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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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2
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Fuscaldo G, Gwini SM, Larsen R, Venkataramani A. Do Health Service staff support the implementation of Voluntary Assisted Dying at their workplace? Intern Med J 2021; 51:1636-1644. [PMID: 33710752 DOI: 10.1111/imj.15285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 01/31/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND On 29 November 2017, the Victorian Parliament passed the Voluntary Assisted Dying (VAD) Act 2017, which came into effect from 19 June 2019. AIM To investigate whether staff from a large regional health service support the legalisation of Voluntary Assisted Dying (VAD) and the implementation of VAD at their workplace. METHODS Staff were invited to complete an anonymous online survey comprising both closed and open-ended questions. RESULTS 38% of the workforce (n = 1624) responded to the survey. Most participants supported the legalisation of VAD (88%), the provision of eligibility assessment and/or the administration of VAD within the health service (80%). There were negligible differences in support for VAD by role, however, specialist doctors were significantly less supportive (65%). Approximately half of the respondents expressed concern about monitoring (49%) or implementation (53%) of VAD. Concerns were also raised about assessment of eligibility, support for staff involved in VAD and pressure on both patients and staff to participate. Nearly three quarters (71%) of participants agreed that if the health service offers VAD services, a special unit or facility should be available. CONCLUSION This study found that health workers have concerns about the implementation of VAD at their workplace but are generally supportive. This paper provides information for health services considering the implementation of VAD, about staff concerns and issues that need to be addressed for the successful introduction of VAD. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- G Fuscaldo
- University Hospital Geelong Barwon Health, Geelong, Australia, 3220.,Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Australia, 3128
| | - S M Gwini
- University Hospital Geelong Barwon Health, Geelong, Australia, 3220.,iMPACT, Faculty of Health, Deakin University, Geelong, Australia, 3220
| | - R Larsen
- University Hospital Geelong Barwon Health, Geelong, Australia, 3220
| | - A Venkataramani
- University Hospital Geelong Barwon Health, Geelong, Australia, 3220
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Gielen J, Van Den Branden S, Broeckaert B. Attitudes of European Physicians toward Euthanasia and Physician-Assisted Suicide: A Review of the Recent Literature. J Palliat Care 2019. [DOI: 10.1177/082585970802400307] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Joris Gielen
- Interdisciplinary Centre for the Study of Religion and World Views, Catholic University Leuven, Leuven, Belgium
| | - Stef Van Den Branden
- Interdisciplinary Centre for the Study of Religion and World Views, Catholic University Leuven, Leuven, Belgium
| | - Bert Broeckaert
- Interdisciplinary Centre for the Study of Religion and World Views, Catholic University Leuven, Leuven, Belgium
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4
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Boz B, Acar K, Ergin A, Kurtulus A, Ergin N, Oguzhanoglu N. Effect of Locus of Control on Acceptability of Euthanasia among Medical Students and Residents in Denizli, Turkey. J Palliat Care 2019. [DOI: 10.1177/082585970702300407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bora Boz
- Pamukkale University, Faculty of Medicine, Department of Forensic Medicine
| | - Kemalettin Acar
- Pamukkale University, Faculty of Medicine, Department of Forensic Medicine
| | - Ahmet Ergin
- Pamukkale University, Faculty of Medicine, Department of Public Health
| | - Ayse Kurtulus
- Pamukkale University, Faculty of Medicine, Department of Public Health
| | - Nesrin Ergin
- Denizli State Hospital, Faculty of Medicine, Department of Public Health
| | - Nalan Oguzhanoglu
- Pamukkale University, Faculty of Medicine, Department of Psychiatry, Denizli, Turkey
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Braverman DW, Marcus BS, Wakim PG, Mercurio MR, Kopf GS. Health Care Professionals' Attitudes About Physician-Assisted Death: An Analysis of Their Justifications and the Roles of Terminology and Patient Competency. J Pain Symptom Manage 2017; 54:538-545.e3. [PMID: 28716621 PMCID: PMC5632116 DOI: 10.1016/j.jpainsymman.2017.07.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/21/2017] [Accepted: 07/07/2017] [Indexed: 11/16/2022]
Abstract
CONTEXT Health care professionals (HCPs) are crucial to physician-assisted death (PAD) provision. OBJECTIVES To quantitatively assess the favorability of justifications for or against PAD legalization among HCPs, the effect of the terms "suicide" and "euthanasia" on their views and their support for three forms of PAD. METHODS Our questionnaire presented three cases: physician-assisted suicide, euthanasia for a competent patient, and euthanasia for an incompetent patient with an advance directive for euthanasia. Respondents judged whether each case was ethical and should be legal and selected their justifications from commonly cited reasons. The sample included physician clinicians, researchers, nonphysician clinicians, and other nonclinical staff at a major academic medical center. RESULTS Of 221 HCPs, the majority thought that each case was ethical and should be legal. In order of declining favorability, justifications supporting PAD legalization were relief of suffering, right to die, mercy, acceptance of death, nonabandonment, and saving money for the health care system; opposing justifications were the slippery slope argument, unnecessary due to palliative care, killing patients is wrong, religious views, and suicide is wrong. The use of suicide and euthanasia terminology did not affect responses. Participants preferred physician-assisted suicide to euthanasia for a competent patient (P < 0.0001) and euthanasia for an incompetent patient to euthanasia for a competent patient (P < 0.005). CONCLUSIONS HCPs endorsed patient-centered justifications over other reasons, including role-specific duties. Suicide and euthanasia language did not bias HCPs against PAD, challenging claims that such value-laden terms hinder dialogue. More research is required to understand the significance of competency in shaping attitudes toward PAD.
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Affiliation(s)
- Derek W Braverman
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
| | | | - Paul G Wakim
- Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Gary S Kopf
- Yale School of Medicine, New Haven, Connecticut, USA
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Ozkara E, Civaner M, Oğlak S, Mayda AS. Euthanasia Education for Health Professionals in Turkey: students change their opinions. Nurs Ethics 2016; 11:290-7. [PMID: 15176642 DOI: 10.1191/0969733004ne.696oa] [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: 11/05/2022]
Abstract
The purpose of this study was to investigate the impact of euthanasia education on the opinions of health sciences students. It was performed among 111 final year students at the College of Health Sciences, Dokuz Eylül University, IRzmir, Turkey. These students train to become paramedical professionals and health technicians. Fifteen hours of educational training concerning ethical values and euthanasia was planned and the students’ opinions about euthanasia were sought before and after the course. Statistical analyses of the data were performed with the related samples t -test by means of the Epi-Info program. Significant changes were shown in the students’ opinions on people’s right to decide about their own life, euthanasia in unconscious patients, and reasons for their objection to euthanasia after completing the course. The results of this study suggest that education can significantly change a person’s approach to euthanasia.
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Affiliation(s)
- Erdem Ozkara
- Dokuz Eylül University, School of Medicine, Department of Forensic Medicine, 35300 Izmir, Turkey.
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Rys S, Deschepper R, Mortier F, Deliens L, Bilsen J. Continuous Sedation Until Death With or Without the Intention to Hasten Death—A Nationwide Study in Nursing Homes in Flanders, Belgium. J Am Med Dir Assoc 2014; 15:570-5. [DOI: 10.1016/j.jamda.2014.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/01/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
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Ozcelik H, Tekir O, Samancioglu S, Fadiloglu C, Ozkara E. Nursing Students' Approaches Toward Euthanasia. OMEGA-JOURNAL OF DEATH AND DYING 2014; 69:93-103. [DOI: 10.2190/om.69.1.f] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: In Turkey, which is a secular, democratic nation with a majority Muslim population, euthanasia is illegal and regarded as murder. Nurses and students can be faced with ethical dilemmas and a lack of a legal basis, with a conflict of religious beliefs and social and cultural values concerning euthanasia. The aim of this study was to investigate undergraduate nursing students' attitudes towards euthanasia. Method: The study, which had a descriptive design, was conducted with 600 students. The 1st, 2nd, 3rd, and 4th year nursing students at a school of nursing were contacted in May 2009, and 383 students (63.8% of the study population of a total of 600 students) gave informed consent. Two tools were used in accordance with questionnaire preparation rules. Results: The majority of students were female and single (96.9%), and their mean age was 21.3 ± 1.5 years. A majority (78.9%) stated they had received no training course/education on the concept of euthanasia. Nearly one-third (32.4%) of the students were against euthanasia; 14.3% of the students in the study agreed that if their relatives had an irreversible, lethal condition, passive euthanasia could be performed. In addition, 24.8% of the students agreed that if they themselves had an irreversible, lethal condition, passive euthanasia could be performed. Less than half (42.5%) of the students thought that discussions about euthanasia could be useful. There was a significant relation between the study year and being against euthanasia ( p < 0.05), the idea that euthanasia could be abused ( p < 0.05), and the idea that euthanasia was unethical ( p < 0.05). Conclusion: It was concluded that the lack of legal regulations, ethical considerations, religious beliefs, and work experience with dying patients affect nursing students' attitudes towards euthanasia.
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McCormack R, Clifford M, Conroy M. Attitudes of UK doctors towards euthanasia and physician-assisted suicide: a systematic literature review. Palliat Med 2012; 26:23-33. [PMID: 22190615 DOI: 10.1177/0269216310397688] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To review studies over a 20-year period that assess the attitudes of UK doctors concerning active, voluntary euthanasia (AVE) and physician-assisted suicide (PAS), assess efforts to minimise bias in included studies, determine the effect of subgroup variables (e.g. age, gender) on doctors' attitudes, and make recommendations for future research. DATA SOURCES Three electronic databases, four pertinent journals, reference lists of included studies. REVIEW METHODS Literature search of English articles between January 1990 and April 2010. Studies were excluded if they did not present independent data (e.g. commentaries) or if they related to doctors outside the UK, patients younger than 18 years old, terminal sedation, withdrawing or withholding treatment, or double-effect. Quantitative and qualitative data were extracted. RESULTS Following study selection and data extraction, 15 studies were included. UK doctors oppose the introduction of both AVE and PAS in the majority of studies. Degree of religiosity appeared as a statistically significant factor in influencing doctors' attitudes. The top three themes in the qualitative analysis were the provision of palliative care, adequate safeguards in the event of AVE or PAS being introduced, and a profession to facilitate AVE or PAS that does not include doctors. CONCLUSIONS UK doctors appear to oppose the introduction of AVE and PAS, even when one considers the methodological limitations of included studies. Attempts to minimise bias in included studies varied. Further studies are necessary to establish if subgroup variables other than degree of religiosity influence attitudes, and to thoroughly explore the qualitative themes that appeared.
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Affiliation(s)
- Ruaidhri McCormack
- Department of Palliative Medicine, Milford Care Centre, Castletroy, Limerick, Ireland.
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GPs' views on the practice of physician-assisted suicide and their role in proposed UK legalisation: a qualitative study. Br J Gen Pract 2010; 59:844-9. [PMID: 19861029 DOI: 10.3399/bjgp09x472908] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND A bill to legalise assisted dying in the UK has been proposed in Parliament's House of Lords three times since 2003. The House of Lords Select Committee concluded in 2005 that 'the few attempts to understand the basis of doctors' views have shown equivocal data varying over time'. Fresh research was recommended to gain a fuller understanding of health sector views. AIM To examine GPs' views of the practice of physician-assisted suicide as defined by the 2005/2006 House of Lords (Joffe) Bill and views of their role in the proposed legislation; and to explore the influences determining GPs' views on physician-assisted suicide. DESIGN OF STUDY Qualitative interview study. SETTING Primary care in South London, England. METHOD Semi-structured interviews with GPs were conducted by a lead interviewer and analysed in a search for themes, using the framework approach. RESULTS Thirteen GPs were interviewed. GPs who had not personally witnessed terminal suffering that could justify assisted dying were against the legislation. Some GPs felt their personal religious views, which regarded assisted dying as morally wrong, could not be the basis of a generalisable medical ethic for others. GPs who had witnessed a person's suffering that, in their opinion, justified physician-assisted suicide were in favour of legislative change. Some GPs felt a specialist referral pathway to provide assisted dying would help to ensure proper standards were met. CONCLUSION GPs' views on physician-assisted suicide ranged from support to opposition, depending principally on their interpretation of their experience of patients' suffering at the end of life. The goal to lessen suffering of the terminally ill, and apprehensions about patients being harmed, were common to both groups. Respect for autonomy and the right of self-determination versus the need to protect vulnerable people from the potential for harm from social coercion were the dominant themes.
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11
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Seale C. Hastening death in end-of-life care: A survey of doctors. Soc Sci Med 2009; 69:1659-66. [DOI: 10.1016/j.socscimed.2009.09.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Indexed: 12/22/2022]
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12
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Tepehan S, Ozkara E, Yavuz MF. Attitudes to euthanasia in ICUs and other hospital departments. Nurs Ethics 2009; 16:319-27. [PMID: 19372126 DOI: 10.1177/0969733009102693] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to reveal doctors' and nurses' attitudes to euthanasia in intensive care units and surgical, internal medicine and paediatric units in Turkey. A total of 205 doctors and 206 nurses working in several hospitals in Istanbul participated. Data were collected by questionnaire and analysed using SPSS v. 12.0. Significantly higher percentages of doctors (35.3%) and nurses (26.6%) working in intensive care units encountered euthanasia requests than those working in other units. Doctors and nurses caring for terminally ill patients in intensive care units differed considerably in their attitudes to euthanasia and patient rights from other health care staff. Euthanasia should be investigated and put on the agenda for discussion in Turkey.
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Abstract
This study reports UK doctors' opinions about legalisation of medically assisted dying (euthanasia and physician-assisted suicide), comparing this with the UK general public. A postal survey of 3733 UK medical practitioners was done. The majority of UK doctors are opposed to legalisation, contrasting with the UK general public. Palliative medicine specialists are particularly opposed. A strong religious belief is independently associated with opposition to assisted dying. Frequency of treating patients who die is not independently associated with attitudes. Many doctors supporting legalisation also express reservations and advocate safeguards; many doctors opposing legalisation believe and accept that treatment and nontreatment decisions may shorten life. It is hoped that future debates about legalisation can proceed with this evidence in mind.
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Affiliation(s)
- C Seale
- Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, 2 Newark Street, London, UK.
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Lee W, Price A, Rayner L, Hotopf M. Survey of doctors' opinions of the legalization of physician assisted suicide. BMC Med Ethics 2009; 10:2. [PMID: 19261197 PMCID: PMC2673229 DOI: 10.1186/1472-6939-10-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 03/05/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assisted dying has wide support among the general population but there is evidence that those providing care for the dying may be less supportive. Senior doctors would be involved in implementing the proposed change in the law. We aimed to measure support for legalizing physician assisted dying in a representative sample of senior doctors in England and Wales, and to assess any association between doctors' characteristics and level of support for a change in the law. METHODS We conducted a postal survey of 1000 consultants and general practitioners randomly selected from a commercially available database. The main outcome of interest was level of agreement with any change in the law to allow physician assisted suicide. RESULTS The corrected participation rate was 50%. We analysed 372 questionnaires. Respondents' views were divided: 39% were in favour of a change to the law to allow assisted suicide, 49% opposed a change and 12% neither agreed nor disagreed. Doctors who reported caring for the dying were less likely to support a change in the law. Religious belief was also associated with opposition. Gender, specialty and years in post had no significant effect. CONCLUSION More senior doctors in England and Wales oppose any step towards the legalization of assisted dying than support this. Doctors who care for the dying were more opposed. This has implications for the ease of implementation of recently proposed legislation.
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Affiliation(s)
- William Lee
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, 10 Cutcombe Rd, London SE59RJ, UK.
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15
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White KM, Wise SE, Young RM, Hyde MK. Exploring the Beliefs Underlying Attitudes to Active Voluntary Euthanasia in a Sample of Australian Medical Practitioners and Nurses: A Qualitative Analysis. OMEGA-JOURNAL OF DEATH AND DYING 2009; 58:19-39. [DOI: 10.2190/om.58.1.b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A qualitative study explored beliefs about active voluntary euthanasia (AVE) in a sample ( N = 18) of medical practitioners and nurses from Australia, where AVE is not currently legal. Four behaviors relating to AVE emerged during the interviews: requesting euthanasia for oneself, legalizing AVE, administering AVE to patients if it were legalized, and discussing AVE with patients if they request it. Using thematic analysis, interviews were analyzed for beliefs related to advantages and disadvantages of performing these AVE behaviors. Medical practitioners and nurses identified a number of similar benefits for performing the AVE-related behaviors, both for themselves personally and as health professionals. Benefits also included a consideration of the positive impact for patients, their families, and the health care system. Disadvantages across behaviors focused on the potential conflict between those parties involved in the decision making process, as well as conflict between one's own personal and professional values.
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Affiliation(s)
| | - Susi E. Wise
- Queensland University of Technology, Brisbane, Australia
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Parker MH, Cartwright CM, Williams GM. Impact of specialty on attitudes of Australian medical practitioners to end-of-life decisions. Med J Aust 2008; 188:450-6. [PMID: 18429710 DOI: 10.5694/j.1326-5377.2008.tb01714.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 12/13/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare attitudes and practices of Australian medical practitioners, by specialty, to a range of medical decisions at the end of life. DESIGN, SETTING AND PARTICIPANTS As part of an international study, in 2003, a structured questionnaire was mailed to 2964 medical practitioners drawn from membership registers of Australian and Australasian professional colleges. Data from 1478 questionnaires were statistically analysed using validated instruments. MAIN OUTCOME MEASURES Practitioners' willingness to comply with requests from patients and/or their relatives for symptom relief which might also hasten death; provision of terminal sedation and euthanasia, or willingness to provide these on their own initiative. RESULTS Respondents reported being much more willing to comply with a patient's request for increasing symptom relief, even at risk of hastening death, than for terminal sedation. Over a quarter of respondents would provide terminal sedation to competent patients on their own initiative. A small number of respondents would intentionally hasten death. There were significant differences by specialty for all three actions. Oncologists, palliative care physicians and geriatricians were least likely to actively hasten death, and more likely to act unilaterally to relieve symptoms as a medical necessity. CONCLUSIONS Perceptions about the causation of death and aspects of medical culture appear to influence physicians' attitudes towards medical decisions at the end of life. Our findings have implications for medical education, interprofessional communication and discussion between the medical profession and the community.
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17
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Turla A, Ozkara E, Ozkanli C, Alkan N. Health professionals' attitude toward euthanasia: a cross-sectional study from Turkey. OMEGA-JOURNAL OF DEATH AND DYING 2007; 54:135-45. [PMID: 17876966 DOI: 10.2190/5492-3833-7541-3160] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There is an ongoing debate on the definition of euthanasia and attempts to change laws about euthanasia and its practice in many countries. It is the medical doctors and the other health professionals who will elucidate the issue. Therefore, we performed this study to reveal attitude of Turkish health professionals toward euthanasia. This is an observational and cross-sectional study and data were collected with a questionnaire. The questionnaire was distributed to 545 health professionals in Samsun, a city in the Black Sea Region in Turkey. Data were analyzed with SPSS package programs. Of all health professionals included in the study, 43.5% were medical doctors and 45.5% auxiliary health professionals. Of all participants, 33.6% did not object to euthanasia and 7.9% were asked to perform euthanasia. Eighty point seven percent of the participants noted that euthanasia could be abused even if a euthanasia law were passed. It can be concluded that the health professionals should have a chance to discuss euthanasia and that their attitude toward and their expectations and worries about euthanasia should be taken into account when a euthanasia law is drafted.
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Hicks MHR. Physician-assisted suicide: a review of the literature concerning practical and clinical implications for UK doctors. BMC FAMILY PRACTICE 2006; 7:39. [PMID: 16792812 PMCID: PMC1550404 DOI: 10.1186/1471-2296-7-39] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Accepted: 06/22/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND A bill to legalize physician-assisted suicide in the UK recently made significant progress in the British House of Lords and will be reintroduced in the future. Until now there has been little discussion of the clinical implications of physician-assisted suicide for the UK. This paper describes problematical issues that became apparent from a review of the medical and psychiatric literature as to the potential effects of legalized physician-assisted suicide. DISCUSSION Most deaths by physician-assisted suicide are likely to occur for the illness of cancer and in the elderly. GPs will deal with most requests for assisted suicide. The UK is likely to have proportionately more PAS deaths than Oregon due to the bill's wider application to individuals with more severe physical disabilities. Evidence from other countries has shown that coercion and unconscious motivations on the part of patients and doctors in the form of transference and countertransference contribute to the misapplication of physician-assisted suicide. Depression influences requests for hastened death in terminally ill patients, but is often under-recognized or dismissed by doctors, some of whom proceed with assisted death anyway. Psychiatric evaluations, though helpful, do not solve these problems. Safeguards that are incorporated into physician-assisted suicide criteria probably decrease but do not prevent its misapplication. SUMMARY The UK is likely to face significant clinical problems arising from physician-assisted suicide if it is legalized. Terminally ill patients with mental illness, especially depression, are particularly vulnerable to the misapplication of physician-assisted suicide despite guidelines and safeguards.
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Affiliation(s)
- Madelyn Hsiao-Rei Hicks
- Section of Community (PRiSM), Department of Health Services Research, Institute of Psychiatry, King's College London, University of London, UK.
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Schildmann J, Herrmann E, Burchardi N, Schwantes U, Vollmann J. Physician assisted suicide: knowledge and views of fifth-year medical students in Germany. DEATH STUDIES 2006; 30:29-39. [PMID: 16296559 DOI: 10.1080/07481180500236693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Suicide and assisted suicide are not criminal acts in Germany. However, attempting suicide may create a legal duty for physicians to try to save a patient's life. This study presents data on medical students' legal knowledge and ethical views regarding physician assisted suicide (PAS). The majority of 85 respondents held PAS to be illegal. More than a third of the students viewed PAS in certain situations to be ethically acceptable whereas a smaller proportion thought that it should be legal. Compared with German physicians the medical students taking part in this study were less opposed to PAS. The majority perceived the undergraduate training concerning ethical aspect of assisted death as deficient.
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Affiliation(s)
- Jan Schildmann
- Institute for Medical Ethics and History of Medicine, Ruhr-University, Bochum, and Department of Medicine III, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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20
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Ozkara E, Hanci H, Civaner M, Yorulmaz C, Karagoz M, Mayda AS, Goren S, Kok AN. Turkey's physicians' attitudes toward euthanasia: a brief research report. OMEGA-JOURNAL OF DEATH AND DYING 2005; 49:109-15. [PMID: 15688545 DOI: 10.2190/e88c-uxa5-tl9t-rvlk] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Euthanasia and assisted suicide are subject to an ongoing debate and discussed with various aspects. Because physicians are in a profession closely related to euthanasia, their attitudes toward this subject are significant. Thus, research intending to explore their opinions is carried out in many countries. In this study, opinions of the physicians regarding euthanasia's definition, contents, legal aspects, and acceptable conditions for its application are addressed. The questionnaire was given to 949 physicians, more than 1% of the total working in Turkey. Of the physicians who participated in the study, 49.9% agreed with the opinion that euthanasia should be legal in certain circumstances. In addition, 19% had come across a euthanasia request and the majority of physicians (55.9%) believed that euthanasia is applied secretly in the country despite the prohibitory legislation. In conclusion, the authors infer from the study itself and believe that euthanasia should be legal in certain circumstances and that the subject, which is not in the agenda of the Turkish population, should continue to be examined.
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Affiliation(s)
- Erdem Ozkara
- Dokuz Eylul University, School of Medicine, Dept. of Forensic Medicine, 35300 Izmir-Turkey.
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Teisseyre N, Mullet E, Sorum PC. Under what conditions is euthanasia acceptable to lay people and health professionals? Soc Sci Med 2005; 60:357-68. [PMID: 15522491 DOI: 10.1016/j.socscimed.2004.05.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Euthanasia is legal only in the Netherlands and Belgium, but it is on occasion performed by physicians elsewhere. We recruited in France two convenience samples of 221 lay people and of 189 professionals (36 physicians, 92 nurses, 48 nurse's aides, and 13 psychologists) and asked them how acceptable it would be for a patient's physician to perform euthanasia in each of 72 scenarios. The scenarios were all combinations of three levels of the patient's life expectancy (3 days, 10 days, or 1 month), four levels of the patient's request for euthanasia (no request, unable to formulate a request because in a coma, some form of request, repeated formal requests), three of the family's attitude (do not uselessly prolong care, no opinion, try to keep the patient alive to the very end), and two of the patient's willingness to undergo organ donation (willing or not willing). We found that most lay people and health care professionals structure the factors in the patient scenarios in the same way: they assign most importance to the extent of requests for euthanasia by the patient and least importance (the lay people) or none (the health professionals) to the patient's willingness to donate organs. They also integrate the information from the different factors in the same way: the factors of patient request, patient life expectancy, and (for the lay people) organ donation are combined additively, and the family's attitude toward prolonging care interacts with patient request (playing a larger role when the patient can make no request). Thus we demonstrate a common cognitive foundation for future discussions, at the levels of both clinical care and public policy, of the conditions under which physician-performed euthanasia might be acceptable.
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Affiliation(s)
- Nathalie Teisseyre
- Laboratoire Cognition et Décision, Ecole Pratique des Hautes Etudes, Université du Mirail, 31058-Toulouse, France
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Müller-Busch HC, Oduncu FS, Woskanjan S, Klaschik E. Attitudes on euthanasia, physician-assisted suicide and terminal sedation--a survey of the members of the German Association for Palliative Medicine. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2004; 7:333-339. [PMID: 15679025 DOI: 10.1007/s11019-004-9349-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Due to recent legislations on euthanasia and its current practice in the Netherlands and Belgium, issues of end-of-life medicine have become very vital in many European countries. In 2002, the Ethics Working Group of the German Association for Palliative Medicine (DGP) has conducted a survey among its physician members in order to evaluate their attitudes towards different end-of-life medical practices, such as euthanasia (EUT), physician-assisted suicide (PAS), and terminal sedation (TS). METHODS An anonymous questionnaire was sent to the 411 DGP physicians, consisting of 14 multiple choice questions on positions that might be adopted in different hypothetical scenarios on situations of "intolerable suffering" in end-of-life care. For the sake of clarification, several definitions and legal judgements of different terms used in the German debate on premature termination of life were included. For statistical analysis t-tests and Pearson-correlations were used. RESULTS The response rate was 61% (n = 251). The proportions of the respondents who were opposed to legalizing different forms of premature termination of life were: 90% opposed to EUT, 75% to PAS, 94% to PAS for psychiatric patients. Terminal sedation was accepted by 94% of the members. The main decisional bases drawn on for the answers were personal ethical values, professional experience with palliative care, knowledge of alternative approaches, knowledge of ethical guidelines and of the national legal frame. CONCLUSIONS In sharp contrast to similar surveys conducted in other countries, only a minority of 9.6% of the DGP physicians supported the legalization of EUT. The misuse of medical knowledge for inhumane killing in the Nazi period did not play a relevant role for the respondents' negative attitude towards EUT. Palliative care needs to be stronger established and promoted within the German health care system in order to improve the quality of end-of-life situations which subsequently is expected to lead to decreasing requests for EUT by terminally ill patients.
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Affiliation(s)
- H C Müller-Busch
- Department of Anesthesiology, Pain Therapy and Palliative Care, GK Havelhöhe, D-14089 Berlin, Germany
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Hackett EA, Francis SA. "Death was a blessing"--should it ever be pharmaceutically hastened? British pharmacists' views. ACTA ACUST UNITED AC 2003; 25:288-93. [PMID: 14689818 DOI: 10.1023/b:phar.0000006520.48054.91] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To investigate the views and experiences of British pharmacists in physician-assisted suicide (PAS) and voluntary active euthanasia (VAE) and to examine whether differences in views were associated with personal characteristics. METHOD A postal questionnaire was mailed to a random sample of 500 registered pharmacists, with addresses in England or Wales, stratified according to sex and community/hospital working environments. MAIN OUTCOME MEASURE Pharmacists' reports of their views and experiences of PAS and VAE. RESULTS Completed questionnaires were received from 295 respondents (response rate: 59%). The majority of respondents (83%) reported that at times, a person had the right to choose their own manner of death; 61% and 53% thought that there should be changes in the Law to legalise VAE and PAS, respectively. If it were legal to do so, 63% stated that they would be willing to dispense medication for VAE and 64% for PAS. However, only 45% agreed that the pharmacist should have a role in advising the prescriber on the choice and dose of drugs used. Sex, age, and years registered as a pharmacist were not found to be significantly associated with views on the practices of PAS and VAE. However, pharmacists who reported having a religion were significantly less likely to favour such practices. On comparing the views of community and hospital pharmacists, community pharmacists were significantly less likely than expected to want to be informed about the intended purpose of lethal drugs. CONCLUSION In this survey, while over half of British pharmacists did not disagree in principle to the legalisation of VAE and/or PAS, they were less supportive of direct involvement in such procedures. Religion was a discriminatory factor associated with negative views of VAE and PAS. The significant minority of pharmacists not wanting to know the purpose of drugs they suspected might be for PAS or VAE is not in accordance with professional accountability, reflecting the complex and sometimes conflicting legal and moral aspects of such practices when deciding upon a course of action.
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Affiliation(s)
- Elizabeth A Hackett
- Pharmacy Department, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.
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