIONAL 2022. [DOI: 10.3238/arztebl.m2022.0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wojtulewicz CM. Analysing the Assisted Dying Bill [HL] debate 2021. New Bioeth 2022; 28:350-367. [PMID: 35771712 DOI: 10.1080/20502877.2022.2090652] [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: 01/29/2023]
Abstract
This paper considers the number of speeches which treat central topics in the House of Lords second reading of the 'Assisted Dying Bill' (October 22, 2021). It summarizes some of the principal arguments for and against the Bill according to the main categories of discussion. These were compassion; palliative care; autonomy, choice and control; legal and social effects. In summarizing the arguments thematically, it is possible to see the current state of the debate and how concerns are shared on either side, even if approaches to and proposed solutions for those problems are different. The paper concludes that the essential source of disagreement lies outside of the arguments raised, and therefore that any change in the law is not likely to arise from political consensus.
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Ibáñez del Prado C. Eutanasia y Psicología. Algunas claves para la intervención en Procesos Adelantados de Muerte. PSICOONCOLOGIA 2022. [DOI: 10.5209/psic.84044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Los países que han optado por regular los Procesos Adelantados de Muerte (PAM) van en aumento en los últimos años. Este tipo de legislaciones implican directamente a los equipos sanitarios.Los psicólogos incluidos en estos equipos están en contacto con estos procesos, por lo que se torna imprescindible dilucidar, mediante la escasa literatura existente, si los PAM presentan variables diferenciales con otros procesos de muerte, que sean necesarias tener en cuenta durante la asistencia psicológica. Esta recopilación de literatura pretende plantear las diferencias que en la actualidad están contrastadas y plantear qué opciones de intervención psicológica están a nuestra disposición para realizar el acompañamiento a estas personas, sus cuidadores y los equipos sanitarios que los asisten.
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Introducing Medical Assistance in Dying in Canada: Lessons on Pragmatic Ethics and the Implementation of a Morally Contested Practice. HEC Forum 2022; 34:307-319. [PMID: 36053402 PMCID: PMC9437383 DOI: 10.1007/s10730-022-09495-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/16/2022]
Abstract
Medical Assistance in Dying (MAiD) in Canada has had a tumultuous social and legal history. In the 6 years since assisted dying was decriminalized by the Canadian Parliament in June 2016, the introduction of this practice into the Canadian healthcare system has been fraught with ethical challenges, practical hurdles and grass-roots innovation. In 2021, MAiD accounted for approximately 3.3% of all Canadian deaths annually, and more patients are seeking MAiD year over year as this option becomes more widely know. Unfortunately, some patients who want MAiD are unable to access it in a timely manner because of a lack of willing MAiD providers. This introduction describes statistics about the uptake of MAiD in Canada and the challenges presented by Canadians’ rapid acceptance of this end of life care option. In this special edition of HEC Forum about the implementation of MAiD in Canada, authors depict a range of ethical challenges and strategies to address issues related to MAiD access and quality, organizational engagement, clinician recruitment and retention, and support for a morally diverse workforce. In each article, the authors reflect on the question: What are the practical ethics involved in introducing assisted dying into a new healthcare context, and how can ethicists and ethics resources collaborate with stakeholders to ensure the integration of ethical considerations as this practice continues to evolve?
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Vissers S, Dierickx S, Chambaere K, Deliens L, Mortier F, Cohen J. Assisted dying request assessments by trained consultants: changes in practice and quality - Repeated cross-sectional surveys (2008-2019). BMJ Support Palliat Care 2022:bmjspcare-2021-003502. [PMID: 35768204 DOI: 10.1136/spcare-2021-003502] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/13/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To study changes in the peer consultation practice of assessing assisted dying requests and its quality among trained 'Life End Information Forum' (LEIF) consultants in Belgium between 2008 and 2019. METHODS Cross-sectional surveys conducted in 2008 (N=132) and 2019 (N=527) among all registered LEIF consultants. RESULTS The response rate was 75% in 2008 and 57% in 2019. In 2019 compared with 2008, more LEIF consultants were significantly less than 40 years old (25%/10%, p=0.006) and at least 60 years old (34%/20%, p=0.006). In their activities regarding assessments of assisted dying requests over 12 months, we found a significant increase in the number of patients who did not meet the substantive requirements for assisted dying in 2019 compared with 2008 (1-4 patients: 41.1 %/58.8%, p=0.020). In their most recent assessments of an assisted dying request, LEIF consultants in 2019 made significantly more assessments of patients aged 80 years or older than in 2008 (31%/9%, p<0.001), and significantly fewer assessments for patients with cancer (53%/70%, p=0.034). Regarding adherence to quality criteria for consultation, LEIF consultants discussed unbearable suffering (87%/65%, p=0.003) and alternative treatments (palliative: 48 %/13%, p<0.001; curative: 28%/5%, p=0.002) significantly more often with the attending physician. CONCLUSIONS Changes in peer consultation practice and its quality among LEIF consultants likely reflect changes in assisted dying practice in general, as well as changes in LEIF consultations on more complex cases for which LEIF consultants' expertise is required.
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Affiliation(s)
- Stijn Vissers
- End-of-Life Care Research Group (Vrije Universiteit Brussel & Ghent University), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sigrid Dierickx
- End-of-Life Care Research Group (Vrije Universiteit Brussel & Ghent University), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kenneth Chambaere
- End-of-Life Care Research Group (Vrije Universiteit Brussel & Ghent University), Vrije Universiteit Brussel, 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), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Freddy Mortier
- End-of-Life Care Research Group (Vrije Universiteit Brussel & Ghent University), Vrije Universiteit Brussel, Brussels, Belgium
- Bioethics Institute Ghent, Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group (Vrije Universiteit Brussel & Ghent University), Vrije Universiteit Brussel, Brussels, Belgium
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Glenny L, Nyatanga B, Regnard C, Bisset M, Damaso S, Davis C, Edwards F, Fallon M, George R, Pollock J, Proffitt A, Robinson V, Spiller J, Thavaraj A, Twycross A, Twycross R, Wright G. Assisted dying. Int J Palliat Nurs 2022; 28:55-58. [PMID: 35446671 DOI: 10.12968/ijpn.2022.28.2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Brian Nyatanga
- Consultant Editor, IJPN; Senior lecturer, University of Worcester
| | - Claud Regnard
- Honorary Consultant in Palliative Care Medicine, St Oswald's Hospice, Newcastle upon Tyne
| | | | - Sergio Damaso
- Clinical Nurse Specialist and Visiting Lecturer in Palliative Care
| | - Carol Davis
- Consultant in Palliative Medicine and Clinical Lead for End-of-Life care, University Hospital Southampton
| | | | - Marie Fallon
- Professor of Palliative Medicine, University of Edinburgh
| | - Rob George
- Professor of Palliative Care, Kings College London; Consultant in Palliative Care, Guys, and St Thomas's Foundation Trust; Independent Clinical and Medicolegal Expert
| | - Jennie Pollock
- Associate Head of Public Policy at the Christian Medical Fellowship
| | - Amy Proffitt
- Consultant in Palliative Medicine; Chair of the Association for Palliative Medicine, London
| | - Vicky Robinson
- Retired Consultant Nurse, Palliative and End-of-Life Care
| | - Juliet Spiller
- Consultant in Palliative Medicine, Marie Curie Hospice, Edinburgh
| | - Angela Thavaraj
- Palliative Care Clinical Nurse Specialist, University Hospital Lewisham, London
| | - Alison Twycross
- Senior Lecturer in Children and Young People's Nursing, The Open University; Editor-in-Chief, Evidence Based Nursing
| | - Robert Twycross
- Emeritus Clinical Reader in Palliative Medicine, Oxford University
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Abstract
PURPOSE OF REVIEW Over the last 30 years, medical assistance in dying (MAiD) including euthanasia (EU) and physician-assisted death (or suicide, PAS) has become the center of a large debate, particularly when these practices have involved people with psychiatric illness, including resistant depression, schizophrenia, personality, or other severe psychiatric disorders. We performed a review utilizing several databases, and by including the most relevant studies in full journal articles investigating the problem of MAiD in patients with psychiatric disorders but not in physical terminal conditions (non-terminal, MAiD-NT). RECENT FINDINGS Literature has shown that a small percentage of people with psychiatric disorders died by MAiD-NT in comparison with patients with somatic diseases in terminal clinical conditions (e.g., cancer, AIDS). However, the problem in the field is complex and not solved yet as confirmed by the fact that only a few countries (e.g., the Netherlands, Belgium, Luxemburg) have legalized MAiD-NT for patients with psychiatric disorders, while most have maintained the practices accessible only to people with somatic disease in a terminal phase. Also, how to make objective the criterion of irremediability of a mental disorder; how to balance suicide prevention with assisted suicide; how to avoid the risk of progressively including in requests for MAiD-NT vulnerable segments of the population, such as minors, elderly, or people with dementia, in a productive-oriented society, are some of the critical points to be discussed. The application of MAiD-NT in people with psychiatric disorders should be further explored to prevent end-of-life rights from contradicting the principles of recovery-oriented care.
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Rutherford J, Willmott L, White BP. What the Doctor Would Prescribe: Physician Experiences of Providing Voluntary Assisted Dying in Australia. OMEGA-JOURNAL OF DEATH AND DYING 2021:302228211033109. [PMID: 34282961 DOI: 10.1177/00302228211033109] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Like many countries where voluntary assisted dying (VAD) is legal, eligible doctors in Victoria, Australia, have sole legal authority to provide it. Doctors' attitudes towards legalised VAD have direct bearing on their willingness to participate in VAD and consequently, on whether permissive laws can effectively facilitate access to VAD. The study aimed to explore how some Victorian doctors are perceiving and experiencing the provision of legalised VAD under a recently commenced law. METHODS Semi-structured interviews with 25 Victorian doctors with no in-principle objection to legalised VAD were conducted between July 2019-February 2020. Interviews were recorded, transcribed, and analysed using thematic analysis. Ethical approval from the relevant institution was obtained. RESULTS Doctors perceive or experience VAD to fundamentally challenge traditional medical practice. Barriers to access to VAD derive from applicant, communication, and doctor-related factors. Doctors' willingness to participate in VAD is situation specific.
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Affiliation(s)
- Jodhi Rutherford
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| | - Ben P White
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia
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Attia JR, Jorm C, Kelly B. Medical assistance in dying: the downside. BMJ Support Palliat Care 2020; 10:259-261. [DOI: 10.1136/bmjspcare-2020-002350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 11/04/2022]
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