Community attitudes on the family of issues surrounding the death of terminal patients

Well-Being as Human Development, Equality, Happiness and the Role of Freedom, Activism, Decentralization, Volunteerism and Voter Participation: A Global Country-Level Study

We propose and test a new model for predicting multiple quantitative measures of well-being globally at the country level based on the United Nations Human Development Index (HDI), income inequality (Net Gini), and National Happiness Index (NHI; U.N. Sustainable Development Solutions Network world survey of life satisfaction). HDI consists of per-capita Gross National Income (economic well-being), average life expectancy (proxy for health well-being), and educational attainment (capabilities well-being). Using data on 105 countries representing 95% of the world's population, a history of grassroots activism (Global Non-violent Action Database), civil liberties and political rights (Freedom Score), political and fiscal decentralization, and voter participation (Institute for Democracy and Electoral Assistance) correlate with HDI and NHI. Citizen volunteering (Gallup Civic Engagement Index) predicts only NHI. In multivariate analyses, Freedom Score is the most robust predictor of all well-being measures, including income equality. Fiscal decentralization and voter turnout also predict HDI and NHI, controlling for other influences. Based on prior analyses in the Global Development of Applied Community Studies project, implications and recommendations are discussed for developing community human research and professional resources across 12 disciplines in countries where they are needed based on social justice, citizenship, well-being, inequality, human rights, and other development challenges. We recommend individual and community-level and qualitative analyses of the above predictors' relationships with these same conceptualizations of well-being, as well as consideration of other social, cultural and political variables and their effect on well-being.

Attitudes toward Assisted Suicide: Does Family Context Matter?

Little is known about how family-related contextual variables impact attitudes toward assisted suicide. A probability sample (N = 272) responded to a multiple-segment factorial vignette designed to examine the effects of 6 variables-patient sex, age, type of illness, relationship status, parenthood status, and family support-on attitudes toward physician- and family-assisted suicide. Respondents were more likely to support physician-assisted suicide if they heard about an older patient or a patient experiencing physical pain than a younger patient or one suffering from depression, respectively. For family-assisted suicide, respondent support was higher when the patient had physical pain than depression, and when the patient's spouse or friend was supportive of the wish to die than unsupportive. Attitudes about physician and family obligation to inform others were affected by type of illness, relationship status, family support, and respondent education and religiosity. The experience of pain, motivations for family involvement, confidentiality issues, and physicians' biases concerning assisted suicide are discussed.

Support for voluntary and nonvoluntary euthanasia: what roles do conditions of suffering and the identity of the terminally ill play?

This study investigated the level of support for voluntary and nonvoluntary euthanasia under three conditions of suffering (pain; debilitated nature of the body; burden on the family) experienced by oneself, a significant other, and a person in general. The sample consisted of 1,897 Thai adults (719 males, 1,178 females) who voluntarily filled in the study's questionnaire. Initial multivariate analysis of variance indicated significant group (oneself, significant other, person in general) differences in level of support for voluntary and nonvoluntary euthanasia and under the three conditions of suffering. Multigroup path analysis conducted on the posited euthanasia model showed that the three conditions of suffering exerted differential direct and indirect influences on the support of voluntary and nonvoluntary euthanasia as a function of the identity of the person for whom euthanasia was being considered. The implications of these findings are discussed.

Synthesis of research and evidence on factors affecting the desire of terminally ill or seriously chronically ill persons to hasten death

Review of empirical studies indicates that suicide is more common in persons suffering from some physical illnesses (e.g., epilepsy, head injuries, Huntington's Chorea, gastrointestinal diseases, AIDS, and cancer), but other chronic diseases and disabilities have not been linked to increased suicide risk (e.g., blindness, senile dementia, multiple sclerosis, and other physical handicaps). The timing of increased suicide risk varies in different illnesses from early presymptomatic stages to the terminal phase. Difficulties in reliably determining when someone is “terminally ill” and problems of the competence of persons with a poor prognosis complicate empirical investigations of euthanasia, assisted suicide, and the desire to hasten death. The role of family and caregivers in end of life decisions needs further clarification. Researchers have found that pain and suffering and quality of life variables may be linked to the desire to die prematurely, particularly in cancer patients. Others find that clinical depression is a major factor. But, since depression is often present, we do not know why a small minority of depressed patients desire and choose to hasten death. Support for alternative hypotheses is examined, including the role of pre-morbid suicidality and depression, individual differences in coping strategies and indirect consequences of the illness. There is a need to clarify links between attitudes, which is the major variable studied, and actual behaviors and decisions. Furthermore, we need theoretical and empirical links between studies of suicide, which is linked to clinical depression and characterized by ambivalence and studies of euthanasia, which is often depicted as rational and with little ambivalence. Evaluative research should be conducted to determine if interventions to reduce the desire for a premature death by suicide, euthanasia, or assisted suicide are effective. In the light of this review, we present several considerations for those involved in proposing changes in public policy concerning euthanasia and assisted suicide.

My parent's dignified death is different from mine: moral problem solving about euthanasia

The purpose of the study was to explore the moral problem solving of Israeli adult children concerning passive euthanasia when considering the death of any citizen in society, one’s own death, a partner’s death, and the impending death of an elderly ill parent. The qualitative analysis of 12 in-depth interview transcripts by analytic induction and constant comparison methods revealed how adults think about moral problems that are of differing distances from the self. A parents’ death, compared with other deaths, elicited strong emotional reactions and was associated with reasoning struggles that involved a wide range of role perspectives; a moral orientation of care; and value priorities of honor through loyalty, compassion and devotion.