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Acquier M, Boyer A, Guidet B, Lautrette A, Reignier J, Thiery G, Robert R. ICU health care workers opinion on physician-assisted-suicide and euthanasia: a French survey. Ann Intensive Care 2023; 13:19. [PMID: 36933060 PMCID: PMC10024783 DOI: 10.1186/s13613-023-01114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/20/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND In France, physician-assisted suicide or euthanasia are not legal but are still debated. French intensive care unit (ICU) health care workers (HCWs) have an insider's perspective on the global quality of the patient's end-of-life, whether it occurs in ICU or not. However, their opinion about euthanasia/physician-assisted suicide remains unknown. The aim of this study is to investigate the opinion of French ICU HCWs about physician-assisted suicide/euthanasia. RESULTS A total of 1149 ICU HCWs participated to a self-administered anonymous questionnaire: 411 (35.8%) physicians and 738 (64.2%) non-physicians. Among them, 76.5% indicated they were in favor of legalizing euthanasia/physician-assisted suicide. Non-physicians HCWs were significantly more in favor of the legalization of euthanasia/physician assisted suicide than physicians (87% vs 57.8% p < 0.001). Euthanasia/physician-assisted suicide of an ICU patient raised the most important difference in positive judgment between physicians and non-physicians HCWs (80.3% vs 42.2%; p < 0.001 of non-physicians and physicians, respectively). The questionnaire included three case vignettes of concrete examples which participated to the increase in the rate of response in favor of euthanasia/physician-assisted suicide legalization (76.5-82.9%; p < 0.001). CONCLUSIONS Keeping in mind the unknown representation of our sample, ICU HCWs, particularly non physicians, would be in favor of a law legalizing euthanasia/physician-assisted suicide.
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Affiliation(s)
- Mathieu Acquier
- Intensive Care Medicine, CHU de Bordeaux, 33000, Bordeaux, France
| | - Alexandre Boyer
- Intensive Care Medicine, CHU de Bordeaux, 33000, Bordeaux, France.
| | - Bertrand Guidet
- Intensive Care Medicine, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint Antoine, Sorbonne Université, 75012, Paris, France
| | - Alexandre Lautrette
- Intensive Care Medicine, Montpied Teaching Hospital, 63000, Clermont-Ferrand, France
| | - Jean Reignier
- Intensive Care Medicine, CHU de Nantes, Nantes, France
- Movement-Interactions-Performance, MIP, UR 4334, Nantes Université, 44000, Nantes, France
| | - Guillaume Thiery
- Intensive Care Medicine, CHU de Saint Etienne, Jean Monnet Université, Saint-Étienne, France
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - René Robert
- CIC Inserm 1402, CHU Poitiers, University of Poitiers, 86000, Poitiers, France
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Rodríguez-Prat A, Wilson DM, Agulles R. Autonomy and control in the wish to die in terminally ill patients: A systematic integrative review. Palliat Support Care 2021; 19:759-766. [PMID: 34231452 DOI: 10.1017/s1478951521000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND/OBJECTIVE Personal autonomy and control are major concepts for people with life-limiting conditions. Patients who express a wish to die (WTD) are often thought of wanting it because of loss of autonomy or control. The research conducted so far has not focused on personal beliefs and perspectives; and little is known about patients' understanding of autonomy and control in this context. The aim of this review was to analyze what role autonomy and control may play in relation to the WTD expressed by people with life-limiting conditions. METHODS A systematic integrative review was conducted. The search strategy used MeSH terms in combination with free-text searching of the EBSCO Discovery Service (which provides access to multiple academic library literature databases, including PubMed and CINAHL), as well as the large PsycINFO, Scopus, and Web of Science library literature databases from their inception until February 2019. The search was updated to January 2021. RESULTS After the screening process, 85 full texts were included for the final analysis. Twenty-seven studies, recording the experiences of 1,824 participants, were identified. The studies were conducted in Australia (n = 5), Canada (n = 5), USA (n = 5), The Netherlands (n = 3), Spain (n = 2), Sweden (n = 2), Switzerland (n = 2), Finland (n = 1), Germany (n = 1), and the UK (n = 1). Three themes were identified: (1) the presence of autonomy for the WTD, (2) the different ways in which autonomy is conceptualized, and (3) the socio-cultural context of research participants. SIGNIFICANCE OF RESULTS Despite the importance given to the concept of autonomy in the WTD discourse, only a few empirical studies have focused on personal interests. Comprehending the context is crucial because personal understandings of autonomy are shaped by socio-cultural-ethical backgrounds and these impact personal WTD attitudes.
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Affiliation(s)
- Andrea Rodríguez-Prat
- Faculty of Humanities, Universitat Internacional de Catalunya, Barcelona, Spain
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, AB, CanadaT6G 1C9
| | - Remei Agulles
- Faculty of Humanities, Universitat Internacional de Catalunya, Barcelona, Spain
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Nie L, Smith-Han K, Iosua E, Walker S. New Zealand medical students' views of euthanasia/assisted dying across different year levels. BMC MEDICAL EDUCATION 2021; 21:125. [PMID: 33622329 PMCID: PMC7901115 DOI: 10.1186/s12909-021-02558-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Previous studies report a majority of the general public support euthanasia/assisted dying (EAD), while a majority of doctors are opposed. In considering policy decisions about EAD, some may discount the views of doctors because they take them to be based on personal values or tradition, rather than reasons that the general public might share. One way to explore this notion is to examine whether medical students' views change during their medical education. The objective of this study was to learn how New Zealand medical students view EAD and whether students at different year levels have different views. METHODS An on-line survey of undergraduate medical students was conducted asking whether they supported a law change to allow EAD. Quantitative data was analysed using unadjusted and multiple logistic regression. Thematic analysis was conducted with the qualitative data. RESULTS A total of 326 students replied to the survey. The overall response rate was 28%. 65% of 2nd year students were supportive of EAD, compared to 39% in 5th year. The odds of 5th year students supporting a law change compared to 2nd year was 0.30 (95% CI: 0.15-0.60). The predominant themes found in the qualitative results indicate that medical students support or oppose EAD for reasons similar to those found in the wider debate, and that their views are influenced by a range of factors. However, several at all year levels cited an aspect of medical school as having influenced their views. This was mentioned by participants who were supportive of, opposed to, or unsure about EAD, but it was the type of influence most often mentioned by those who were opposed. CONCLUSIONS The quantitative findings show students at the end of 5th year were less likely to support EAD than students at the end of 2nd year. We suggest that this difference is most likely due to their time in medical education. This suggests that the lower support found among doctors is in part related to medical education and medical work rather than age, personality, or social context. The qualitative findings indicate that this is not related to a particular educational experience at Otago Medical School but a range.
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Affiliation(s)
- Luke Nie
- University of Otago, Dunedin, New Zealand
| | | | - Ella Iosua
- University of Otago, Dunedin, New Zealand
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Kolodziejczyk I, Kuzma J. Knowledge and Attitudes Towards Abortion and Euthanasia Among Health Students in Papua New Guinea. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:977-987. [PMID: 33363426 PMCID: PMC7753174 DOI: 10.2147/amep.s281199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to explore knowledge and attitudes of health program students towards ethical issues pertaining to the beginning and the end of human life, and associations between these attitudes and demographic variables. PARTICIPANTS AND METHODS The study took a mixed-method approach with self-administered survey questionnaires and in-depth interviews. A total of 88 students participated in the survey, and 10 students participated in interviews. The study was conducted among students in the Health Extension Program at a Christian university in Papua New Guinea. RESULTS Students showed a higher acceptance of abortion than euthanasia. More year-4 students presented significantly deeper knowledge of euthanasia and abortion compared to year-1 students. There were no gender differences regarding knowledge and attitude towards these two bioethical issues. The majority of students opposed the idea of women's right to abortion, which is attributed mainly to socio-cultural reasons. The qualitative analysis indicated a very strong perception that having children 'defines' womanhood and also revealed general disapproval of any form of euthanasia. A low level of acceptance of various forms of euthanasia is associated with a respect for older people in Melanesian society and beliefs that ancestors' support is required for achieving prosperity in life. CONCLUSION The study offered a comprehensive description and analysis of students' knowledge and attitudes towards ethical issues pertaining to the beginning and the end of human life. Presented a low level of knowledge towards bioethical issues, together with a small proportion of the knowledge gained from lectures and tutorials, indicated inadequate teaching of bioethics and calls for further improvement. In the perspective of rapid social and cultural changes in the Papua New Guinea society, further studies on changing attitudes towards bioethics issues would be valuable.
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Affiliation(s)
- Iwona Kolodziejczyk
- Centre for Learning and Teaching, Divine Word University, Madang, Papua New Guinea
| | - Jerzy Kuzma
- Medical Department, Divine Word University, Madang, Papua New Guinea
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Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Authors' response. Indian J Med Res 2020; 152:147-148. [PMID: 32801227 PMCID: PMC7853257 DOI: 10.4103/0971-5916.292093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Tanu Anand
- Multidisciplinary Research Unit/Model Rural Health Research Unit, New Delhi, India
| | | | - Reeta Rasaily
- Division of Reproductive Biology, Maternal Health & Child Health, New Delhi, India
| | - Ravinder Singh
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Santasabuj Das
- Division of Clinical Medicine, ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Harpreet Singh
- Informatics, Systems & Research Management Cell, Indian Council of Medical Research, New Delhi, India
| | - Ira Praharaj
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Raman R Gangakhedkar
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Balram Bhargava
- Department of Health Research, Ministry of Health & Family Welfare; Indian Council of Medical Research, New Delhi, India
| | - Samiran Panda
- ICMR-National AIDS Research Institute, Pune, Maharashtra, India
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6
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Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Authors' response. Indian J Med Res 2020; 152:128-129. [PMID: 32773429 PMCID: PMC7853284 DOI: 10.4103/0971-5916.291401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Tanu Anand
- Multidisciplinary Research Unit/Model Rural Health Research Unit, New Delhi, India
| | | | - Reeta Rasaily
- Division of Reproductive Biology, Maternal Health & Child Health, New Delhi, India
| | - Ravinder Singh
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Santasabuj Das
- Division of Clinical Medicine, ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Harpreet Singh
- Informatics, Systems & Research Management Cell, Indian Council of Medical Research, New Delhi, India
| | - Ira Praharaj
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Raman R Gangakhedkar
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Balram Bhargava
- Department of Health Research, Ministry of Health & Family Welfare; Indian Council of Medical Research, New Delhi, India
| | - Samiran Panda
- ICMR-National AIDS Research Institute, Pune, Maharashtra, India
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Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Authors' response. Indian J Med Res 2020; 152:141. [PMID: 32773423 PMCID: PMC7853261 DOI: 10.4103/0971-5916.291338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Tanu Anand
- Multidisciplinary Research Unit/Model Rural Health Research Unit, New Delhi, India
| | | | - Reeta Rasaily
- Division of Reproductive Biology, Maternal Health & Child Health, New Delhi, India
| | - Ravinder Singh
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Santasabuj Das
- Division of Clinical Medicine, ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Harpreet Singh
- Informatics, Systems & Research Management Cell, Indian Council of Medical Research, New Delhi, India
| | - Ira Praharaj
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Raman R Gangakhedkar
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Balram Bhargava
- Department of Health Research, Ministry of Health & Family Welfare; Indian Council of Medical Research, New Delhi, India
| | - Samiran Panda
- ICMR-National AIDS Research Institute, Pune, Maharashtra, India
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8
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Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Authors' response. Indian J Med Res 2020; 152:117-118. [PMID: 32773416 PMCID: PMC7853289 DOI: 10.4103/0971-5916.290527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Tanu Anand
- Multidisciplinary Research Unit/Model Rural Health Research Unit, New Delhi, India
| | | | - Reeta Rasaily
- Division of Reproductive Biology, Maternal Health & Child Health, New Delhi, India
| | - Ravinder Singh
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Santasabuj Das
- Division of Clinical Medicine, ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Harpreet Singh
- Informatics, Systems & Research Management Cell, Indian Council of Medical Research, New Delhi, India
| | - Ira Praharaj
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Raman R Gangakhedkar
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Balram Bhargava
- Department of Health Research, Ministry of Health & Family Welfare; Indian Council of Medical Research, New Delhi, India
| | - Samiran Panda
- ICMR-National AIDS Research Institute, Pune, Maharashtra, India
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Gielen J, Van Den Branden S, Broeckaert B. Attitudes of European Physicians toward Euthanasia and Physician-Assisted Suicide: A Review of the Recent Literature. J Palliat Care 2019. [DOI: 10.1177/082585970802400307] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Joris Gielen
- Interdisciplinary Centre for the Study of Religion and World Views, Catholic University Leuven, Leuven, Belgium
| | - Stef Van Den Branden
- Interdisciplinary Centre for the Study of Religion and World Views, Catholic University Leuven, Leuven, Belgium
| | - Bert Broeckaert
- Interdisciplinary Centre for the Study of Religion and World Views, Catholic University Leuven, Leuven, Belgium
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Velan B, Ziv A, Kaplan G, Rubin C, Connelly Y, Karni T, Tal O. Truth-telling and doctor-assisted death as perceived by Israeli physicians. BMC Med Ethics 2019; 20:13. [PMID: 30777058 PMCID: PMC6380017 DOI: 10.1186/s12910-019-0350-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/31/2019] [Indexed: 11/22/2022] Open
Abstract
Background Medicine has undergone substantial changes in the way medical dilemmas are being dealt with. Here we explore the attitude of Israeli physicians to two debatable dilemmas: disclosing the full truth to patients about a poor medical prognosis, and assisting terminally ill patients in ending their lives. Methods Attitudes towards medico-ethical dilemmas were examined through a nationwide online survey conducted among members of the Israeli Medical Association, yielding 2926 responses. Results Close to 60% of the respondents supported doctor-assisted death, while one third rejected it. Half of the respondents opposed disclosure of the full truth about a poor medical prognosis, and the others supported it. Support for truth-telling was higher among younger physicians, and support for doctor-assisted death was higher among females and among physicians practicing in hospitals. One quarter of respondents supported both truth-telling and assisted death, thereby exhibiting respect for patients’ autonomy. This approach characterizes younger doctors and is less frequent among general practitioners. Another quarter of the respondents rejected truth-telling, yet supported assisted death, thereby manifesting compassionate pragmatism. This was associated with medical education, being more frequent among doctors educated in Israel, than those educated abroad. All this suggests that both personal attributes and professional experience affect attitudes of physicians to ethical questions. Conclusions Examination of attitudes to two debatable medical dilemmas allowed portrayal of the multi-faceted medico-ethical scene in Israel. Moreover, this study, demonstrates that one can probe the ethical atmosphere of a given medical community, at various time points by using a few carefully selected questions. Electronic supplementary material The online version of this article (10.1186/s12910-019-0350-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Baruch Velan
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel. .,Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel.
| | - Arnona Ziv
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Giora Kaplan
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.,Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Carmit Rubin
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Yaron Connelly
- Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Tami Karni
- Comprehensive Breast Care Institute, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Orna Tal
- Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
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Abohaimed S, Matar B, Al-Shimali H, Al-Thalji K, Al-Othman O, Zurba Y, Shah N. Attitudes of Physicians towards Different Types of Euthanasia in Kuwait. Med Princ Pract 2019; 28:199-207. [PMID: 30703772 PMCID: PMC6598031 DOI: 10.1159/000497377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/31/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Although in recent years the world has witnessed great advances in the medical field, much ambiguity still surrounds the issue of euthanasia and physician-assisted suicide, with increasingly favorable attitudes among physicians around the world. In our study, we aimed to assess the attitudes of physicians in Kuwait towards different types of euthanasia and examine whether physicians' frequent encounters with terminally ill patients were associated with their approval. SUBJECTS AND METHODS We conducted a cross- sectional study on 464 physicians employed in government hospitals (6 general and 3 specialty hospitals). A self-administered questionnaire adapted from previous studies was used. RESULTS Of the physicians in our study, 43.9% reported that the Ministry of Health should legalize euthanasia under certain restricted conditions. In addition, 29.1% of our population was willing to perform euthanasia. After controlling for several characteristics in logistic regression analysis, approval of passive euthanasia was significantly associated with the following 2 factors: frequent exposure to terminally ill patients (AOR = 2.45) and obtention of the basic medical degree from Asia (AOR = 4.36) or North America/Europe (AOR = 3.24) compared to Kuwait. Male gender was significantly associated with willingness to perform euthanasia. Religion was the major reason for opposing euthanasia. CONCLUSION The attitudes of physicians towards euthanasia are diverse, and therefore the Ministry of Health should provide guidelines for physicians dealing with situations where patients or their families request euthanasia.
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Affiliation(s)
| | - Basma Matar
- Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | | | | | | | - Yasmin Zurba
- Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Nasra Shah
- Department of Community Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
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Isgandarova N. Medical Assistance in Dying: Challenges for Muslim Healthcare Professionals. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2018; 72:202-211. [PMID: 30231815 DOI: 10.1177/1542305018796184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There appears to be a great deal of discussion among non-Muslim healthcare professionals, especially nurses and physicians, about medical assistance in dying. However, the discussion of medical assistance in dying among Muslim health caregivers including physicians, social workers, spiritual caregivers, etc. remains insufficient. A thorough analysis of the content of available resources revealed that we need more literature to analyze the attitude of Muslim health caregivers towards medical assistance in dying. This article describes the general attitude towards medical assistance in dying among non-Muslim. This will allow us to observe the challenges and dilemmas faced by Muslim healthcare professionals around medical assistance in dying.
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de Nonneville A, Chabal T, Marin A, La Piana JM, Fichaux M, Tuzzolino V, Duffaud F, Auquier P, Boulanger A, Baumstark K, Salas S. Determinants of favorable or unfavorable opinion about euthanasia in a sample of French cancer patients receiving palliative care. BMC Palliat Care 2018; 17:104. [PMID: 30157836 PMCID: PMC6114533 DOI: 10.1186/s12904-018-0357-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 08/17/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Opinion about euthanasia has been explored among the general population and recently in patients receiving palliative care. 96% of the French population declared themselves in favor of euthanasia while less of 50% of palliative care patients are. The aim of the present study was to explore and identify potential determinant factors associated with favorable or unfavorable opinion about euthanasia in a French population of cancer patients receiving palliative care. METHODS We performed a cross-sectional study among patients in two palliative care units. Eligible patients were identified by the medical staff. Face-to-face interviews were performed by two investigators. Two groups were defined as favorable or unfavorable about euthanasia according to the answer on the specific question about patient opinion on euthanasia. A multivariate analysis including age, belief in God, chemotherapy and gender was built. RESULTS Seventy-eight patients were interviewed. Median age was 60.5 years (range: 31-87.2). In univariate analysis, patients with a favorable opinion were most often under 60 years old (62 versus 38% unfavorable; p = 0.035), in couple (64 versus 35%; p = 0.032), didn't believe in God (72 versus 28% were non-believers; p < 0.001) and had more frequently an history of chemotherapy treatment (58 versus 42% received at least one cycle of chemotherapy; p = 0.005). In a multivariate analysis, age < 60 years, absence of belief in God and an antecedent of chemotherapy were independently associated with a favorable opinion about euthanasia (OR = 0.237 [0.076-0.746]; p = 0.014, OR = 0.143 [0.044-0.469]; p = 0.001, and OR = 10.418 [2.093-51.853]; p = 0.004, respectively). CONCLUSION We report here determinants of opinion about euthanasia in palliative care cancer patients. Thus, young patients who do not believe in God and have a history of chemotherapy treatment are more likely to request the discontinuation or restriction of their treatment. A better understanding of these determinants is essential for the development of information and/or interventions tailored to the palliative context.
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Affiliation(s)
| | - Théo Chabal
- Aix Marseille University, 13005 Marseille, France
- Department of Oncology and Palliative Care, Timone Hospital, 13005 Marseille, France
- Département de médecine générale, Aix Marseille Université, Marseille, France
| | - Anthony Marin
- Aix Marseille University, 13005 Marseille, France
- Department of Oncology and Palliative Care, Timone Hospital, 13005 Marseille, France
- Département de médecine générale, Aix Marseille Université, Marseille, France
| | | | - Marie Fichaux
- Department of Oncology and Palliative Care, Timone Hospital, 13005 Marseille, France
| | - Véronique Tuzzolino
- Department of Oncology and Palliative Care, Timone Hospital, 13005 Marseille, France
| | - Florence Duffaud
- Aix Marseille University, 13005 Marseille, France
- Department of Oncology and Palliative Care, Timone Hospital, 13005 Marseille, France
| | - Pascal Auquier
- Unité d’Aide Méthodologique à la Recherche Clinique et Epidémiologique, AP-HM, Marseille, France
- Self-perceived Health Assessment Research Unit, Aix Marseille Université, EA3279, Marseille, France
| | | | - Karine Baumstark
- Unité d’Aide Méthodologique à la Recherche Clinique et Epidémiologique, AP-HM, Marseille, France
- Self-perceived Health Assessment Research Unit, Aix Marseille Université, EA3279, Marseille, France
| | - Sébastien Salas
- Aix Marseille University, 13005 Marseille, France
- Department of Oncology and Palliative Care, Timone Hospital, 13005 Marseille, France
- Department of Oncology and palliative care, Hôpital de la Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
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Hurst SA, Zellweger U, Bosshard G, Bopp M. Medical end-of-life practices in Swiss cultural regions: a death certificate study. BMC Med 2018; 16:54. [PMID: 29673342 PMCID: PMC5909244 DOI: 10.1186/s12916-018-1043-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/23/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND End-of-life decisions remain controversial. Switzerland, with three main languages shared with surrounding countries and legal suicide assistance, allows exploration of the effects of cultural differences on end-of-life practices within the same legal framework. METHODS We conducted a death certificate study on a nationwide continuous random sample of Swiss residents. Using an internationally standardized tool, we sent 4998, 2965, and 1000 anonymous questionnaires to certifying physicians in the German-, French-, and Italian-speaking regions. RESULTS The response rates were 63.5%, 51.9%, and 61.7% in the German-, French-, and Italian-speaking regions, respectively. Non-sudden, expected deaths were preceded by medical end-of-life decisions (MELDs) more frequently in the German- than in the French- or Italian-speaking region (82.3% vs. 75.0% and 74.0%, respectively), mainly due to forgoing life-prolonging treatment (70.0%, 59.8%, 57.4%). Prevalence of assisted suicide was similar in the German- and French-speaking regions (1.6%, 1.2%), with no cases reported in the Italian-speaking region. Patient involvement was smaller in the Italian- than in the French- and German-speaking regions (16.0%, 31.2%, 35.6%). Continuous deep sedation was more frequent in the Italian- than in the French- and German-speaking regions (34.4%, 26.9%, 24.5%), and was combined with MELDs in most cases. CONCLUSION We found differences in MELD prevalence similar to those found between European countries. On an international level, MELDs are comparably frequent in all regions of Switzerland, in line with the greater role given to patient autonomy. Our findings show how cultural contexts and legislation can interact in shaping the prevalence of MELDs.
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Affiliation(s)
- Samia A Hurst
- Institute for Ethics, History, and the Humanities, Geneva University Medical School, 1211, Genève, Switzerland
| | - Ueli Zellweger
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zürich, Switzerland
| | - Georg Bosshard
- Clinic for Geriatric Medicine, Zurich University Hospital, and Center on Aging and Mobility, University of Zurich and City Hospital Waid, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zürich, Switzerland.
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Determinants of favourable opinions about euthanasia in a sample of French physicians. BMC Palliat Care 2015; 14:59. [PMID: 26542685 PMCID: PMC4635994 DOI: 10.1186/s12904-015-0055-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/27/2015] [Indexed: 12/03/2022] Open
Abstract
Background The question whether euthanasia should be legalised has led to substantial public debate in France. The objective of this study in a sample of French physicians was to establish the potential determinants of a favourable opinion about euthanasia in general and when faced with a specific situation as embodied in the Humbert affair. Methods The study was a cross-sectional survey investigating two different samples of medical doctors: (1) those specialised in palliative care and affiliated to the French Society for Patient Accompaniment and Palliative Care; (2) medical interns (medical doctors in training course) in a French medical university (Marseille). A questionnaire was sent (email) to each voluntary participant including sociodemographics, professional status, mention of believing in God, and opinion about euthanasia (the question was designed to assess the general opinion about euthanasia and the opinion about a specific case, the Vincent Humbert’ case (a man who was rendered quadriplegic, blind, and mute after an accident and has requested euthanasia). Results A total of 413 physicians participated in the research (participation rate: 48.5 %). Less than half of the population were favourable to euthanasia in general and almost two-thirds of the population were favourable to Vincent Humbert’s request for euthanasia. Based on the multivariate analysis, individuals believing in God and being a medical intern were significant independent factors linked to having a favourable opinion about euthanasia in general and about the Vincent Humbert’s request. Discussion There is still no study in France on the development of opinion about euthanasia and its impact. The issue goes beyond the strictly professional sphere and involves broader socio-political stakes. These stakes do not necessarily take into account medical practices and experiences or the desires of end-of-life patients. The professional upheaval that the future French legal framework will doubtlessly trigger will require further research. Conclusion The professional upheaval that the future French legal framework will doubtlessly trigger will require further research.
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Stolz E, Burkert N, Großschädl F, Rásky É, Stronegger WJ, Freidl W. Determinants of Public Attitudes towards Euthanasia in Adults and Physician-Assisted Death in Neonates in Austria: A National Survey. PLoS One 2015; 10:e0124320. [PMID: 25906265 PMCID: PMC4408035 DOI: 10.1371/journal.pone.0124320] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/27/2015] [Indexed: 11/29/2022] Open
Abstract
Background Euthanasia remains a controversial topic in both public discourses and legislation. Although some determinants of acceptance of euthanasia and physician-assisted death have been identified in previous studies, there is still a shortage of information whether different forms of euthanasia are supported by the same or different sub-populations and whether authoritarian personality dispositions are linked to attitudes towards euthanasia. Methods A large, representative face-to-face survey was conducted in Austria in 2014 (n = 1,971). Respondents faced three scenarios of euthanasia and one of physician assisted death differing regarding the level of specificity, voluntariness and subject, requiring either approval or rejection: (1) abstract description of euthanasia, (2) abstract description of physician-assisted suicide, (3) the case of euthanasia of a terminally-ill 79-year old cancer patient, and (4) the case of non-voluntary, physician assisted death of a severely disabled or ill neonate. A number of potential determinants for rejection ordered in three categories (socio-demographic, personal experience, orientations) including authoritarianism were tested via multiple logistic regression analyses. Results Rejection was highest in the case of the neonate (69%) and lowest for the case of the older cancer patient (35%). A consistent negative impact of religiosity on the acceptance across all scenarios and differential effects for socio-economic status, area of residence, religious confession, liberalism, and authoritarianism were found. Individuals with a stronger authoritarian personality disposition were more likely to reject physician-assisted suicide for adults but at the same time also more likely to approve of physician-assisted death of a disabled neonate. Conclusion Euthanasia in adults was supported by a partially different sub-population than assisted death of disabled neonates.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Nathalie Burkert
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Franziska Großschädl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Éva Rásky
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | | | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
- * E-mail:
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Abstract
PURPOSE OF REVIEW Physician-assisted suicide (PAS) and euthanasia have been increasingly discussed in end-of-life care, as PAS and euthanasia have now been legalized in three European countries and PAS has been legalized in Washington, Oregon, and Montana in the USA. This review focuses on some aspects of PAS and euthanasia and discusses deep terminal sedation (DTS), which is increasingly used to treat intractable symptoms at the end of life. RECENT FINDINGS PAS and euthanasia present potential risks for vulnerable populations, such as the depressed and disabled. The Oregon experience does not allow specific analysis regarding disabled patients, but fewer psychiatric consultations are being done to evaluate patients for depression. In the Netherlands, a small number of patients undergo euthanasia without an explicit request. Twenty percent of cases go unreported, raising questions of whether they met legal standards. The use of DTS in all countries has increased, but in a significant number of cases, DTS is used with an explicit intent to hasten death. Double-effect arguments to justify DTS may not actually apply. SUMMARY Caution is warranted regarding PAS and euthanasia, as vulnerable patients may still be at risk. More research is needed to characterize the use (and misuse) of DTS.
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Stronegger WJ, Burkert NT, Grossschädl F, Freidl W. Factors associated with the rejection of active euthanasia: a survey among the general public in Austria. BMC Med Ethics 2013; 14:26. [PMID: 23826902 PMCID: PMC3750397 DOI: 10.1186/1472-6939-14-26] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 07/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent decades, the general public has become increasingly receptive toward a legislation that allows active voluntary euthanasia (AVE). The purpose of this study was to survey the current attitude towards AVE within the Austrian population and to identify explanatory factors in the areas of socio-demographics, personal experiences with care, and ideological orientation. A further objective was to examine differences depending on the type of problem formulation (abstract vs. situational) for the purpose of measuring attitude. METHODS A representative cross-sectional study was conducted across the Austrian population. Data were acquired from 1,000 individuals aged 16 years and over based on telephone interviews (CATI). For the purpose of measuring attitude toward AVE, two different problem formulations (abstract vs. situational) were juxtaposed. RESULTS The abstract question about active voluntary euthanasia was answered negatively by 28.8%, while 71.2% opted in favour of AVE or were undecided. Regression analyses showed rejection of AVE was positively correlated with number of adults and children in the household, experience with care of seriously ill persons, a conservative worldview, and level of education. Mean or high family income was associated with lower levels of rejection. No independent correlations were found for variables such as sex, age, political orientation, self-rated health, and experiences with care of terminally ill patients. Correlation for the situational problem formulation was weaker and included fewer predictors than for the abstract question. CONCLUSIONS Our results suggest that factors relating to an individual's interpersonal living situation and his/her cognitive convictions might be important determinants of the attitude toward AVE. If and to the extent that personal care experience plays a role, it is rather associated with rejection than with acceptance of AVE.
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Affiliation(s)
- Willibald J Stronegger
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstrasse 6/I, 8010, Graz, Austria.
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Kouwenhoven PSC, Raijmakers NJH, van Delden JJM, Rietjens JAC, Schermer MHN, van Thiel GJMW, Trappenburg MJ, van de Vathorst S, van der Vegt BJ, Vezzoni C, Weyers H, van Tol DG, van der Heide A. Opinions of health care professionals and the public after eight years of euthanasia legislation in the Netherlands: a mixed methods approach. Palliat Med 2013; 27:273-80. [PMID: 22695742 DOI: 10.1177/0269216312448507] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The practice of euthanasia and physician-assisted suicide (PAS) in the Netherlands has been regulated since 2002 by the Euthanasia Act. In the ongoing debate about the interpretation of this Act, comparative information about the opinions of the different stakeholders is needed. AIM To evaluate the opinions of Dutch physicians, nurses and the general public on the legal requirements for euthanasia and PAS. DESIGN A cross-sectional survey among Dutch physicians and nurses in primary and secondary care and members of the Dutch general public, followed by qualitative interviews among selected respondents. The participants were: 793 physicians, 1243 nurses and 1960 members of the general public who completed the questionnaire; 83 were interviewed. RESULTS Most respondents agreed with the requirement of a patient request (64-88%) and the absence of a requirement concerning life expectancy (48-71%). PAS was thought acceptable by 24-39% of respondents for patients requesting it because of mental suffering due to loss of control, chronic depression or early dementia. In the case of severe dementia, one third of physicians, 58% of nurses and 77% of the general public agreed with performing euthanasia based on an advance directive. Interviewees illustrated these findings and supported the Act. CONCLUSIONS Health care professionals and the general public mostly support the legal requirements for euthanasia and PAS. The law permits euthanasia or PAS for mental suffering but this possibility is not widely endorsed. The general public is more liberal towards euthanasia for advanced dementia than health care professionals. We conclude that there is ample support for the law after eight years of legal euthanasia.
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Abstract
PURPOSE OF REVIEW At present, clinicians and healthcare providers are increasingly urged to advance the provision of state-of-the-art palliative care for patients with incurable cancer. This review provides an overview about the recent findings and practical suggestions. RECENT FINDINGS In the last decade, the awareness about the logistic and personal resources needed to meet the somatic and psychological needs of patients with progressive and life-threatening diseases has increased and in parallel, palliative care concepts and expertise have evolved substantially. Care concepts for patients with metastatic cancer emphasized the potential of interdisciplinary care. For example, in 2010, a randomized trial reported a benefit for patients with lung cancer who received early palliative care in addition to routine care. It is discussed that this was because of increased quality of life and detailed exploration of patient preferences. SUMMARY Patients, families and physicians benefit from shared care concepts of oncology and specialized palliative care. Although this concept is already becoming increasingly implemented in tertiary (comprehensive cancer-) care settings, the potential of this approach should be explored for other clinical settings such as office-based oncology.
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Otani H, Morita T, Esaki T, Ariyama H, Tsukasa K, Oshima A, Shiraisi K. Burden on oncologists when communicating the discontinuation of anticancer treatment. Jpn J Clin Oncol 2011; 41:999-1006. [PMID: 21764830 PMCID: PMC3146312 DOI: 10.1093/jjco/hyr092] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective Communicating the discontinuation of anticancer treatment to patients is a difficult task. The primary aim of this study was to clarify the level of oncologist-reported burden when communicating about discontinuation of an anticancer treatment. The secondary aims were (i) to identify the sources of burden contributing to their levels and (ii) to explore the useful strategies to alleviate their burden. Methods A multicenter nationwide questionnaire survey was conducted on 620 oncologists across Japan (response rate, 67%). Results High levels of perceived burden were reported by 47% of respondents, and 17% reported that they sometimes, often or always wanted to stop oncology work because of this burden. There was a significant association between high levels of burden and: a feeling that breaking bad news would deprive the patient of hope; concern that the patient's family would blame the oncologist; concern that the patient may lose self-control; and a feeling that there was not enough time to break the bad news. Strategies perceived to be useful by oncologists included training in how to effectively communicate to patients discontinuation of anticancer treatment, a reduction in total workload to allow sufficient time to break bad news, and development of a multidisciplinary model to facilitate cooperation with other professionals and facilities. Conclusions Many oncologists reported high levels of burden relating to communication of discontinuation of anticancer treatment. A specific communication skills training program, sufficient time for communication and development of a multidisciplinary model could help alleviate the burden on oncologists.
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Affiliation(s)
- Hiroyuki Otani
- Department of Palliative Care Team, and Psycho-Oncology, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1347, Japan.
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Broeckaert B, Gielen J, van Iersel T, Van den Branden S. Euthanasia and Palliative Care in Belgium: The Attitudes of Flemish Palliative Care Nurses and Physicians Toward Euthanasia. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/21507716.2010.505900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mpinga EK, Verloo H, Rapin CH, Chastonay P. [Pain and conflicts: a comparative approach and implications for end-of-life quality of care]. Pain Res Manag 2009; 14:287-92. [PMID: 19714268 PMCID: PMC2734515 DOI: 10.1155/2009/371953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2024]
Abstract
UNLABELLED Are conflicts to an organization what pain is to an organism? OBJECTIVES To explore the similarities and the differences between pain and conflicts in palliative care settings, and to better understand the potential importance of conflicts in end of life quality of care. METHODS Comparative and reflective methods focusing on how conflicts and pain are taken care of in health structures. RESULTS Pain and conflicts present numerous similarities such as identity, typology, prevalence, warning function, economic and social costs, denial, occultation and hurdles to appropriate management. Differences also exist regarding pain - there are prevention programs on local and international levels; there are specific research and training programs; and there is also some social visibility. This does not yet exist on a larger scale regarding conflicts. CONCLUSION Decision makers at clinical and public health levels should probably push to label conflicts as indicators of quality of care and develop appropriate health policy programs.
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Affiliation(s)
- Emmanuel K Mpinga
- Institut de médecine sociale et préventive, Département de médecine et santé communautaires, Faculté de médecine, Université de Genève, Genève, Suisse.
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Benoit DD, Depuydt PO, Decruyenaere JM. Should We Admit Critically Ill Cancer Patients to the ICU? Intensive Care Med 2009. [DOI: 10.1007/978-0-387-92278-2_77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Burette P, Boüüaert C, Vanmeerbeek M, Giet D. [Four years of application of the law that decriminalizes euthanasia in Belgium]. Presse Med 2008; 37:1281-8. [PMID: 18313886 DOI: 10.1016/j.lpm.2007.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 07/29/2007] [Accepted: 09/16/2007] [Indexed: 11/28/2022] Open
Abstract
Legislation decriminalizing euthanasia came into effect in Belgium in 2002. Its application is monitored by a federal Commission, which submitted 2 reports to the Parliament, one covering the first 15 months of application and the other the years 2004 and 2005. This article analyzes and comments on the contents of these 2 documents, which provide interesting information on the medical practice of euthanasia in Belgium.
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Affiliation(s)
- Philippe Burette
- Département de médecine générale, Université de Liège, CHU Sart-Tilman, B-4000 Liège, Belgique
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Bendiane MK, Galinier A, Favre R, Ribiere C, Lapiana JM, Obadia Y, Peretti-Watel P. French district nurses' opinions towards euthanasia, involvement in end-of-life care and nurse patient relationship: a national phone survey. JOURNAL OF MEDICAL ETHICS 2007; 33:708-711. [PMID: 18055901 PMCID: PMC2598217 DOI: 10.1136/jme.2006.018374] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 10/15/2006] [Accepted: 10/16/2006] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To assess French district nurses' opinions towards euthanasia and to study factors associated with these opinions, with emphasis on attitudes towards terminal patients. DESIGN AND SETTING An anonymous telephone survey carried out in 2005 among a national random sample of French district nurses. PARTICIPANTS District nurses currently delivering home care who have at least 1 year of professional experience. Of 803 district nurses contacted, 602 agreed to participate (response rate 75%). MAIN OUTCOME MEASURES Opinion towards the legalisation of euthanasia (on a five-point Likert scale from "strongly agree" to "strongly disagree"), attitudes towards terminal patients (discussing end-of-life issues with them, considering they should be told their prognosis, valuing the role of advance directives and surrogates). RESULTS Overall, 65% of the 602 nurses favoured legalising euthanasia. Regarding associated factors, this proportion was higher among those who discuss end-of-life issues with terminal patients (70%), who consider competent patients should always be told their prognosis (81%) and who value the role of advance directives and surrogates in end-of-life decision-making for incompetent patients (68% and 77% respectively). Women and older nurses were less likely to favour legalising euthanasia, as were those who believed in a god who masters their destiny. CONCLUSIONS French nurses are more in favour of legalising euthanasia than French physicians; these two populations contrast greatly in the factors associated with this support. Further research is needed to investigate how and to what extent such attitudes may affect nursing practice and emotional well-being in the specific context of end-of-life home care.
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Affiliation(s)
- M-K Bendiane
- Southeastern Health Regional Observatory (ORS-PACA), Marseilles, France
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27
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Bendiane MK, Galinier A, Obadia Y, Favre R, Ribiere C, Moatti JP, Peretti-Watel P. Connaissances et attitudes des infirmiers libéraux face à la douleur en fin de vie. Presse Med 2007; 36:1196-202. [PMID: 17363210 DOI: 10.1016/j.lpm.2007.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Accepted: 10/26/2006] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nurses play a crucial role in end-of-life care, especially for outpatients. It is important to assess their knowledge and attitudes regarding pain management during the end-of-life period. METHODS A random national sample of 602 French nurses providing home care responded to a telephone survey. The questionnaire included a scale of knowledge about pain and a short clinical case related to severe pain management, requiring WHO level 3 analgesia, for a dying patient. RESULTS The pain knowledge score depended on nurses' training and was higher for those living with another health professional. For the clinical case, only 60% of nurses favored the prescription of the analgesia recommended by international guidelines. This support depended on objective skills in pain management, but was less frequent for elderly or women patients. DISCUSSION Attitudes toward pain management at the end of life do not depend only on book learning. They are also influenced by more subjective factors that may cause inequality in care for women and the elderly. Nurse training programs should take such factors into account.
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Affiliation(s)
- Marc-Karim Bendiane
- Observatoire régional de la santé Provence Alpes Côte d'Azur (ORS Paca), Marseille.
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Kakuk P. The Slippery Slope of the Middle Ground: Reconsidering Euthanasia in Britain. HEC Forum 2007; 19:145-59. [PMID: 17694995 DOI: 10.1007/s10730-007-9036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Peter Kakuk
- Institute of Behavioral Sciences of the University of Debrecen Medical and Health Sciences Center, Nagyerdei Blvd. 98, P.O. Box 45, 4012 Debrecen, Hungary.
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Lake A. Listening, or just hearing what they say? Med Chir Trans 2007; 100:157-8. [PMID: 17339313 PMCID: PMC1809162 DOI: 10.1177/014107680710000317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alfred Lake
- Anaesthesia, Glan Clwyd Hospital, Bodelwyddan, UK.
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Louhiala P, Hilden HM. Attitudes of Finnish doctors towards euthanasia in 1993 and 2003. JOURNAL OF MEDICAL ETHICS 2006; 32:627-8. [PMID: 17074818 PMCID: PMC2563299 DOI: 10.1136/jme.2006.016246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Questionnaire studies on the attitudes of Finnish doctors towards euthanasia were conducted in 1993 and 2003, and the results show that they have not become more positive.
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Affiliation(s)
- P Louhiala
- Department of Public Health, University of Helsinki, Helsinki, Finland.
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Mpinga EK, Chastonay P, Rapin CH. Conflits et fin de vie dans le contexte des soins palliatifs : une revue systématique de littérature. Rech Soins Infirm 2006. [DOI: 10.3917/rsi.086.0068] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Guedj M, Gibert M, Maudet A, Muñoz Sastre MT, Mullet E, Sorum PC. The acceptability of ending a patient's life. JOURNAL OF MEDICAL ETHICS 2005; 31:311-7. [PMID: 15923476 PMCID: PMC1734167 DOI: 10.1136/jme.2004.008664] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES To clarify how lay people and health professionals judge the acceptability of ending the life of a terminally ill patient. DESIGN Participants judged this acceptability in a set of 16 scenarios that combined four factors: the identity of the actor (patient or physician), the patient's statement or not of a desire to have his life ended, the nature of the action as relatively active (injecting a toxin) or passive (disconnecting life support), and the type of suffering (intractable physical pain, complete dependence, or severe psychiatric illness). PARTICIPANTS 115 lay people and 72 health professionals (22 nurse's aides, 44 nurses, six physicians) in Toulouse, France. MAIN MEASUREMENTS Mean acceptability ratings for each scenario for each group. RESULTS Life ending interventions are more acceptable to lay people than to the health professionals. For both, acceptability is highest for intractable physical suffering; is higher when patients end their own lives than when physicians do so; and, when physicians are the actors, is higher when patients have expressed a desire to die (voluntary euthanasia) than when they have not (involuntary euthanasia). In contrast, when patients perform the action, acceptability for the lay people and nurse's aides does not depend on whether the patient has expressed a desire to die, while for the nurses and physicians unassisted suicide is more acceptable than physician assisted suicide. CONCLUSIONS Lay participants judge the acceptability of life ending actions in largely the same way as do healthcare professionals.
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Affiliation(s)
- M Guedj
- Centre d'Etudes et de Recherches en Psychopathologie, MDR, Université du Mirail, Toulouse, France
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Miccinesi G, Fischer S, Paci E, Onwuteaka-Philipsen BD, Cartwright C, van der Heide A, Nilstun T, Norup M, Mortier F. Physicians’ attitudes towards end-of-life decisions: a comparison between seven countries. Soc Sci Med 2005; 60:1961-74. [PMID: 15743647 DOI: 10.1016/j.socscimed.2004.08.061] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Accepted: 08/25/2004] [Indexed: 10/26/2022]
Abstract
In the context of an European collaborative research project (EURELD), a study on attitudes towards medical end-of-life decisions was conducted among physicians in Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland. Australia also joined the consortium. A written questionnaire with structured questions was sent to practising physicians from specialties frequently involved in the care of dying patients. 10,139 questionnaires were studied. Response rate was equal to or larger than 50% in all countries except Italy (39%). Apart from general agreement with respect to the alleviation of pain and symptoms with possible life-shortening effect, there was large variation in support--between and within countries--for medical decision that may result in the hastening of death. A principal component factor analysis found that 58% of the variance of the responses is explained by four factors. 'Country' explained the largest part of the variation of the standardized factor scores.
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Affiliation(s)
- Guido Miccinesi
- Center for Study and Prevention of Cancer, Epidemiology Unit, Via S.Salvi 12, Florence, 50135 Firenze, Italy.
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Peretti-Watel P, Bendiane MK, Obadia Y, Lapiana JM, Galinier A, Pegliasco H, Favre R, Moatti JP. Disclosure of Prognosis to Terminally Ill Patients: Attitudes and Practices Among French Physicians. J Palliat Med 2005; 8:280-90. [PMID: 15890039 DOI: 10.1089/jpm.2005.8.280] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Disclosure of the prognosis to terminally ill patients is a strong prerequisite for integrating the physical, psychological, spiritual, and social aspects of end-of-life care. OBJECTIVE This study aimed to assess French physicians' general attitudes and effective practices (with patients followed up to death recently) toward such disclosure. DESIGN/SUBJECTS We used data from a cross-sectional survey conducted among a national sample of 917 French general practitioners, oncologists, and neurologists. RESULTS A majority of respondents opted for prognosis disclosure only at patients' request, very few opted for systematic disclosure without patient's request, and a significant minority opted for systematic concealment. Concerning deceased patients described by respondents, 44.5% of competent patients were informed of prognosis by their physician, 27.3% were informed by someone else, 9.0% refused to be informed, and 19.2% were simply not informed. Concealment was more frequent for older patients, and physicians involved in a nongovernmental organization (NGO) for patients' support were more likely to disclose the prognosis, even without patient's request. CONCLUSIONS Disclosure of the prognosis to terminally ill patients is still far from systematic in France. Further research is needed to better understand the motivations of French physicians' disclosure practices, which are probably culturally shaped.
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Affiliation(s)
- P Peretti-Watel
- Regional Center for Disease Control of South-Eastern France, 23 rue Stanislas Torrents, 13006 Marseille, France.
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