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Roff C, Cook-Cottone C. Assisted death in eating disorders: a systematic review of cases and clinical rationales. Front Psychiatry 2024; 15:1431771. [PMID: 39143961 PMCID: PMC11322357 DOI: 10.3389/fpsyt.2024.1431771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/12/2024] [Indexed: 08/16/2024] Open
Abstract
Background Assisted dying for reasons solely related to an eating disorder (ED) has occurred in multiple countries, including those which restrict the practice to individuals with a terminal condition. The aims of this systematic review were to (1) identify all known cases of assisted deaths among patients with EDs and (2) describe the clinical rationales used to grant patients' requests for assisted death. Methods We conducted a systematic search of peer-reviewed studies and publicly available government reports to identify cases of assisted death in patients with EDs. In reports that included qualitative data about the case, clinical rationales were extracted and grouped into domains by qualitative content analysis. Results We identified 10 peer-reviewed articles and 20 government reports describing at least 60 patients with EDs who underwent assisted dying between 2012 and 2024. Clinical rationales were categorized into three domains: irremediability, terminality, and voluntary request. Reports emphasized that patients with EDs who underwent assisted death had terminal, incurable, and/or untreatable conditions and had adequate decision-making capacity to make a life-ending decision. Most government reports did not include descriptive-enough data to verify psychiatric conditions. Conclusion The results of our systematic review underscore considerable gaps in the reporting of assisted death in patients with psychiatric conditions, posing substantial concerns about oversight and public safety. In many cases, the clinical rationales that were used to affirm patients with EDs were eligible for assisted death lack validity and do not cohere with empirical understanding.
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Affiliation(s)
| | - Catherine Cook-Cottone
- Department of Counseling, School, and Educational Psychology, University at Buffalo, Buffalo, NY, United States
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Rahimian Z, Rahimian L, Lopez‐Castroman J, Ostovarfar J, Fallahi MJ, Nayeri MA, Vardanjani HM. What medical conditions lead to a request for euthanasia? A rapid scoping review. Health Sci Rep 2024; 7:e1978. [PMID: 38515545 PMCID: PMC10955044 DOI: 10.1002/hsr2.1978] [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: 10/01/2023] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
Background and Aims Euthanasia is a controversial issue related to the right to die. Although euthanasia is mostly requested by terminally sick individuals, even in societies where it is legal, it is unclear what medical conditions lead to euthanasia requests. In this scoping review, we aimed to compile medical conditions for which euthanasia has been requested or performed around the world. Methods The review was preferred reporting items for systematic reviews and meta-analysis for scoping reviews (PRISMA-ScR) checklist. Retrieved search results were screened and unrelated documents were excluded. Data on reasons for conducting or requesting euthanasia along with the study type, setting, and publication year were extracted from documents. Human development index and euthanasia legality were also extracted. Major medical fields were used to categorize reported reasons. Group discussions were conducted if needed for this categorization. An electronic search was undertaken in MEDLINE through PubMed for published documents covering the years January 2000 to September 2022. Results Out of 3323 records, a total of 197 papers were included. The most common medical conditions in euthanasia requests are cancer in a terminal phase (45.4%), Alzheimer's disease and dementia (19.8%), constant unbearable physical or mental suffering (19.8%), treatment-resistant mood disorders (12.2%), and advanced cardiovascular disorders (12.2%). Conclusion Reasons for euthanasia are mostly linked to chronic or terminal physical conditions. Psychiatric disorders also lead to a substantial proportion of euthanasia requests. This review can help to identify the features shared by conditions that lead to performing or requesting euthanasia.
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Affiliation(s)
- Zahra Rahimian
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
- MD‐MPH Department, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Leila Rahimian
- School of DentistryShiraz University of Medical SciencesShirazIran
| | - Jorge Lopez‐Castroman
- Department of Psychiatry, CHU Nîmes & IGFCNRS‐INSERMUniversity of MontpellierMontpellierFrance
- CIBERSAMMadridSpain
| | - Jeyran Ostovarfar
- MD‐MPH Department, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Mohammad J. Fallahi
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical SciencesShirazIran
| | - Mohammad A. Nayeri
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
- MD‐MPH Department, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Hossein M. Vardanjani
- MD‐MPH Department, School of Medicine, Research Center for Traditional Medicine and History of MedicineShiraz University of Medical SciencesShirazIran
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3
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Ortega-Galán ÁM, Ibáñez-Masero O, Fernández-Martínez E, Ortiz-Amo R, Fernández-Santos L, Ruiz-Fernández MD. The paradoxical position of nurses regarding euthanasia and its legalisation: A descriptive quantitative study. J Clin Nurs 2023; 32:8007-8016. [PMID: 37715363 DOI: 10.1111/jocn.16869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/04/2023] [Accepted: 08/21/2023] [Indexed: 09/17/2023]
Abstract
AIMS AND OBJECTIVES To learn about the attitudes of nurses working in the Andalusian Public Health System regarding euthanasia and its legalisation. BACKGROUND Euthanasia often finds itself in the crosshairs of ethical and political debate on an international scale. Currently, the Spanish Organic Law 3/2021 of 24 March, 2021, recognises euthanasia as a fundamental right in Spain. It is of particular interest to know about the views, attitudes and stances that Andalusian nurses have of euthanasia as they are key players within the framework of euthanasia and administration of life-ending drugs. They play a central role in guiding patients through the euthanasia application process. DESIGN Observational descriptive study. METHODS A study of Andalusian Public Health System nurses was carried out using non-probability convenience sampling. 518 nurses with an average age of 44.75 years answered in a questionnaire that was distributed on an online platform. Socio-demographic and occupational variables were assessed, together with the Death Anxiety Scale and the Euthanasia Attitude Scale. A bivariate analysis and a multivariate linear regression model were performed. The STROBE checklist was used. RESULTS The mean score obtained on the Euthanasia Attitude Scale was 75.95 (SD = 16.53). The mean score obtained on the Death Anxiety Scale was 7.56 (SD = 3.05). The variables age and work experience were negatively correlated with the total scores of the Euthanasia Attitude Scale and the categories 'Ethical considerations', 'Practical considerations' and 'Treasuring life'. On the other hand, there was a significant positive correlation between age and work experience and 'Spiritual beliefs' category. CONCLUSIONS The current situation shows a worrying paradox. There is a stark difference between positive professional attitudes towards euthanasia and the desire to participate in its application. RELEVANCE TO CLINICAL PRACTICE It is vital that educational and healthcare institutions make the necessary efforts to ensure that nurses develop sound moral judgement, displaying the moral conscience and ethical commitment required of this established profession. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
| | | | | | - Rocío Ortiz-Amo
- Department of Psychology, Area of Social Work and Social Services, University of Almería, Almería, Spain
| | | | - María Dolores Ruiz-Fernández
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almería, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
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Mroz S, Deliens L, Cohen J, Chambaere K. Developments after the liberalization of laws concerning assisted dying—experience from Belgium and other countries. DEUTSCHES ÄRZTEBLATT INTERNATIONAL 2022. [DOI: 10.3238/arztebl.m2022.0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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5
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Calati R, Olié E, Dassa D, Gramaglia C, Guillaume S, Madeddu F, Courtet P. Euthanasia and assisted suicide in psychiatric patients: A systematic review of the literature. J Psychiatr Res 2021; 135:153-173. [PMID: 33486164 DOI: 10.1016/j.jpsychires.2020.12.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/16/2020] [Accepted: 12/01/2020] [Indexed: 02/01/2023]
Abstract
The number of psychiatric patients requesting Euthanasia or Assisted Suicide (EAS) continues to increase. The aims of this systematic review were to: 1) describe the available data related to psychiatric patients having received or requesting EAS (pEAS) for each country in which is allowed; 2) and describe the ethically salient points that arise. PubMed, PsycINFO, and Scopus databases were searched to identify articles published up to September 2020. Among the retrieved publications, only studies on pEAS cases (pEAS-C), pEAS requests, or physician reports/attitude towards pEAS reporting some quantitative data on patients having received or requesting pEAS were retained. Among the 24 included studies, thirteen (54%) were about pEAS in the Netherlands, four (17%) in Belgium, and seven (29%) in Switzerland. Results were different across different countries. In the Netherlands, pEAS-C were mostly women (70-77%) and often had at least two psychiatric disorders (56-97%). Mood disorders were mainly represented (55-70%) together with personality disorders (52-54%). History of suicide attempts was present in 34-52%. Moreover, 37-62% of them had at least one comorbid medical condition. In Belgium pEAS-C were mostly women (75%), but the majority (71%) had a single diagnosis, mood disorder. In Switzerland available data were less detailed. As pEAS-C seem to be very similar to 'traditional suicides', pEAS procedures should be carefully revised to establish specific criteria of access and guidelines of evaluation of the request. A deeper focus on unbearable suffering, decision capacity and possibilities of improvements is warranted as well as the involvement of mental health professionals.
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Affiliation(s)
- Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Milan, Italy; Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France; PSNREC, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France.
| | - Emilie Olié
- PSNREC, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - Déborah Dassa
- PSNREC, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Carla Gramaglia
- Department of Translational Medicine, Institute of Psychiatry, University of Eastern Piedmont, Novara, Italy; Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
| | - Sébastien Guillaume
- PSNREC, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - Fabio Madeddu
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Philippe Courtet
- PSNREC, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
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Moshe S, Gershfeld-Litvin A. Old and Depressed? What We Think About Ending Their Suffering—Attitudes Toward Euthanasia for Elderly Suffering From Physical Versus Mental Illness. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:1026-1041. [DOI: 10.1177/0030222820961241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aims to extend our knowledge regarding attitudes toward euthanasia. Specifically, the effect of patient’s age and illness type. 123 participants were randomly assigned to 1 of 4 groups completed the Assessing Right to Die Attitudes (ARDA) questionnaire after reading a patients age (79 vs. 29 year old) and illness type (cancer vs. depression) description. Findings revealed more positive attitudes toward euthanasia when the patient was physically ill, as opposed to mentally ill. Participants’ attitude towards euthanasia was more positive when the patient was elderly. Illness type as a function of the patient’s age did not significantly influence attitudes towards euthanasia. The results of the current study reinforce the individual influence of illness type and of patient age on attitudes toward euthanasia, and suggest additional avenues for further research regarding their combined influence.
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Affiliation(s)
- Shir Moshe
- Academic College of Tel Aviv–Yaffo, Yaffo, Israel
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Jones DG. Ethical Perspectives on Body Donation Following Physician-Assisted Death. ANATOMICAL SCIENCES EDUCATION 2020; 13:504-511. [PMID: 31696652 DOI: 10.1002/ase.1930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/30/2019] [Accepted: 11/03/2019] [Indexed: 06/10/2023]
Abstract
The increasing availability of physician-assisted death (PAD) has opened up a novel means of making donated bodies available for anatomical dissection. This practice has come to the fore in Canada, but is unlikely to be confined to that country as legislation changes in other countries. The ethical considerations raised by this development are placed within the framework of the ethical guidelines on body donation promulgated by the International Federation of Associations of Anatomists. The discussion centers on understanding the ethical dimensions of moral complicity, and whether it is accepted or rejected. If rejected it is possible to separate ethical concerns regarding PAD from subsequent use of donated bodies, as long as there is fully informed consent and complete ethical and procedural separation of the two. Openness about the origin of bodies for dissection is essential. Students should be instructed on the nuances of moral complicity, and consideration be given to those with moral doubts about PAD. Two issues are raised in considering whether these moves represent an ethical slippery slope: the attraction represented by obtaining relatively "high quality" bodies, and the manner in which organ donation following PAD has led to challenges to the dead donor rule. Although body donation raises fewer concerns, the ethical dimensions of the two are similar. The ethical constraints outlined here have the capacity to prevent an ethical slippery slope and constitute a sound basis for addressing an innovative opportunity for anatomists.
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Wainman BC, Cornwall J. Body Donation after Medically Assisted Death: An Emerging Consideration for Donor Programs. ANATOMICAL SCIENCES EDUCATION 2019; 12:417-424. [PMID: 30848063 DOI: 10.1002/ase.1874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 06/09/2023]
Abstract
Around the world, the recent introduction of assisted death laws has meant that undertaking medical assistance in dying (MAID) is now an option for some persons wishing to end their life. Some of these people donate their bodies to medical science, and by doing so have created a new route from which donor programs can now receive bodies. Such donations have also illuminated a myriad of novel ethical questions. This article considers the emotive and controversial topic of MAID in relation to body donation, describing the experiences of McMaster University, Canada, where several MAID body donors have been received by the anatomical donor program. It provides background on the development and implementation of MAID in Canada, and describes the experience of staff and students at McMaster to MAID donations. It also explores the relevance of MAID to body donation programs, and discusses several of the ethical challenges facing body donation programs who may encounter MAID body donors. These include the appropriateness of accepting MAID donors, issues with informed consent, the effect of personal engagement with MAID donors, information sharing around MAID donations, governance issues, and negative historical parallels between MAID and euthanasia. Suggestions on how to manage MAID body donation focus on how issues affecting institutions, faculty, and students may be approached utilizing appropriate transparency and communication, some of which may facilitate student professional development around the topic of MAID. It is also suggested that the development of ethically appropriate guidelines on MAID body donations may positively guide the anatomical community.
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Affiliation(s)
- Bruce C Wainman
- Pathology and Molecular Medicine and Education Program in Anatomy, McMaster University, Hamilton, Ontario, Canada
| | - Jon Cornwall
- Centre for Early Learning in Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
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9
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Demedts D, Roelands M, Libbrecht J, Bilsen J. The attitudes, role & knowledge of mental health nurses towards euthanasia because of unbearable mental suffering in Belgium: A pilot study. J Psychiatr Ment Health Nurs 2018; 25:400-410. [PMID: 29802774 DOI: 10.1111/jpm.12475] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 05/16/2018] [Accepted: 05/23/2018] [Indexed: 12/20/2022]
Abstract
UNLABELLED WHAT IS KNOWN ABOUT THE SUBJECT?: Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002 under strict conditions of careful practice. UMS euthanasia occurs fairly rarely in Belgium, but the frequency has increased substantially over the past few years. Although most mental health nurses play an important role and are supportive of euthanasia in general, their role, attitude and knowledge when it comes to UMS euthanasia were unknown until now. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Most mental health nurses in Belgium appear to be supportive towards UMS euthanasia and where UMS euthanasia is carried out, mental health nurses are often involved in the preceding decision-making process. Mental health nurses critically reflect on the interpretation and application of the legal euthanasia criteria as experienced in their daily work with their patients, and identify several problems. After a rather quiet period in Belgium, the public ethical debate regarding UMS euthanasia has recently been reopened and intensified. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia. This applies at several levels: legal, healthcare policy, bedside care and education. Specific attention must be paid within the UMS euthanasia process to ensure adequate cooperation between physicians, nurses and patients. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions. ABSTRACT Introduction Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002, under certain circumstances that govern careful practice. Despite the legal framework, there are specific difficulties and concerns regarding UMS euthanasia. Mental health nurses are often involved in the process, but little is known about their attitudes towards UMS euthanasia, their role and their knowledge. Aim To determine the attitudes, role and knowledge of mental health nurses regarding UMS euthanasia. Methods A cross-sectional survey was performed at a convenience sample of four psychiatric hospitals in Belgium (n = 133) as a pilot study. Self-administered questionnaires were provided to mental health nurses. Results Half the nurses in our sample had been involved at least once in the process of UMS euthanasia. A large majority of mental health nurses were supportive of UMS euthanasia. Nurses show differences in attitudes related to the different psychiatric pathologies of the patients, and in whether or not minors are involved. In some cases, they believed that the mental suffering of psychiatric patients can be unbearable and irreversible and that psychiatric patients can be competent to voluntarily request UMS euthanasia. Nurses stated that they have an important role in the UMS euthanasia process, but also demanded more knowledge and clear guidelines to implement the procedure. Discussion Nurses have a key role regarding UMS euthanasia but face several challenges: the recent process, resistance to a multidisciplinary approach by psychiatrists and an unclear role defined by the legal framework. Nurses do not appear to have a common voice on the topic and the development of clear guidelines appears to be essential. Social recovery can offer a way out of an UMS euthanasia request, but it will not always offer a solution. Implications for Practice Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia at various levels: bedside practice, healthcare management, education and policy. A form of systematic cooperation between nurses, physicians and patients can contribute to the utmost careful decision-making process needed in these cases. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions.
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Affiliation(s)
- Dennis Demedts
- Research group Mental Health and Wellbeing, Vrije Universiteit Brussels (VUB), Brussels, Belgium.,Department of Health and Landscape Architecture, Erasmus University College Brussels (EhB), Brussels, Belgium.,Knowledge Center Brussels Integrated Care, Erasmus University College Brussels, Brussels, Belgium
| | - Marc Roelands
- Research group Mental Health and Wellbeing, Vrije Universiteit Brussels (VUB), Brussels, Belgium
| | - Julien Libbrecht
- Department of Health and Landscape Architecture, Erasmus University College Brussels (EhB), Brussels, Belgium
| | - Johan Bilsen
- Research group Mental Health and Wellbeing, Vrije Universiteit Brussels (VUB), Brussels, Belgium
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10
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Cohen-Almagor R, Ely EW. Euthanasia and palliative sedation in Belgium. BMJ Support Palliat Care 2018; 8:307-313. [PMID: 29305500 DOI: 10.1136/bmjspcare-2017-001398] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/16/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022]
Abstract
The aim of this article is to use data from Belgium to analyse distinctions between palliative sedation and euthanasia. There is a need to reduce confusion and improve communication related to patient management at the end of life specifically regarding the rapidly expanding area of patient care that incorporates a spectrum of nuanced yet overlapping terms such as palliative care, sedation, palliative sedation, continued sedation, continued sedation until death, terminal sedation, voluntary euthanasia and involuntary euthanasia. Some physicians and nurses mistakenly think that relieving suffering at the end of life by heavily sedating patients is a form of euthanasia, when indeed it is merely responding to the ordinary and proportionate needs of the patient. Concerns are raised about abuse in the form of deliberate involuntary euthanasia, obfuscation and disregard for the processes sustaining the management of refractory suffering at the end of life. Some suggestions designed to improve patient management and prevent potential abuse are offered.
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Affiliation(s)
| | - E Wesley Ely
- Geriatric Research, VA Tennessee Valley Healthcare System, Education and Clinical Center (GRECC), Nashville, Tennessee, USA.,Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA.,Center for Health Services Research, Vanderbilt University, Nashville, Tennessee, USA
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11
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Stolz E, Mayerl H, Gasser-Steiner P, Freidl W. Attitudes towards assisted suicide and euthanasia among care-dependent older adults (50+) in Austria: the role of socio-demographics, religiosity, physical illness, psychological distress, and social isolation. BMC Med Ethics 2017; 18:71. [PMID: 29212490 PMCID: PMC5719645 DOI: 10.1186/s12910-017-0233-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/29/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Care-dependency constitutes an important issue with regard to the approval of end-of-life decisions, yet attitudes towards assisted suicide and euthanasia are understudied among care-dependent older adults. We assessed attitudes towards assisted suicide and euthanasia and tested empirical correlates, including socio-demographics, religiosity, physical illness, psychological distress and social isolation. METHODS A nationwide cross-sectional survey among older care allowance recipients (50+) in private households in Austria was conducted in 2016. In computer-assisted personal interviews, 493 respondents were asked whether or not they approved of the availability of assisted suicide and euthanasia in case of long-term care dependency and whether or not they would consider using assisted suicide or euthanasia for themselves. Multiple logistic regression analysis was used to assess the impact of potential determinants of attitudes towards assisted suicide and euthanasia. RESULTS About a quarter (24.8-26.0%) of the sampled care-dependent older adults approved of the availability of assisted suicide and euthanasia respectively indicated the will to (hypothetically) make use of assisted suicide or euthanasia. Attitudes towards assisted suicide were most favourable among care-dependent older adults living in urban areas, those who did not trust physicians, those who reported active suicide ideation, and individuals with a strong fear of dying. With regard to euthanasia, living alone, religiosity and fear of dying were the central determinants of acceptance. CONCLUSIONS Positive attitudes towards and will to (hypothetically) use assisted suicide and euthanasia were expressed by a substantial minority of care-dependent older adults in Austria and are driven by current psychological suffering and fear of the process of dying in the (near) future. Community-based psychosocial care should be expanded to address psychological distress and fears about end-of-life issues among care-dependent older adults.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, 8010, Graz, Austria
| | - Hannes Mayerl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, 8010, Graz, Austria
| | - Peter Gasser-Steiner
- Department of Sociology, University of Graz, Universitätsstraße 15/IV, 8010, Graz, Austria
| | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, 8010, Graz, Austria.
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12
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Verhofstadt M, Thienpont L, Peters GJY. When unbearable suffering incites psychiatric patients to request euthanasia: qualitative study. Br J Psychiatry 2017; 211:238-245. [PMID: 28970302 PMCID: PMC5623879 DOI: 10.1192/bjp.bp.117.199331] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 12/19/2016] [Accepted: 01/30/2017] [Indexed: 11/23/2022]
Abstract
BackgroundThe concept of 'unbearable suffering' is central to legislation governing whether euthanasia requests may be granted, but remains insufficiently understood, especially in relation to psychiatric patients.AimsTo provide insights into the suffering experiences of psychiatric patients who have made a request for euthanasia.MethodTestimonials from 26 psychiatric patients who requested euthanasia were analysed using QualiCoder software.ResultsFive domains of suffering were identified: medical, intrapersonal, interpersonal, societal and existential. Hopelessness was confirmed to be an important contributor. The lengthy process of applying for euthanasia was a cause of suffering and added to experienced hopelessness, whereas encountering physicians who took requests seriously could offer new perspectives on treatment.ConclusionsThe development of measurement instruments to assess the nature and extent of suffering as experienced by psychiatric patients could help both patients and physicians to better navigate the complicated and sensitive process of evaluating requests in a humane and competent way. Some correlates of suffering (such as low income) indicate the need for a broad medical, societal and political debate on how to reduce the burden of financial and socioeconomic difficulties and inequalities in order to reduce patients' desire for euthanasia. Euthanasia should never be seen (or used) as a means of resolving societal failures.
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Affiliation(s)
- Monica Verhofstadt
- Monica Verhofstadt, BSc, Faculty Of Psychology and Education Science, Open University of The Netherlands, Heerlen, The Netherlands; Lieve Thienpont, MD, Vonkel, LEIFpunt-Gent (Life End Information Forum, consultation team Ghent), Ghent, Belgium; Gjalt-Jorn Ygram Peters, PhD, Faculty Of Psychology and Education Science, Open University of the Netherlands, Heerlen, The Netherlands
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13
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Karsoho H, Fishman JR, Wright DK, Macdonald ME. Suffering and medicalization at the end of life: The case of physician-assisted dying. Soc Sci Med 2016; 170:188-196. [PMID: 27821302 DOI: 10.1016/j.socscimed.2016.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 09/22/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
'Suffering' is a central discursive trope for the right-to-die movement. In this article, we ask how proponents of physician-assisted dying (PAD) articulate suffering with the role of medicine at the end of life within the context of a decriminalization and legalization debate. We draw upon empirical data from our study of Carter v. Canada, the landmark court case that decriminalized PAD in Canada in 2015. We conducted in-depth interviews with 42 key participants of the case and collected over 4000 pages of legal documents generated by the case. In our analysis of the data, we show the different ways proponents construct relationships between suffering, mainstream curative medicine, palliative care, and assisted dying. Proponents see curative medicine as complicit in the production of suffering at the end of life; they lament a cultural context wherein life-prolongation is the moral imperative of physicians who are paternalistic and death-denying. Proponents further limit palliative care's ability to alleviate suffering at the end of life and even go so far as to claim that in some instances, palliative care produces suffering. Proponents' articulation of suffering with both mainstream medicine and palliative care might suggest an outright rejection of a place for medicine at the end of life. We further find, however, that proponents insist on the involvement of physicians in assisted dying. Proponents emphasize how a request for PAD can set in motion an interactive therapeutic process that alleviates suffering at the end of life. We argue that the proponents' articulation of suffering with the role of medicine at the end of life should be understood as a discourse through which one configuration of end-of-life care comes to be accepted and another rejected, a discourse that ultimately does not challenge, but makes productive use of the larger framework of the medicalization of dying.
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Affiliation(s)
- Hadi Karsoho
- Department of Sociology, Department of Social Studies of Medicine, 3647 Peel Street, Room 307, Montreal, QC H3A 1X1, Canada.
| | - Jennifer R Fishman
- Biomedical Ethics Unit, Department of Social Studies of Medicine, 3647 Peel Street, Room 307, Montreal, QC H3A 1X1, Canada.
| | - David Kenneth Wright
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1H 8M5, Canada.
| | - Mary Ellen Macdonald
- Oral Health and Society Research Unit, Faculty of Dentistry, McGill University, Montreal, QC H3A 1G1, Canada.
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Cohen-Almagor R. First Do No Harm: Euthanasia of Patients with Dementia in Belgium. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2016; 41:74-89. [PMID: 26661050 PMCID: PMC4882626 DOI: 10.1093/jmp/jhv031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In Memory of Ed Pellegrino. Euthanasia in Belgium is not limited to terminally ill patients. It may be applied to patients with chronic degenerative diseases. Currently, people in Belgium wish to make it possible to euthanize incompetent patients who suffer from dementia. This article explains the Belgian law and then explores arguments for and against euthanasia of patients with dementia. It probes the dementia paradox by elucidating Dworkin's distinction between critical and experiential interests, arguing that at the end-of-life this distinction is not clearcut. It argues against euthanasia for patients with dementia, for respecting patients' humanity and for providing them with more care, compassion, and good doctoring.
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Cohen-Almagor R. First do no harm: intentionally shortening lives of patients without their explicit request in Belgium. JOURNAL OF MEDICAL ETHICS 2015; 41:625-629. [PMID: 26041861 DOI: 10.1136/medethics-2014-102387] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 05/13/2015] [Indexed: 06/04/2023]
Abstract
The aim of this article is to provide a critical review of one of the most worrying aspects of the euthanasia policy and practice in Belgium--the deliberate shortening of lives of some patients without their explicit voluntary request. Some suggestions designed to improve the situation and prevent abuse are offered.
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16
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Thienpont L, Verhofstadt M, Van Loon T, Distelmans W, Audenaert K, De Deyn PP. Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study. BMJ Open 2015; 5:e007454. [PMID: 26216150 PMCID: PMC4530448 DOI: 10.1136/bmjopen-2014-007454] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To identify patterns in euthanasia requests and practices relating to psychiatric patients; to generate recommendations for future research. DESIGN Retrospective analysis of data obtained through medical file review. SETTING Outpatient psychiatric clinical setting in the Dutch-speaking region of Belgium, between October 2007 and December 2011; follow-up at the end of December 2012. PARTICIPANTS 100 consecutive psychiatric patients requesting euthanasia based on psychological suffering associated with psychiatric disorders (77 women, 23 men; mean age 47 years; age range 21-80 years). MAIN OUTCOME MEASURES Patient sociodemographic characteristics; diagnoses; decisions on euthanasia requests; circumstances of euthanasia procedures; patient outcomes at follow-up. RESULTS Most patients had been referred for psychiatric counselling by their physician (n=55) or by LEIF (Life End Information Forum) (n=36). 90 patients had >1 disorder; the most frequent diagnoses were depression (n=58) and personality disorder (n=50). 38 patients required further testing and/or treatment, including 13 specifically tested for autism spectrum disorder (ASD); 12 received an ASD diagnosis (all Asperger syndrome). In total, 48 of the euthanasia requests were accepted and 35 were carried out. Of the 13 remaining patients whose requests were accepted, 8 postponed or cancelled the procedure, because simply having this option gave them enough peace of mind to continue living. In December 2012, 43 patients had died, including 35 by euthanasia; others died by suicide (6), palliative sedation (1) and anorexia nervosa (1). CONCLUSIONS Depression and personality disorders are the most common diagnoses in psychiatric patients requesting euthanasia, with Asperger syndrome representing a neglected disease burden. Further research is needed, especially prospective quantitative and qualitative studies, to obtain a better understanding of patients with psychiatric disorders who request euthanasia due to unbearable psychological suffering.
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Affiliation(s)
| | - Monica Verhofstadt
- MSc student at the Open University of the Netherlands, Heerlen, The Netherlands
| | | | | | - Kurt Audenaert
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
| | - Peter P De Deyn
- University of Antwerp, Institute Born-Bunge, Wilrijk, Belgium
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Middelheim General Hospital, ZNA, Antwerp, Belgium
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17
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Abstract
Since the Netherlands produced the Groningen protocol describing the methods to be used for pediatric euthanasia and Belgium passed laws authorizing euthanasia for children who consent to it, the issue of pediatric euthanasia has become a relevant topic to discuss. Most rejections of pediatric euthanasia fall into 1 or more of 3 categories, each of which has problems. This article shows how several recent arguments against pediatric euthanasia fail to prove that pediatric euthanasia is unacceptable. It does not follow from this that the practice is permissible but rather that if one is to reject such a practice, stronger arguments will need to be made, especially in countries where adult euthanasia or assisted suicide is already permitted.
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Affiliation(s)
- Stephen S Hanson
- Department of Philosophy, University of Louisville, Louisville, KY, USA
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Roelands M, Van den Block L, Geurts S, Deliens L, Cohen J. Attitudes of belgian students of medicine, philosophy, and law toward euthanasia and the conditions for its acceptance. DEATH STUDIES 2015; 39:139-150. [PMID: 25255845 DOI: 10.1080/07481187.2014.920433] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Euthanasia is legal in Belgium if due care criteria are met, which is judged by committees including physicians, ethicists, and jurists. We examined whether students in these disciplines differ in how they judge euthanasia as an acceptable act. A cross-sectional, anonymous e-mail survey revealed that they have similar attitudes and accept its legalization. Therefore, joint decision-making of physicians, ethicists, and lawyers regarding euthanasia seems to have a common attitudinal base in Belgium. However, they differ to some extent regarding the conditions they put forward for euthanasia being acceptable. Philosophy of life (religion) was an independent predictor of these attitudes.
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Affiliation(s)
- Marc Roelands
- a End-of-Life Care Research Group , Vrije Universiteit Brussel and Ghent University , Brussels , Belgium
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Köneke V. Trust increases euthanasia acceptance: a multilevel analysis using the European Values Study. BMC Med Ethics 2014; 15:86. [PMID: 25528457 PMCID: PMC4289573 DOI: 10.1186/1472-6939-15-86] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/16/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This study tests how various kinds of trust impact attitudes toward euthanasia among the general public. The indication that trust might have an impact on euthanasia attitudes is based on the slippery slope argument, which asserts that allowing euthanasia might lead to abuses and involuntary deaths. Adopting this argument usually leads to less positive attitudes towards euthanasia. Tying in with this, it is assumed here that greater trust diminishes such slippery slope fears, and thereby increases euthanasia acceptance. METHODS The effects of various trust indicators on euthanasia acceptance were tested using multilevel analysis, and data from the European Values Study 2008 (N = 49,114, 44 countries). More precisely, the influence of people's general levels of trust in other people, and their confidence in the health care system, were measured--both at the individual and at the country level. Confidence in the state and the press were accounted for as well, since both institutions might monitor and safeguard euthanasia practices. RESULTS It was shown that the level of trust in a country was strongly positively linked to euthanasia attitudes, both for general trust and for confidence in health care. In addition, within countries, people who perceived their fellow citizens as trustworthy, and who had confidence in the press, were more supportive of euthanasia than their less trusting counterparts. The pattern was, however, not true for confidence in the state and for confidence in the health care system at the individual level. Notably, all confirmative effects held, even when other variables such as religiosity, education, and values regarding autonomy were controlled for. CONCLUSIONS Trust seems to be a noteworthy construct to explain differences in attitudes towards euthanasia, especially when drawing cross-country comparisons. Therefore, it should be added to the existing literature on correlates of euthanasia attitudes.
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Affiliation(s)
- Vanessa Köneke
- Cologne Graduate School and SOCLIFE Research Training Group, University of Cologne, Albertus-Magnus-Platz, 50931 Cologne, Germany.
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20
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Shah A, Mushtaq A. The right to live or die? A perspective on voluntary euthanasia. Pak J Med Sci 2014; 30:1159-60. [PMID: 25225548 PMCID: PMC4163254 DOI: 10.12669/pjms.305.5777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/25/2014] [Indexed: 11/15/2022] Open
Abstract
"It is choice alone that is being honored, without regards for what is chosen." The debate on euthanasia in medical community stays unresolved. In this manuscript, we present arguments for and against euthanasia, review arguments from both the sides and conclude it with our opinion.
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Affiliation(s)
- Amber Shah
- Amber Shah, Final Year Medical Student, Sind Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ammara Mushtaq
- Ammara Mushtaq, Final Year Medical Student, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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21
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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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Rys S, Deschepper R, Mortier F, Deliens L, Bilsen J. Bridging the Gap Between Continuous Sedation Until Death and Physician-Assisted Death. Am J Hosp Palliat Care 2014; 32:407-16. [DOI: 10.1177/1049909114527152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The distinction between continuous sedation until death (CSD) and physician-assisted death (PAD) has become a topic of medical ethical debate. We conducted 6 focus groups to examine how nursing home clinicians perceive this distinction. For some, the difference is clear whereas others consider CSD a form of euthanasia. Another group situates CSD between pain relief and ending life. Arguments for these perspectives refer to the following themes: intention, dosage of sedative drugs, unconsciousness, and the pace of the dying process. Generally, CSD is considered emotionally easier to deal with since it entails a gradual dying process. Nursing home clinicians have diverging perceptions of the relation between CSD and PAD; some consider CSD to be more than a purely palliative measure, that is, also as a means to hasten death.
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Affiliation(s)
- Sam Rys
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Reginald Deschepper
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Freddy Mortier
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
- Bioethics Institute Ghent, Ghent University, Ghent, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Centre for Palliative Care, VU University Medical Center, Amsterdam, the Netherlands
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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Affiliation(s)
- Bernard Dan
- Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, B-1020, Belgium.
| | - Christine Fonteyne
- Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, B-1020, Belgium
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Van Brussel L, Van Landeghem P, Cohen J. Media coverage of medical decision making at the end of life: a Belgian case study. DEATH STUDIES 2014; 38:125-135. [PMID: 24517711 DOI: 10.1080/07481187.2012.738766] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article presents a content analysis of Belgian media coverage of end-of-life decision making. The authors examine a selection of press articles and the differences among media genres in covering the issue. In general terms, they found an overreporting of euthanasia; a focus on dying processes resulting from cancer and Alzheimer's disease; and an attention to political discussions and political voices, which outnumber patient voices. In genre-specific terms, unlike mainstream media, niche media reported less mediagenic aspects of the end of life. Finally, although popular mainstream media focus on personal aspects of the end-of-life, elite mainstream media privilege political aspects.
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Affiliation(s)
- Leen Van Brussel
- a Centre for Studies on Media and Culture , Vrije University Brussels , Brussels , Belgium
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25
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Cohen-Almagor R. First do no harm: pressing concerns regarding euthanasia in Belgium. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2013; 36:515-21. [PMID: 23859807 DOI: 10.1016/j.ijlp.2013.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This article is concerned with the practice of euthanasia in Belgium. Background information is provided; then major developments that have taken place since the enactment of the Belgian Act on Euthanasia are analysed. Concerns are raised about (1) the changing role of physicians and imposition on nurses to perform euthanasia; (2) the physicians' confusion and lack of understanding of the Act on Euthanasia; (3) inadequate consultation with an independent expert; (4) lack of notification of euthanasia cases, and (5) organ transplantations of euthanized patients. Some suggestions designed to improve the situation and prevent abuse are offered.
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26
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Stronegger WJ, Burkert NT, Grossschädl F, Freidl W. Factors associated with the rejection of active euthanasia: a survey among the general public in Austria. BMC Med Ethics 2013; 14:26. [PMID: 23826902 PMCID: PMC3750397 DOI: 10.1186/1472-6939-14-26] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 07/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent decades, the general public has become increasingly receptive toward a legislation that allows active voluntary euthanasia (AVE). The purpose of this study was to survey the current attitude towards AVE within the Austrian population and to identify explanatory factors in the areas of socio-demographics, personal experiences with care, and ideological orientation. A further objective was to examine differences depending on the type of problem formulation (abstract vs. situational) for the purpose of measuring attitude. METHODS A representative cross-sectional study was conducted across the Austrian population. Data were acquired from 1,000 individuals aged 16 years and over based on telephone interviews (CATI). For the purpose of measuring attitude toward AVE, two different problem formulations (abstract vs. situational) were juxtaposed. RESULTS The abstract question about active voluntary euthanasia was answered negatively by 28.8%, while 71.2% opted in favour of AVE or were undecided. Regression analyses showed rejection of AVE was positively correlated with number of adults and children in the household, experience with care of seriously ill persons, a conservative worldview, and level of education. Mean or high family income was associated with lower levels of rejection. No independent correlations were found for variables such as sex, age, political orientation, self-rated health, and experiences with care of terminally ill patients. Correlation for the situational problem formulation was weaker and included fewer predictors than for the abstract question. CONCLUSIONS Our results suggest that factors relating to an individual's interpersonal living situation and his/her cognitive convictions might be important determinants of the attitude toward AVE. If and to the extent that personal care experience plays a role, it is rather associated with rejection than with acceptance of AVE.
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Affiliation(s)
- Willibald J Stronegger
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstrasse 6/I, 8010, Graz, Austria.
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Andrew EVW, Cohen J, Evans N, Meñaca A, Harding R, Higginson I, Pool R, Gysels M. Social-cultural factors in end-of-life care in Belgium: a scoping of the research literature. Palliat Med 2013; 27:131-43. [PMID: 22143040 DOI: 10.1177/0269216311429619] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As end-of-life (EoL) care expands across Europe and the world, service developments are increasingly studied. The sociocultural context in which such changes take place, however, is often neglected in research. AIM To explore sociocultural factors in EoL care in Belgium as represented by the literature. DESIGN A scoping of the empirical research literature following a systematic search procedure with a focus on thematic analysis based on the literature findings. DATA SOURCES Searches were carried out in eight electronic databases, five journals, reference lists, and grey literature (through September 2010). Articles informing about sociocultural issues in EoL care were included. RESULTS One hundred and fifteen original studies met the inclusion criteria, the majority (107) published between 2000 and 2010. Four major themes were: Setting; Caregivers; Communication; and Medical EoL Decisions (the largest category). Minority Ethnic Groups was an emerging theme. Gaps included: research in Wallonia and Brussels; the role and experiences of informal caregivers; issues of access to palliative care; and experiences of minority ethnic groups. There was a paucity of in-depth qualitative studies. CONCLUSIONS Various sociocultural factors influence the provision of EoL care in Belgium. This country provides a unique opportunity to witness how euthanasia is put into practice when legalized, in a context where palliative care is also highly developed and where many health care institutions have Catholic affiliation, providing an important example to others. Attention to how the sociocultural context affects EoL care adds to the current evidence base of service provision, which is essential in the further development of EoL care.
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Affiliation(s)
- Erin V W Andrew
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic - Universitat de Barcelona), Barcelona, Spain.
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Lewis P, Black I. Adherence to the request criterion in jurisdictions where assisted dying is lawful? A review of the criteria and evidence in the Netherlands, Belgium, Oregon, and Switzerland. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2013; 41:885-98, Table of Contents. [PMID: 24446946 DOI: 10.1111/jlme.12098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Some form of assisted dying (voluntary euthanasia and/or assisted suicide) is lawful in the Netherlands, Belgium, Oregon, and Switzerland. In order to be lawful in these jurisdictions, a valid request must precede the provision of assistance to die. Non-adherence to the criteria for valid requests for assisted dying may be a trigger for civil and/or criminal liability, as well as disciplinary sanctions where the assistor is a medical professional. In this article, we review the criteria and evidence in respect of requests for assisted dying in the Netherlands, Belgium, Oregon, and Switzerland, with the aim of establishing whether individuals who receive assisted dying do so on the basis of valid requests. We conclude that the evidence suggests that individuals who receive assisted dying in the four jurisdictions examined do so on the basis of valid requests and third parties who assist death do not act unlawfully. However, further research on the elements that may undermine the validity of requests for assisted dying is warranted. More research on the reasons why requests for assisted dying are refused is also desirable.
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Affiliation(s)
- Penney Lewis
- Professor of Law at the Dickson Poon School of Law and Centre of Medical Law and Ethics, King's College London
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29
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Alvargonzález D. Alzheimer's disease and euthanasia. J Aging Stud 2012; 26:377-85. [DOI: 10.1016/j.jaging.2012.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/19/2012] [Accepted: 04/16/2012] [Indexed: 11/16/2022]
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Abstract
BACKGROUND Sex-related differences in end-of-life decisions (EOLD) are underresearched and unexplored. OBJECTIVES To investigate whether there are (1) differences in demographic and/or clinical characteristics between male and female decedents; (2) differences between men and women in the prevalence of EOLD with a possible or certain life-shortening effect; (3) differences in EOL decision making between men and women. METHODS In 2007, we performed a postmortem survey in Flanders, Belgium among physicians certifying a large representative sample (n=6927) of death certificates. Response rate was 58.4%. RESULTS Of patients with nonsudden death, women more often die in a care home than men (31.4% vs. 18.2%) who more often die at home (24.1% vs. 17.9%). Men tend to die more often from cancer than women (45.4% vs. 32.1%). Decisions to withhold or withdraw potentially life-prolonging treatment are more often made in women (28.0% vs. 22.8%, P=0.003); euthanasia and pain and symptoms treatment [alleviation of pain and symptoms (APS)] occur more often in men (3.6% vs. 2.1% euthanasia, P=0.023; 41.8% vs. 36.9% APS, P=0.012). These differences disappear after controlling for confounders. Bivariate associations were found between sex and EOL decision making. Some of them remained after controlling for confounders. CONCLUSIONS It is not the patient's sex in itself that determines the likelihood of an EOLD, but the different clinical profiles of men and women at the end of life. Although sex is not a determining factor in the prevalence of EOLD, it influences the decision-making process, indicating that there may be a difference in the way that male and female patients participate in EOL decision making.
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Kamble SV, Sorum PC, Mullet E. Young Indians' Views of the Acceptability of Physician-Assisted Suicide. ACTA ACUST UNITED AC 2012. [DOI: 10.1037/a0029380] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The acceptability by people in India of physician-assisted suicide was examined. Two hundred ninety-three Indian university students judged acceptability of PAS in 36 scenarios composed of all combinations of four factors: (a) the patient's age, (b) the level of incurability of the illness, (c) the type of suffering, and (d) the extent to which the patient requests a life-ending procedure. Three clusters of participants were found. For 29%, PAS was mainly unacceptable but less so if the patient was older or requested it. For 29%, it was mainly acceptable but less so if the patient was younger or did not request it. For 42%, it was clearly unacceptable if the patient was young but was clearly acceptable if patient was elderly, and more so if the patient requested it. The patient's age was the main determinant of acceptability, which is in accordance with the Hindu philosophy of reincarnation.
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Affiliation(s)
- Shanmukh V. Kamble
- Department of Psychology, Karnatak University, Dharwad, Karnataka State, India
| | - Paul C. Sorum
- Departments of Medicine and Pediatrics, Albany Medical College
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Jochmans I, Darius T, Kuypers D, Monbaliu D, Goffin E, Mourad M, Ledinh H, Weekers L, Peeters P, Randon C, Bosmans JL, Roeyen G, Abramowicz D, Hoang AD, De Pauw L, Rahmel A, Squifflet JP, Pirenne J. Kidney donation after circulatory death in a country with a high number of brain dead donors: 10-year experience in Belgium. Transpl Int 2012; 25:857-66. [DOI: 10.1111/j.1432-2277.2012.01510.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Cohen J, Van Wesemael Y, Smets T, Bilsen J, Deliens L. Cultural differences affecting euthanasia practice in Belgium: one law but different attitudes and practices in Flanders and Wallonia. Soc Sci Med 2012; 75:845-53. [PMID: 22682367 DOI: 10.1016/j.socscimed.2012.04.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 04/11/2012] [Accepted: 04/13/2012] [Indexed: 11/24/2022]
Abstract
Since 2002, Belgium has had a national law legalising euthanasia. The law prescribes several substantive due care requirements and two procedural due care requirements, i.e. consultation with an independent physician and reporting of euthanasia to a Federal Control Committee. A large discrepancy in reporting rates between the Dutch-speaking (Flanders) and the French-speaking (Wallonia) parts of Belgium has led to speculation about cultural differences affecting the practice of euthanasia in both regions. Using Belgian data from the European Values Study conducted in 2008 among a representative sample of the general public and data from a large-scale mail questionnaire survey on euthanasia of 480 physicians from Flanders and 305 from Wallonia (conducted in 2009), this study presents empirical evidence of differences between both regions in attitudes towards and practice of euthanasia. Acceptance of euthanasia by the general population was found to be slightly higher in Flanders than in Wallonia. Compared with their Flemish counterparts, Walloon physicians held more negative attitudes towards performing euthanasia and towards the reporting obligation, less often labelled hypothetical cases correctly as euthanasia, and less often defined a case of euthanasia having to be reported. A higher proportion of Flemish physicians had received a euthanasia request since the introduction of the law. In cases of a euthanasia request, Walloon physicians consulted less often with an independent physician. Requests were more often granted in Flanders than in Wallonia (51% vs 38%), and performed euthanasia cases were more often reported (73% vs 58%). The study points out some significant differences between Flanders and Wallonia in practice, knowledge and attitudes regarding euthanasia and its legal requirements which are likely to explain the discrepancy between Wallonia and Flanders in the number of euthanasia cases reported. Cultural factors seem to play an important role in the practice of (legal) euthanasia and the extent to which legal safeguards are followed.
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Affiliation(s)
- Joachim Cohen
- End-of Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.
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Rurup ML, Smets T, Cohen J, Bilsen J, Onwuteaka-Philipsen BD, Deliens L. The first five years of euthanasia legislation in Belgium and the Netherlands: description and comparison of cases. Palliat Med 2012; 26:43-9. [PMID: 21775411 DOI: 10.1177/0269216311413836] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Netherlands and Belgium legalized euthanasia in 2002. AIM In this study we describe and compare cases of reported euthanasia and physician-assisted suicide in the first 5 years of legislation. DESIGN/SETTING/PARTICIPANTS The databases of the cases reported in Belgium and the Netherlands were made available by the review committees. We compared characteristics of all cases reported between September 2002-December 2007. RESULTS In the Netherlands 10,319 cases were reported, in Belgium 1917. Gender and age distributions were similar in both countries. Most patients suffered from cancer (83-87%), but patients more often suffered from diseases of the nervous system in Belgium (8.3% vs. 3.9%). In the Netherlands, reported euthanasia more often occurred at home compared with Belgium (81% vs. 42%), where it occurred more often in hospital (52% vs. 9%). In the Netherlands, all cases were based on the oral request of a competent patient. In Belgium, 2.1% of the reported cases was based on an advance directive. CONCLUSIONS We conclude that countries debating legislation must realise that the rules and procedures for euthanasia they would agree upon and the way they are codified or not into law may influence the practice that develops once the legislation is effected or what part of that practice is reported.
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Affiliation(s)
- Mette L Rurup
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
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Ruijs CDM, Goedhart J, Kerkhof AJFM, van der Wal G, Onwuteaka-Philipsen BD. Recruiting end-of-life cancer patients in the Netherlands for a study on suffering and euthanasia requests. Fam Pract 2011; 28:689-95. [PMID: 21677047 DOI: 10.1093/fampra/cmr035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the Netherlands, GPs performed euthanasia or physician-assisted suicide (EAS) in ∼1 of 10 end-of-life cancer patients in their care. Of all explicit requests for EAS directed at GPs, ∼44% resulted in EAS. However, the suffering of patients who do and do not request EAS has never been studied. An important barrier for such research is the low prevalence of end-of-life cancer patients per practice (on average two/year). We studied whether it is possible to recruit end-of-life cancer patients, following-up for requests for EAS (if any), in an interview study in general practice, whether selection occurred and which were the threats and opportunities to recruitment. Our target was to recruit at least 50 patients. METHODS Characteristics of all eligible patients were monitored. RESULTS One in every three eligible patients were recruited by 44 GPs in a 3-year inclusion period, resulting in 64 patients in the interview study with follow-up until death. The prevalence of explicit requests for EAS was higher (27%; P = 0.026) in the interview sample, and the presence of a depressed mood according to the GP was lower (5%; P = 0.013) than in the sample with eligible but not participating patients. CONCLUSIONS Recruitment of slightly more than the minimal target number of end-of-life cancer patients in this study in general practice was realized. Monitoring of all eligible patients permitted to evaluate the selection which occurred. Recruitment through GPs who were direct professional colleagues of one of the researchers was a positive recruitment factor.
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Affiliation(s)
- C D M Ruijs
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Palliative Care Centre of Expertise, VU University Medical Centre, Amsterdam.
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Van Wesemael Y, Cohen J, Bilsen J, Smets T, Onwuteaka-Philipsen B, Deliens L. Process and outcomes of euthanasia requests under the belgian act on euthanasia: a nationwide survey. J Pain Symptom Manage 2011; 42:721-33. [PMID: 21570807 DOI: 10.1016/j.jpainsymman.2011.02.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 02/10/2011] [Accepted: 02/10/2011] [Indexed: 11/23/2022]
Abstract
CONTEXT Since 2002, the administration of a lethal drug by a physician at the explicit request of the patient has been legal in Belgium. The incidence of euthanasia in Belgium has been studied, but the process and outcomes of euthanasia requests have not been investigated. OBJECTIVES To describe which euthanasia requests were granted, withdrawn, and rejected since the enactment of the euthanasia law in terms of the characteristics of the patient, treating physician, and aspects of the consultation with a second physician. METHODS A representative sample of 3006 Belgian physicians received a questionnaire investigating their most recent euthanasia request. RESULTS The response rate was 34%. Since 2002, 39% of respondents had received a euthanasia request. Forty-eight percent of requests had been carried out, 5% had been refused, 10% had been withdrawn, and in 23%, the patient had died before euthanasia could be performed. Physicians' characteristics associated with receiving a request were not being religious, caring for a high number of terminally ill patients, and having experience in palliative care. Patient characteristics associated with granting a request were age, having cancer, loss of dignity, having no depression, and suffering without prospect of improvement as a reason for requesting euthanasia. A positive initial position toward the request from the attending physician and positive advice from the second physician also contributed to having a request granted. CONCLUSION Under the Belgian Act on Euthanasia, about half of the requests are granted. Factors related to the reason for the request, position of the attending physician toward the request, and advice from the second physician influence whether a request is granted or not.
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Affiliation(s)
- Yanna Van Wesemael
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Jette, Belgium.
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Ruijs CDM, Kerkhof AJFM, van der Wal G, Onwuteaka-Philipsen BD. Depression and explicit requests for euthanasia in end-of-life cancer patients in primary care in the Netherlands: a longitudinal, prospective study. Fam Pract 2011; 28:393-9. [PMID: 21421745 DOI: 10.1093/fampra/cmr006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the Netherlands, many (45%) cancer patients die at home, in the care of GPs. About 1 out of 10 end-of-life cancer deaths is hastened by GPs through euthanasia or physician-assisted suicide. However, the relationship between depression and requests for euthanasia has never been prospectively studied directly in primary care. OBJECTIVE This study aimed to assess the prevalence of depression in end-of-life cancer patients requesting euthanasia in primary care, as well as to assess the relationship between depression and requesting euthanasia. METHODS Primary care patients with incurable cancer and an estimated life expectancy of half a year or shorter were interviewed every 2 months, using standardized psychometric instruments. Also, non-recruited eligible patients were monitored. RESULTS Out of 258 eligible patients, 76 patients were recruited, of whom 64 patients were followed up until death. Of these, 27% (n = 17) explicitly requested euthanasia. One patient suffered from major depression. According to the depression subscale of the Hospital Anxiety and Depression Scale, 47% of the patients who explicitly requested euthanasia versus 28% of those without an euthanasia request suffered from a depressed mood at inclusion; the difference was not significant (P = 0.2). Corresponding figures for the last interview before death were 40% and 41% (P = 0.6). CONCLUSIONS Major depression was not a major factor in explicit requests for euthanasia in end-of-life cancer patients in primary care. Further depressed mood was not associated with explicitly requesting euthanasia in this patient group, although statistical underpower cannot be ruled out in this small sample.
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Pereira J. Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. ACTA ACUST UNITED AC 2011; 18:e38-45. [PMID: 21505588 DOI: 10.3747/co.v18i2.883] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Euthanasia or assisted suicide-and sometimes both-have been legalized in a small number of countries and states. In all jurisdictions, laws and safeguards were put in place to prevent abuse and misuse of these practices. Prevention measures have included, among others, explicit consent by the person requesting euthanasia, mandatory reporting of all cases, administration only by physicians (with the exception of Switzerland), and consultation by a second physician.The present paper provides evidence that these laws and safeguards are regularly ignored and transgressed in all the jurisdictions and that transgressions are not prosecuted. For example, about 900 people annually are administered lethal substances without having given explicit consent, and in one jurisdiction, almost 50% of cases of euthanasia are not reported. Increased tolerance of transgressions in societies with such laws represents a social "slippery slope," as do changes to the laws and criteria that followed legalization. Although the initial intent was to limit euthanasia and assisted suicide to a last-resort option for a very small number of terminally ill people, some jurisdictions now extend the practice to newborns, children, and people with dementia. A terminal illness is no longer a prerequisite. In the Netherlands, euthanasia for anyone over the age of 70 who is "tired of living" is now being considered. Legalizing euthanasia and assisted suicide therefore places many people at risk, affects the values of society over time, and does not provide controls and safeguards.
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Affiliation(s)
- J Pereira
- Division of Palliative Care, University of Ottawa; Department of Palliative Medicine, Bruyère Continuing Care; and Palliative Care Service, The Ottawa Hospital, Ottawa, ON
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Karlsson M, Milberg A, Strang P. Suffering and euthanasia: a qualitative study of dying cancer patients' perspectives. Support Care Cancer 2011; 20:1065-71. [PMID: 21573739 DOI: 10.1007/s00520-011-1186-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 05/02/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Although intolerable suffering is a core concept used to justify euthanasia, little is known about dying cancer patients' own interpretations and conclusions of suffering in relation to euthanasia. METHODS Sixty-six patients with cancer in a palliative phase were selected through maximum-variation sampling, and in-depth interviews were conducted on suffering and euthanasia. The interviews were analyzed using qualitative content analysis with no predetermined categories. RESULTS The analysis demonstrated patients' different perspectives on suffering in connection to their attitude to euthanasia. Those advocating euthanasia, though not for themselves at the time of the study, did so due to (1) perceptions of suffering as meaningless, (2) anticipatory fears of losses and multi-dimensional suffering, or (3) doubts over the possibility of receiving help to alleviate suffering. Those opposing euthanasia did so due to (1) perceptions of life, despite suffering, as being meaningful, (2) trust in bodily or psychological adaptation to reduce suffering, a phenomenon personally experienced by informants, and (3) by placing trust in the provision of help and support by healthcare services to reduce future suffering. CONCLUSIONS Dying cancer patients draw varying conclusions from suffering: suffering can, but does not necessarily, lead to advocations of euthanasia. Patients experiencing meaning and trust, and who find strategies to handle suffering, oppose euthanasia. In contrast, patients with anticipatory fears of multi-dimensional meaningless suffering and with lack of belief in the continuing availability of help, advocate euthanasia. This indicates a need for healthcare staff to address issues of trust, meaning, and anticipatory fears.
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Affiliation(s)
- Marit Karlsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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Smets T, Cohen J, Bilsen J, Van Wesemael Y, Rurup ML, Deliens L. The labelling and reporting of euthanasia by Belgian physicians: a study of hypothetical cases. Eur J Public Health 2010; 22:19-26. [PMID: 21131347 DOI: 10.1093/eurpub/ckq180] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Belgium legalized euthanasia in 2002. Physicians must report each euthanasia case to the Federal Control and Evaluation Committee. This study examines which end-of-life decisions (ELDs) Belgian physicians label 'euthanasia', which ELDs they think should be reported and the physician characteristics associated with correct labelling of euthanasia cases, the awareness that they should be reported and the reporting of them. METHODS Five hypothetical cases of ELDs: intensified pain alleviation, palliative/terminal sedation, euthanasia with neuromuscular relaxants, euthanasia with morphine and life-ending without patient request were presented in a cross-sectional survey of 914 physicians in Belgium in 2009. RESULTS About 19% of physicians did not label a euthanasia case with neuromuscular relaxants 'euthanasia', 27% did not know that it should be reported. Most physicians labelled a euthanasia case with morphine 'intensification of pain and symptom treatment' (39%) or 'palliative/terminal sedation' (37%); 21% of physicians labelled this case 'euthanasia'. Cases describing other ELDs were sometimes also labelled 'euthanasia'. Factors associated with a higher likelihood of labelling a euthanasia case correctly were: living in Flanders, being informed about the euthanasia law and having a positive attitude towards societal control over euthanasia. Whether a physician correctly labelled the euthanasia cases strongly determined their reporting knowledge and intentions. CONCLUSION There is no consensus among physicians about the labelling of euthanasia and other ELDs, and about which cases must be reported. Mislabelling of ELDs could impede societal control over euthanasia. The provision of better information to physicians appears to be necessary.
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Affiliation(s)
- Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
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Smets T, Bilsen J, Cohen J, Rurup ML, Mortier F, Deliens L. Reporting of euthanasia in medical practice in Flanders, Belgium: cross sectional analysis of reported and unreported cases. BMJ 2010; 341:c5174. [PMID: 20923842 PMCID: PMC2950259 DOI: 10.1136/bmj.c5174] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2010] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To estimate the rate of reporting of euthanasia cases to the Federal Control and Evaluation Committee and to compare the characteristics of reported and unreported cases of euthanasia. Design Cross sectional analysis. Setting Flanders, Belgium. PARTICIPANTS A stratified at random sample was drawn of people who died between 1 June 2007 and 30 November 2007. The certifying physician of each death was sent a questionnaire on end of life decision making in the death concerned. MAIN OUTCOME MEASURES The rate of euthanasia cases reported to the Federal Control and Evaluation Committee; physicians' reasons for not reporting cases of euthanasia; the relation between reporting and non-reporting and the characteristics of the physician and patient; the time by which life was shortened according to the physician; the labelling of the end of life decision by the physician involved; and differences in characteristics of due care between reported and unreported euthanasia cases. RESULTS The survey response rate was 58.4% (3623/6202 eligible cases). The estimated total number of cases of euthanasia in Flanders in 2007 was 1040 (95% CI 970 to 1109), thus the incidence of euthanasia was estimated as 1.9% of all deaths (95% CI 1.6% to 2.3%). Approximately half (549/1040 (52.8%, 95% CI 43.9% to 60.5%)) of all estimated cases of euthanasia were reported to the Federal Control and Evaluation Committee. Physicians who perceived their case as euthanasia reported it in 93.1% (67/72) of cases. Cases of euthanasia were reported less often when the time by which life was shortened was less than one week compared with when the perceived life shortening was greater (37.3% v 74.1%; P<0.001). Unreported cases were generally dealt with less carefully than reported cases: a written request for euthanasia was more often absent (87.7% v 17.6% verbal request only; P<0.001), other physicians and caregivers specialised in palliative care were consulted less often (54.6% v 97.5%; 33.0% v 63.9%; P<0.001 for both), the life ending act was more often performed with opioids or sedatives (92.1% v 4.4%; P<0.001), and the drugs were more often administered by a nurse (41.3% v 0.0%; P<0.001). CONCLUSIONS One out of two euthanasia cases is reported to the Federal Control and Evaluation Committee. Most non-reporting physicians do not perceive their act as euthanasia. Countries debating legalisation of euthanasia should simultaneously consider developing a policy facilitating the due care and reporting obligations of physicians.
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Affiliation(s)
- Tinne Smets
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
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Inghelbrecht E, Bilsen J, Mortier F, Deliens L. The role of nurses in physician-assisted deaths in Belgium. CMAJ 2010; 182:905-10. [PMID: 20479043 DOI: 10.1503/cmaj.091881] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Belgium's law on euthanasia allows only physicians to perform the act. We investigated the involvement of nurses in the decision-making and in the preparation and administration of life-ending drugs with a patient's explicit request (euthanasia) or without an explicit request. We also examined factors associated with these deaths. METHODS In 2007, we surveyed 1678 nurses who, in an earlier survey, had reported caring for one or more patients who received a potential life-ending decision within the year before the survey. Eligible nurses were surveyed about their most recent case. RESULTS The response rate was 76%. Overall, 128 nurses reported having cared for a patient who received euthanasia and 120 for a patient who received life-ending drugs without his or her explicit request. Respectively, 64% (75/117) and 69% (81/118) of these nurses were involved in the physician's decision-making process. More often this entailed an exchange of information on the patient's condition or the patient's or relatives' wishes (45% [34/117] and 51% [41/118]) than sharing in the decision-making (24% [18/117] and 31% [25/118]). The life-ending drugs were administered by the nurse in 12% of the cases of euthanasia, as compared with 45% of the cases of assisted death without an explicit request. In both types of assisted death, the nurses acted on the physician's orders but mostly in the physician's absence. Factors significantly associated with a nurse administering the life-ending drugs included being a male nurse working in a hospital (odds ratio [OR] 40.07, 95% confidence interval [CI] 7.37-217.79) and the patient being over 80 years old (OR 5.57, 95% CI 1.98-15.70). INTERPRETATION By administering the life-ending drugs in some of the cases of euthanasia, and in almost half of the cases without an explicit request from the patient, the nurses in our study operated beyond the legal margins of their profession.
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Affiliation(s)
- Els Inghelbrecht
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
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