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Laperle P, Achille M, Ummel D. To Lose a Loved One by Medical Assistance in Dying or by Natural Death with Palliative Care: A Mixed Methods Comparison of Grief Experiences. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:931-953. [PMID: 35420908 PMCID: PMC11317015 DOI: 10.1177/00302228221085191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The integration of assisted dying into end-of-life care is raising reflections on bereavement. Patients and families may be faced with a choice between this option and natural death assisted by palliative care; a choice that may affect grief. Therefore, this study describes and compares grief experiences of individuals who have lost a loved one by medical assistance in dying or natural death with palliative care. A mixed design was used. Sixty bereaved individuals completed two grief questionnaires. The qualitative component consisted of 16 individual semi-structured interviews. We found no statistically significant differences between medically assisted and natural deaths, and scores did not suggest grief complications. Qualitative results are nuanced: positive and negative imprints may influence grief in both contexts. Hastened and natural deaths are death circumstances that seem to generally help ease mourning. However, they can still, in interaction with other risk factors, produce difficult experiences for some family caregivers.
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Affiliation(s)
- Philippe Laperle
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Marie Achille
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Deborah Ummel
- Department of Psychoeducation, Université de Sherbrooke, Longueuil, Canada
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2
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Boven C, Dillen L, Van Humbeeck L, Van Den Block L, Piers R, Van Den Noortgate N. Relatives' needs in terms of bereavement care throughout euthanasia processes: A qualitative study. J Clin Nurs 2024; 33:3259-3272. [PMID: 38661114 DOI: 10.1111/jocn.17185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
AIM To explore relatives' needs in terms of bereavement care during euthanasia processes, how healthcare providers respond to these needs, and the degree of commonality between relatives' and healthcare providers' reports. DESIGN A phenomenological design was employed, utilising reflexive thematic analysis to examine interviews conducted with relatives (N = 19) and healthcare providers (N = 47). RESULTS Relatives' needs throughout euthanasia processes are presented in five main themes and several subthemes, with similar findings between both sets of participants. Although relatives infrequently communicated their needs explicitly to healthcare providers, they appreciated it when staff proactively met their needs. Healthcare providers aimed to assist with the relatives' grief process by tending to their specific needs. However, aftercare was not consistently offered, but relatives did not have high expectations for professional follow-up care. CONCLUSION Our research offers important directions for healthcare professionals, empowering them to provide needs-based bereavement care during euthanasia processes. Moreover, it emphasises the importance of recognising the unique needs of relatives and proactively addressing them in the period before the loss to positively contribute to relatives' grief process. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Insights into relatives' needs in the context of euthanasia. Good practices on how healthcare providers can attend to relatives' needs before, during and after the loss IMPACT: Current literature and guidelines on needs-based bereavement care in the context of euthanasia and, more generally, assisted dying, are limited. These findings provide concrete directions for practice in supporting (nearly) bereaved relatives in the context of euthanasia, potentially mitigating adverse health outcomes. REPORTING METHOD Standards for Reporting Qualitative Research (SRQR checklist). PATIENT OR PUBLIC CONTRIBUTION Relatives of deceased cancer patients were involved in the conduct of the study.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
| | | | - Lieve Van Den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels Health Campus, Brussels, Belgium
- End-of-Life Care Research Group, Ghent University, Campus Ghent University Hospital, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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Renckens SC, Pasman HR, van der Heide A, Onwuteaka-Philipsen BD. Aftercare Provision for Bereaved Relatives Following Euthanasia or Physician-Assisted Suicide: A Cross-Sectional Questionnaire Study Among Physicians. Int J Public Health 2024; 69:1607346. [PMID: 39119216 PMCID: PMC11306013 DOI: 10.3389/ijph.2024.1607346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/12/2024] [Indexed: 08/10/2024] Open
Abstract
Objectives: Relatives of patients who died after euthanasia or physician-assisted suicide (EAS) might need (specific) aftercare. We examined if and how physicians provide aftercare to bereaved relatives of patients who died after EAS, and which patient-, physician- and process characteristics are associated with providing aftercare. Methods: A cross-sectional questionnaire study was conducted among 127 physicians (general practitioners, clinical specialists, and elderly care physicians) in the Netherlands. Associations were examined using multivariable logistic regression analyses. Results: Most physicians had had at least one follow-up conversation with bereaved relatives (77.2%). Clinical specialists less often provided aftercare compared to GPs. Also, aftercare was more often provided when the deceased had a cohabiting partner. Topics addressed during aftercare conversations included looking back on practical aspects of the EAS trajectory, the emotional experience of relatives during the EAS trajectory and relatives' current mental wellbeing. A minority of aftercare conversations led to referral to additional care (6.3%). Conclusion: Aftercare conversations with a physician covering a wide-range of topics are likely to be valuable for all bereaved relatives, and not just for "at risk" populations typically targeted by policies and guidelines.
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Affiliation(s)
- Sophie C. Renckens
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - H. Roeline Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
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Nissim R, Chu P, Stere A, Tong E, An E, Selby D, Bean S, Isenberg-Grzeda E, Rodin G, Li M, Hales S. "Walk me through the final day": A thematic analysis study on the family caregiver experience of the Medical Assistance in Dying procedure day. Palliat Med 2024; 38:660-668. [PMID: 38720655 PMCID: PMC11158002 DOI: 10.1177/02692163241248725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Legalization of assisted dying is progressively expanding worldwide. In Canada, the Medical Assistance in Dying Act became law in 2016. As assisted dying regulations evolve worldwide, comprehending its subjective impact and broader consequences, especially on family members, becomes pivotal for shaping practice, policy, and training. AIM The goal of this study is to understand the experience of family caregivers on the assisted dying procedure day. DESIGN Qualitative, thematic analysis, research using semi-structured interviews. SETTING/PARTICIPANTS Family caregivers of patients who received assisted dying in two hospitals in Canada were recruited. Interviews were conducted at least 6 months after patient death. Conceptual saturation was achieved after analyzing 18 interviews. RESULTS While caregivers expressed gratitude for the availability of Medical Assistance in Dying, they also described the procedure day as potentially jarring and unsettling. We identified five aspects that shaped their experience: attuned support from the clinical team; preparation for clinical details; congruence between the setting and the importance of the event; active participation and ceremony; and pacing and timing of the procedure. Together, these aspects impacted the level of uneasiness felt by caregivers on the procedure day. CONCLUSIONS This study emphasized the importance of a family-centered approach to delivering Medical Assistance in Dying. It underscored recognizing the needs of family caregivers during the procedure day and offering strategies to ease their experience. Healthcare providers in jurisdictions where assisted dying is legal or deliberated should consider the applicability of these findings to their unique context.
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Affiliation(s)
- Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paige Chu
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Alison Stere
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Eryn Tong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ekaterina An
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Debbie Selby
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sally Bean
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Elie Isenberg-Grzeda
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Yan H, Bytautas J, Isenberg SR, Kaplan A, Hashemi N, Kornberg M, Hendrickson T. Grief and bereavement of family and friends around medical assistance in dying: scoping review. BMJ Support Palliat Care 2023; 13:414-428. [PMID: 36100431 PMCID: PMC10803956 DOI: 10.1136/spcare-2022-003715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The increase in the number of jurisdictions legalising medical assistance in dying (MAiD) has contributed to a growth in the number of family and friends who may face unique elements of grief and bereavement. The aim of this study was to review the literature of grief and bereavement of family and friends following MAiD, and to summarise findings for the development of community resources and programming. METHODS We performed a scoping review with workshop consultation of stakeholders. Six electronic databases and the grey literature were searched for qualitative, quantitative and review articles. Content-analytical techniques and multidisciplinary discussions led to the development of concepts and a conceptual framework. RESULTS Twenty-eight articles met the inclusion criteria. We identified five concepts that impact the grief and bereavement of family/friends: relationships between family/friends and the patient as well as healthcare providers; aspects of MAiD grief which can include secrecy and/or anticipatory grief; preparations which may include family/friends and should be centralised and harmonised; end of life as an opportunity for ceremony; and the aftereffects during which mental health outcomes are studied. CONCLUSION This multidisciplinary scoping review incorporates stakeholder consultation to find that support is needed to address the complicated and changing emotions of family/friends before, during and after a MAiD death. Furthermore, additional societal normalisation of MAiD is necessary to reduce secrecy and stigma and improve the accessibility of resources for family/friends.
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Affiliation(s)
- Han Yan
- U of T IHPME, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Bytautas
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Ari Kaplan
- MAiDHouse, Toronto, Ontario, Canada
- Faculty of Law, Western University, London, ON, Canada
| | - Narges Hashemi
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Temmy Latner Centre for Palliative Care, Toronto, Ontario, Canada
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Boven C, Dillen L, Dierickx S, Van den Block L, Piers R, Van Den Noortgate N, Van Humbeeck L. Relatives' Experiences of Being Involved in Assisted Dying: A Qualitative Study. QUALITATIVE HEALTH RESEARCH 2023; 33:1154-1164. [PMID: 37791685 PMCID: PMC10626978 DOI: 10.1177/10497323231196827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Recent literature demonstrates an interdependence between relatives and healthcare providers throughout euthanasia processes. Yet, current guidelines and literature scarcely specify the interactions between healthcare providers and bereaved relatives. The aim of this work consisted of providing an insight into bereaved relatives' experiences (1) of being involved in euthanasia processes and (2) of their interactions with healthcare providers before, during, and after the euthanasia. The research process was guided by the principles of constructivist grounded theory. Nineteen Dutch-speaking bereaved relatives of oncological patients, who received euthanasia at home or in a hospital less than 24 months ago, participated via semi-structured interviews. These interviews were conducted between May 2021 and June 2022. Due to the intensity of euthanasia processes, relatives wanted to be involved as early as possible, in order to receive time, space, and access to professionals' support whilst preparing themselves for the upcoming loss of a family member with cancer. Being at peace with the euthanasia request facilitated taking a supportive attitude, subsequently aiding in achieving a serene atmosphere. A serene atmosphere facilitated relatives' grief process because it helped them in creating and preserving good memories. Relatives appreciated support from healthcare providers, as long as overinvolvement on their part was not occurring. This study advocates for a relational approach in the context of euthanasia and provides useful complements to the existing euthanasia guidelines.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
| | - Sigrid Dierickx
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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Serota K, Atkinson M, Buchman DZ. Unacknowledged Pain and Disenfranchised Grief: A Narrative Analysis of Physical and Emotional Pain in Complex MAiD Bereavement Stories. Can J Pain 2023; 7:2231046. [PMID: 37593750 PMCID: PMC10431743 DOI: 10.1080/24740527.2023.2231046] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/26/2023] [Accepted: 06/26/2023] [Indexed: 08/19/2023]
Abstract
Background Pain can influence an individual's choice to pursue medical assistance in dying (MAiD) and may also influence how family members experience that decision. Family conflict or discordance surrounding a loved one's MAiD decision can cause unique challenges affecting grief and bereavement, including disenfranchised grief. There is limited knowledge of how individuals with complex MAiD bereavement experiences describe the role of physical and emotional pain in their bereavement stories. Aims This article explores the role of physical and emotional pain in the stories of family members with complex MAiD bereavement and identifies opportunities to improve care for individuals and families experiencing disagreement around MAiD. Methods We conducted qualitative interviews and utilized a narrative and ethics of care approach to analyze the data. Results We conducted N = 12 narrative interviews with participants in three provinces: Ontario, British Columbia, and Alberta. Descriptions of physical pain were used to justify the morality, or immorality, of MAiD in the context of patient suffering. Emotional pain described experiences where participants' feelings about MAiD went unacknowledged by their family or friends, institutions, and sociopolitical environments. We conceptualize this unacknowledged emotional pain as disenfranchised grief and make recommendations to improve care for individuals experiencing complex MAiD bereavement. Conclusions Experiences of physical and emotional pain leave a lasting impact on family members with complex MAiD bereavement. Health care professionals should continue to improve care for family members following MAiD, especially where there is disagreement or family conflict.
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Affiliation(s)
- Kristie Serota
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael Atkinson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Z Buchman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
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Ibáñez del Prado C. Eutanasia y Psicología. Algunas claves para la intervención en Procesos Adelantados de Muerte. PSICOONCOLOGIA 2022. [DOI: 10.5209/psic.84044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Los países que han optado por regular los Procesos Adelantados de Muerte (PAM) van en aumento en los últimos años. Este tipo de legislaciones implican directamente a los equipos sanitarios.Los psicólogos incluidos en estos equipos están en contacto con estos procesos, por lo que se torna imprescindible dilucidar, mediante la escasa literatura existente, si los PAM presentan variables diferenciales con otros procesos de muerte, que sean necesarias tener en cuenta durante la asistencia psicológica. Esta recopilación de literatura pretende plantear las diferencias que en la actualidad están contrastadas y plantear qué opciones de intervención psicológica están a nuestra disposición para realizar el acompañamiento a estas personas, sus cuidadores y los equipos sanitarios que los asisten.
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Snijdewind MC, de Keijser J, Casteelen G, Boelen PA, Smid GE. "I lost so much more than my partner" - Bereaved partners' grief experiences following suicide or physician-assisted dying in case of a mental disorder. BMC Psychiatry 2022; 22:454. [PMID: 35799148 PMCID: PMC9261256 DOI: 10.1186/s12888-022-04098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND There is a lack of existing research on grief following the intentional death of people suffering from a mental disorder. Our study aims to provide insight into grief experiences and social reactions of bereaved persons who lost their life partners, who were suffering from a mental disorder, to physician-assisted dying (PAD) or suicide. METHODS For this mixed-methods research, we conducted a survey and in-depth interviews with 27 persons living in the Netherlands and bereaved by the death of their life partners. The deceased life partners suffered from a mental disorder and had died by physician-assisted dying (n = 12) or suicide (n = 15). Interviews explored grief experiences and social reactions. In the survey we compared self-reported grief reactions of partners bereaved by suicide and PAD using the Grief Experience Questionnaire. RESULTS Compared to suicide, physician-assisted dying was associated with less severe grief experiences of the bereaved partners. Participants reported that others rarely understood the suffering of their deceased partners and sometimes expected them to justify their partners' death. Following physician-assisted dying, the fact that the partner's euthanasia request was granted, helped others understand that the deceased person's mental suffering had been unbearable and irremediable. Whereas, following suicide, the involvement of the bereaved partners was sometimes the focus of judicial inquiry, especially, if the partner had been present during the death. CONCLUSION When individuals suffering from a mental disorder die by suicide or PAD, their bereaved partners may experience a lack of understanding from others. Although both ways of dying are considered unnatural, their implications for bereaved partners vary considerably. We propose looking beyond the dichotomy of PAD versus suicide when studying grief following the intentional death of people suffering from a mental disorder, and considering other important aspects, such as expectedness of the death, suffering during it, and partners' presence during the death.
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Affiliation(s)
- M. C. Snijdewind
- ARQ Centrum’45, Nienoord 5, 1112 XE, Diemen, The Netherlands ,grid.5650.60000000404654431Department of Ethics, Law and Humanities, Amsterdam UMC, Academic Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - J. de Keijser
- grid.4830.f0000 0004 0407 1981Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - G. Casteelen
- Expertisecentrum Euthanasie, P.O. Box 13480, 2501 EL Den Haag, The Netherlands
| | - P. A. Boelen
- ARQ Centrum’45, Nienoord 5, 1112 XE, Diemen, The Netherlands ,grid.491097.2ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE, Diemen, The Netherlands ,grid.5477.10000000120346234Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands
| | - G. E. Smid
- ARQ Centrum’45, Nienoord 5, 1112 XE, Diemen, The Netherlands ,grid.491097.2ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE, Diemen, The Netherlands ,grid.449771.80000 0004 0545 9398Department of Humanistic Chaplaincy Studies, University of Humanistic Studies, Kromme Nieuwegracht 29, 3512 HD Utrecht, the Netherlands
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Bernier L, Bernatchez S, Sweeney Beaudry A. L’avortement tardif et l’aide médicale à mourir au-delà de l’autonomie individuelle : comment réguler les pratiques pour assurer le vivre ensemble ? CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1089781ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Snijdewind MC, de Keijser J, Casteelen G, Boelen PA, Smid GE. "Only One Way Out"-Partners' Experiences and Grief Related to the Death of Their Loved One by Suicide or Physician-Assisted Dying Due to a Mental Disorder. Front Psychiatry 2022; 13:894417. [PMID: 35873257 PMCID: PMC9304962 DOI: 10.3389/fpsyt.2022.894417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous research has provided insight into the grief of suicide survivors, but little is known about grief following physician-assisted dying (PAD), and no prior study specifically focused on grief following PAD due to a mental disorder. The current study aims to increase insight into experiences preceding PAD or suicide of a loved one due to a mental disorder and their impact on mental health symptoms. METHODS We performed a survey study and in-depth interviews with 27 bereaved life partners. The deceased had been in treatment for mental disorders and had died by PAD (n = 12) or suicide (n = 15). Interviews explored grief experiences and experiences with mental health care. In the survey, we assessed self-reported symptoms of grief, post-traumatic stress, anxiety, depression, quality of life, and impairments in social, and occupational functioning. RESULTS All participants reported generally low levels of mental health symptoms. Longer time since death and death by PAD were associated with lower grief intensity. Interviews showed various degrees of expectedness of the partners' death, and a varying impact of being present at the death on bereaved partners. CONCLUSION Expectedness of the death of the partner, absence of suffering of the partner at the time of dying, and presence of physician support may in part explain the protective effects of PAD against severe grief reactions. Physicians considering their position regarding their personal involvement in PAD due to a mental disorder could take grief reactions of the bereaved partner into account.
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Affiliation(s)
- Marianne C Snijdewind
- ARQ Centrum'45, Diemen, Netherlands.,Department of Ethics, Law and Humanities, Amsterdam UMC, Academic Medical Centre, Amsterdam, Netherlands
| | - Jos de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | | | - Paul A Boelen
- ARQ Centrum'45, Diemen, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands
| | - Geert E Smid
- ARQ Centrum'45, Diemen, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands.,Department of Humanistic Chaplaincy Studies, University of Humanistic Studies, Utrecht, Netherlands
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Sinnarajah A, Feldstain A, Wasylenko E. Responding to requests for hastened death in patients living with advanced neurologic disease. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:217-237. [PMID: 36055717 DOI: 10.1016/b978-0-323-85029-2.00002-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A request for hastened death can mean many things, from an emotional plea for help with unmet needs to a request for legal provision of chemically induced hastened death. Regardless of whether the clinician supports legally available hastened death, knowing how to respond to requests for hastened death is important. Responding in an empathic and open manner will strengthen the therapeutic relationship between the patient and clinician. Suggested scripts on how to respond are provided. A framework for assessing the patient's preparation at various stages in the decisional journey is suggested. Additional factors including caring for the family and involving other healthcare providers are discussed. Last, there is some exploration of ethics considerations and a summary of legal chemically induced hastened death availability internationally.
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Affiliation(s)
- Aynharan Sinnarajah
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - Andrea Feldstain
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Department of Psychosocial Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Eric Wasylenko
- Department of Oncology, University of Calgary, Calgary, AB, Canada; John Dossetor Health Ethics Centre, University of Alberta, Edmonton, AB, Canada
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Balard F, Pott M, Yampolsky E. Suicide among the elderly in France and Switzerland: What does the societal context tell us about the place of relatives? DEATH STUDIES 2021; 46:1583-1592. [PMID: 34014812 DOI: 10.1080/07481187.2021.1926634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Based on a comparison of accounts by relatives of elderly people who died by suicide in France and by assisted suicide in Switzerland, this article analyzes the place of family members and their interpretations of the suicide of their elderly relative. It highlights the way the societal and legal context influences the collection of data, the feelings of relatives and their interpretations. While in France, relatives try to avoid the risk of the family being stigmatized and try to retrospectively reconstruct the reasons for the suicide, the institutionalization of suicide in Switzerland means that the reasons for suicide are formulated in advance.
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Affiliation(s)
- Frédéric Balard
- Laboratoire Lorrain de Sciences Sociales, Université de Lorraine, Nancy, France
| | - Murielle Pott
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Eva Yampolsky
- Institute for the Humanities in Medicine, Lausanne University Hospital, University of Lausanne [UNIL], Lausanne, Switzerland
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Beuthin R, Bruce A, Thompson M, Andersen AEB, Lundy S. Experiences of grief-bereavement after a medically assisted death in Canada: Bringing death to life. DEATH STUDIES 2021; 46:1982-1991. [PMID: 33538647 DOI: 10.1080/07481187.2021.1876790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Medical assistance in dying (MAiD) legislation was passed in Canada in 2016, yet the bereavement experience of family and friends is not well understood. Using interpretive description, we interviewed nine bereaved individuals. The time before the assisted death seems most impactful-an experience of bringing death to life shapes bereavement after death. We identified themes that inform this grieving: (1) certainty of date/time of death-intensifies a parade of lasts, initiates a countdown and affords time to say good-bye; (2) active family engagement as planners supports sense-making; and (3) enacting MAiD as ceremony slows time to "digest" loss.
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Affiliation(s)
- Rosanne Beuthin
- End of Life Care, Vancouver Island Health Authority, Victoria, Canada
| | - Anne Bruce
- School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
| | | | | | - Sarah Lundy
- Faculty of Law, University of Victoria, Victoria, Canada
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15
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Hashemi N, Amos E, Lokuge B. Quality of Bereavement for Caregivers of Patients Who Died by Medical Assistance in Dying at Home and the Factors Impacting Their Experience: A Qualitative Study. J Palliat Med 2021; 24:1351-1357. [PMID: 33513049 DOI: 10.1089/jpm.2020.0654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Medical Assistance in Dying (MAiD) was legalized in Canada in June 2016. MAiD is available to those who are at least 18 years of age with an irremediable medical condition and an irreversible state of decline causing unbearable suffering. Between June 2016 and December 2019, 13,946 MAiD cases were reported in Canada.3 Although 35.2% have taken place in the home, very little is known about the experience of caregivers in this setting. Objectives: This study explored caregivers' experience with MAiD in the home-setting and their bereavement process. Setting/Subjects: Caregivers of patients of the Temmy Latner Centre for Palliative Care in Toronto, Canada, who underwent MAiD by a physician at home. This study was approved by the Sinai Health Research Ethics Board. Design: This study used a semistructured interview guide and standardized questionnaires. Thirteen caregivers were contacted at least six months post-MAiD to participate in a one-on-one interview. The interviews were transcribed, coded, and evaluated using a thematic analysis approach. Results: The main themes that emerged from the interviews were the caregivers' experience with MAiD, their interaction with the MAiD team, disclosure about MAiD, their bereavement experience, and comparison of experiencing a MAiD death to a natural death. Conclusion: We hypothesize that caregivers in our study were better prepared for the upcoming death due to more certainty as to how and when their loved one would die. Having closure and being able to say goodbye may also have positively influenced the bereavement experience. Finally, MAiD may have spared the caregivers the trauma of witnessing their loved one deteriorate in their final days of life.
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Affiliation(s)
- Narges Hashemi
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Amos
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bhadra Lokuge
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
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16
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Smid GE. A framework of meaning attribution following loss. Eur J Psychotraumatol 2020; 11:1776563. [PMID: 33244357 PMCID: PMC7678673 DOI: 10.1080/20008198.2020.1776563] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023] Open
Abstract
The loss of a loved one causes the world and the place of the bereaved survivor in it to change irreversibly. A key aspect of the grieving process is the integration of the loss in the bereaved survivor's life story, identity change, and a new future orientation through meaning attribution. Meaning attribution can have favourable or unfavourable effects on the grieving process and hence determines the extent to which a loss disrupts the bereaved survivor's functioning. A framework of meaning attribution after loss is presented, comprising 17 determinants that fall into five categories: event-related, cultural, social, individual and relational determinants. Each determinant may lead to both positive and negative meanings, thereby facilitating or complicating the grieving process. The framework of meaning attribution highlights the importance of an integrated network for mental health care, spiritual care, and end-of-life care in the prevention and treatment of traumatic grief. It also emphasizes the support from relatives, collective rituals, cultural views, legal settlements, and other societal factors that may foster or impede adaptation to loss. The framework of meaning attribution informs research across a range of research themes, including specialist care for traumatic grief, a culturally sensitive care network for traumatic grief, and improving care for ambiguous loss in a global context.
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Affiliation(s)
- Geert E. Smid
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
- University of Humanistic Studies, Utrecht, The Netherlands
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17
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Attia JR, Jorm C, Kelly B. Medical assistance in dying: the downside. BMJ Support Palliat Care 2020; 10:259-261. [DOI: 10.1136/bmjspcare-2020-002350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 11/04/2022]
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18
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Brown J, Goodridge D, Harrison A, Kemp J, Thorpe L, Weiler R. Care Considerations in a Patient- and Family-Centered Medical Assistance in Dying Program. J Palliat Care 2020; 37:341-351. [PMID: 32854581 DOI: 10.1177/0825859720951661] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Medical Assistance in Dying (MAID) became legal in Canada in June 2016. As part of a project designed to improve end-of-life care for those requesting MAID, qualitative data from patients, families, and providers were used to assess opportunities to enhance patient-and family-centered care (PFCC) in this program. METHODS Thirty interviews were conducted with patients, families, and healthcare providers. Five patients who requested an assessment for MAID, 11 family members, and 14 healthcare providers were interviewed about their experiences in 2017. Comparative coding and thematic analysis were completed with the support of NVivo12. RESULTS Emotional PFCC considerations included: exploring and validating the emotional journey, navigating the uncertain, judgmental experiences, and the emotional impact on families and the care team. Physical PFCC considerations included: sensitivity in eligibility assessments, weaving in interdisciplinary care, provision of anticipatory guidance, and death location. Spiritual PFCC considerations included: honoring choice, listening to life stories, supporting spiritual needs, and acknowledging loss. Relational PFCC considerations included: defining the circle of support, supporting the circle, and relational investments. CONCLUSION Fundamental to a PFCC MAID program, practitioners must be afforded time to provide holistic care. Program-related suggestions include incorporating interdisciplinary care early, and throughout the illness trajectory, consistency in care providers, appropriate anticipatory guidance, and bereavement supports for family, and dedicate space for MAID provisions. Patients and families must be included in the ongoing development and re-evaluation of MAID programs to ensure continued focus on quality end-of-life care.
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Affiliation(s)
- Janine Brown
- Health Sciences Graduate Program, College of Medicine, 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Faculty of Nursing, 6846University of Regina, Saskatchewan, Canada
| | - Donna Goodridge
- College of Medicine, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Averi Harrison
- College of Medicine, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jordan Kemp
- College of Medicine, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lilian Thorpe
- Department of Community Health & Epidemiology, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Department of Psychiatry, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert Weiler
- Department of Anesthesiology, Perioperative Medicine and Pain Management, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Provincial MAID Program, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
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19
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Improving the Medical Assistance in Dying (MAID) process: A qualitative study of family caregiver perspectives. Palliat Support Care 2020; 17:590-595. [PMID: 30887936 DOI: 10.1017/s147895151900004x] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The road to legalization of Medical Assistance in Dying (MAID) across Canada has largely focused on legislative details such as eligibility and establishment of regulatory clinical practice standards. Details on how to implement high-quality, person-centered MAID programs at the institutional level are lacking. This study seeks to understand what improvement opportunities exist in the delivery of the MAID process from the family caregiver perspective. METHOD This multi-methods study design used structured surveys, focus groups, and unstructured e-mail/phone conversations to gather experiential feedback from family caregivers of patients who underwent MAID between July 2016 and June 2017 at a large academic hospital in Toronto, Canada. Data were combined and a qualitative, descriptive approach used to derive themes within family perspectives. RESULT Improvement themes identified through the narrative data (48% response rate) were grouped in two categories: operational and experiential aspects of MAID. Operational themes included: process clarity, scheduling challenges and the 10-day period of reflection. Experiential themes included clinician objection/judgment, patient and family privacy, and bereavement resources. SIGNIFICANCE OF RESULTS To our knowledge, this is the first time that family caregivers' perspectives on the quality of the MAID process have been explored. Although practice standards have been made available to ensure all legislated components of the MAID process are completed, detailed guidance for how to best implement patient and family centered MAID programs at the institutional level remain limited. This study provides guidance for ways in which we can enhance the quality of MAID from the perspective of family caregivers.
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20
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Death by request in Switzerland: Posttraumatic stress disorder and complicated grief after witnessing assisted suicide. Eur Psychiatry 2020; 27:542-6. [DOI: 10.1016/j.eurpsy.2010.12.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 12/07/2010] [Accepted: 12/11/2010] [Indexed: 11/23/2022] Open
Abstract
AbstractBackgroundDespite continuing political, legal and moral debate on the subject, assisted suicide is permitted in only a few countries worldwide. However, few studies have examined the impact that witnessing assisted suicide has on the mental health of family members or close friends.MethodsA cross-sectional survey of 85 family members or close friends who were present at an assisted suicide was conducted in December 2007. Full or partial Post-Traumatic Distress Disorder (PTSD; Impact of Event Scale–Revised), depression and anxiety symptoms (Brief Symptom Inventory) and complicated grief (Inventory of Complicated Grief) were assessed at 14 to 24 months post-loss.ResultsOf the 85 participants, 13% met the criteria for full PTSD (cut-off≥35), 6.5% met the criteria for subthreshold PTSD (cut-off≥25), and 4.9% met the criteria for complicated grief. The prevalence of depression was 16%; the prevalence of anxiety was 6%.ConclusionA higher prevalence of PTSD and depression was found in the present sample than has been reported for the Swiss population in general. However, the prevalence of complicated grief in the sample was comparable to that reported for the general Swiss population. Therefore, although there seemed to be no complications in the grief process, about 20% of respondents experienced full or subthreshold PTSD related to the loss of a close person through assisted suicide.
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21
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Hunt RW. A perfect storm: fear of litigation for end of life care. Med J Aust 2020; 212:140-140.e1. [DOI: 10.5694/mja2.50465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Sundar S. Treating sepsis in dying patients is futile. BMJ 2019; 367:l6706. [PMID: 31792100 DOI: 10.1136/bmj.l6706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Santhanam Sundar
- Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
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23
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Booker R, Bruce A. Palliative sedation and medical assistance in dying: Distinctly different or simply semantics? Nurs Inq 2019; 27:e12321. [PMID: 31756038 PMCID: PMC9285680 DOI: 10.1111/nin.12321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/17/2019] [Accepted: 08/03/2019] [Indexed: 11/29/2022]
Abstract
Medical assistance in dying (MAiD) and palliative sedation (PS) are both legal options in Canada that may be considered by patients experiencing intolerable and unmanageable suffering. A contentious, lively debate has been ongoing in the literature regarding the similarities and differences between MAiD and PS. The aim of this paper is to explore the propositions that MAiD and PS are essentially similar and conversely that MAiD and PS are distinctly different. The relevance of such a debate is apparent for clinicians and patients alike. Understanding the complex and multi‐faceted nuances between PS and MAiD allows patients and caregivers to make more informed decisions pertaining to end‐of‐life care. It is hoped that this paper will also serve to foster further debate and consideration of the issues associated with PS and MAiD with a view to improve patient care and the quality of both living and dying in Canada.
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Affiliation(s)
- Reanne Booker
- Palliative and End-of-Life Care Services, Calgary, AB, Canada.,Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Anne Bruce
- School of Nursing, University of Victoria, Victoria, BC, Canada
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24
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Dierickx S, Cohen J. Medical assistance in dying: research directions. BMJ Support Palliat Care 2019; 9:370-372. [DOI: 10.1136/bmjspcare-2018-001727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/13/2019] [Indexed: 11/03/2022]
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25
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Andriessen K, Krysinska K, Castelli Dransart DA, Dargis L, Mishara BL. Grief After Euthanasia and Physician-Assisted Suicide. CRISIS 2019; 41:255-272. [PMID: 31657640 DOI: 10.1027/0227-5910/a000630] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Several countries have regulated euthanasia and physician-assisted suicide (PAS). Research has looked at the experiences of patients, family, and professionals. However, little is known of the effects on bereaved individuals. Aims: We aimed to assess (a) what is known about the grief and mental health of people bereaved by euthanasia or PAS and (b) the quality of the research. Method: Systematic review according to PRISMA guidelines with searches in Cinahl, Embase, PsycINFO, Pubmed, and Scopus. Results: The searches identified 10 articles (eight studies), and the study quality was fair. People bereaved by euthanasia/PAS generally had similar or lower scores on measures of disordered grief, mental health, and posttraumatic stress compared with those who died naturally. Lack of social support and secrecy may compound their grief. Being involved in the decision-making process and having the feeling of honoring the deceased's will may facilitate their grief. Limitations: Studies used self-reports from non-random self-selected participants, were retrospective, and were conducted in only three countries. Conclusion: There is little evidence of increased risk of adverse grief or mental health outcomes in people bereaved by euthanasia/PAS. As more countries legalize assisted dying, high-quality studies of the factors that may hinder or facilitate the grief process are needed.
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Affiliation(s)
- Karl Andriessen
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Karolina Krysinska
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Luc Dargis
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices (CRISE), Montréal, Canada
| | - Brian L Mishara
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices (CRISE), Montréal, Canada.,Psychology Department, Université du Québec á Montréal, Canada
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26
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Gamondi C, Fusi-Schmidhauser T, Oriani A, Payne S, Preston N. Family members' experiences of assisted dying: A systematic literature review with thematic synthesis. Palliat Med 2019; 33:1091-1105. [PMID: 31244384 DOI: 10.1177/0269216319857630] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Families' experiences of assisted dying are under-investigated and families are rarely considered in clinical guidelines concerning assisted dying. AIM To systematically review family experiences of assisted dying. DESIGN A systematic literature review using thematic synthesis. DATA SOURCES MEDLINE, Embase, CINAHL, AMED (Allied and Complementary Medicine) and PsycINFO databases (January 1992 to February 2019). Studies investigating families' experiences on the practice of legalised assisted dying were included. We excluded studies prior to legalisation within the jurisdiction, secondary data analysis and opinion papers. RESULTS Nineteen articles met the inclusion criteria. Publications were derived from four countries: The Netherlands, United States (Oregon, Washington and Vermont), Canada and Switzerland. Dutch studies predominately investigated family involvement in euthanasia, while Swiss and American studies only reported on assisted suicide. Eleven studies had a qualitative design, using predominately in-depth interviews; seven were retrospective surveys. Five analytical themes represented families' experiences in assisted dying: (1) context of the decision, (2) grounding the decision, (3) cognitive and emotional work, (4) experiencing the final farewell and (5) grief and bereavement. The results showed that families can be very involved in supporting patients seeking assisted dying, where open communication is maintained. Family involvement appeared to be influenced by the type of legislation in their country and the families' perception of the social acceptability of assisted dying. CONCLUSION Our data confirm that families across all jurisdictions are involved in assisted suicide decision and enactment. Family needs are under-researched, and clinical guidelines should incorporate recommendations about how to consider family needs and how to provide them with evidence-based tailored interventions.
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Affiliation(s)
- Claudia Gamondi
- 1 Palliative and Supportive Care Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,2 Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Tanja Fusi-Schmidhauser
- 2 Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Anna Oriani
- 2 Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Sheila Payne
- 3 International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- 3 International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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27
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Antifaeff K. Social Work Practice with Medical Assistance in Dying: A Case Study. HEALTH & SOCIAL WORK 2019; 44:185-192. [PMID: 30796809 DOI: 10.1093/hsw/hlz002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/28/2018] [Accepted: 09/18/2018] [Indexed: 06/09/2023]
Abstract
Medical assistance in dying (MAiD) recently became legal in Canada, and social workers have an integral role providing psychosocial care to those considering this end-of-life care option. Research has found that most requests for assisted dying have a psychosocial dimension. Social workers are uniquely equipped to understand the personal and contextual factors informing the choice for MAiD and offer supports. A case example highlights practice opportunities for social workers throughout the MAiD process.
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Affiliation(s)
- Kelsey Antifaeff
- Vancouver General Hospital, Vancouver Coastal Health, 899 West 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
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28
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Roest B, Trappenburg M, Leget C. The involvement of family in the Dutch practice of euthanasia and physician assisted suicide: a systematic mixed studies review. BMC Med Ethics 2019; 20:23. [PMID: 30953490 PMCID: PMC6451224 DOI: 10.1186/s12910-019-0361-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/27/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Family members do not have an official position in the practice of euthanasia and physician assisted suicide (EAS) in the Netherlands according to statutory regulations and related guidelines. However, recent empirical findings on the influence of family members on EAS decision-making raise practical and ethical questions. Therefore, the aim of this review is to explore how family members are involved in the Dutch practice of EAS according to empirical research, and to map out themes that could serve as a starting point for further empirical and ethical inquiry. METHODS A systematic mixed studies review was performed. The databases Pubmed, Embase, PsycInfo, and Emcare were searched to identify empirical studies describing any aspect of the involvement of family members before, during and after EAS in the Netherlands from 1980 till 2018. Thematic analysis was chosen as method to synthesize the quantitative and qualitative studies. RESULTS Sixty-six studies were identified. Only 14 studies had family members themselves as study participants. Four themes emerged from the thematic analysis. 1) Family-related reasons (not) to request EAS. 2) Roles and responsibilities of family members during EAS decision-making and performance. 3) Families' experiences and grief after EAS. 4) Family and 'the good euthanasia death' according to Dutch physicians. CONCLUSION Family members seem to be active participants in EAS decision-making, which goes hand in hand with ambivalent feelings and experiences. Considerations about family members and the social context appear to be very important for patients and physicians when they request or grant a request for EAS. Although further empirical research is needed to assess the depth and generalizability of the results, this review provides a new perspective on EAS decision-making and challenges the Dutch ethical-legal framework of EAS. Euthanasia decision-making is typically framed in the patient-physician dyad, while a patient-physician-family triad seems more appropriate to describe what happens in clinical practice. This perspective raises questions about the interpretation of autonomy, the origins of suffering underlying requests for EAS, and the responsibilities of physicians during EAS decision-making.
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Affiliation(s)
- Bernadette Roest
- University of Humanistic Studies, Kromme Nieuwegracht 29, 3512HD Utrecht, The Netherlands
| | - Margo Trappenburg
- University of Humanistic Studies, Kromme Nieuwegracht 29, 3512HD Utrecht, The Netherlands
| | - Carlo Leget
- University of Humanistic Studies, Kromme Nieuwegracht 29, 3512HD Utrecht, The Netherlands
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29
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Goldberg R, Nissim R, An E, Hales S. Impact of medical assistance in dying (MAiD) on family caregivers. BMJ Support Palliat Care 2019; 11:107-114. [PMID: 30826737 DOI: 10.1136/bmjspcare-2018-001686] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/20/2019] [Accepted: 01/24/2019] [Indexed: 11/03/2022]
Abstract
Medical assistance in dying (MAiD) is a globally polarising topic which often sparks debate surrounding the ethical and moral dilemmas that arise with a life-ending intervention. To gain a better understanding of this intervention, it is important to explore the experience of those most intimately affected by MAiD. Family caregivers of those with a terminal illness are the backbone of the healthcare and support team, often providing a substantial amount of informal care while at the same time coping with their own distress and anticipatory grief. However, we know the least about how MAiD impacts the psychosocial well-being of these same individuals. The aim of this article is to explore the experience of MAiD from the family caregiver perspective, namely their beliefs and opinions about the intervention, how the process of MAiD impacts them, how the intervention shapes their view of their loved one's quality of death, and the psychosocial outcomes after the passing of their loved one. Beyond the literature, challenges within both the clinical and research realms will be discussed and future directions will be offered. While MAiD is currently legal in only a small number of countries, a better understanding of the impact of MAiD will help inform policy and legislation as they are developed in other jurisdictions. Further, this article aims to inform future research and clinical interventions in order to better understand and support those seeking MAiD and their families.
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Affiliation(s)
- Rachel Goldberg
- Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rinat Nissim
- Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Ekaterina An
- Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Sarah Hales
- Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada .,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
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30
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Srinivasan EG. Bereavement and the Oregon Death with Dignity Act: How does assisted death impact grief? DEATH STUDIES 2018; 43:647-655. [PMID: 30465484 DOI: 10.1080/07481187.2018.1511636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This qualitative study explores bereavement experiences with an assisted death. Thematic analysis of data from interviews with 22 people who had a family member die under Oregon's Death with Dignity Act revealed the following five themes: (a) general grief reactions, (b) anticipating the death, (c) sense of control, (d) level of agreement with assisted death, and (e) grief expression and stigma. Grief from an assisted death is a varied experience, including aspects that are unique to this mode of death, and aspects that can both ease and bring challenges to the grieving process.
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Affiliation(s)
- E G Srinivasan
- Department of Psychology, University of Wisconsin-La Crosse , La Crosse , WI , USA
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31
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Holmes S, Wiebe E, Shaw J, Nuhn A, Just A, Kelly M. Exploring the experience of supporting a loved one through a medically assisted death in Canada. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:e387-e393. [PMID: 30209112 PMCID: PMC6135137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore the experience of family and close friends of patients seeking medical assistance in dying (MAID) in Canada. DESIGN Qualitative study using semistructured interviews. SETTING A clinic in Vancouver, BC, that provides MAID services. PARTICIPANTS Eighteen support people for patients seeking MAID. METHODS Clinic patients seeking MAID identified their primary support people during consultations for an assisted death evaluation. Identified support people were invited to participate in the study, and those who were interested were asked to contact the interviewers. Semistructured interviews were conducted, transcribed, coded, and subjected to content analysis to elucidate common themes. MAIN FINDINGS All participants were supportive of their loved one's wish for assisted death and they provided emotional and practical support in preparation for MAID. Support persons talked about the journey they went through from their loved one's diagnosis to the MAID request to the actual death. Some were initially opposed but changed their minds after seeing the suffering their loved ones endured. The time before the assisted death involved saying goodbye and, for some, ceremonial rituals (celebration of life, poems, singing, etc). Those interviewed after their loved one's assisted death found the death peaceful and reported that it offered advantages compared with natural death in their loved one's individual circumstances. CONCLUSION This study provides insight into experiences of support people coping with a loved one who is seeking or has sought MAID in the context of a country unfamiliar with the legal process of a planned and hastened death. Participants were supportive of their loved one's wishes for assistance in death to end suffering and found the process to be peaceful overall.
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Affiliation(s)
- Sheila Holmes
- Internal medicine resident at the University of British Columbia in Vancouver
| | - Ellen Wiebe
- Clinical Professor in the Department of Family Practice at the University of British Columbia and a family physician who practises in women's health and assisted death.
| | - Jessica Shaw
- Assistant Professor in the Faculty of Social Work at the University of Calgary in Alberta
| | | | - Alanna Just
- Research assistant at a women's medical clinic in Vancouver and a Master of Philosophy in Medical Science (Psychiatry) candidate at the University of Cambridge
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Benrimoh D, Perreault A, Van Den Eynde F. Euthanasia requests in a Canadian psychiatric emergency room: A case series: Part 1 of the McGill University euthanasia in psychiatry case series. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 55:37-44. [PMID: 29157510 DOI: 10.1016/j.ijlp.2017.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 08/25/2017] [Accepted: 10/04/2017] [Indexed: 06/07/2023]
Abstract
Euthanasia was decriminalized in Quebec in December 2015, and Canada-wide in June 2016. Both the Provincial and Federal legislation have limited the right to medical assistance in dying (MAID) to end-of-life cases; which makes MAID inaccessible to most patients solely suffering from psychiatric illness. While some end-stage anorexia nervosa or elderly patients may meet the end-of-life criterion because of their medical comorbidities or their age (Kelly et al., 2003), repeated suicide attempts or psychotic disorganization would not qualify since they would not be seen as elements of an illness leading to a foreseeable "natural death" (Canada, 2016). This is in contradiction to other jurisdictions, such as Belgium and the Netherlands as well as the eligibility criteria stated in the Supreme Court of Canada's decision in Carter v. Canada (Supreme Court of Canada, 2015). Here we analyze three cases of patients who presented to a psychiatric emergency department and requested MAID for psychiatric reasons. While none of the patients were eligible for MAID under Canadian law, we find that their demographics match closely that of patients granted MAID for psychiatric reasons in jurisdictions where that practice is allowed. Based on these cases, we comment on potentially negative consequences that may come from decriminalizing MAID for psychiatric reasons (such as an increased assessment burden on ED staff) and potentially positive consequences (such as encouraging suffering patients who had not consulted to seek care). While it is by no means our intention to take a political or moral stand on this important issue, or to conclusively weigh the negatives and positives of allowing MAID for psychiatric reasons, we do stress the importance of an active voice for psychiatry in this ongoing public debate.
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Affiliation(s)
- David Benrimoh
- McGill University, Department of Psychiatry, 1033 avenue des Pins Ouest, Montreal, QC H3A 1A1, Canada.
| | - Antoine Perreault
- McGill University, Department of Psychiatry, 1033 avenue des Pins Ouest, Montreal, QC H3A 1A1, Canada
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Schmidt KW. [Assisted suicide in the movies - what is (not) shown?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:99-107. [PMID: 27896390 DOI: 10.1007/s00103-016-2474-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Whereas changes to the existing legal situation regarding assisted suicide have been a topic of controversial debate in Germany for the last few years, this issue has long been of interest for international film-makers. Since the mid-1980s, the theme of assisted suicide has repeatedly been taken up by cinema, predominantly as central to a relationship drama. A sick person asks somebody close to them for help. Often this somebody is a physician or a nurse, ultimately an obvious way of solving the practical problem of how the assistant is to gain access to a lethal substance. At the same time, this constellation enables a physician or nurse to be forced into a dramatic conflict between professional ethics and a personal obligation towards a loved one.Alongside more classic clinical pictures such as terminal cancer, recent films about assisted suicide have featured neurodegenerative diseases and physical disabilities. Another new development is that elderly patients are no longer alone in requesting assistance; films also and increasingly portray young adults. Besides a fear of unbearable pain, more recent films have also increasingly addressed the worry that permanent nursing might be required, as well as the subjectively experienced loss of dignity. The possibilities offered by palliative care hardly play a role in feature films. However, we should not forget, that movies are fictional and orchestrated, or, in other words, they are neither educational nor documental. They neither need nor want to portray reality, although they do wish to draw upon real experiences. They exploit highly emotional and ethically controversial themes to create tensions and stir up emotions in the audience, but ultimately they seek to entertain. Movies about death and dying are always "die-tainment".
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Affiliation(s)
- Kurt W Schmidt
- Zentrum für Ethik in der Medizin am Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431, Frankfurt/M., Deutschland.
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Reisbig AMJ, Hafen M, Siqueira Drake AA, Girard D, Breunig ZB. Companion Animal Death. OMEGA-JOURNAL OF DEATH AND DYING 2017; 75:124-150. [DOI: 10.1177/0030222815612607] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Human–animal relationships are increasingly incorporated into families as a normal part of family life. Despite this, relationships with animals are often viewed as inferior to human relationships. This becomes problematic during times of loss and grief when members of a grieving companion animal owner's support system do not understand the salience of the relationship with the animal. Veterinary and other helping professionals need basic information about the experience of companion animal loss in order to help support and normalize the experiences of grieving companion animal owners. The present study qualitatively describes human–animal relationships and the subsequent loss and coping experienced by owners of beloved companion animals. Comparison with human and other types of loss and factors unique to companion animal loss are discussed, and practical applications for veterinary and other helping professionals are provided.
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Affiliation(s)
- Allison M. J. Reisbig
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, NE, USA
| | - McArthur Hafen
- College of Veterinary Medicine, Kansas State University, KS, USA
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No Negative Impact of Palliative Sedation on Relatives' Experience of the Dying Phase and Their Wellbeing after the Patient's Death: An Observational Study. PLoS One 2016; 11:e0149250. [PMID: 26871717 PMCID: PMC4752210 DOI: 10.1371/journal.pone.0149250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 01/28/2016] [Indexed: 11/19/2022] Open
Abstract
Background Palliative sedation is the widely-used intervention of administering sedating agents to induce a state of unconsciousness to take away a dying patient’s perception of otherwise irrelievable symptoms. However, it remains questionable whether this ethically complex intervention is beneficial for patients and whether the associated lack of communication in the last phase of life has a negative impact on relatives’ wellbeing. Methods An observational questionnaire study was conducted among relatives of a consecutive sample of patients who died a non-sudden death in the Erasmus MC Cancer Institute or in the hospice ‘Laurens Cadenza’ (both in Rotterdam) between 2010 and 2013. Results Relatives filled in questionnaires regarding 151 patients who had been sedated and 90 patients who had not been sedated. The median time since all patients had passed away was 21 (IQR 14–32) months. No significant differences were found in relatives´ assessments of the quality of end-of-life care, patients´ quality of life in the last week before death and their quality of dying, between patients who did and did not receive sedation, or in relatives’ satisfaction with their own life, their general health and their mental wellbeing after the patient’s death. Conclusions The use of sedation in these patients appears to have no negative effect on bereaved relatives’ evaluation of the patient’s dying phase, or on their own wellbeing after the patient’s death.
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Bruinsma SM, Tiemeier HW, Verkroost-van Heemst J, van der Heide A, Rietjens JAC. Risk factors for complicated grief in older adults. J Palliat Med 2015; 18:438-46. [PMID: 25671395 DOI: 10.1089/jpm.2014.0366] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Older adults grieving the death of a spouse have been found to have a higher risk of complicated grief compared with younger adults. OBJECTIVE The study objective was to find out whether personal characteristics of the patient and the bereaved partner, or characteristics of the patient's illness, end-of-life care, and the nature of death are risk factors for complicated grief in older adults. METHODS We performed a nested case-control study within the Rotterdam Study. We selected 100 couples of which one person had deceased and the other person experienced "complicated grief," and 100 control couples of which one person had deceased and the other person experienced "normal grief." Complicated grief was assessed with a 17-item Inventory of Complicated Grief (ICG). Determinants were assessed using several sources of information that were available for all participants of the Rotterdam Study. Additionally, medical files of the deceased were manually screened. Logistic regression analysis was performed. RESULTS Only depression at baseline was significantly associated with complicated grief. Bereaved partners with depression at baseline had a higher risk of complicated grief compared to bereaved partners without depression (OR=3.48; 95% CI=1.40-8.68). CONCLUSIONS Our results suggest that complicated grief in older adults is not clearly related to the circumstances of dying of the deceased partner. Preexisting conditions such as depression seem to be more important in explaining the occurrence of complicated grief.
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Affiliation(s)
- Sophie M Bruinsma
- 1 Department of Public Health, Erasmus University Medical Centre , Rotterdam, the Netherlands
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Bernheim JL, Distelmans W, Mullie A, Ashby MA. Questions and answers on the Belgian model of integral end-of-life care: experiment? Prototype? : "Eu-euthanasia": the close historical, and evidently synergistic, relationship between palliative care and euthanasia in Belgium: an interview with a doctor involved in the early development of both and two of his successors. JOURNAL OF BIOETHICAL INQUIRY 2014; 11:507-29. [PMID: 25124983 PMCID: PMC4263821 DOI: 10.1007/s11673-014-9554-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 04/10/2014] [Indexed: 05/11/2023]
Abstract
This article analyses domestic and foreign reactions to a 2008 report in the British Medical Journal on the complementary and, as argued, synergistic relationship between palliative care and euthanasia in Belgium. The earliest initiators of palliative care in Belgium in the late 1970s held the view that access to proper palliative care was a precondition for euthanasia to be acceptable and that euthanasia and palliative care could, and should, develop together. Advocates of euthanasia including author Jan Bernheim, independent from but together with British expatriates, were among the founders of what was probably the first palliative care service in Europe outside of the United Kingdom. In what has become known as the Belgian model of integral end-of-life care, euthanasia is an available option, also at the end of a palliative care pathway. This approach became the majority view among the wider Belgian public, palliative care workers, other health professionals, and legislators. The legal regulation of euthanasia in 2002 was preceded and followed by a considerable expansion of palliative care services. It is argued that this synergistic development was made possible by public confidence in the health care system and widespread progressive social attitudes that gave rise to a high level of community support for both palliative care and euthanasia. The Belgian model of so-called integral end-of-life care is continuing to evolve, with constant scrutiny of practice and improvements to procedures. It still exhibits several imperfections, for which some solutions are being developed. This article analyses this model by way of answers to a series of questions posed by Journal of Bioethical Inquiry consulting editor Michael Ashby to the Belgian authors.
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Affiliation(s)
- Jan L Bernheim
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan, 103, 1090, Brussels, Belgium,
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Bruinsma SM, Brown J, van der Heide A, Deliens L, Anquinet L, Payne SA, Seymour JE, Rietjens JAC. Making sense of continuous sedation in end-of-life care for cancer patients: an interview study with bereaved relatives in three European countries. Support Care Cancer 2014; 22:3243-52. [PMID: 25022759 DOI: 10.1007/s00520-014-2344-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 06/29/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the study was to explore relatives' descriptions and experiences of continuous sedation in end-of-life care for cancer patients and to identify and explain differences between respondents from the Netherlands, Belgium, and the UK. METHODS In-depth interviews were held between January 2011 and May 2012 with 38 relatives of 32 cancer patients who received continuous sedation until death in hospitals, the community, and hospices/palliative care units. RESULTS Relatives' descriptions of the practice referred to the outcome, to practical aspects, and to the goals of sedation. While most relatives believed sedation had contributed to a 'good death' for the patient, yet many expressed concerns. These related to anxieties about the patient's wellbeing, their own wellbeing, and questions about whether continuous sedation had shortened the patient's life (mostly UK), or whether an alternative approach would have been better. Such concerns seemed to have been prompted by relatives witnessing unexpected events such as the patient coming to awareness during sedation. In the Netherlands and in Belgium, several relatives reported that the start of the sedation allowed for a planned moment of 'saying goodbye'. In contrast, UK relatives discerned neither an explicit point at which sedation was started nor a specific moment of farewell. CONCLUSIONS Relatives believed that sedation contributed to the patient having a good death. Nevertheless, they also expressed concerns that may have been provoked by unexpected events for which they were unprepared. There seems to exist differences in the process of saying goodbye between the NL/BE and the UK.
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Affiliation(s)
- S M Bruinsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands,
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Gamondi C, Pott M, Forbes K, Payne S. Exploring the experiences of bereaved families involved in assisted suicide in Southern Switzerland: a qualitative study. BMJ Support Palliat Care 2013; 5:146-52. [PMID: 24644190 DOI: 10.1136/bmjspcare-2013-000483] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 08/16/2013] [Indexed: 11/04/2022]
Abstract
BACKGROUND In Switzerland, helping with assisted suicide under certain conditions is not prosecuted. With approximately 300 cases annually, this leaves behind a large group of bereaved people where its consequences are mostly unknown. The study aimed to explore family involvement in decision making prior to assisted suicide, and to examine their ways of coping during the bereavement period. METHODS A qualitative interview study used the principles of Grounded Theory analysis. Eleven relatives of eight patients, who died in Southern Switzerland after assisted suicide, participated in semistructured interviews. RESULTS The large majority of family members faced moral dilemmas during the decision-making phase. Their respect for patient's autonomy was a key justification to resolve dilemmas. Two types of involvement were identified: categorised as 'passive' when the decision making was located with the patient, and 'active' when assisted suicide was proposed by the family member and/or the relative was involved in some way. The relatives reported feelings of isolation during and after assisted suicide. Family members reported fear of social stigma and did not openly disclose assisted suicide as the cause of death. None of those interviewed received formal psychological support. CONCLUSIONS Bereaved families express moral dilemmas, feelings of isolation and secrecy in the management of assisted suicide in Southern Switzerland. These features seem underestimated and not sufficiently recognised by the healthcare professionals. Management of assisted suicide requests should include consideration of family members' needs, in addition to those of the patient.
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Affiliation(s)
- Claudia Gamondi
- Palliative Care Department, Oncology Institute of Southern Switzerland, Ticino, Switzerland Palliative Care Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Murielle Pott
- Clinical Research Unit, Haute Ecole de Santé Vaud, Lausanne, Switzerland
| | - Karen Forbes
- Department of Palliative Medicine, University of Bristol, Bristol, UK
| | - Sheila Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Pols H, Oak S. Physician-assisted dying and psychiatry: recent developments in The Netherlands. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2013; 36:506-514. [PMID: 23816378 DOI: 10.1016/j.ijlp.2013.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The Netherlands was one of the first countries in the world to establish a legal framework for physician-assisted dying (PAD). In this article, we provide an overview of the public, political, legal, and medical debates on physician-assisted dying in The Netherlands, focusing on the role of psychiatry and mental illness. The number of individuals with chronic mental illness requesting PAD has been relatively small (although the number can be expected to increase because of the activities of various civic organizations advocating the right to die) and Dutch psychiatrists have been extremely reluctant to respond to such requests. Nevertheless, mental conditions have been central to the public debate on PAD by helping to define the nature and limits of current legislation and professional practice. Although a few Dutch psychiatrists have campaigned to increase the involvement of psychiatrists and many support PAD in principle, the majority has been hesitant to engage in PAD despite increasing public pressure.
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Affiliation(s)
- Hans Pols
- Unit for History and Philosophy of Science, Carslaw F07, University of Sydney, NSW 2006, Australia.
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Dees MK, Vernooij-Dassen MJ, Dekkers WJ, Elwyn G, Vissers KC, van Weel C. Perspectives of decision-making in requests for euthanasia: a qualitative research among patients, relatives and treating physicians in the Netherlands. Palliat Med 2013; 27:27-37. [PMID: 23104511 DOI: 10.1177/0269216312463259] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Euthanasia has been legally performed in the Netherlands since 2002. Respect for patient's autonomy is the underpinning ethical principal. However, patients have no right to euthanasia, and physicians have no obligation to provide it. Although over 3000 cases are conducted per year in the Netherlands, there is little known about how decision-making occurs and no guidance to support this difficult aspect of clinical practice. AIM To explore the decision-making process in cases where patients request euthanasia and understand the different themes relevant to optimise this decision-making process. DESIGN A qualitative thematic analysis of interviews with patients making explicit requests for euthanasia, most-involved relative(s) and treating physician. PARTICIPANTS/SETTING Thirty-two cases, 31 relatives and 28 treating physicians. Settings were patients' and relatives' homes and physicians' offices. RESULTS Five main themes emerged: (1) initiation of sharing views and values about euthanasia, (2) building relationships as part of the negotiation, (3) fulfilling legal requirements, (4) detailed work of preparing and performing euthanasia and (5) aftercare and closing. CONCLUSIONS A patient's request for euthanasia entails a complex process that demands emotional work by all participants. It is characterised by an intensive period of sharing information, relationship building and negotiation in order to reach agreement. We hypothesise that making decisions about euthanasia demands a proactive approach towards participants' preferences and values regarding end of life, towards the needs of relatives, towards the burden placed on physicians and a careful attention to shared decision-making. Future research should address the communicational skills professionals require for such complex decision-making.
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Affiliation(s)
- Marianne K Dees
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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Macleod S. Assisted dying in liberalised jurisdictions and the role of psychiatry: a clinician's view. Aust N Z J Psychiatry 2012; 46:936-45. [PMID: 23028195 DOI: 10.1177/0004867411434714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Assisted dying is a contentious and topical issue. Mental disorder is a relevant influence on requests of hastened death. The psychiatry of dying is not a prominent component in the assessment of euthanasia and physician-assisted suicide (PAS) in jurisdictions with liberalised assisted dying laws. The literature on the assessment processes, with particular reference to mental status, involved in euthanasia requests is considered. METHODS An experienced palliative medicine specialist and psychiatrist selectively reviewed the recent literature published about the mental health issues involved in euthanasia and PAS. RESULTS Assessments of competency, sustained wish to die prematurely, depressive disorder, demoralisation and 'unbearable suffering' in the terminally ill are clinically uncertain and difficult tasks. There is a growing psychiatric and psychological literature on the mental status of the terminally ill. As yet psychiatry does not have the expertise to 'select' those whose wish for hastened death is rational, humane and 'healthy'. Rarely in those societies with liberalised assisted dying laws are psychiatrists involved in the decision-making for individuals requesting early death. This role is fulfilled by non-specialists. CONCLUSIONS There remain significant concerns about the accuracy of psychiatric assessment in the terminally ill. Mental processes are more relevant influences on a hastened wish to die than are the physical symptoms of terminal malignant disease. Psychiatric review of persons requesting euthanasia is relevant. It is not obligatory or emphasised in those legislations allowing assisted dying. Psychiatry needs to play a greater role in the assessment processes of euthanasia and PAS.
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Affiliation(s)
- Sandy Macleod
- Health Sciences Centre, University of Canterbury, Christchurch, New Zealand.
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Beydon L, Pelluchon C, Beloucif S, Baghdadi H, Baumann A, Bazin JE, Bizouarn P, Crozier S, Devalois B, Eon B, Fieux F, Frot C, Gisquet E, Guibet Lafaye C, Kentish-Barnes N, Muzard O, Nicolas-Robin A, Lopez MO, Roussin F, Puybasset L. [Euthanasia, assisted suicide and palliative care: a review by the Ethics Committee of the French Society of Anaesthesia and Intensive Care]. ACTA ACUST UNITED AC 2012; 31:694-703. [PMID: 22922010 DOI: 10.1016/j.annfar.2012.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 07/19/2012] [Indexed: 10/28/2022]
Abstract
CONTEXT Management of the end of life is a major social issue which was addressed in France by law, on April 22nd 2005. Nevertheless, a debate has emerged within French society about the legalization of euthanasia and/or assisted suicide (E/AS). This issue raises questions for doctors and most especially for anesthetists and intensive care physicians. OBJECTIVE To highlight, dispassionately and without dogmatism, key points taken from the published literature and the experience of countries which have legislated for E/AS. RESULTS The current French law addresses most of the end of life issues an intensive care physician might encounter. It is credited for imposing palliative care when therapies have become senseless and are withdrawn. However, this requirement for palliative care is generally applied too late in the course of a fatal illness. There is a great need for more education and stronger incentives for early action in this area. On the rare occasions when E/AS is requested, either by the patient or their loved-ones, it often results from a failure to consider that treatments have become senseless and conflict with patient's best interest. The implementation of E/AS cannot be reduced to a simple affirmation of the Principle of autonomy. Such procedures present genuine difficulties and the risk of drift. CONCLUSION We deliver a message of prudence and caution. Should we address painful end of life and moral suffering issues, by suppressing the subject, i.e. ending the patient's life, when comprehensive palliative care has not first been fully granted to all patients in need of it ?
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Affiliation(s)
- L Beydon
- Pôle d'anesthésie-réanimation, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France.
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Gysels M, Evans N, Meñaca A, Andrew E, Toscani F, Finetti S, Pasman HR, Higginson I, Harding R, Pool R. Culture and end of life care: a scoping exercise in seven European countries. PLoS One 2012; 7:e34188. [PMID: 22509278 PMCID: PMC3317929 DOI: 10.1371/journal.pone.0034188] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/28/2012] [Indexed: 11/18/2022] Open
Abstract
AIM Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence on cultural issues in EoL care generated in the different countries. METHODS We scoped the literature for Germany, Norway, Belgium, The Netherlands, Spain, Italy and Portugal, carrying out electronic searches in 16 international and country-specific databases and handsearches in 17 journals, bibliographies of relevant papers and webpages. We analysed the literature which was unearthed, in its entirety and by type (reviews, original studies, opinion pieces) and conducted quantitative analyses for each country and across countries. Qualitative techniques generated themes and sub-themes. RESULTS A total of 868 papers were reviewed. The following themes facilitated cross-country comparison: setting, caregivers, communication, medical EoL decisions, minority ethnic groups, and knowledge, attitudes and values of death and care. The frequencies of themes varied considerably between countries. Sub-themes reflected issues characteristic for specific countries (e.g. culture-specific disclosure in the southern European countries). The work from the seven European countries concentrates on cultural traditions and identities, and there was almost no evidence on ethnic minorities. CONCLUSION This scoping review is the first comparative exploration of the cultural differences in the understanding of EoL care in these countries. The diverse body of evidence that was identified on socio-cultural issues in EoL care, reflects clearly distinguishable national cultures of EoL care, with differences in meaning, priorities, and expertise in each country. The diverse ways that EoL care is understood and practised forms a necessary part of what constitutes best evidence for the improvement of EoL care in the future.
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Affiliation(s)
- Marjolein Gysels
- Barcelona Centre for International Health Research, Universitat de Barcelona, Barcelona, Spain.
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Abstract
Suicide is generally viewed as an unexpected cause of death. However, some suicides might be expected to a certain extent, which needs to be further studied. The relationships between expecting suicide, feeling understanding for the suicide, and later grief experiences were explored. In total, 142 bereaved participants completed the Grief Experience Questionnaire and additional measurements on expectance and understanding. Results supported the prediction of a link between expecting suicide and understanding the suicide. Higher expectance and understanding were related to less searching for explanation and preoccupation with the suicide. There was no direct association with other grief experiences. We conclude that more attention should be brought to the relation between expecting the suicide of a loved one and later grief responses in research and in clinical practice.
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Affiliation(s)
- Joanna Wojtkowiak
- Joanna Wojtkowiak, Department of Nursing Home Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Verena Wild, Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; Jos Egger, Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands; Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands; Pompe Institute for Forensic Psychiatry, Forum GGZ, Nijmegen, The Netherlands
| | - Verena Wild
- Joanna Wojtkowiak, Department of Nursing Home Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Verena Wild, Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; Jos Egger, Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands; Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands; Pompe Institute for Forensic Psychiatry, Forum GGZ, Nijmegen, The Netherlands
| | - Jos Egger
- Joanna Wojtkowiak, Department of Nursing Home Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Verena Wild, Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; Jos Egger, Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands; Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands; Pompe Institute for Forensic Psychiatry, Forum GGZ, Nijmegen, The Netherlands
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Kimsma GK. Death by request in The Netherlands: facts, the legal context and effects on physicians, patients and families. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2010; 13:355-61. [PMID: 20668949 PMCID: PMC2949557 DOI: 10.1007/s11019-010-9265-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards euthanasia or physician-assisted suicide. This article does not focus on the arguments for or against euthanasia and the ethical justification of physician-assisted dying. These arguments have been described extensively in Kimsma and Van Leeuwen (Asking to die. Inside the Dutch debate about euthanasia, Kluwer Academic Publishers, Dordrecht, 1998).
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Affiliation(s)
- G K Kimsma
- Vrije Universiteit Medical Center, Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
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Lobb EA, Kristjanson LJ, Aoun SM, Monterosso L, Halkett GKB, Davies A. Predictors of complicated grief: a systematic review of empirical studies. DEATH STUDIES 2010; 34:673-698. [PMID: 24482845 DOI: 10.1080/07481187.2010.496686] [Citation(s) in RCA: 343] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A systematic review of the literature on predictors of complicated grief (CG) was undertaken with the aim of clarifying the current knowledge and to inform future planning and work in CG following bereavement. Predictors of CG prior to the death include previous loss, exposure to trauma, a previous psychiatric history, attachment style, and the relationship to the deceased. Factors associated with the death include violent death, the quality of the caregiving or dying experience, close kinship relationship to the deceased, marital closeness and dependency, and lack of preparation for the death. Perceived social support played a key role after death, along with cognitive appraisals and high distress at the time of the death. Inconsistent definitions of CG and measurement tools were noted in the earlier studies reviewed. Limitations identified in the studies included use of cross-sectional designs, heterogeneous samples, high attrition, demographic differences between cases and controls, differences in length of time since death, and differences in types of death experienced. Notwithstanding these limitations, some consistent findings have emerged. Further research into conceptualizations of CG in terms of attachment theory and constructivist and cognitive-behavioral concepts of finding purpose and meaning after bereavement is warranted.
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Affiliation(s)
- Elizabeth A Lobb
- Cunningham Centre for Palliative Care, Calvary Health Care Sydney, Korgarah, New South Wales, Australia.
| | - Linda J Kristjanson
- WA Centre for Cancer and Palliative Care, Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Western Australia, Australia
| | - Samar M Aoun
- WA Centre for Cancer and Palliative Care, Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Western Australia, Australia
| | - Leanne Monterosso
- WA Centre for Cancer and Palliative Care, Curtin Health Innovation Research Institute, Curtin University of Technology, Western Australia, Australia
| | - Georgia K B Halkett
- WA Centre for Cancer and Palliative Care, Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Western Australia, Australia
| | - Anna Davies
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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van Heest FB, Finlay IG, Kramer JJE, Otter R, Meyboom-de Jong B. Telephone consultations on palliative sedation therapy and euthanasia in general practice in The Netherlands in 2003: a report from inside. Fam Pract 2009; 26:481-7. [PMID: 19833823 DOI: 10.1093/fampra/cmp069] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND GPs with a special interest and with specific training in palliative medicine (GP advisors) supported professional carers (mostly GPs) through a telephone advisory service. Each telephone call was formally documented on paper and subsequently evaluated. OBJECTIVE Data from 2003 were analysed independently to reveal how often and in what way palliative sedation and euthanasia were discussed. METHODS The telephone documentation forms and corresponding evaluation forms of two GP advisors were systematically analysed for problems relating to the role of sedation and/or euthanasia both quantitatively and qualitatively. RESULTS In 87 (21%) of 415 analysed consultations, sedation and/or euthanasia were discussed either as the presenting question (sedation 26 times, euthanasia 37 times and both 10 times) or arising during discussion (sedation 11 times and euthanasia three times). Qualitative analysis revealed that GPs telephoned to explore therapeutic options and/or wanted specific information. Pressure on the GP (either internal or external) to relieve suffering (including shortening life by euthanasia) had often precipitated the call. On evaluation, 100% of the GPs reported that the advice received was of value in the patient's care. CONCLUSION GPs caring for patients dying at home encountered complex clinical dilemmas in end-of-life care (including palliative sedation therapy and euthanasia). They valued practical advice from, and open discussion with, GP advisors. The advice often helped the GP find solutions to the patient's problems that did not require deliberately foreshortening life.
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Affiliation(s)
- Florien B van Heest
- Department for Palliative Medicine, Integraal Kankercentrum Noord Oost, 9700 AH Groningen, The Netherlands.
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Ganzini L, Goy ER, Dobscha SK, Prigerson H. Mental health outcomes of family members of Oregonians who request physician aid in dying. J Pain Symptom Manage 2009; 38:807-15. [PMID: 19783401 DOI: 10.1016/j.jpainsymman.2009.04.026] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 04/14/2009] [Accepted: 04/22/2009] [Indexed: 11/12/2022]
Abstract
Oregon legalized physician aid in dying over 10 years ago but little is known about the effects of this choice on family members' mental health. We surveyed 95 family members of decedent Oregonians who had explicitly requested aid in dying, including 59 whose loved one received a lethal prescription and 36 whose loved one died by lethal ingestion. For comparison purposes, family members of Oregonians who died of cancer or amyotrophic lateral sclerosis also were surveyed. A mean of 14 months after death, 11% of family members whose loved one requested aid in dying had major depressive disorder, 2% had prolonged grief, and 38% had received mental health care. Among those whose family member requested aid in dying, whether or not the patient accessed a lethal prescription had no influence on subsequent depression, grief, or mental health services use; however, family members of Oregonians who received a lethal prescription were more likely to believe that their loved one's choices were honored and less likely to have regrets about how the loved one died. Comparing family members of those who requested aid in dying to those who did not revealed no differences in primary mental health outcomes of depression, grief, or mental health services use. Family members of Oregonians who requested aid in dying felt more prepared and accepting of the death than comparison family members. In summary, pursuit of aid in dying does not have negative effects on surviving family members and may be associated with greater preparation and acceptance of death.
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Affiliation(s)
- Linda Ganzini
- Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Health Services Research and Development, Research Service (R&D 66), Portland Veterans Affairs Medical Center, Portland, Oregon 97239, USA.
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Jansen-van der Weide MC, Onwuteaka-Philipsen BD, Heide AVD, Wal GVD. How patients and relatives experience a visit from a consulting physician in the euthanasia procedure: a study among relatives and physicians. DEATH STUDIES 2009; 33:199-219. [PMID: 19350750 DOI: 10.1080/07481180802672272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study investigated the impact of a visit from a consulting physician on the patient and the relatives during the euthanasia procedure in The Netherlands. Data on experiences with the consultant's visit were collected from 86 relatives and 3,614 general practitioners, who described their most recent request for euthanasia or physician-assisted suicide. More than three-quarters of the patients experienced the visit as they had expected, or became more positive. Although about 1 out of 5 patients had negative experiences, this study indicates that, in general, a visit from a consulting physician is not perceived to be burdensome for patients.
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Affiliation(s)
- Marijke C Jansen-van der Weide
- Department of Public and Occupational Health and Institute for Research in Extramural Medicine, VU University Medical Center Amsterdam, The Netherlands
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