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Bloomer MJ, Saffer L, Hewitt J, Johns L, McAuliffe D, Bonner A. Maybe for unbearable suffering: Diverse racial, ethnic and cultural perspectives of assisted dying. A scoping review. Palliat Med 2024:2692163241268449. [PMID: 39126283 DOI: 10.1177/02692163241268449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
BACKGROUND Assisted dying, also commonly known as euthanasia and physician-assisted suicide, is legal in many countries. Interest in assisted dying is growing due to evolving societal understandings of a good death and a desire for choice. Ethico-legal perspectives are well-known, but as societies become more heterogenous, a greater understanding of the perspectives of people from diverse racial, ethnic, and cultural backgrounds is needed. AIM To explore perspectives of people from diverse racial, ethnic and cultural backgrounds about assisted dying. DESIGN Scoping review with narrative synthesis. The protocol was registered with Open Science Framework. DATA SOURCES Medline, CINAHL Complete, PsycINFO and ProQuest Dissertations & Theses Global were searched from inception to May 2023. Citations were independently assessed against inclusion and exclusion criteria. RESULTS Of the 17 included studies, perspectives of assisted dying were presented according to religion, religiosity, spirituality, race, ethnicity and ancestry. Perspectives were diverse, presenting more as a spectrum, with multiple intersections and interconnections. Support and/or opposition for assisted dying differed according to cultural attributes, but even amongst those with similar cultural attributes, perspectives differed according to life experiences and notions of suffering. CONCLUSION Perspectives on assisted dying are dynamic and evolving. Even where assisted dying is legalised, individual's cultural attributes contribute to unique perspectives of assisted dying as an end-of-life option. Thus, understanding a person's culture, beliefs, expectations and choices in illness, treatment goals and care is fundamental, extending beyond what may be already considered as part of clinician-patient care relationships and routine advance care planning.
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Affiliation(s)
- Melissa J Bloomer
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Health and Hospital Service, Woolloongabba, QLD, Australia
| | - Laurie Saffer
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Intensive Care Unit, Epworth HealthCare, Richmond, VIC, Australia
| | - Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Queen Elizabeth II Hospital, Metro South Health and Hospital Service, Coopers Plains, QLD, Australia
- Law Futures Centre, Griffith University, Nathan, QLD, Australia
| | - Lise Johns
- School of Health Sciences and Social Work, Griffith University, Nathan, QLD, Australia
| | - Donna McAuliffe
- School of Health Sciences and Social Work, Griffith University, Nathan, QLD, Australia
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Kidney Health Service, Metro North Hospital and Health Service, Herston, QLD, Australia
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Frey R, Balmer D. The views of Aotearoa/New Zealand adults over 60 years regarding the End of Life Choice Act 2019. JOURNAL OF RELIGION AND HEALTH 2022; 61:1605-1620. [PMID: 34355303 PMCID: PMC8340805 DOI: 10.1007/s10943-021-01359-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 06/13/2023]
Abstract
This study described the views of older New Zealand adults toward assisted dying and specifically the End of Life Choice Act (2019), an Act making assisted dying legal. An anonymous postal and online survey of 636 adults 60 years and older was conducted. The majority of respondents did not support legalization (85.7%), while 8.8% were in favor (5.5% did not specify a view). Weighted binary logistic regression indicated that the odds of support for legalization were lower in those respondents with a religious affiliation (OR = .020, S.E. = 0.60, p = .00), and there were 2.66 times greater odds in those identifying as male (S.E. = 0.34, p = .005). On the other hand, those respondents under 65 years had increased odds of supporting legalization (OR = 1.89, S.E. = .029, p = .045). Results indicate that most participants were concerned about potential abuses and coercive practices if assisted dying became legally available in New Zealand.
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Affiliation(s)
- Rosemary Frey
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand.
| | - Deborah Balmer
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
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Castelli Dransart DA, Lapierre S, Erlangsen A, Canetto SS, Heisel M, Draper B, Lindner R, Richard-Devantoy S, Cheung G, Scocco P, Gusmão R, De Leo D, Inoue K, De Techterman V, Fiske A, Hong JP, Landry M, Lepage AA, Marcoux I, Na PJ, Neufeld E, Ummel D, Winslov JH, Wong C, Wu J, Wyart M. A systematic review of older adults' request for or attitude toward euthanasia or assisted-suicide. Aging Ment Health 2021; 25:420-430. [PMID: 31818122 DOI: 10.1080/13607863.2019.1697201] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over. METHOD The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times from February 2016 until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded. RESULTS This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures. CONCLUSION Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions.
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Affiliation(s)
| | - Sylvie Lapierre
- Department of Psychology, Université du Québec à Trois Rivières, Trois Rivières, Canada
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre, Copenhagen, Denmark
| | | | - Marnin Heisel
- Department of Psychiatry, Western University, Canada
| | - Brian Draper
- School of Psychiatry, University of NSW, Sidney Australia, and Eastern Suburbs Older Person's Mental Health Prince of Wales Hospital Randwick, Australia
| | | | - Stephane Richard-Devantoy
- Department of Psychiatry, McGill University, and Douglas Mental Health University Institute, Montreal, Canada
| | - Gary Cheung
- Department of Psychological Medecine, School of Medecine, University of Auckland, New Zealand
| | | | | | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
| | - Ken Inoue
- Research and Education Faculty, Medical Sciences Cluster Health Service Center, Kochi University, Japan
| | - Vincent De Techterman
- School of Social Work Fribourg, HES-SO University of Applied Sciences and Art Western Switzerland, Switzerland
| | - Amy Fiske
- Department of Psychology, West Virginia University, USA
| | - Jin Pyo Hong
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Marjolaine Landry
- Department of Nursing, Université du Québec à Trois Rivières, Canada
| | - Andrée-Anne Lepage
- Department of Psychology, Université du Québec à Trois Rivières, Trois Rivières, Canada
| | - Isabelle Marcoux
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Peter Jongho Na
- Department of Psychiatry, New York University Langone Health, USA
| | | | - Deborah Ummel
- Department of Psychoeducation, Université de Sherbrooke, Montréal, Canada
| | | | | | - Jing Wu
- Department of Sociology and Work Science, University of Gothenburg, Sweden
| | - Marilyn Wyart
- Unit of Geropsychiatry, Clinique Saint Antoine, Montarnaud, France
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Ortiz-Dowling EM, Crist JD, Shea K, Phillips LR. Gender Differences in End-of-Life Care in Older Mexican American Adults. J Palliat Care 2020; 35:256-266. [PMID: 32093547 DOI: 10.1177/0825859720907419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mexican Americans (MAs), 1 of 10 subgroups of Latinos, are the largest and fastest growing Latino subgroup in the United States; yet, their access to end-of-life (EOL) care using hospice services is low. An investigation was needed into extant research-based knowledge about factors influencing EOL care decisions among MAs to guide health-care professionals in assisting MAs to make timely, acceptable, and satisfactory EOL care decisions. To determine whether gender was an influence on EOL decision-making among older MAs, CINAHL and PubMed were searched for articles published between 1994 and 2018. Relevant sources were also identified through the reference lists of review articles. Reports were included if they were written in English, involved participants aged 50 years and older who identified themselves as MA, and data derived directly from participants. Reports in which MAs were not equally represented in the sample, large databases, and instrumentation development and testing articles were excluded. Of the 345 unduplicated articles identified in our electronic search and the 47 identified through review articles, 22 met the inclusion criteria. Content analysis was conducted using a priori codes from the Ethno-Cultural Gerontological Nursing Model (ECGNM). Only 8 (36%) of the 22 articles reported on MA older adults' gendered experiences related to EOL decision-making. Results indicate an association between gender and EOL decision-making. As the older MA population grows, tackling disparities in EOL services use requires attention to how culture and gender influence EOL decision-making and care.
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Affiliation(s)
| | - Janice D Crist
- Wildcat Hartford Center, College of Nursing, 16080The University of Arizona, Tucson, AZ, USA
| | - Kimberly Shea
- College of Nursing, 16080The University of Arizona, Tucson, AZ, USA.,Arizona Telemedicine Program, 16080The University of Arizona, Tucson, AZ, USA
| | - Linda R Phillips
- Arizona Geriatric Workforce Enhancement Program, The University of Arizona Center on Aging, Tucson, AZ, USA
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Knowledge Gaps About End-of-Life Decision Making Among Mexican American Older Adults and Their Family Caregivers: An Integrative Review. J Transcult Nurs 2018; 30:380-393. [DOI: 10.1177/1043659618812949] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Religiosity and the Wish of Older Adults for Physician-Assisted Suicide. RELIGIONS 2018. [DOI: 10.3390/rel9030066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Periyakoil VS, Kraemer H, Neri E. Multi-Ethnic Attitudes Toward Physician-Assisted Death in California and Hawaii. J Palliat Med 2016; 19:1060-1065. [PMID: 27276445 DOI: 10.1089/jpm.2016.0160] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As aid-in-dying laws are gaining more public acceptance and support, it is important to understand diverse perceptions toward physician-assisted death (PAD). We compare attitudes of residents from California and Hawaii to identify variables that may predict attitudes toward PAD. METHODS A cross-sectional online survey of 1095 participants (a 75.8% survey completion rate) from California and 819 from Hawaii (a 78.4% survey completion rate). Data were collected between July through October 2015. RESULTS Majority of study participants in California (72.5%) and Hawaii (76.5%) were supportive of PAD. Only 36.8% of participants in Hawaii and 34.8% of participants in California reported completing advance directives. To better understand which subgroups were most in favor of PAD, data were analyzed using both recursive partitioning and stepwise logistic regression. Older participants were more supportive of PAD in both states. Also, all ethnic groups were equally supportive of PAD. Completion of advance directives was not a significant predictor of attitudes toward PAD. Persons who reported that faith/religion/spirituality was less important to them were more likely to support PAD in both states. Thus, the major influences on the attitudes to PAD were religious/spiritual views and age, not ethnicity and gender. Even in the subgroups least supportive of PAD, the majority supported PAD. CONCLUSIONS This study shows that in the ethnically diverse states of California and Hawaii, faith/religion/spirituality and age are major influencers of attitudes toward PAD and not ethnicity and gender. Even in the subgroups least supportive of PAD, the majority supports PAD.
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Affiliation(s)
- Vyjeyanthi S Periyakoil
- 1 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Palo Alto, California
- 2 Department of Medicine, VA Palo Alto Health Care System , Palo Alto, California
| | - Helena Kraemer
- 1 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Palo Alto, California
| | - Eric Neri
- 1 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Palo Alto, California
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Macias RL, Gold PB, Jones DR. Age and physical health as predictors of family contact among adults with severe psychiatric illness. Psychiatr Q 2013; 84:183-95. [PMID: 22922812 DOI: 10.1007/s11126-012-9238-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We assessed the association of frequency of family contact with age and physical health for a sample of adults with severe psychiatric illness (N = 171). This cross-sectional, observational study measured frequency of face-to-face and telephone contact with family members; satisfaction with family relations; and severity of participants' chronic or permanent physical health conditions. In this sample of adults with severe psychiatric illness, having a physical health condition and advancing age correlated negatively with frequency of face-to-face contact with family members. However, a hierarchical regression analysis controlling for residence in a family member's home, and participants' ratings of satisfaction with family relations, showed that the combination of being older and having more severe health conditions was associated with a more frequent rate of family contact than would be expected based on age or physical health considered alone. Because almost all older participants in this heterogeneous sample had serious physical health conditions, as well as frequent telephone and face-to-face contact with their family members, we recommend the recruitment of family members as collaborators in illness management interventions for aging and mid-life adults with psychiatric illness.
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Affiliation(s)
- R Lillianne Macias
- National Latino Research Center on Family and Social Change, Department of Psychology, Georgia State University, Atlanta, GA, USA.
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