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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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Gerson SM, Gamondi C, Wiebe E, Deliens L. Should Palliative Care Teams be Involved in Medical Assisted Dying? J Pain Symptom Manage 2023; 66:e233-e237. [PMID: 37072103 DOI: 10.1016/j.jpainsymman.2023.04.004] [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] [Received: 03/15/2023] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/20/2023]
Abstract
Palliative care teams offer holistic care for patients experiencing serious illness and related suffering, nevertheless, there are times when clinicians are asked by patients for help to obtain assisted dying. Patients in a growing number of areas may be eligible to request medically administered or self-administered lethal medications to control the timing of death and palliative care practices, established to neither hasten nor postpone death, may be challenged when caring for patients asking for assisted dying. In this "Controversies in Palliative Care" article, we invite three experts to provide a synopsis of the key studies that inform their thought processes, share practical advice on their clinical approach, and highlight the opportunities for future research. These experts suggest palliative care teams should be and are involved in medical assisted dying, but how palliative care teams are involved may depend on type of assisted dying requested, team members' scope of practice, legal regulations, and institutional guidelines. Research is needed on many aspects of assisted dying and palliative care including improving evidence-based clinical guidelines, addressing the needs of families, and coping strategies for all involved. An international study comparing assisted dying practices within, and outside palliative care may inform policy helping to clarify whether the integration of palliative care in assisted dying improves end-of-life care. In addition to research, it is recommended that researchers and clinicians collaborate on the development of a clinical textbook on assisted dying and palliative care to support all palliative care team members, offering guidelines and recommendations for practice.
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Affiliation(s)
- Sheri Mila Gerson
- Compassionate Care Counseling and Consulting, PLLC, (S.M.G.), Olympia, Washington, USA.
| | - Claudia Gamondi
- Palliative and Supportive Care Clinic (C.G.), Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Palliative and Supportive Care Service (C.G.), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ellen Wiebe
- Faculty of Medicine (E.W.), University of British Columbia, Vancouver, Canada
| | - Luc Deliens
- End-of Life Care Research Group (L.D.), Faculty of Medicine, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
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Quah ELY, Chua KZY, Lua JK, Wan DWJ, Chong CS, Lim YX, Krishna L. A Systematic Review of Stakeholder Perspectives of Dignity and Assisted Dying. J Pain Symptom Manage 2023; 65:e123-e136. [PMID: 36244639 DOI: 10.1016/j.jpainsymman.2022.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The debate on assisted dying and its components, euthanasia and physician-assisted suicide has evolved with the emergence of the right to dignity and the wish to hasten death (WTHD). Whilst shaped by local legal and sociocultural considerations, appreciation of how patients, healthcare professionals and lawmakers relate notions of dignity to self-concepts of personhood and the desire for assisted dying will better inform and direct support of patients. METHODS Guided by the Systematic Evidence Based Approach, a systematic scoping review (SSR in SEBA) on perspectives of dignity, WTHD and personhood featured in PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL, Scopus databases and four key Palliative Care journals was conducted. The review hinged on the following questions: "what is the relationship between dignity and the wish to hasten death (WTHD) in the assisted dying debate?", "how is dignity conceptualised by patients with WTHD?" and "what are prevailing perspectives on the role of assisted dying in maintaining a dying patient's dignity?" RESULTS 6947 abstracts were identified, 663 full text articles reviewed, and 88 articles included. The four domains identified include 1) concepts of dignity through the lens of the Ring Theory of Personhood (RToP) including their various definitions and descriptions; 2) the relationship between dignity, WTHD and assisted dying with loss of dignity and autonomy foregrounded; 3) stakeholder perspectives for and against assisted dying including those of patient, healthcare provider and lawmaker; and 4) other dignity-conserving measures as alternatives to assisted dying. CONCLUSION Concepts of dignity constantly evolve throughout the patient's end of life journey. Understanding when and how these concepts of personhood change and trigger the fear of a loss of dignity or intractable suffering could direct timely, individualised and appropriate person-centred dignity conserving measures. We believe an RToP-based tool could fulfil this role and further study into the design of this tool is planned.
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Affiliation(s)
- Elaine Li Ying Quah
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Jun Kiat Lua
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Darius Wei Jun Wan
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Chi Sum Chong
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Yun Xue Lim
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore
| | - Lalit Krishna
- Yong Loo Lin School of Medicine (E.L.Y.Q, K.Z.Y.C, J.K.L., D.W.J.W., C.S.C., Y.X.L., L.K), National University of Singapore, Singapore; Division of Cancer Education (L.K), National Cancer Centre Singapore Singapore; Division of Supportive and Palliative Care (L.K), National Cancer Centre Singapore (L.K), Singapore; Palliative Care Institute Liverpool (L.K), Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom; Health Data Science (L.K), Liverpool; Duke-NUS Medical School (L.K), Singapore; Centre of Biomedical Ethics (L.K), Singapore; PalC (L.K), The Palliative Care Centre for Excellence in Research and Education, Dover Park Hospice, Singapore.
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Mazzola MA, Russell JA. Neurology ethics at the end of life. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:235-257. [PMID: 36599511 DOI: 10.1016/b978-0-12-824535-4.00012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ethical challenges in medical decision making are commonly encountered by clinicians caring for patients afflicted by neurological injury or disease at the end of life (EOL). In many of these cases, there are conflicting opinions as to what is right and wrong originating from multiple sources. There is a particularly high prevalence of impaired patient judgment and decision-making capacity in this population that may result in a misrepresentation of their premorbid values and goals. Conflict may originate from a discordance between what is legal or from stakeholders who view and value life and existence differently from the patient, at times due to religious or cultural influences. Promotion of life, rather than preservation of existence, is the goal of many patients and the foundation on which palliative care is built. Those who provide EOL care, while being respectful of potential cultural, religious, and legal stakeholder perspectives, must at the same time recognize that these perspectives may conflict with the optimal ethical course to follow. In this chapter, we will attempt to review some of the more notable ethical challenges that may arise in the neurologically afflicted at the EOL. We will identify what we believe to be the most compelling ethical arguments both in support of and opposition to specific EOL issues. At the same time, we will consider how ethical analysis may be influenced by these legal, cultural, and religious considerations that commonly arise.
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Schildmann J, Cinci M, Kupsch L, Oldenburg M, Wörmann B, Nadolny S, Winkler E. Evaluating requests for physician-assisted suicide. A survey among German oncologists. Cancer Med 2022; 12:1813-1820. [PMID: 35770954 PMCID: PMC9883542 DOI: 10.1002/cam4.4981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/26/2022] [Accepted: 06/13/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cancer patients form a notable proportion of requestors for physician-assisted suicide (PAS). This manuscript provides data on German oncologists' views concerning due criteria for the assessment of requests for PAS and quality assurance. METHODS The German Society of Haematology and Medical Oncology (DGHO) has conducted a survey among its members to elicit data about practices and views on regulating PAS in March 2021. Descriptive analysis and bivariate logistic regression of quantitative data on socio-demographic and other determinants possibly associated with respondents' views on PAS as well as content analysis of qualitative data were performed. RESULTS About 57.1% (n = 425) of respondents (n = 745) indicated that they had been asked for information about PAS by patients. Information about palliative (92.7%; n = 651) and psychological care options (85.6%; n = 598) was deemed most important in cases of requests for PAS. More than half of the respondents (57.6%; n = 429) were in favour of a formal expert assessment of decisional capacity and about 33.4% (n = 249) favoured a time span of 14 days between the counselling and prescription of a lethal drug. There was no association between participants who received more requests and a preference for disclosing publicly their willingness to assist with suicide. A majority of respondents requested measures of quality assurance (71.3%; n = 531). CONCLUSION According to respondents' views, the regulation of PAS will require diligent procedures regarding the assessment of decisional capacity and counselling. The findings suggest that the development of adequate and feasible criteria to assess the quality of practices is an important task.
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Affiliation(s)
- Jan Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Centre for Health SciencesMedical Faculty of Martin Luther University Halle‐WittenbergHalle (Saale)Germany
| | - Marc Cinci
- Department of Medical Oncology, National Centre for Tumour Diseases, Section for Translational Medical EthicsUniversity HospitalHeidelbergGermany
| | - Leonie Kupsch
- Institute for History and Ethics of Medicine, Interdisciplinary Centre for Health SciencesMedical Faculty of Martin Luther University Halle‐WittenbergHalle (Saale)Germany
| | - Michael Oldenburg
- German Society of Haematology and Medical Oncology (DGHO)BerlinGermany
| | - Bernhard Wörmann
- German Society of Haematology and Medical Oncology (DGHO)BerlinGermany,Department of Internal Medicine, Haematology/Oncology and Tumour ImmunologyCharité University MedicineBerlinGermany
| | - Stephan Nadolny
- Institute for History and Ethics of Medicine, Interdisciplinary Centre for Health SciencesMedical Faculty of Martin Luther University Halle‐WittenbergHalle (Saale)Germany
| | - Eva Winkler
- Department of Medical Oncology, National Centre for Tumour Diseases, Section for Translational Medical EthicsUniversity HospitalHeidelbergGermany
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Stängle S, Fringer A. "Discussion or silent accompaniment: a grounded theory study about voluntary stopping of eating and drinking in Switzerland". Palliat Care 2022; 21:85. [PMID: 35610598 PMCID: PMC9128132 DOI: 10.1186/s12904-022-00941-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background Voluntary stopping of eating and drinking as an option to end life prematurely is gaining international attention, and health care professionals are increasingly confronted with the wish to die through voluntary stopping of eating and drinking by individuals. While to date, there are no guidelines in Switzerland to orient professional support, it is of interest how professionals and other people involved react to the situation. The aim of this qualitative study was to explore how health care professionals in Switzerland accompany individuals during voluntary stopping of eating and drinking and to analyze this decision-making process. Methods Charmaz's grounded theory constructivist methodology uses guidelines for systematic, theory-driven data analysis underpinned by a pragmatic philosophical perspective. Data were collected in autumn 2016 as part of a regional palliative care conference on voluntary stopping of eating and drinking. All participants of the expert meeting (N = 50, including nurses, counsellors, ethicists, medical doctors, politicians, volunteers, and relatives) were invited to the focus group interviews, of which N = 47 participated. We conducted five focus group interviews, each lasting one hour. Results The results showed that the accompaniment of those willing to die during voluntary stopping of eating and drinking was either discussed and cleared with one another or was unspoken and silently accompanied. Conclusions The demands of participants for more knowledge must be heeded, and there is also a need for systematic instructions on how to proceed in the case of voluntary stopping of eating and drinking support and what needs to be considered.
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Affiliation(s)
- Sabrina Stängle
- Institute of Nursing, ZHAW School of Health Professions, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland. .,Department of Nursing Science, Witten/Herdecke University Faculty of Health, Stockumer Strasse 12, 58453, Witten, Germany.
| | - André Fringer
- Institute of Nursing, ZHAW School of Health Professions, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland.,Department of Nursing Science, Witten/Herdecke University Faculty of Health, Stockumer Strasse 12, 58453, Witten, Germany
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Kini V, Mosley B, Ressalam J, Bolcic-Jankovic D, Lum HD, Kessler ER, DeCamp M, Campbell EG. A novel methodology to identify and survey physicians participating in medical aid-in-dying. Sci Rep 2022; 12:6056. [PMID: 35410431 PMCID: PMC9001750 DOI: 10.1038/s41598-022-09971-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/24/2022] [Indexed: 12/25/2022] Open
Abstract
Physicians who participate in medical-aid-in-dying (MAID) cannot be easily identified and studied due to cost and anonymity barriers. We developed and empirically tested a novel methodology to identify and survey physicians highly likely to participate in MAID activities. We used a state-level comprehensive administrative claims database to identify a cohort of patients with diagnoses and hospice enrollment similar to those known to have filled a prescription for MAID from 2017-2018. We then identified physicians who provided routine outpatient care to these patients using National Provider Identifier numbers. We surveyed these physicians in 3 waves (n = 583 total surveys), ranking physicians in order of their likelihood of being asked about MAID for each wave based on characteristics including specialty and the number of unique patients they had provided care to. We re-ranked physicians in waves 2 and 3 based on responses from prior waves. Physicians were surveyed only once and there was no follow-up to preserve anonymity. Surveys assessed the proportion of respondents who participated in MAID activities (discussions, referrals, and/or prescriptions). We identified 6369 physicians that provided care to 2960 patients. In survey waves one, two, and three respectively, response rates (55%, 52%, and 55%; p = 0.98) and the proportion of respondents that participated in MAID activities (58%, 56%, and 42%; p = 0.05) were similar. Small adjustments made to physician ranking criteria in waves two and three did not increase the proportion of physicians that participated in MAID activities. We used a novel methodology using administrative data to identify and survey physicians at high likelihood of participating in MAID activities. We achieved good overall response rates (52%), and a high proportion of respondents that participated in MAID activities (52%), demonstrating that it is possible to overcome cost and anonymity barriers to conducting quantitative research on MAID. This methodology could be used in larger scale studies of MAID or other bioethical issues with "hidden" physician populations.
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Affiliation(s)
- Vinay Kini
- grid.5386.8000000041936877XDivision of Cardiology, Weill Cornell Medical College, 520 E 70th St, Starr 433, New York, NY 10021 USA
| | - Bridget Mosley
- grid.430503.10000 0001 0703 675XDepartment of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Julie Ressalam
- grid.430503.10000 0001 0703 675XCenter for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Dragana Bolcic-Jankovic
- grid.266685.90000 0004 0386 3207Center for Survey Research, University of Massachusetts Boston, Boston, USA
| | - Hillary D. Lum
- grid.430503.10000 0001 0703 675XDivision of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Elizabeth R. Kessler
- grid.430503.10000 0001 0703 675XDivision of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Matthew DeCamp
- grid.430503.10000 0001 0703 675XCenter for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, USA ,grid.430503.10000 0001 0703 675XGeneral Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Eric G. Campbell
- grid.430503.10000 0001 0703 675XCenter for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, USA ,grid.430503.10000 0001 0703 675XGeneral Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
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Davidson JE, Stokes L, DeWolf Bosek MS, Turner M, Bojorquez G, Lee YS, Upvall M. Nurses' values on medical aid in dying: A qualitative analysis. Nurs Ethics 2022; 29:636-650. [PMID: 35104169 DOI: 10.1177/09697330211051029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: Explore nurses' values and perceptions regarding the practice of medical aid in dying. Background: Medical aid in dying is becoming increasing legal in the United States. The laws and American Nurses Association documents limit nursing involvement in this practice. Nurses' values regarding this controversial topic are poorly understood. Methodology: Cross-sectional electronic survey design sent to nurse members of the American Nurses Association. Inductive thematic content analysis was applied to open-ended comments. Ethical Considerations: Approved by the institutional review board (#191046). Participants: 1213 nurses provided 3639 open-ended comments. More than 80% of participants self-identified as white 58% held a graduate degree; and half were of Christian faith. Results: Values ranged on a continuum expressed through four themes: "Honoring Patient Autonomy without Judgment," "Honoring with Limitations," "Not until...," and "Adamantly against." Some felt it was a duty to honor the patients' wishes, set aside own beliefs, and respect patients' choices often with a spiritual connotation. Nurses held concerns about the process, policy, potential psychological harm, legal risk, and the need to learn more about MAID. Nurse who were adamantly against MAID associated the practice with murder/suicide and against religious beliefs. Disparate values were expressed about changing the MAID legislation to allow patient support with taking MAID medications and allowing MAID via advance directive. Conclusions: Nurses desire more education on MAID. There is not one universally held position on the nurse's role during MAID. Healthcare policy/standards need to accommodate the wide variation in nurses' values. Implications: Nurses desire education regarding their role in MAID. Nurses are encouraged to participate in policy discussions as the practice becomes increasingly legal. Managers need to expect that nurses, patients, and families will need psychological support to participate in MAID. Careful construction of policy/standards is needed to minimize conflict, moral distress, and psychological harm amongst nurses. Further research is needed.
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Affiliation(s)
- Judy E Davidson
- Department of Nursing, 315531University of California San Diego, La Jolla, CA, USA
| | - Liz Stokes
- Center for Ethics and Human Rights, 8277American Nurses Association, Silver Spring, MD, USA
| | | | - Martha Turner
- Center for Ethics and Human Rights, 8277American Nurses Association, Silver Spring MD, USA.,School of Nursing, University of Minnesota, SE Minneapolis, MN, USA
| | - Genesis Bojorquez
- Hillcrest Inpatient Medicine Service, 315531University of California San Diego Health, San Diego, CA, USA
| | - Youn-Shin Lee
- School of Nursing, 229133San Diego State University, San Diego, CA, USA
| | - Michele Upvall
- Department of Nursing, 561287VinUniversity, Gia Lam District, Hanoi
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Stukalin I, Olaiya OR, Naik V, Wiebe E, Kekewich M, Kelly M, Wilding L, Halko R, Oczkowski S. Medications and dosages used in medical assistance in dying: a cross-sectional study. CMAJ Open 2022; 10:E19-E26. [PMID: 35042691 PMCID: PMC8920593 DOI: 10.9778/cmajo.20200268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is little evidence describing the technical aspects of medical assistance in dying (MAiD) in Canada, such as medications, dosages and complications. Our objective was to describe clinical practice in providing MAiD in Ontario and Vancouver, Canada, and explore relations between medications used, time until death and complications. METHODS We conducted a retrospective cohort study of a sample of adult (age ≥ 18 yr) patients who received MAiD in Ontario between 2016 and 2018, and patients who received MAiD in 1 of 3 Canadian academic hospitals (in Hamilton and Ottawa, Ontario, and Vancouver, British Colombia) between 2019 and 2020. We used de-identified data for 2016-2018 from the Office of the Chief Coroner for Ontario MAiD Database and chart review data for 2019-2020 from the 3 centres. We used multivariable parametric survival analysis to identify relations between medications, dosages and time from procedure start until death. RESULTS The sample included 3557 patients (1786 men [50.2%] and 1770 women [49.8%] with a mean age of 74 [standard deviation 13] yr). The majority of patients (2519 [70.8%]) had a diagnosis of cancer. The medications most often used were propofol (3504 cases [98.5%]), midazolam (3251 [91.4%]) and rocuronium (3228 [90.8%]). The median time from the first injection until death was 9 (interquartile range 6) minutes. Standard-dose lidocaine (40-60 mg) and high-dose propofol (> 1000 mg) were associated with prolonged time until death (prolonged by a median of 1 min and 3 min, respectively). Complications occurred in 41 cases (1.2%), mostly related to venous access or need for administration of a second medication. INTERPRETATION In a large sample of patients who died with medical assistance, certain medications were associated with small differences in time from injection to death, and complications were rare. More research is needed to identify the medication protocols that predict outcomes consistent with patient and family expectations for a medically assisted death.
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Affiliation(s)
- Igor Stukalin
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Oluwatobi R Olaiya
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Viren Naik
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Ellen Wiebe
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Mike Kekewich
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Michaela Kelly
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Laura Wilding
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Roxanne Halko
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont
| | - Simon Oczkowski
- Department of Medicine (Stukalin), University of Calgary, Calgary, Alta.; Division of Plastic Surgery (Olaiya), Department of Surgery, McMaster University, Hamilton, Ont.; The Ottawa Hospital (Naik, Kekewich, Wilding); Department of Anesthesiology and Pain Medicine (Naik), University of Ottawa, Ottawa, Ont.; Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK; Office of the Chief Coroner for Ontario (Halko), Toronto, Ont.; Departments of Medicine (Oczkowski), and Health Research Methods, Evidence, and Impact (Olaiya, Oczkowski), McMaster University, Hamilton, Ont.
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10
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Abstract
Despite the use of aggressive multimodality therapies, the prognosis of brain tumor patients remains poor. Tumors of glial origin typically have the worst prognosis, with a predicted median survival of 12-15months for glioblastoma multiforme (WHO grade IV) and 2-5years for anaplastic glioma (WHO grade III). Palliative care problems and needs in patients with primary and secondary brain tumors are significantly different, both due to different trajectory of disease and to variable prognosis which in metastatic brain tumors is related to the natural history of primary tumors. This chapter describes the complex interactions influencing communication and the treatment decision process in primary brain tumor patients. The whole trajectory of disease and particularly the end-of-life (EOL) phase of brain tumor (BT) patients are quite different in respect to the expected trajectory observed in the general cancer population. The need to improve the communication of prognosis in BT patients has been clearly reported in neuro-oncological literature, but several issues may hinder a good communication in these patients. Adequate prognostic awareness (PA) is important for several reasons: to respect patient autonomy, to obtain her/his preferences about treatments and goal of care, and to share EOL treatment decisions. The high incidence of cognitive deficits in BT patients is one of the most challenging issues influencing the quality of communication and the participation of patients in the process of treatment decisions. Impaired neurocognitive functions may impact capacities of understanding, appreciation, reasoning, and expression of choice, reducing Medical Decisions Capacity (MDC). The lack of capacity to express preferences about EOL treatment decisions represents an important ethical issue, with a great impact on both the patient's family and healthcare professionals involved in the decision processes. Also, patients' coping styles may have an important influence in critical aspects of care such as communication of diagnosis and prognosis, discussion with patients and their caregivers about goal of treatments, early introduction of PC, and advanced planning of patients' preferences concerning EOL treatment and issues. Several barriers hinder good communication in BT patients. This chapter analyzes emerging literature data and possible strategies to improve communication about prognosis and goals of care and to promote patients' involvement in the treatment decision process particularly in the palliative care setting.
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Affiliation(s)
- Andrea Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | - Antonio Tanzilli
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Dario Benincasa
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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11
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Ward V, Freeman S, Callander T, Xiong B. Professional experiences of formal healthcare providers in the provision of medical assistance in dying (MAiD): A scoping review. Palliat Support Care 2021; 19:744-758. [PMID: 33781368 DOI: 10.1017/s1478951521000146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This scoping review describes the existing literature which examines the breadth of healthcare providers' (HCP's) experiences with the provision of medical assistance in dying (MAiD). METHOD This study employed a scoping review methodology: (1) identify research articles, (2) identify relevant studies, (3) select studies based on inclusion/exclusion criteria, (4) chart the data, and (5) summarize the results. RESULTS In total, 30 papers were identified pertaining to HCP's experiences of providing MAiD. Fifty-three percent of the papers were from Europe (n = 16) and 40% of studies were from the USA or Canada (n = 12). The most common participant populations were physicians (n = 17) and nurses (n = 12). This scoping review found that HCPs experienced a variety of emotional responses to providing or providing support to MAiD. Some HCPs experienced positive emotions through helping patients at the end of the patient's life. Still other HCPs experienced very intense and negative emotions such as immense internal moral conflict. HCPs from various professions were involved in various aspects of MAiD provision such as responding to initial requests for MAiD, supporting patients and families, nursing support during MAiD, and the administration of medications to end of life. SIGNIFICANCE OF RESULTS This review consolidates many of the experiences of HCPs in relation to the provision of MAiD. Specifically, this review elucidates many of the emotions that HCPs experience through participation in MAiD. In addition to describing the emotional experiences, this review highlights some of the roles that HCPs participate in with relation to MAiD. Finally, this review accentuates the importance of team supports and self-care for all team members in the provision of MAiD regardless of their degree of involvement.
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Affiliation(s)
- Valerie Ward
- Northern Medical Program, University of Northern British Columbia, Prince George, BC, Canada
| | - Shannon Freeman
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Taylor Callander
- Northern Medical Program, University of Northern British Columbia, Prince George, BC, Canada
| | - Beibei Xiong
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
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12
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Winters JP, Pickering N, Jaye C. Because it was new: Unexpected experiences of physician providers during Canada's early years of legal medical assistance in dying. Health Policy 2021; 125:1489-1497. [PMID: 34629201 DOI: 10.1016/j.healthpol.2021.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/27/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
Implementing newly legalized euthanasia or assisted dying presents challenges. The procedure is high-stakes and irreversible and the context is controversial and associated with high emotions and strong opinions. This qualitative study reports unexpected experiences of twenty-one medical doctors who provided Medical Assistance in Dying (MAID) in the first years after legalization in Canada. The phrase 'because it was new' occurred multiple times as doctors attributed unanticipated experiences to the lack of individual and collective experience or knowledge. Positively viewed surprises included increased awareness of palliative care and an unexpected personal sense of fulfillment from helping others. Negative surprises were attributed multiple factors including ambiguously phrased legislation, systems issues and individual inexperience. Participants described issues such as technical difficulties around provision, provider anxiety, logistical snags and inability to adequately counsel and guide families. Participants expressed desire for more guidance, mentoring, training, and team communication. This article draws on phenomenological analysis of data to present providers' accounts of their experiences in the Canadian context. This will assist new providers and jurisdictions in anticipating and preparing for circumstances that were unexpected for the first cohort.
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Affiliation(s)
- Janine Penfield Winters
- Bioethics Centre, University of Otago, 71 Fredrick Street, North Dunedin, Dunedin 9010, New Zealand.
| | - Neil Pickering
- Bioethics Centre, University of Otago, 71 Fredrick Street, North Dunedin, Dunedin 9010, New Zealand.
| | - Chrystal Jaye
- Department of General Practice and Rural Medicine, University of Otago, 55 Hanover Street, Dunedin Central, Dunedin 9016, New Zealand.
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13
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Chaudhary U, Chander BS, Ohry A, Jaramillo-Gonzalez A, Lulé D, Birbaumer N. Brain Computer Interfaces for Assisted Communication in Paralysis and Quality of Life. Int J Neural Syst 2021; 31:2130003. [PMID: 34587854 DOI: 10.1142/s0129065721300035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The rapid evolution of Brain-Computer Interface (BCI) technology and the exponential growth of BCI literature during the past 20 years is a consequence of increasing computational power and the achievements of statistical learning theory and machine learning since the 1960s. Despite this rapid scientific progress, the range of successful clinical and societal applications remained limited, with some notable exceptions in the rehabilitation of chronic stroke and first steps towards BCI-based assisted verbal communication in paralysis. In this contribution, we focus on the effects of noninvasive and invasive BCI-based verbal communication on the quality of life (QoL) of patients with amyotrophic lateral sclerosis (ALS) in the locked-in state (LIS) and the completely locked-in state (CLIS). Despite a substantial lack of replicated scientific data, this paper complements the existing methodological knowledge and focuses future investigators' attention on (1) Social determinants of QoL and (2) Brain reorganization and behavior. While it is not documented in controlled studies that the good QoL in these patients is a consequence of BCI-based neurorehabilitation, the proposed determinants of QoL might become the theoretical background needed to develop clinically more useful BCI systems and to evaluate the effects of BCI-based communication on QoL for advanced ALS patients and other forms of severe paralysis.
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Affiliation(s)
- Ujwal Chaudhary
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen 72076, Germany.,ALSVOICE gGmbH, Mössingen 72116, Germany
| | - Bankim Subhash Chander
- ALSVOICE gGmbH, Mössingen 72116, Germany.,Department of Psychiatry and Psychotherapy, Center for Innovative Psychiatric and Psychotherapeutic Research, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim 68159, Germany
| | - Avi Ohry
- Sackler Faculty of Medicine, Tel Aviv University & Reuth Medical & Rehabilitation Center, Tel Aviv, Israel
| | - Andres Jaramillo-Gonzalez
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen 72076, Germany
| | | | - Niels Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen 72076, Germany.,ALSVOICE gGmbH, Mössingen 72116, Germany
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14
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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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15
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Russell JA. Hastened death in veterans with amyotrophic lateral sclerosis. Muscle Nerve 2021; 63:785-786. [PMID: 33660291 DOI: 10.1002/mus.27210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/19/2021] [Accepted: 02/27/2021] [Indexed: 11/06/2022]
Affiliation(s)
- James A Russell
- Division of Neurology - Emeritus, Lahey Hospital and Medical Center (Beth Israel Lahey Health), Burlington, Massachusetts, 01085, USA.,Clinical Professor of Neurology, Tufts University School of Medicine, Boston, Massachusetts, USA
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16
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Oczkowski SJW, Crawshaw D, Austin P, Versluis D, Kalles-Chan G, Kekewich M, Curran D, Miller PQ, Kelly M, Wiebe E, Dees M, Frolic A. How We Can Improve the Quality of Care for Patients Requesting Medical Assistance in Dying: A Qualitative Study of Health Care Providers. J Pain Symptom Manage 2021; 61:513-521.e8. [PMID: 32835830 DOI: 10.1016/j.jpainsymman.2020.08.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Since Canada decriminalized medical assistance in dying (MAID) in 2015, clinicians and organizations have developed policies and protocols to implement assisted dying in clinical practice. Five years on, there is little consensus as to what constitutes high-quality care in MAID. OBJECTIVES To describe MAID clinicians' perspectives on quality of care in MAID, including challenges, successes, and clinical practice suggestions. METHODS We conducted an exploratory, multicenter, and qualitative study at four Canadian centers. Using a semistructured interview guide, we conducted interviews with 20 health care providers. Interviews were transcribed and deidentified before analysis. Adopting a qualitative descriptive approach, we used a thematic analysis to identify primary and secondary themes in the interviews and practice suggestions to improve quality of care to patients who request MAID. RESULTS We identified three major themes. 1) Improving access and patient experience: clinicians described struggles in ensuring equitable access to MAID and supporting MAID patients and their families. 2) Supporting providers and sustainability: clinicians described managing MAID workload, remuneration, educational needs, and the emotional impact of participating in assisted dying. 3) Institutional support: descriptions of MAID communication tools and training, use of standardized care pathways, interprofessional collaboration, and human resource planning. Clinicians also described suggestions for clinical practice to improve quality of care. CONCLUSION Canadian health care providers described unique challenges in caring for patients who request MAID, along with practices to improve the quality of care.
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Affiliation(s)
- Simon J W Oczkowski
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Hamilton Health Sciences, Hamilton, Ontario, Canada.
| | - Diane Crawshaw
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Peggy Austin
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Donald Versluis
- School of Nursing, McMaster University, Hamilton, Ontario, Canada; Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | | | - Mike Kekewich
- Department of Clinical and Organizational Ethics, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Paul Q Miller
- Hamilton Health Sciences, Hamilton, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michaela Kelly
- London School of Hygiene and Tropical Medicine, London, England
| | - Ellen Wiebe
- Department of Family Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marianne Dees
- Q Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrea Frolic
- Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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17
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Stängle S, Büche D, Häuptle C, Fringer A. Experiences, Personal Attitudes, and Professional Stances of Swiss Health Care Professionals Toward Voluntary Stopping of Eating and Drinking to Hasten Death: A Cross-Sectional Study. J Pain Symptom Manage 2021; 61:270-278.e11. [PMID: 32768556 DOI: 10.1016/j.jpainsymman.2020.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/23/2022]
Abstract
CONTEXT Voluntary stopping of eating and drinking (VSED) is the self-determined decision of an individual with the decision-making capacity to cause premature death. During the course of VSED, the person is dependent on the support of relatives and health professionals. To date, little is known of the attitudes of Swiss health professionals on this topic. OBJECTIVES The objective of this study was to assess the experiences, personal attitudes, and professional stances of Swiss health care professionals toward VSED. METHODS We conducted a nationwide cross-sectional survey by questioning family physicians and the heads of outpatient care and long-term care (e.g., nursing directors, institute directors, or head nurses) about VSED (n = 1681; response rate 40.1%). Descriptive data analysis and hypothesis testing (occupational group, age, sex, professional years, VSED experience, and regions) were subsequently conducted. RESULTS Individuals who are willing to die are granted the right to professional accompaniment during VSED (agreement 97.8%), and their death is usually classified as a natural form of dying (63.5%) and only rarely (5.4%) as suicide. Family physicians have significantly more moral concerns during accompaniment compared with the heads of outpatient and long-term care (P < 0.001). CONCLUSION Swiss health care professionals support the autonomy and self-determination of patients, which is also reflected in their positive attitude toward VSED, even if they have moral reservations when accompanying patients.
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Affiliation(s)
- Sabrina Stängle
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University, Witten, Germany; School of Health Professions, Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland.
| | - Daniel Büche
- Cantonal Hospital St. Gallen, Palliative Centre St. Gallen, St. Gallen, Switzerland
| | - Christian Häuptle
- Cantonal Hospital St. Gallen, Centre for General Practitioner Medicine, St. Gallen, Switzerland
| | - André Fringer
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University, Witten, Germany; School of Health Professions, Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland
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18
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"An indelible mark" the response to participation in euthanasia and physician-assisted suicide among doctors: A review of research findings. Palliat Support Care 2020; 18:82-88. [PMID: 31340873 DOI: 10.1017/s1478951519000518] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The debate regarding euthanasia and physician-assisted suicide (E/PAS) raises key issues about the role of the doctor, and the professional, ethical, and clinical dimensions of the doctor-patient relationship. This review aimed to examine the published evidence regarding the response of doctors who have participated in E/PAS. METHODS Original research papers were identified reporting either qualitative or qualitative data published in peer-reviewed literature between 1980 and March 2018, with a specific focus on the impact on, or response from, physicians to their participation in E/PAS. PRISMA and CASP guidelines were followed. RESULTS Nine relevant papers met selection criteria. Given the limited published data, a descriptive synthesis of quantitative and qualitative findings was performed. Quantitative surveys were limited in scope but identified a mixed set of responses. Where studies measured psychological impact, 30-50% of doctors described emotional burden or discomfort about participation, while findings also identified a comfort or satisfaction in believing the request of the patient was met. Significant, ongoing adverse personal impact was reported between 15% to 20%. A minority of doctors sought personal support, generally from family or friends, rather than colleagues. The themes identified from the qualitative studies were summarized as: 1) coping with a request; 2) understanding the patient; 3) the doctor's role and agency in the death of a patient; 4) the personal impact on the doctor; and 5) professional guidance and support. SIGNIFICANCE OF RESULTS Participation in E/PAS can have a significant emotional impact on participating clinicians. For some doctors, participation can contrast with perception of professional roles, responsibilities, and personal expectations. Despite the importance of this issue to medical practice, this is a largely neglected area of empirical research. The limited studies to date highlight the need to address the responses and impact on clinicians, and the support for clinicians as they navigate this challenging area.
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19
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Sweet A, Blanke C, Kelly B, Mendz GL, Kissane DW. Letters to the Editor. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:800-804. [PMID: 33404335 DOI: 10.1177/1073110520979393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Ashley Sweet
- Ashley Sweet M.D., M.B.E., is a general surgery resident and member of the ethics consult service at Oregon Health and Science University in Portland, Oregon. Charles Blanke M.D., FASCO, is a medical oncologist and end-of-life specialist at the Knight Cancer Institute, Oregon Health and Science University, in Portland Oregon
| | - Charles Blanke
- Ashley Sweet M.D., M.B.E., is a general surgery resident and member of the ethics consult service at Oregon Health and Science University in Portland, Oregon. Charles Blanke M.D., FASCO, is a medical oncologist and end-of-life specialist at the Knight Cancer Institute, Oregon Health and Science University, in Portland Oregon
| | - Brian Kelly
- Brian Kelly, M.D., is a Professor of Psychiatry, Head of School and Dean of Medicine at the School of Medicine & Public Health and a member of the Faculty of Health and Medicine at the University of Newcastle in Australia
| | - George L Mendz
- George L. Mendz Ph.D., M.Bioeth, LicSci is Professor and Head of Research at the School of Medicine, Sydney, The University of Notre Dame Australia. David W. Kissane, A.C., M.D., M.P.M., FRANZCP, FAChPM, FACLP is the Chair of Palliative Care Research at the School of Medicine, Sydney, The University of Notre Dame Australia
| | - David W Kissane
- George L. Mendz Ph.D., M.Bioeth, LicSci is Professor and Head of Research at the School of Medicine, Sydney, The University of Notre Dame Australia. David W. Kissane, A.C., M.D., M.P.M., FRANZCP, FAChPM, FACLP is the Chair of Palliative Care Research at the School of Medicine, Sydney, The University of Notre Dame Australia
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20
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Bentley B, O'connor M, Shaw J, Breen L. A Narrative Review of Dignity Therapy Research. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12282] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Moira O'connor
- School of Psychology and Speech Pathology, Curtin University,
| | | | - Lauren Breen
- School of Psychology and Speech Pathology, Curtin University,
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21
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Thomas HL. Demedicalisation: radically reframing the assisted dying debate-an essay by Lucy Thomas. BMJ 2020; 371:m2919. [PMID: 32998910 DOI: 10.1136/bmj.m2919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zworth M, Saleh C, Ball I, Kalles G, Chkaroubo A, Kekewich M, Miller PQ, Dees M, Frolic A, Oczkowski S. Provision of medical assistance in dying: a scoping review. BMJ Open 2020; 10:e036054. [PMID: 32641328 PMCID: PMC7348461 DOI: 10.1136/bmjopen-2019-036054] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The purpose of this study is to map the characteristics of the existing medical literature describing the medications, settings, participants and outcomes of medical assistance in dying (MAID) in order to identify knowledge gaps and areas for future research. DESIGN Scoping review. SEARCH STRATEGY We searched electronic databases (MEDLINE, EMBASE, PsychINFO, CINAHL and CENTRAL), clinical trial registries, conference abstracts and professional guidelines from jurisdictions where MAID is legal, up to February 2020. Eligible report types included technical summaries, institutional policies, practice surveys, practice guidelines and clinical studies that describe MAID provision in adults who have provided informed consent for MAID. RESULTS 163 articles published between 1989 and 2020 met eligibility criteria. 75 studies described details for MAID administered by intravenous medications and 50 studies provided data on oral medications. In intravenous protocols, MAID was most commonly administered using a barbiturate (34/163) or propofol (22/163) followed by a neuromuscular blocker. Oral protocols most often used barbiturates alone (37/163) or in conjunction with an opioid medication (7/163) and often recommended using a prokinetic agent prior to lethal drug ingestion. Complications included prolonged duration of the dying process, difficulty in obtaining intravenous access and difficulty in swallowing oral agents. Most commonly, the role of physicians was prescribing (83/163) and administering medications (75/163). Nurses' roles included administering medications (17/163) and supporting the patient (16/163) or family (13/163). The role of families involved providing support to the patient (17/163) and bringing medications from the pharmacy for self-administration (4/163). CONCLUSIONS We identified several trends in MAID provision including common medications and doses for oral and parenteral administration, roles of healthcare professionals and families, and complications that may cause patient, family and provider distress. Future research should aim to identify the medications, dosages, and administration techniques and procedures that produce the most predictable outcomes and mitigate distress for those involved.
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Affiliation(s)
- Max Zworth
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Carol Saleh
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ian Ball
- Division of Critical Care Medicine, Western University, London, Ontario, Canada
| | | | | | - Mike Kekewich
- Department of Clinical and Organizational Ethics, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul Q Miller
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Division of Emergency Medicine, Department of Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Marianne Dees
- Department for Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
| | | | - Simon Oczkowski
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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23
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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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Fodder for Despair, Masquerading as Hope: Diagnosing the Postures of Hope(lessness) at the End of Life. RELIGIONS 2019. [DOI: 10.3390/rel10120651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Hope is needed for persons confronting the limits of human life, antagonised by the threats of death. It is needed also for those health and medical professionals constrained by the institution of medicine, determined by market metaphors and instrumental reasoning. Yet, despair can masquerade as hope for such persons when functional hoping for particular outcomes or aims proves futile and aimless. The following will examine such masquerades, while giving attention to particular expressions of autonomy, which persist as fodder for despair in our late modern milieu. The late classical account of Hercules and his death, as well as contemporary reasons for soliciting medical assistance in dying, will focus on the diagnostics of despair, while a Christian account practicing presence, and of hope as a concrete posture enfleshed by habits of patience, among other virtues, will point toward counter-narratives that might sustain persons in times of crisis and enable persons’ flourishing as human beings, even unto death.
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Xiao J, Chow KM, Chan CWH, Li M, Deng Y. Qualitative study on perceived dignity of cancer patients undergoing chemotherapy in China. Support Care Cancer 2019; 28:2921-2929. [DOI: 10.1007/s00520-019-05123-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/06/2019] [Indexed: 12/01/2022]
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Gerson SM, Bingley A, Preston N, Grinyer A. When is hastened death considered suicide? A systematically conducted literature review about palliative care professionals' experiences where assisted dying is legal. BMC Palliat Care 2019; 18:75. [PMID: 31472690 PMCID: PMC6717643 DOI: 10.1186/s12904-019-0451-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/26/2019] [Indexed: 11/18/2022] Open
Abstract
Background Laws allowing assisted suicide and euthanasia have been implemented in many locations around the world but some individuals suffering with terminal illness receiving palliative care services are hastening death or die by suicide without assistance. This systematic review aims to summarise evidence of palliative care professionals’ experiences of patients who died by suicide or hastened death in areas where assisted dying is legal and to understand when hastened death is considered to be a suicide. Methods AMED, CINAHL Complete, PsycINFO, PubMED, and Academic Search Ultimate were searched for articles from inception through June 2018. Quality assessment used the Hawker framework. Results A total of 1518 titles were screened resulting in thirty studies meeting eligibility criteria for this review. Published studies about professionals’ experiences from areas with legalised assisted dying includes limited information about patients who hasten death outside legal guidelines, die by suicide without assistance, or if the law impacts suicide among palliative care patients. Conclusion There are a range of experiences and emotions professionals’ experience with patients who die by euthanasia, assisted suicide, or hasten death without assistance. The included literature suggests improved communication among professionals is needed but does not explicitly identify when a hastened death is deemed a suicide in areas where assisted dying is practiced. More research is needed to help clarify what hastened death means in a palliative care context and identify how and if assisted dying impacts issues of suicide in palliative care settings. Electronic supplementary material The online version of this article (10.1186/s12904-019-0451-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheri Mila Gerson
- School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Dumfries, Scotland, DG1 4ZL, UK. .,Division of Health Research, Lancaster University, Lancaster, UK.
| | - Amanda Bingley
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Bailrigg, Lancaster, LA1 4YG, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Bailrigg, Lancaster, LA1 4YG, UK
| | - Anne Grinyer
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Bailrigg, Lancaster, LA1 4YG, UK
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Cain CL, Koenig BA, Starks H, Thomas J, Forbes L, McCleskey S, Wenger NS. Hospital and Health System Policies Concerning the California End of Life Option Act. J Palliat Med 2019; 23:60-66. [PMID: 31298605 DOI: 10.1089/jpm.2019.0169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The End of Life Option Act (EOLOA) legalized physician aid in dying for competent, terminally ill Californians in 2016. The law allows clinicians, hospitals, and health systems to decide whether to participate. About 4 in 10 California hospitals permit the EOLOA, but little is known about their approaches and concerns. Objective: Describe hospital EOLOA policies and challenges. Design and Measurements: Survey study of hospitals in California, administered September 2017 to March 2018. We describe hospital policies concerning the EOLOA and perform thematic analysis of open-ended questions about challenges, including availability of providers, process of implementing EOLOA, experiences of distress by providers and patients, and questions about medications. Results: Of 315 hospitals surveyed, 270 (86%) responded. Every surveyed hospital had established a position on the EOLOA. Among hospitals permitting EOLOA, 38% required safeguards not required in the law, 87% provided for referral to another provider if the patient's physician did not participate, and 65% counseled staff, if needed. Among hospitals not permitting the EOLOA, nearly all allowed providers to follow patients choosing to pursue the EOLOA elsewhere and most permitted a provider to refer to another provider or system. Most hospitals expressed concerns about implementation of the EOLOA and interest in sharing promising practices. Conclusions: This survey of California hospitals demonstrates considerable heterogeneity in implementing the EOLOA. For many Californians, access to the EOLOA depends on where one receives medical care. Implementation would be improved by hospitals and health systems sharing promising practices.
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Affiliation(s)
- Cindy L Cain
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Barbara A Koenig
- Program in Bioethics, University of California San Francisco, San Francisco, California
| | - Helene Starks
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | - Judy Thomas
- Coalition for Compassionate Care of California, Sacramento, California
| | - Lindsay Forbes
- Program in Bioethics, University of California San Francisco, San Francisco, California
| | - Sara McCleskey
- Department of Health Policy and Management, University of California Los Angeles, Los Angeles, California
| | - Neil S Wenger
- Division of General Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California
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Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M. Dignity and Psychotherapeutic Considerations in End-of-Life Care. J Palliat Care 2019. [DOI: 10.1177/082585970402000303] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Harvey Max Chochinov
- Department of Psychiatry, University of Manitoba; Manitoba Palliative Care Research Unit and Department of Psychosocial Oncology, CancerCare Manitoba; Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; and Edith Cowan University, Perth, Australia
| | - Thomas Hack
- Department of Psychosocial Oncology, CancerCare Manitoba, and Faculty of Nursing, University of Manitoba
| | - Thomas Hassard
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Susan McClement
- Manitoba Palliative Care Research Unit, CancerCare Manitoba, and Faculty of Nursing, University of Manitoba
| | - Mike Harlos
- St. Boniface General Hospital, Winnipeg, Manitoba, Canada
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Goy ER, Carlson B, Simopoulos N, Jackson A, Ganzini L. Determinants of Oregon Hospice Chaplains’ Views on Physician-Assisted Suicide. J Palliat Care 2019. [DOI: 10.1177/082585970602200204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although religiousness is a strong predictor of attitudes towards physician-assisted suicide (PAS), Oregon hospice chaplains express wide variation in their opposition to or support for legalized PAS. We explored factors associated with chaplains’ views on PAS. Methods A mailed survey to chaplains from 51 Oregon hospices. Results Fifty of 77 eligible hospice chaplains (65%) returned surveys. Views on PAS were associated with views on suicide in general. Moral and theological beliefs were the most important influences on views on PAS. Chaplains who were opposed to PAS believed that God alone may take life, that life is an absolute good, and that suffering has a divine purpose. Those who supported PAS placed emphasis on the importance of self-de-termination and sanctity of life as defined by quality of life. Conclusions Oregon hospice chaplains’ diverse views towards PAS are closely related to their views on suicide in general, and their personal and theological beliefs.
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Affiliation(s)
- Elizabeth R. Goy
- Portland Veterans Affairs Medical Center and Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Bryant Carlson
- Portland Veterans Affairs Medical Center, Portland, Oregon, USA
| | | | - Ann Jackson
- Oregon Hospice Association, Portland, Oregon, USA
| | - Linda Ganzini
- Portland Veterans Affairs Medical Center and Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
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Health Care Providers' Experiences with Implementing Medical Aid-in-Dying in Vermont: a Qualitative Study. J Gen Intern Med 2019; 34:636-641. [PMID: 30684201 PMCID: PMC6445925 DOI: 10.1007/s11606-018-4811-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/22/2018] [Accepted: 12/06/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The evolving legal landscape for medical aid-in-dying (AID) in the USA raises clinical and public health challenges and concerns regarding how health care providers will accommodate AID while expanding access to high-quality end-of-life care. OBJECTIVE To describe Vermont health care providers' experiences practicing under the "Patient Choice and Control at End of Life" Act. DESIGN Qualitative semi-structured interviews analyzed using grounded theory. PARTICIPANTS The larger study included 144 health care providers, terminally ill patients, caregivers, policy stakeholders, and other Vermont residents working in 10 out of Vermont's 14 counties. This article reports on a subset of 37 providers who had clinical experience with the law. MAIN MEASURES Themes from interviews. KEY RESULTS Physicians were roughly split between hospital and community-based practices. Most were women (68%) and the largest subgroup specialized in internal or family medicine (53%). Most of the nurses and social workers were women (89%) and most worked for hospice and home health agencies (61%). We identified five domains in which participants engaged with AID: (1) clinical communication and counseling; (2) the Act 39 protocol; (3) prescribing medication; (4) planning for death; and (5) professional education. How providers experienced these five domains of clinical practice depended on their practice setting and the supportive resources available. CONCLUSION Health care providers' participation in AID involves clinical tasks outside of responding to patients' requests and writing prescriptions. Research to identify best practices should focus on all domains of clinical practice in order to best prepare providers.
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Corrigendum. ANZ J Surg 2018; 88:1357. [DOI: 10.1111/ans.14973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Truskett PG. Time to die: choice or chance. ANZ J Surg 2018; 88:947-948. [PMID: 30276993 DOI: 10.1111/ans.14835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Philip G Truskett
- Department of Surgery, Prince of Wales Clinical School, Sydney, New South Wales, Australia
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Yun YH, Kim KN, Sim JA, Yoo SH, Kim M, Kim YA, Kang BD, Shim HJ, Song EK, Kang JH, Kwon JH, Lee JL, Nam EM, Maeng CH, Kang EJ, Do YR, Choi YS, Jung KH. Comparison of attitudes towards five end-of-life care interventions (active pain control, withdrawal of futile life-sustaining treatment, passive euthanasia, active euthanasia and physician-assisted suicide): a multicentred cross-sectional survey of Korean patients with cancer, their family caregivers, physicians and the general Korean population. BMJ Open 2018; 8:e020519. [PMID: 30206075 PMCID: PMC6144336 DOI: 10.1136/bmjopen-2017-020519] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study determined attitudes of four groups-Korean patients with cancer, their family caregivers, physicians and the general Korean population-towards five critical end-of-life (EOL) interventions-active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide. DESIGN AND SETTING We enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a 'good death' with critical interventions at EoL care. RESULTS All participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling 'life was meaningful' (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing 'freedom from pain' negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, 'not being a burden to the family' was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89). CONCLUSION Groups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.
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Affiliation(s)
- Young Ho Yun
- Department of Biomedical Science, College of Medicine, Seoul National University, Seoul, Korea
- Department of Biomedical Informatics, College of Medicine, Seoul National University, Seoul, Korea
| | - Kyoung-Nam Kim
- Public Health Medical Service, Seoul National University Hospital, Seoul, Korea
| | - Jin-Ah Sim
- Department of Biomedical Science, College of Medicine, Seoul National University, Seoul, Korea
| | - Shin Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ae Kim
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Beo Deul Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun-Jeong Shim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, School of Medicine, Chonbuk National University, Jeonju, Korea
| | - Eun-Kee Song
- Division of Hematology/Oncology, Chonbuk National University Medical School, Jeonju, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Postgraduate Medical School, Gyeongsang National University, Jinju, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jung Lim Lee
- Department of Hemato-oncology, Daegu Fatima Hospital, Daegu, Korea
| | - Eun Mi Nam
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Chi Hoon Maeng
- Department of Medical Oncology and Hematology, Kyung Hee University Hospital, Seoul, Korea
| | - Eun Joo Kang
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Rok Do
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yoon Seok Choi
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Gruenewald DA. Voluntarily Stopping Eating and Drinking: A Practical Approach for Long-Term Care Facilities. J Palliat Med 2018; 21:1214-1220. [PMID: 29870302 DOI: 10.1089/jpm.2018.0100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Some residents of long-term care (LTC) facilities with lethal or serious chronic illnesses may express a wish to hasten their death by voluntarily stopping eating and drinking (VSED). LTC facility clinicians, administrators, and staff must balance resident safety, moral objections to hastened death, and other concerns with resident rights to autonomy, self-determination, and bodily integrity. Initially, requests for hastened death, including VSED must be treated as opportunities to uncover underlying concerns. After a concerted effort to address root causes of suffering, some residents will continue to request hastened death. Rigorous resident assessment, interdisciplinary care planning, staff training, and clear and complete documentation are mandatory. In addition, an independent second opinion from a consultant with palliative care and/or hospice expertise is indicated to help determine the most appropriate response. When VSED is the only acceptable option to relieve suffering of residents with severe chronic and lethal illnesses, facilitating VSED requests honors resident-centered care. The author offers practice suggestions and a checklist for LTC facilities and staff caring for residents requesting and undergoing VSED.
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Affiliation(s)
- David A Gruenewald
- 1 Palliative Care and Hospice Service, Geriatrics and Extended Care Service, Veterans Affairs Puget Sound Healthcare System , Seattle, Washington.,2 Palliative Medicine Fellowship, Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine , Seattle, Washington
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Fujioka JK, Mirza RM, McDonald PL, Klinger CA. Implementation of Medical Assistance in Dying: A Scoping Review of Health Care Providers' Perspectives. J Pain Symptom Manage 2018; 55:1564-1576.e9. [PMID: 29477968 DOI: 10.1016/j.jpainsymman.2018.02.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 11/16/2022]
Abstract
RESEARCH AIMS With the growing interest in Medical Assistance in Dying (MAiD), understanding health care professionals' roles and experiences in handling requests is necessary to evaluate the quality, consistency, and efficacy of current practices. This scoping review sought to map the existing literature on health care providers' perspectives of their involvement in MAiD. METHODS A scoping review was conducted to address the following: 1) What are the roles of diverse health care professionals in the provision of MAiD? and 2) What professional challenges arise when confronted with MAiD requests? A literature search in electronic databases and gray literature sources was performed. Articles were screened, and a thematic content analysis synthesized key findings. RESULTS After evaluating 1715 citations and 148 full-text papers, 33 articles were included. Perspectives of nurses (n = 10), physicians (n = 7), mental health providers (n = 7), pharmacists (n = 4), social workers (n = 3), and medical examiners (n = 1) were explored. Professional roles included consulting/supporting patients and/or other staff members with requests, assessing eligibility, administering/dispensing the lethal drugs, providing aftercare to bereaved relatives, and regulatory oversight. Challenges included lack of clear guidelines/protocols, role ambiguity, evaluating capacity/consent, conscientious objection, and lack of interprofessional collaboration. CONCLUSION Evidence from various jurisdictions highlighted a need for clear guidelines and protocols that define each profession's role, scope of practice, and legal boundaries for MAiD. Comprehensive models of care that incorporate multidisciplinary teams alongside improved clinician education may be effective to support MAiD implementation. Little is known about health care providers' perspectives in handling requests, especially outside physician practice and nursing.
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Affiliation(s)
- Jamie K Fujioka
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada; National Initiative for the Care of the Elderly, Toronto, Ontario, Canada.
| | - Raza M Mirza
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada; National Initiative for the Care of the Elderly, Toronto, Ontario, Canada
| | - P Lynn McDonald
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada; National Initiative for the Care of the Elderly, Toronto, Ontario, Canada
| | - Christopher A Klinger
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada; National Initiative for the Care of the Elderly, Toronto, Ontario, Canada
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Sprung CL, Somerville MA, Radbruch L, Collet NS, Duttge G, Piva JP, Antonelli M, Sulmasy DP, Lemmens W, Ely EW. Physician-Assisted Suicide and Euthanasia. J Palliat Care 2018; 33:197-203. [DOI: 10.1177/0825859718777325] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medical professional societies have traditionally opposed physician-assisted suicide and euthanasia (PAS-E), but this opposition may be shifting. We present 5 reasons why physicians shouldn’t be involved in PAS-E. 1. Slippery slopes: There is evidence that safeguards in the Netherlands and Belgium are ineffective and violated, including administering lethal drugs without patient consent, absence of terminal illness, untreated psychiatric diagnoses, and nonreporting; 2. Lack of self-determination: Psychological and social motives characterize requests for PAS-E more than physical symptoms or rational choices; many requests disappear with improved symptom control and psychological support; 3. Inadequate palliative care: Better palliative care makes most patients physically comfortable. Many individuals requesting PAS-E don’t want to die but to escape their suffering. Adequate treatment for depression and pain decreases the desire for death; 4. Medical professionalism: PAS-E transgresses the inviolable rule that physicians heal and palliate suffering but never intentionally inflict death; 5. Differences between means and ends: Proeuthanasia advocates look to the ends (the patient’s death) and say the ends justify the means; opponents disagree and believe that killing patients to relieve suffering is different from allowing natural death and is not acceptable. Conclusions: Physicians have a duty to eliminate pain and suffering, not the person with the pain and suffering. Solutions for suffering lie in improving palliative care and social conditions and addressing the reasons for PAS-E requests. They should not include changing medical practice to allow PAS-E.
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Affiliation(s)
- Charles L. Sprung
- General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Margaret A. Somerville
- Professor of Bioethics, School of Medicine, The University of Notre Dame Australia, Sydney, Australia; Samuel Gale Professor of Law Emerita, Professor Faculty of Medicine Emerita, Founding Director of the Centre for Medicine, Ethics and Law Emerita, McGill University Montreal, Canada
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Gunnar Duttge
- Center for Medical Law, Georg-August-University Göttingen, Göttingen, Germany
| | - Jefferson P. Piva
- Federal University of Rio Grande do Sul (Brazil), Medical Director-Pediatric Emergency and Critical Care, Department H Clinicas P. Alegre, Brazil
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore—Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Daniel P. Sulmasy
- Kennedy Institute of Ethics and Pellegrino Center, Departments of Medicine and Philosophy, Georgetown University, Washington D.C., United States
| | - Willem Lemmens
- Department of Philosophy, Centre for Ethics, University of Antwerp, Belgium
| | - E. Wesley Ely
- Department of Medicine, Vanderbilt University Medical Center and Veteran’s Affair TN Valley Geriatric Research Education Clinical Center (GRECC), Nashville, TN, United States
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De Conno F, Boffi R, Brunelli C, Panzeri C. Age-related Differences in Patients Admitted to a Palliative Home Care Service. TUMORI JOURNAL 2018; 88:117-22. [PMID: 12088250 DOI: 10.1177/030089160208800207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims The aim of the study was to investigate possible differences in access to the service, symptomatology and therapy in relation to age among terminal cancer patients admitted to a home care program. We examined prospectively all 116 terminal cancer patients enrolled in a home care program in 1998, comparing those up to 70 years of age (48 patients) with those above 70 (68 patients). We also compared the age-related characteristics of this population with those of all 348 patients enrolled in the program in 1989-1991. There were no significant differences between the two age groups of the 1998 population in terms of symptoms, tumor site or medication, although NSAID use tended to be greater in older patients, and opioid and anti-emetic use greater in younger patients. Patients up to 70 years of age had significantly shorter survival from admission to home care than those over 70, and a greater proportion had metastases. There were no such significant age-related differences as regards survival and the presence of metastases in patients enrolled 10 years before. In conclusion, among terminally ill cancer patients referred to a palliative home care service in Milan, mostly treated at the National Cancer Institute, the 10-year admission trend showed that palliative care is made available increasingly later, particularly to those up to 70 years of age, in contrast to current recommendations.
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Affiliation(s)
- Franco De Conno
- Rehabilitation, Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy.
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Huang HL, Yao CA, Hu WY, Cheng SY, Hwang SJ, Chen CD, Lin WY, Lin YC, Chiu TY. Prevailing Ethical Dilemmas Encountered by Physicians in Terminal Cancer Care Changed After the Enactment of the Natural Death Act: 15 Years' Follow-up Survey. J Pain Symptom Manage 2018; 55:843-850. [PMID: 29221846 DOI: 10.1016/j.jpainsymman.2017.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
Abstract
CONTEXT Advance directive laws have influences on ethical dilemmas encountered by physicians caring for terminal cancer patients. OBJECTIVES To identify the prevailing ethical dilemmas among terminal care physicians 15 years after the Natural Death Act was enacted in Taiwan. METHODS This study is a cross-sectional survey from April 2014 to February 2015 using the clustering sampling method and a well-structured questionnaire. Targeted participants included physicians at oncology and related wards or palliative care units where terminal cancer care may be provided in Taiwan. RESULTS Among the 500 physicians surveyed, 383 responded (response rate 76.6%) and 346 valid questionnaires were included in the final analysis (effective response rate 69.2%). The most frequently identified ethical dilemma was "place of care," followed by "use of antimicrobial agents" and "artificial nutrition and hydration." The dilemma of "truth telling," which ranked first in the 2005-2006 survey, now ranked at the fourth place. Stepwise logistic regression analysis revealed that female gender and knowledge of palliative care were negatively correlated with the extent of dilemmas regarding issues of "life and death." CONCLUSION The prevailing ethical dilemmas have changed in Taiwan 15 years after the enactment of the Natural Death Act, supporting that some previous strategies had worked. Our results suggest that education on the core values of palliative care, improvement of community-based hospice care program, and creating treatment guidelines with prognostication may resolve the current dilemmas. This type of survey should be adapted by individual countries to guide policy decisions on end-of-life care.
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Affiliation(s)
- Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Chien-An Yao
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Wen-Yu Hu
- School of Nursing, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Dao Chen
- Department of Family Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Chun Lin
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
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Russell JA, Epstein LG, Bonnie RJ, Conwit R, Graf WD, Kirschen M, Kurek JA, Larriviere DG, Pascuzzi RM, Rizzo M, Sattin JA, Simmons Z, Taylor L, Tsou A, Williams MA. Lawful physician-hastened death: AAN position statement. Neurology 2018; 90:420-422. [PMID: 29483313 PMCID: PMC5837869 DOI: 10.1212/wnl.0000000000005012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 12/08/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- James A Russell
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA.
| | - Leon G Epstein
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Richard J Bonnie
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Robin Conwit
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - William D Graf
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Matthew Kirschen
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Julie A Kurek
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Daniel G Larriviere
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Robert M Pascuzzi
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Matthew Rizzo
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Justin A Sattin
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Zachary Simmons
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Lynne Taylor
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Amy Tsou
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Michael A Williams
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
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Abstract
SummaryAssisted suicide is an emotive issue that will undoubtedly continue to grab media headlines, especially as medical science is able to prolong survival in chronic medical disorders. The law in the UK as applied under the Suicide Act 1961 is currently very sympathetic to cases of assisted suicide, whereby the individual has travelled abroad to a country where it is lawful to end their life, in that people assisting them and thus committing an offence have not been prosecuted. This article analyses a recent High Court case pertaining to the Suicide Act 1961 demonstrating the central importance of the Human Rights Act 1998 in such cases. It then discusses implications for clinicians and the future of the Suicide Act itself.
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Petrillo L. The End of Life Option Act: Important Considerations for Pharmacists as California Implements Physician Aid in Dying. JOURNAL OF CONTEMPORARY PHARMACY PRACTICE 2017. [DOI: 10.37901/jcphp16-00029] [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] Open
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Gamondi C, Borasio GD, Oliver P, Preston N, Payne S. Responses to assisted suicide requests: an interview study with Swiss palliative care physicians. BMJ Support Palliat Care 2017; 9:e7. [DOI: 10.1136/bmjspcare-2016-001291] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 06/23/2017] [Accepted: 07/18/2017] [Indexed: 11/03/2022]
Abstract
ObjectivesAssisted suicide in Switzerland is mainly performed by right-to-die societies. Medical involvement is limited to the prescription of the drug and certification of eligibility. Palliative care has traditionally been perceived as generally opposed to assisted suicide, but little is known about palliative care physicians’ involvement in assisted suicide practices. This paper aims to describe their perspectives and involvement in assisted suicide practices.MethodsA qualitative interview study was conducted with 23 palliative care physicians across Switzerland. Thematic analysis was used to interpret data.ResultsSwiss palliative care physicians regularly receive assisted suicide requests while none reported having received specific training in managing these requests. Participants reported being involved in assisted suicide decision making most were not willing to prescribe the lethal drug. After advising patients of the limits on their involvement in assisted suicide, the majority explored the origins of the patient’s request and offered alternatives. Many participants struggled to reconcile their understanding of palliative care principles with patients’ wishes to exercise their autonomy. The majority of participants had no direct contact with right-to-die societies, many desired better collaboration. A desire was voiced for a more structured debate on assisted suicide availability in hospitals and clearer legal and institutional frameworks.ConclusionsThe Swiss model of assisted suicide gives palliative care physicians opportunities to develop roles which are compatible with each practitioner’s values, but may not correspond to patients’ expectations. Specific education for all palliative care professionals and more structured ways to manage communication about assisted suicide are warranted.
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Petrillo LA, Dzeng E, Harrison KL, Forbes L, Scribner B, Koenig BA. How California Prepared for Implementation of Physician-Assisted Death: A Primer. Am J Public Health 2017; 107:883-888. [PMID: 28426307 DOI: 10.2105/ajph.2017.303755] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Physician-assisted death is now legal in California, and similar laws are being considered in many other states. The California law includes safeguards, yet health care providers will face practical and ethical issues while implementing physician-assisted death that are not addressed by the law. To help providers and health care facilities in California prepare to provide optimal care to patients who inquire about physician-assisted death, we brought together experts from California, Oregon, and Washington. We convened a conference of 112 stakeholders in December 2015, and herein present their recommendations. Themes of recommendations regarding implementation include (1) institutions should develop and revise physician-assisted death policies; (2) legal physician-assisted death will have implications for California's culturally and socioeconomically diverse population, and for patients from vulnerable groups; (3) conscientious objection and moral distress for health care providers must be considered; and (4) palliative care is essential to the response to the law. The expert conference participants' insights are a valuable guide, both for providers and health care facilities in California planning or revising their response, and for other jurisdictions where physician-assisted death laws are being considered or implemented.
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Affiliation(s)
- Laura A Petrillo
- Laura A. Petrillo is with the Division of Geriatrics, University of California, San Francisco (UCSF), and San Francisco Veterans Affairs. Elizabeth Dzeng is with the Division of Hospital Medicine, UCSF, and UCSF Bioethics. Krista L. Harrison is with the Division of Geriatrics, UCSF. Lindsay Forbes and Barbara A. Koenig are with the Institute for Health and Aging, UCSF, and UCSF Bioethics. Benjamin Scribner is with the School of Nursing, UCSF
| | - Elizabeth Dzeng
- Laura A. Petrillo is with the Division of Geriatrics, University of California, San Francisco (UCSF), and San Francisco Veterans Affairs. Elizabeth Dzeng is with the Division of Hospital Medicine, UCSF, and UCSF Bioethics. Krista L. Harrison is with the Division of Geriatrics, UCSF. Lindsay Forbes and Barbara A. Koenig are with the Institute for Health and Aging, UCSF, and UCSF Bioethics. Benjamin Scribner is with the School of Nursing, UCSF
| | - Krista L Harrison
- Laura A. Petrillo is with the Division of Geriatrics, University of California, San Francisco (UCSF), and San Francisco Veterans Affairs. Elizabeth Dzeng is with the Division of Hospital Medicine, UCSF, and UCSF Bioethics. Krista L. Harrison is with the Division of Geriatrics, UCSF. Lindsay Forbes and Barbara A. Koenig are with the Institute for Health and Aging, UCSF, and UCSF Bioethics. Benjamin Scribner is with the School of Nursing, UCSF
| | - Lindsay Forbes
- Laura A. Petrillo is with the Division of Geriatrics, University of California, San Francisco (UCSF), and San Francisco Veterans Affairs. Elizabeth Dzeng is with the Division of Hospital Medicine, UCSF, and UCSF Bioethics. Krista L. Harrison is with the Division of Geriatrics, UCSF. Lindsay Forbes and Barbara A. Koenig are with the Institute for Health and Aging, UCSF, and UCSF Bioethics. Benjamin Scribner is with the School of Nursing, UCSF
| | - Benjamin Scribner
- Laura A. Petrillo is with the Division of Geriatrics, University of California, San Francisco (UCSF), and San Francisco Veterans Affairs. Elizabeth Dzeng is with the Division of Hospital Medicine, UCSF, and UCSF Bioethics. Krista L. Harrison is with the Division of Geriatrics, UCSF. Lindsay Forbes and Barbara A. Koenig are with the Institute for Health and Aging, UCSF, and UCSF Bioethics. Benjamin Scribner is with the School of Nursing, UCSF
| | - Barbara A Koenig
- Laura A. Petrillo is with the Division of Geriatrics, University of California, San Francisco (UCSF), and San Francisco Veterans Affairs. Elizabeth Dzeng is with the Division of Hospital Medicine, UCSF, and UCSF Bioethics. Krista L. Harrison is with the Division of Geriatrics, UCSF. Lindsay Forbes and Barbara A. Koenig are with the Institute for Health and Aging, UCSF, and UCSF Bioethics. Benjamin Scribner is with the School of Nursing, UCSF
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Affiliation(s)
- Jonathan Katz
- From the Forbes Norris MDA/ALS Research Center (J.K.), California Pacific Medical Center, San Francisco; and the MDA/ALS Clinical Research Center (H.M.), Neurological Institute, Columbia University Medical Center, New York, NY.
| | - Hiroshi Mitsumoto
- From the Forbes Norris MDA/ALS Research Center (J.K.), California Pacific Medical Center, San Francisco; and the MDA/ALS Clinical Research Center (H.M.), Neurological Institute, Columbia University Medical Center, New York, NY
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Castelli Dransart DA, Scozzari E, Voélin S. Stances on Assisted Suicide by Health and Social Care Professionals Working With Older Persons in Switzerland. ETHICS & BEHAVIOR 2016. [DOI: 10.1080/10508422.2016.1227259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Elena Scozzari
- School of Social Work Fribourg, University of Applied Sciences and Art Western Switzerland
| | - Sabine Voélin
- School of Social Work Geneva, University of Applied Sciences and Art Western Switzerland
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Achille MA, Ogloff JRP. Attitudes Toward and Desire for Assisted Suicide among Persons with Amyotrophic Lateral Sclerosis. OMEGA-JOURNAL OF DEATH AND DYING 2016; 48:1-21. [PMID: 15688543 DOI: 10.2190/g5ta-9kv0-mt3g-rwm0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study aimed at investigating attitudes toward assisted suicide among individuals with amyotrophic lateral sclerosis, and the differences in health status (illness severity and functional disability) and psychosocial adjustment (depression, perceived stress, social support, and coping) between those in favor of and those against assisted suicide. This study also aimed at describing the characteristics of terminally-ill individuals who acknowledge contemplating assisted suicide. Forty-four individuals diagnosed with amyotrophic lateral sclerosis were surveyed about their attitudes and the circumstances that would make them contemplate assisted suicide and filled out standardized measures of mood, stress, social support, coping, and illness status. Seventy percent of the sample found assisted suicide morally acceptable and 60% thought it should be legalized. In addition, 60% of patients agreed they could foresee circumstances that would make them contemplate assisted suicide, but only three (7%) indicated they would have requested it already if it had been legal. Willingness to contemplate assisted suicide was associated with reports of elevated levels of depressive symptoms and reports of hopelessness. Results highlight the need to assess psychological status carefully when terminally ill individuals begin contemplating assisted suicide or voice a request for it.
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Affiliation(s)
- Marie A Achille
- Department of Psychology, University of Montreal, P.O. Box 6128, Downtown Station, Montreal, Quebec, Canada H3C 3J7.
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Petrillo LA, Dzeng E, Smith AK. California's End of Life Option Act: Opportunities and Challenges Ahead. J Gen Intern Med 2016; 31:828-9. [PMID: 27114358 PMCID: PMC4945570 DOI: 10.1007/s11606-016-3713-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/22/2016] [Accepted: 04/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Laura A Petrillo
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. .,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Elizabeth Dzeng
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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End-Of-Life Decisions in Chronic Disorders of Consciousness: Sacrality and Dignity as Factors. NEUROETHICS-NETH 2016. [DOI: 10.1007/s12152-016-9257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gildenhuys P. The Legitimacy of Prohibiting Euthanasia. BIOÉTHIQUEONLINE 2016. [DOI: 10.7202/1035512ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
John Arras argues against the legalization of physician-assisted suicide and active
euthanasia on the basis of social costs that he anticipates will result from legalization.
Arras believes that the legalization of highly restricted physician-assisted suicide will
result in the legalization of active euthanasia without special restrictions, a prediction I
grant for the sake of argument. Arras further anticipates that the practices of
physician-assisted suicide and euthanasia will be abused, so that many patients who engage
in these practices will lose out as a result. He refers to these losses as social costs to
legalization. But the social costs at play in typical public policy debates are borne by
individuals other than the agent who engages in the controversial activity, specifically by
people who cannot be held responsible for enduring those costs. Even if plausible
interpretations of Arras’ predictions about the abuse of the practice are granted,
legalization of physician-assisted suicide or euthanasia brings no social costs of this
latter sort. For this reason, and also because a ban on euthanasia is unfair to those who
would profit from it, the losses in utility brought about by legalization would have to be
very great to justify a ban.
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Affiliation(s)
- Peter Gildenhuys
- Department of Philosophy, Lafayette College, Easton (PA), United
States
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