1
|
Zeilinger EL, Petersen A, Brunevskaya N, Fuchs A, Wagner T, Pietschnig J, Kitta A, Ecker F, Kum L, Adamidis F, Bär J, Sifuentes Caccire C, Unseld M, Masel EK. Experiences and attitudes of nurses with the legislation on assisted suicide in Austria. Palliat Support Care 2024:1-7. [PMID: 39390951 DOI: 10.1017/s147895152400107x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
OBJECTIVES In 2022, assisted suicide (AS) was legalized in Austria. We aimed to investigate the experiences and attitudes of palliative care (PC) and hospice nurses toward AS in Austria after the first year of implementation of the new law. METHODS A cross-sectional survey was distributed online to nurses in every known specialized and general hospice and PC units in Austria (n = 255 units). The questionnaire included sociodemographic characteristics, the Assisted Suicide Attitude Scale, the Comfort Discussing Assisted Suicide Scale, and questions on recent experiences with AS requests. We used Spearman's correlation coefficient for determining associations between sociodemographic characteristics and attitudes toward AS, as well as comfort discussing AS. For comparison of frequencies, we applied ꭓ2 tests. We computed a linear regression model to examine predictors for attitudes toward AS. RESULTS The total sample were N = 280 nurses. More than half (61.2%) indicated that they had cared for a patient who expressed a wish for AS within the first year of implementation. Though responses varied widely, more nurses expressed support for AS than those were opposed (50.36% and 31.75%, respectively). Factors that statistically contributed to more reluctance toward AS in the regression model were older age, religiousness, and experience of working with patients expressing a wish for AS. SIGNIFICANCE OF RESULTS This work provides valuable insight into nurses' perceptions toward the legislation of AS in the first year since the new law was passed. The results can inform the future development of the AS system and support for nurses in end-of-life care, and critically contribute to international discussions on this controversial topic.
Collapse
Affiliation(s)
- Elisabeth Lucia Zeilinger
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Department of Clinical Research SBG, Academy for Ageing Research, Haus der Barmherzigkeit, Vienna, Austria
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Arzu Petersen
- Faculty of Philosophy and Education, University of Vienna, Vienna, Austria
| | - Nadine Brunevskaya
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Amelie Fuchs
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Theresa Wagner
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Jakob Pietschnig
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Anna Kitta
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Franziska Ecker
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Lea Kum
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Feroniki Adamidis
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Joachim Bär
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Connie Sifuentes Caccire
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Matthias Unseld
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Department of Clinical Research SBG, Academy for Ageing Research, Haus der Barmherzigkeit, Vienna, Austria
| | - Eva Katharina Masel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
2
|
Lyon C. Canada's Medical Assistance in Dying System can Enable Healthcare Serial Killing. HEC Forum 2024:10.1007/s10730-024-09528-3. [PMID: 39093520 DOI: 10.1007/s10730-024-09528-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 08/04/2024]
Abstract
The Canadian approach to assisted dying, Medical Assistance in Dying (MAiD), as of early 2024, is assessed for its ability to protect patients from criminal healthcare serial killing (HSK) to evaluate the strength of its safeguards. MAiD occurs through euthanasia or self-administered assisted suicide (EAS) and is legal or considered in many countries and jurisdictions. Clinicians involved in HSK typically target patients with the same clinical features as MAiD-eligible patients. They may draw on similar rationales, e.g., to end perceived patient suffering and provide pleasure for the clinician. HSK can remain undetected or unconfirmed for considerable periods owing to a lack of staff background checks, poor surveillance and oversight, and a failure by authorities to act on concerns from colleagues, patients, or witnesses. The Canadian MAiD system, effectively euthanasia-based, has similar features with added opportunities for killing afforded by clinicians' exemption from criminal culpability for homicide and assisted suicide offences amid broad patient eligibility criteria. An assessment of the Canadian model offers insights for enhancing safeguards and detecting abuses in there and other jurisdictions with or considering legal EAS. Short of an unlikely recriminalization of EAS, better clinical safeguarding measures, standards, vetting and training of those involved in MAiD, and a radical restructuring of its oversight and delivery can help mitigate the possibility of abuses in a system mandated to accommodate homicidal clinicians.
Collapse
Affiliation(s)
- Christopher Lyon
- Department of Environment and Geography, University of York, York, YO10 5DD, UK.
- Leverhulme Centre for Anthropocene Biodiversity, University of York, York, YO10 5DD, UK.
| |
Collapse
|
3
|
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.
Collapse
Affiliation(s)
| | - Catherine Cook-Cottone
- Department of Counseling, School, and Educational Psychology, University at Buffalo, Buffalo, NY, United States
| |
Collapse
|
4
|
Harrawood KA. Medical aid in dying: The role of the nurse practitioner. J Am Assoc Nurse Pract 2024:01741002-990000000-00193. [PMID: 38206106 DOI: 10.1097/jxx.0000000000000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
ABSTRACT Medical aid in dying (MAID) is a practice that has been expanding in the United States over the past few decades. As it becomes a viable option for a growing portion of the American population, nurse practitioners (NPs) need to be prepared to engage in conversation with patients about the practice. Although historically only physicians were able to participate in MAID, the role has recently expanded to include additional advanced practice providers, including NPs. Reviewing the history of MAID and examining how current legislation affects clinical practice can support the NP's ability to educate and counsel patients about the option. Identifying specific areas in which MAID providers report needing additional training and support can help providers work toward delivering the highest quality patient care possible. As MAID becomes accessible to greater numbers of people, NPs need to be prepared to talk to patients who are navigating serious, life-limiting illnesses about the possibility of MAID.
Collapse
Affiliation(s)
- Kathryn A Harrawood
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
5
|
Treleaven L, Komesaroff P, La Brooy C, Olver I, Kerridge I, Philip J. A review of the utility of prognostic tools in predicting 6-month mortality in cancer patients, conducted in the context of voluntary assisted dying. Intern Med J 2023; 53:2180-2197. [PMID: 37029711 DOI: 10.1111/imj.16081] [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: 10/28/2022] [Accepted: 03/07/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Eligibility to access the Victorian voluntary assisted dying (VAD) legislation requires that people have a prognosis of 6 months or less (or 12 months or less in the setting of a neurodegenerative diagnosis). Yet prognostic determination is frequently inaccurate and prompts clinician discomfort. Based on functional capacity and clinical and biochemical markers, prognostic tools have been developed to increase the accuracy of life expectancy predictions. AIMS This review of prognostic tools explores their accuracy to determine 6-month mortality in adults when treated under palliative care with a primary diagnosis of cancer (the diagnosis of a large proportion of people who are requesting VAD). METHODS A systematic search of the literature was performed on electronic databases Medline, Embase and Cinahl. RESULTS Limitations of prognostication identified include the following: (i) prognostic tools still provide uncertain prognoses; (ii) prognostic tools have greater accuracy predicting shorter prognoses, such as weeks to months, rather than 6 months; and (iii) functionality was often weighted significantly when calculating prognoses. Challenges of prognostication identified include the following: (i) the area under the curve (a value that represents how well a model can distinguish between two outcomes) cannot be directly interpreted clinically and (ii) difficulties exist related to determining appropriate thresholds of accuracy in this context. CONCLUSIONS Prognostication is a significant aspect of VAD, and the utility of the currently available prognostic tools appears limited but may prompt discussions about prognosis and alternative means (other than prognostic estimates) to identify those eligible for VAD.
Collapse
Affiliation(s)
- Lydia Treleaven
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Komesaroff
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Camille La Brooy
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ian Olver
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Ian Kerridge
- Department of Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Sydney Health Ethics, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jennifer Philip
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Palliative Care Service, St Vincent's Hospital, Melbourne, Victoria, Australia
- Palliative Care Service, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|