1
|
Piili RP, Hökkä M, Vänskä J, Tolvanen E, Louhiala P, Lehto JT. Facing a request for assisted death - views of Finnish physicians, a mixed method study. BMC Med Ethics 2024; 25:50. [PMID: 38702731 PMCID: PMC11067268 DOI: 10.1186/s12910-024-01051-x] [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: 12/05/2023] [Accepted: 04/28/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Assisted death, including euthanasia and physician-assisted suicide (PAS), is under debate worldwide, and these practices are adopted in many Western countries. Physicians' attitudes toward assisted death vary across the globe, but little is known about physicians' actual reactions when facing a request for assisted death. There is a clear gap in evidence on how physicians act and respond to patients' requests for assisted death in countries where these actions are not legal. METHODS A survey including statements concerning euthanasia and PAS and an open question about their actions when facing a request for assisted death was sent to all Finnish physicians. Quantitative data are presented as numbers and percentages. Statistical significance was tested by using the Pearson chi-square test, when appropriate. The qualitative analysis was performed by using an inductive content analysis approach, where categories emerge from the data. RESULTS Altogether, 6889 physicians or medical students answered the survey, yielding a response rate of 26%. One-third of participants agreed or partly agreed that they could assist a patient in a suicide. The majority (69%) of the participants fully or partly agreed that euthanasia should only be accepted due to difficult physical symptoms, while 12% fully or partly agreed that life turning into a burden should be an acceptable reason for euthanasia. Of the participants, 16% had faced a request for euthanasia or PAS, and 3033 answers from 2565 respondents were achieved to the open questions concerning their actions regarding the request and ethical aspects of assisted death. In the qualitative analysis, six main categories, including 22 subcategories, were formed regarding the phenomenon of how physicians act when facing this request. The six main categories were as follows: providing an alternative to the request, enabling care and support, ignoring the request, giving a reasoned refusal, complying with the request, and seeing the request as a possibility. CONCLUSIONS Finnish physicians' actions regarding the requests for assisted death, and attitudes toward euthanasia and PAS vary substantially. Open discussion, education, and recommendations concerning a request for assisted death and ethics around it are also highly needed in countries where euthanasia and PAS are not legal.
Collapse
Affiliation(s)
- Reetta P Piili
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Palliative Care Centre, Tampere University Hospital, Palliative Care Unit, Sädetie 6, R-building, Tampere, 33520, Finland.
| | - Minna Hökkä
- Diaconia University of Applied Sciences, Helsinki, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | | | - Elina Tolvanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Tampere University Hospital, Palliative Care Unit, Sädetie 6, R-building, Tampere, 33520, Finland
| | - Pekka Louhiala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Tampere University Hospital, Palliative Care Unit, Sädetie 6, R-building, Tampere, 33520, Finland
| |
Collapse
|
2
|
Lizzio-Wilson M, Thomas EF, Louis WR, Crane MF, Kho M, Molenberghs P, Wibisono S, Minto K, Amiot CE, Decety J, Breen LJ, Noonan K, Forbat L, Allen F. Using Latent Profile Analysis to Understand Health Practitioners' Attitudes Toward Voluntary Assisted Dying. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228221149453. [PMID: 36826344 DOI: 10.1177/00302228221149453] [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: 02/25/2023]
Abstract
Prior work has documented considerable diversity among health practitioners regarding their support for voluntary assisted dying (VAD). We examined whether their attitudes are characterised by different combinations of personal support, normative support by other health practitioners, and whether they are predisposed to vicariously experience others' emotions (i.e., empathy). We also examined whether these profiles experienced different mental health outcomes (i.e., burnout and posttraumatic stress) in relation to VAD. To test this, 104 Australian health practitioners were surveyed after VAD was legalised in Victoria, Australia in 2019. Results indicated that practitioners' attitudes were characterised by three profiles: 1) strong personal and normative support (strong VAD supporters), 2) moderate personal and normative support (moderate VAD supporters), and 3) lower personal and normative support (apprehensive practitioners). However, each profile reported similar mental health outcomes. Findings suggest that the normative environments in which health practitioners operate may explain their diverse attitudes on VAD.
Collapse
Affiliation(s)
- Morgana Lizzio-Wilson
- Department of Psychology, The University of Exeter, Exeter, UK
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Emma F Thomas
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Winnifred R Louis
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Monique F Crane
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Madison Kho
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | | | - Susilo Wibisono
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Kiara Minto
- School of Historical and Philosophical Inquiry, University of Queensland, Brisbane, QLD, Australia
| | - Catherine E Amiot
- Département de Psychologie, Université du Québec à Montréal, Montreal, QC, Canada
| | - Jean Decety
- Department of Psychology, The University of Chicago, Chicago, IL, USA
| | - Lauren J Breen
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Kerrie Noonan
- Death Literacy Institute, University of Western Sydney, Penrith South, NSW, Australia
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | |
Collapse
|
3
|
Yesil I. Whose Choice? A Qualitative Inquiry into Professionals' Moral Positions on Euthanasia in Belgium. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221123153. [PMID: 36036183 DOI: 10.1177/00302228221123153] [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: 12/22/2023]
Abstract
Death, which was once accepted as an incalculable otherworld journey initiated by the cessation of biological functions, became an object of socio-political regulation in late modernity. Euthanasia, a form of managing death and dying, has grown in popularity with accompanying controversy. What remains under-explored, however, are conceptions of selfhood animating different framings in moral and ethical debates around euthanasia from professional perspectives. Drawing on 20 interviews with physicians and other key professionals in the euthanasia field in Belgium, this study finds that moral division among participants lies in different attributes of selfhood related to euthanasia, which emphasize autonomous, social, or embodied aspects. This paper demonstrates that the diminishing role of religion in appeasing existential anxiety about death, combined with an increasing emphasis on choice as the basis of selfhood, facilitates the contemporary desire to control one's own demise.
Collapse
Affiliation(s)
- Ilay Yesil
- Sociology, University of Bern, Bern, Switzerland
| |
Collapse
|
4
|
Piili RP, Louhiala P, Vänskä J, Lehto JT. Ambivalence toward euthanasia and physician-assisted suicide has decreased among physicians in Finland. BMC Med Ethics 2022; 23:71. [PMID: 35820881 PMCID: PMC9275272 DOI: 10.1186/s12910-022-00810-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background Debates around euthanasia and physician-assisted suicide (PAS) are ongoing around the globe. Public support has been mounting in Western countries, while some decline has been observed in the USA and Eastern Europe. Physicians’ support for euthanasia and PAS has been lower than that of the general public, but a trend toward higher acceptance among physicians has been seen in recent years. The aim of this study was to examine the current attitudes of Finnish physicians toward euthanasia and PAS and whether there have been changes in these attitudes over three decades. Methods A questionnaire survey was conducted with all Finnish physicians of working age in 2020 and the results were compared to previous studies conducted in 1993, 2003 and 2013. Results The proportions of physicians fully agreeing and fully disagreeing with the legalization of euthanasia increased from 1993 to 2020 (from 5 to 25%, p < 0.001, and from 30 to 34%, p < 0.001, respectively). The number of physicians, who expressed no opinion for or against euthanasia (cannot say) decreased from 19 to 5% (p < 0.001) during the same period. The proportion of physicians having no opinion (cannot say) of whether a physician should be punished for assisting in a suicide decreased from 20 to 10% (p < 0.001). Conclusions This study shows that Finnish physicians’ ambivalence toward euthanasia and PAS has decreased. The ongoing debate has probably forced physicians to form more solid opinions on these matters. Our study highlights that attitudes toward euthanasia and PAS are still divided within the medical profession. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00810-y.
Collapse
Affiliation(s)
- Reetta P Piili
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. .,Palliative Care Centre, Department of Oncology, Tampere University Hospital, Palliative Care Unit, Sädetie 6, R-building, 33520, Tampere, Finland.
| | - Pekka Louhiala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Palliative Care Centre, Department of Oncology, Tampere University Hospital, Palliative Care Unit, Sädetie 6, R-building, 33520, Tampere, Finland
| |
Collapse
|
5
|
Schildmann J, Junghanss C, Oldenburg M, Schuler U, Trümper L, Wörmann B, Winkler E. Role and responsibility of oncologists in assisted suicide. Practice and views among members of the German Society of Haematology and Medical Oncology. ESMO Open 2021; 6:100329. [PMID: 34896697 PMCID: PMC8666647 DOI: 10.1016/j.esmoop.2021.100329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/08/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Physician-assisted suicide (PAS) is a controversial practice and regulatory frameworks differ regarding assigned physicians' roles. This study explores clinical experience and views of German oncologists concerning ethically and legally relevant aspects of PAS after change of the law. Materials and methods An online survey was conducted among members of the German Society of Haematology and Medical Oncology (DGHO) in March 2021. Descriptive analysis, bivariate and multivariable logistic regression of quantitative data on determinants related to (un)willingness to assist with suicide as well qualitative analysis of free-text comments were carried out. Results Seven hundred and forty-five of 3588 DGHO members responded (20.8%). Of these, 29.9% reported requests for a lethal drug and 3.0% (n = 22) reported to have assisted with suicide. Almost half of them (47.0%, n = 350) objected to providing PAS, whereas 45.9% indicated a willingness at least under certain conditions. Of those respondents who did not object to PAS, 25.4% would also consider assistance if those willing to die had a psychiatric disease and 10.2% if requestors had no disease at all. A majority viewed a role for physicians regarding different tasks associated with assisted suicide. Respondents with <10 years of professional experience, working in hospital with religious affiliation and with subspecialisation in palliative care were significantly less frequently willing to assist suicide. Conclusions Respondents are divided in their personal attitudes towards PAS but a majority supports involvement of physicians regarding different tasks related to assisted suicide. Data about the practice and envisaged professional role may inform development of an acceptable ethico-legal framework for a controversial practice. In Germany, as in other countries, assisted suicide has become lawful more recently. To be able to develop guidance on the highly controversial subject, empirical data on practice and related aspects are needed. 30% of responding oncologists report requests for lethal drugs by their patients and 3% have assisted with suicide. Compared with 2015, significantly more oncologists report requests for lethal drugs and willingness to assist with suicide. Palliative care qualification and less professional experience were negatively associated with willingness to assist suicide.
Collapse
Affiliation(s)
- J Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - C Junghanss
- Division of Medicine, Department of Hematology, Oncology and Palliative Medicine, University Medical Center, Rostock, Germany
| | - M Oldenburg
- German Society of Haematology and Medical Oncology (DGHO), Berlin, Germany
| | - U Schuler
- Department of Internal Medicine I, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - L Trümper
- Department of Hematology and Medical Oncology, University Medicine Göttingen, Göttingen, Germany
| | - B Wörmann
- German Society of Haematology and Medical Oncology (DGHO), Berlin, Germany; Department of Internal Medicine, Hematology/Oncology and Tumor Immunology, Charité University Medicine, Berlin, Germany
| | - E Winkler
- National Center for Tumor Diseases, Section for Translational Medical Ethics, Department of Medical Oncology, University Hospital, Heidelberg, Germany
| |
Collapse
|
6
|
Braun M, Niederkrotenthaler T. Effects of Educative Materials on Doctors' Intention to Initiate Life-Saving Procedures After a Suicide Attempt: Randomised Controlled Trial. Front Psychol 2021; 12:718084. [PMID: 34413818 PMCID: PMC8369827 DOI: 10.3389/fpsyg.2021.718084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The topic of euthanasia, assisted dying, and how to deal with death wishes has received strong public and media attention in many countries. Nevertheless, there is currently no research which has analysed if educative materials that favour or disfavour the initiation of life-saving measures after a suicide attempt impact on attitudes to initiate such procedures among physicians. Materials and Methods: A double-blind randomised controlled trial was conducted to test if educative materials that either support life-saving measures or rather recommend against it after a near-fatal suicide attempt has an effect on intentions to initiate such measures (trial registration: DRKS00024953, www.drks.de). N = 192 doctors from the Medical University Vienna (Austria) participated in the study and either read educative materials not recommending (n = 59), or recommending life-saving measures (n = 64), or were not reading educative materials (n = 69, control group). The primary outcome was intentions to initiate life-saving measures in an open case vignette featuring the case of a terminally ill cancer patient. Other variables assessed were demographics, experiences with terminally ill and dying patients, training or qualification in mental health, specialty, position, whether doctors worked in emergency medicine, and attitudes toward assisted dying. A logistic regression analysis was used. Results: There was no immediate effect of educative materials on intentions to initiate life-saving measures, χ2(2) = 0.94, p = 0.63. The adjusted model including all tested predictors was significant [χ2(15) = 37.82, df = 15, p < 0.001]. Attending position, male gender, low age, and more negative attitudes to assisted dying predicted a decision for life-saving measures. Higher agreement with life-saving measures was reported for a case vignette about a patient with schizophrenia than for a case vignette about a patient with Huntington's disease. Discussion: Educative materials either favouring or disfavouring the initiation of life-saving measures after a suicide attempt do not appear to immediately influence related decision-making processes. Related intentions appear mainly influenced by personal opinions on the topic and by the specific patient case. Good-quality in-depth discussions regarding end-of-life decisions and to develop well-founded and non-opinionated guidelines are highly warranted.
Collapse
Affiliation(s)
| | - Thomas Niederkrotenthaler
- Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
7
|
Rutherford J, Willmott L, White BP. What the Doctor Would Prescribe: Physician Experiences of Providing Voluntary Assisted Dying in Australia. OMEGA-JOURNAL OF DEATH AND DYING 2021:302228211033109. [PMID: 34282961 DOI: 10.1177/00302228211033109] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Like many countries where voluntary assisted dying (VAD) is legal, eligible doctors in Victoria, Australia, have sole legal authority to provide it. Doctors' attitudes towards legalised VAD have direct bearing on their willingness to participate in VAD and consequently, on whether permissive laws can effectively facilitate access to VAD. The study aimed to explore how some Victorian doctors are perceiving and experiencing the provision of legalised VAD under a recently commenced law. METHODS Semi-structured interviews with 25 Victorian doctors with no in-principle objection to legalised VAD were conducted between July 2019-February 2020. Interviews were recorded, transcribed, and analysed using thematic analysis. Ethical approval from the relevant institution was obtained. RESULTS Doctors perceive or experience VAD to fundamentally challenge traditional medical practice. Barriers to access to VAD derive from applicant, communication, and doctor-related factors. Doctors' willingness to participate in VAD is situation specific.
Collapse
Affiliation(s)
- Jodhi Rutherford
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| | - Ben P White
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
8
|
Sellars M, Tacey M, McDougall R, Hayes B, Pratt B, Hempton C, Detering K, Aldrich R, Benson M, Kirwan J, Gold M, O'Driscoll L, Ko D. Support for and willingness to be involved in voluntary assisted dying: A multisite, cross-sectional survey study of clinicians in Victoria, Australia. Intern Med J 2021; 51:1619-1628. [PMID: 34148272 DOI: 10.1111/imj.15434] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
CONTEXT In the Australian state of Victoria, specialist doctors are central to the operation of Voluntary Assisted Dying (VAD). However, a broad range of clinicians may be involved in the care of patients requesting or using VAD. OBJECTIVES To conduct a multisite, cross-sectional survey of clinicians in seven Victorian hospitals, to describe levels of support for and willingness to be involved in VAD and consider factors associated with clinician support for the VAD legislation and physicians' willingness to provide VAD in practice. METHODS All clinicians were invited to complete an online survey measuring demographic characteristics, awareness of and support for the VAD legislation, willingness to participate in VAD related activities, and reasons for willingness or unwillingness to participate in VAD. RESULTS Of 5690 who opened the survey, 5159 (90.1%) were included in the final sample and 73% (n=3768) supported the VAD legislation. The strongest predictor of support for the VAD legislation was clinical role. Forty percent (n=238) of medical specialists indicated they would be willing to participate in either the VAD consulting or coordinating role. Doctors did not differ in willingness between high impact (44%) and low impact specialty (41%), however, doctors specializing in palliative care or geriatric medicine were significantly less willing to participate (27%). CONCLUSION Approximately 73% of surveyed staff supported Victoria's VAD legislation. However, only a minority of medical specialists reported willingness to participate in VAD, suggesting potential access issues for patients requesting VAD in accordance with the legal requirements in Victoria. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Marcus Sellars
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University
| | - Mark Tacey
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Rosalind McDougall
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Barbara Hayes
- Advance Care Planning Program, Northern Health, Bundoora, Australia
| | - Bridget Pratt
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Courtney Hempton
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Waurn Ponds, Australia.,Monash Bioethics Centre, Monash University, Clayton, Australia
| | - Karen Detering
- Faculty of Health, Arts and Innovation, Swinburne University, Hawthorn, Melbourne, Australia.,Tasmanian Health Services, Tasmania, Australia
| | | | - Melanie Benson
- Department of Supportive and Palliative Care, Peninsula Health, Frankston
| | - Jeffrey Kirwan
- Research & Medical Services, Eastern Health, Box Hill, Australia
| | - Michelle Gold
- Palliative Care Service, Alfred Health, Prahran, Australia
| | - Lisa O'Driscoll
- 3mproving End of Life Care, Alfred Health, Prahran, Australia
| | - Danielle Ko
- Palliative Care, Quality and Patient Safety, Austin Health, Heidelberg, Australia
| |
Collapse
|
9
|
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.
Collapse
Affiliation(s)
- Luke Nie
- University of Otago, Dunedin, New Zealand
| | | | - Ella Iosua
- University of Otago, Dunedin, New Zealand
| | | |
Collapse
|
10
|
Rutherford J. Conscientious participants and the ethical dimensions of physician support for legalised voluntary assisted dying. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106702. [PMID: 33184125 DOI: 10.1136/medethics-2020-106702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 05/24/2023]
Abstract
The Australian state of Victoria legalised voluntary assisted dying (VAD) in June 2019. Like most jurisdictions with legalised VAD, the Victorian law constructs physicians as the only legal providers of VAD. Physicians with conscientious objection to VAD are not compelled to participate in the practice, requiring colleagues who are willing to participate to transact the process for eligible applicants. Physicians who provide VAD because of their active, moral and purposeful support for the law are known as conscientious participants. Conscientious participation has received scant attention in the bioethics literature. Patient access to VAD is contingent on the development of a sufficient corpus of conscientious participants in permissive jurisdictions. This article reports the findings of a small empirical study into how some Victorian physicians with no in-principle opposition towards the legalisation of VAD, are ethically orientating themselves towards the law, in the first 8 months of the law's operation. It finds that in-principle-supportive physicians employ bioethical principles to justify their position but struggle to reconcile that approach with the broader medical profession's opposition. This study is part of the first tranche of empirical research emerging from Australia since the legalisation of VAD in that country for the first time in over 20 years.
Collapse
Affiliation(s)
- Jodhi Rutherford
- Australian Cente for Health Law Research, Queensland University of Technology Faculty of Law, Brisbane, Queensland, Australia
| |
Collapse
|
11
|
Abstract
Critical care clinicians strive to reverse the disease process and are frequently faced with difficult end-of-life (EoL) situations, which include transitions from curative to palliative care, avoidance of disproportionate care, withholding or withdrawing therapy, responding to advance treatment directives, as well as requests for assistance in dying. This article presents a summary of the most common issues encountered by intensivists caring for patients around the end of their life. Topics explored are the practices around limitations of life-sustaining treatment, with specific mention to the thorny subject of assisted dying and euthanasia, as well as the difficulties encountered regarding the adoption of advance care directives in clinical practice and the importance of integrating palliative care in the everyday practice of critical-care physicians. The aim of this article is to enhance understanding around the complexity of EoL decisions, highlight the intricate cultural, religious, and social dimensions around death and dying, and identify areas of potential improvement for individual practice.
Collapse
Affiliation(s)
- Victoria Metaxa
- Critical Care Department, King's College Hospital NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
12
|
Rutherford J, Willmott L, White BP. Physician attitudes to voluntary assisted dying: a scoping review. BMJ Support Palliat Care 2020; 11:200-208. [PMID: 32563993 DOI: 10.1136/bmjspcare-2020-002192] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/07/2020] [Accepted: 05/18/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Voluntary assisted dying (VAD) became legal in the Australian state of Victoria on 19 June 2019 and will be legal in Western Australia from 2021. Other Australian states are progressing similar law reform processes. In Australia and internationally, doctors are central to the operation of all legal VAD regimes. It is broadly accepted that doctors, as a profession, are less in favour of VAD law reform than the rest of the community. To date, there has been little analysis of the factors that motivate doctors' support or opposition to legalised VAD in Australia. AIM To review all studies reporting the attitudes of Australian doctors regarding the legalisation of VAD, including their willingness to participate in it, and to observe and record common themes in existing attitudinal data. DESIGN Scoping review and thematic analysis of qualitative and quantitative data. DATA SOURCES CINAHL, Embase, Scopus, PubMed and Informit were searched from inception to June 2019. RESULTS 26 publications detailing 19 studies were identified. Thematic analysis of quantitative and qualitative findings was performed. Three overarching themes emerged. 'Attitudes towards regulation' encompassed doctors' orientation towards legalisation, the shortcomings of binary categories of support or opposition and doctors' concerns about additional regulation of their professional practices. 'Professional and personal impact of legalisation' described tensions between palliative care and VAD, and the emotional and social impact of being providers of VAD. 'Practical considerations regarding access' considered doctors' concerns about eligibility criteria and their willingness to provide VAD. CONCLUSION A detailed understanding of medical perspectives about VAD would facilitate the design of legislative models that take better account of doctors' concerns. This may facilitate their greater participation in VAD and help address potential access issues arising from availability of willing doctors.
Collapse
Affiliation(s)
- Jodhi Rutherford
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ben P White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
13
|
Jakhar J, Ambreen S, Prasad S. Right to Life or Right to Die in Advanced Dementia: Physician-Assisted Dying. Front Psychiatry 2020; 11:622446. [PMID: 33551882 PMCID: PMC7858261 DOI: 10.3389/fpsyt.2020.622446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jitender Jakhar
- Department of Psychiatry, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, University of Delhi, New Delhi, India
| | - Saaniya Ambreen
- Department of Psychiatry, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, University of Delhi, New Delhi, India
| | - Shiv Prasad
- Faculty of Medical Sciences, Lady Hardinge Medical College, University of Delhi, New Delhi, India
| |
Collapse
|
14
|
Picard G, Bier JC, Capron I, De Deyn PP, Deryck O, Engelborghs S, Hanseeuw B, Lemper JC, Mormont E, Petrovic M, Salmon E, Segers K, Sieben A, Thiery E, Ventura M, Versijpt J, Ivanoiu A. Dementia, End of Life, and Euthanasia: A Survey Among Dementia Specialists Organized by the Belgian Dementia Council. J Alzheimers Dis 2019; 69:989-1001. [DOI: 10.3233/jad-181277] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gaëtane Picard
- Department of Neurology, Clinique Saint-Pierre, Ottignies, Belgium
| | - Jean-Christophe Bier
- Department of Neurology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Capron
- Department of Neurology, Cliniques de l’Europe – St Michel, Brussels, Belgium
| | - Peter Paul De Deyn
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Belgium
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Olivier Deryck
- Department of Neurology, Memory Clinic General Hospital Sint-Jan Brugge-Oostende Brugge, Belgium
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Belgium
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Bernard Hanseeuw
- Department of Neurology, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium
- Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium
| | | | - Eric Mormont
- Department of Neurology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
- Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium
| | - Mirko Petrovic
- Department of Internal Medicine, Section of Geriatrics, Ghent University, Gent, Belgium
| | - Eric Salmon
- GIGA Cyclotron Research Centre Imaging, University of Liége, Liége, Belgium
- Department of Neurology, Memory Clinic, Centre Hospitalier Universitaire (CHU) Liége, Liége, Belgium
| | - Kurt Segers
- Department of Neurology, Brugmann University Hospital, Brussels, Belgium
| | - Anne Sieben
- Department of Neurology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Evert Thiery
- Department of Neurology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | | | - Jan Versijpt
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Adrian Ivanoiu
- Department of Neurology, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium
- Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Ben Thabet J, Mâalej M, Khemakhem H, Yaich S, Abbes W, Omri S, Zouari L, Zouari N, Dammak J, Charfi N, Maâlej M. The Management of Depressed Patients by the Tunisian General Practitioners: A Critical Trans-sectional Study. Community Ment Health J 2019; 55:137-143. [PMID: 30229347 DOI: 10.1007/s10597-018-0335-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 09/15/2018] [Indexed: 11/28/2022]
Abstract
Under-diagnosed and under-treated, depression has a pejorative prognosis. The general practitioners (GP) represent the most often consulted healthcare professionals by depressed patients. The aim was to describe how the Tunisian GPs manage the depressed patients and to note the difficulties they encounter in order to suggest corrective measures. A survey was conducted among 140 GPs in Sfax Governorate. The percentage of the GPs whose responses conformed to the scientific data in at least 67% of the items was 31.4%. Four factors were correlated to a good management of depression: age (p = 0.028), masculine gender (p = 0.016), long career (p = 0.034) and participation to continuous medical education sessions on depression (p = 0.01). Our study revealed inadequacies in the management of depression by the GPs. GPs were invited to sensitizing meetings. A training on depression was assured for the future internship supervisors by the commission of medicine of family in the Faculty of Medicine of Sfax.
Collapse
Affiliation(s)
- Jihène Ben Thabet
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia. .,Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.
| | - Manel Mâalej
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Hana Khemakhem
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Sourour Yaich
- Department of Preventive Medicine, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Wafa Abbes
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Sana Omri
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Lobna Zouari
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Nasreddine Zouari
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Jamel Dammak
- Department of Preventive Medicine, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Nada Charfi
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Mohamed Maâlej
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| |
Collapse
|
17
|
Confidence and attitudes of pharmacy students towards suicidal crises: patient simulation using people with a lived experience. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1185-1195. [PMID: 30155558 DOI: 10.1007/s00127-018-1582-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/20/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE Health care professionals, including pharmacists, have the potential to recognise and assist those at risk of suicide. The primary aim of this study was to assess the impact of utilising people with a lived experience of mental illness as simulated patients on final year pharmacy students' attitudes toward and confidence in caring for people at risk of suicide after first receiving Mental Health First Aid (MHFA) training. METHODS A parallel group repeated measures design was used. People with a lived experience of mental illness enacted patients experiencing a mental health crisis, including possible suicidal ideation. Following MHFA training, the first group directly participated in the simulation, the second group observed, and the final group had no exposure to the simulation. Validated surveys measuring student attitudes and confidence were conducted at three time points; pre and post MHFA, and then at 2-4 weeks follow-up. RESULTS Full datasets of survey responses were received from 34/40 direct participants (85%), 104/146 observers (71%) and 50/66 comparison students (76%). Mean confidence scores significantly improved for all groups post MHFA training (p < 0.05). At follow-up, all 8 confidence items for the direct participant and observer group maintained significance from baseline to post intervention (p < 0.05). Mixed results in relation to attitudes towards suicide were evident at each time point and among each participant group. CONCLUSIONS Utilising people with a lived experience of mental illness as simulated patients has a positive effect on sustaining pharmacy student confidence in discussing suicidal behaviour post MHFA training. The inconsistency in attitudes towards suicide suggests that attitudes are complex in nature, involving multiple dynamic influences.
Collapse
|
18
|
Pomfret S, Mufti S, Seale C. Medical students and end-of-life decisions: the influence of religion. Future Healthc J 2018; 5:25-29. [PMID: 31098527 PMCID: PMC6510046 DOI: 10.7861/futurehosp.5-1-25] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The objective of this study was to see if medical students' attitudes about medically assisted dying were influenced by their religious background and current beliefs. A cohort study was conducted using a self-completion study questionnaire in a large UK medical school. In total, 400 out of 505 questionnaires were completed (79%). The study population's characteristics are summarised as follows: mean age 22.7 years (range 18-44); 68.5% believe in god, 31.5% have no belief in god; religious background: Christian 45%, Hindu 16.5%, Muslim 22%, Other 10% and None 7%. The majority of students did not agree with euthanasia and physician-assisted suicide in the study scenario. Those who had a belief in god were more likely to disagree with actions that hasten death. The findings show this was particularly the case with students from a Muslim background. Gender was not related to overall agreement with actions that hasten death; being older, a finalist and a graduate were weakly associated with a greater likelihood of agreeing with such acts. This is an important issue which warrants further enquiry. The demographics of the UK medical population continue to shift, containing a higher proportion of people from Asia and with Asian British backgrounds than the general population. This study provides us with a basis for further exploration of the potential for disparity between the opinions of the UK population and those of medical workers and trainees, and how that might inform decisions about patient care at the end of life.
Collapse
Affiliation(s)
| | | | - Clive Seale
- Barts and The London School of Medicine and Dentistry, London, UK
| |
Collapse
|
19
|
Porter K, Warburton KG. Physicians' views on current legislation around euthanasia and assisted suicide: Results of surveys commissioned by the Royal College of Physicians. Future Healthc J 2018; 5:30-34. [PMID: 31098528 PMCID: PMC6510045 DOI: 10.7861/futurehosp.5-1-30] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Euthanasia and physician-assisted suicide have always been the subject of intense debate across society. In 2006 and in 2014, the Royal College of Physicians surveyed its members for their opinions on the subject. The results of these surveys are summarised here.
Collapse
|
20
|
Bator EX, Philpott B, Costa AP. This moral coil: a cross-sectional survey of Canadian medical student attitudes toward medical assistance in dying. BMC Med Ethics 2017; 18:58. [PMID: 29078769 PMCID: PMC5658957 DOI: 10.1186/s12910-017-0218-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 10/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In February, 2015, the Supreme Court of Canada struck down the ban on medical assistance in dying (MAiD). In June, 2016, the federal government passed Bill C-14, permitting MAiD. Current medical students will be the first physician cohort to enter a system permissive of MAiD, and may help to ensure equitable access to care. This study assessed medical student views on MAiD, factors influencing these views, and opportunities for medical education. METHODS An exploratory cross-sectional survey was developed and distributed to medical students across all years of a three-year Canadian undergraduate medical program. The investigators administered the survey to participants during academic sessions from November to December, 2015. Analysis of the results included summary descriptive statistics, Pearson's chi-square test of independence to identify differences between participants by year of study, logistic regression to identify factors that influence students' stances on MAiD, and Wilcoxon signed rank test to measure changes in student support for MAiD and comfort discussing MAiD. RESULTS There were 405 participants for a response rate of 87%. The majority of students (88%) supported the Supreme Court's decision, 61% would provide the means for a patient to end their life, and 38% would personally administer a lethal medication. Students who were more willing to provide the means for MAiD found medical education/clinical experience and patient autonomy to be important contributors to their stances on MAiD. Those students who were less willing to provide the means for MAiD found religious/spiritual beliefs and teachings, as well as concern about potential negative consequences, to be important contributors to their stances on MAiD. Educational training desired by participants included medicolegal (91%), communication skills (80%), technical skills (75%), and religious (49%). CONCLUSIONS Medical students generally supported and would provide the means for MAiD to patients. They also indicated a desire for directed medical education on MAiD.
Collapse
Affiliation(s)
- Eli Xavier Bator
- Michael G. DeGroote School of Medicine, Waterloo Regional Campus, McMaster University, 10B Victoria St S, Kitchener, ON, N2G 1C5, Canada.
| | - Bethany Philpott
- Michael G. DeGroote School of Medicine, Waterloo Regional Campus, McMaster University, 10B Victoria St S, Kitchener, ON, N2G 1C5, Canada
| | - Andrew Paul Costa
- Michael G. DeGroote School of Medicine, Waterloo Regional Campus, McMaster University, 10B Victoria St S, Kitchener, ON, N2G 1C5, Canada
| |
Collapse
|
21
|
Braverman DW, Marcus BS, Wakim PG, Mercurio MR, Kopf GS. Health Care Professionals' Attitudes About Physician-Assisted Death: An Analysis of Their Justifications and the Roles of Terminology and Patient Competency. J Pain Symptom Manage 2017; 54:538-545.e3. [PMID: 28716621 PMCID: PMC5632116 DOI: 10.1016/j.jpainsymman.2017.07.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/21/2017] [Accepted: 07/07/2017] [Indexed: 11/16/2022]
Abstract
CONTEXT Health care professionals (HCPs) are crucial to physician-assisted death (PAD) provision. OBJECTIVES To quantitatively assess the favorability of justifications for or against PAD legalization among HCPs, the effect of the terms "suicide" and "euthanasia" on their views and their support for three forms of PAD. METHODS Our questionnaire presented three cases: physician-assisted suicide, euthanasia for a competent patient, and euthanasia for an incompetent patient with an advance directive for euthanasia. Respondents judged whether each case was ethical and should be legal and selected their justifications from commonly cited reasons. The sample included physician clinicians, researchers, nonphysician clinicians, and other nonclinical staff at a major academic medical center. RESULTS Of 221 HCPs, the majority thought that each case was ethical and should be legal. In order of declining favorability, justifications supporting PAD legalization were relief of suffering, right to die, mercy, acceptance of death, nonabandonment, and saving money for the health care system; opposing justifications were the slippery slope argument, unnecessary due to palliative care, killing patients is wrong, religious views, and suicide is wrong. The use of suicide and euthanasia terminology did not affect responses. Participants preferred physician-assisted suicide to euthanasia for a competent patient (P < 0.0001) and euthanasia for an incompetent patient to euthanasia for a competent patient (P < 0.005). CONCLUSIONS HCPs endorsed patient-centered justifications over other reasons, including role-specific duties. Suicide and euthanasia language did not bias HCPs against PAD, challenging claims that such value-laden terms hinder dialogue. More research is required to understand the significance of competency in shaping attitudes toward PAD.
Collapse
Affiliation(s)
- Derek W Braverman
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
| | | | - Paul G Wakim
- Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Gary S Kopf
- Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
22
|
Dierickx S, Deliens L, Cohen J, Chambaere K. Euthanasia for people with psychiatric disorders or dementia in Belgium: analysis of officially reported cases. BMC Psychiatry 2017; 17:203. [PMID: 28641576 PMCID: PMC5481967 DOI: 10.1186/s12888-017-1369-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/23/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Euthanasia for people who are not terminally ill, such as those suffering from psychiatric disorders or dementia, is legal in Belgium under strict conditions but remains a controversial practice. As yet, the prevalence of euthanasia for people with psychiatric disorders or dementia has not been studied and little is known about the characteristics of the practice. This study aims to report on the trends in prevalence and number of euthanasia cases with a psychiatric disorder or dementia diagnosis in Belgium and demographic, clinical and decision-making characteristics of these cases. METHODS We analysed the anonymous databases of euthanasia cases reported to the Federal Control and Evaluation Committee Euthanasia from the implementation of the euthanasia law in Belgium in 2002 until the end of 2013. The databases we received provided the information on all euthanasia cases as registered by the Committee from the official registration forms. Only those with one or more psychiatric disorders or dementia and no physical disease were included in the analysis. RESULTS We identified 179 reported euthanasia cases with a psychiatric disorder or dementia as the sole diagnosis. These consisted of mood disorders (N = 83), dementia (N = 62), other psychiatric disorders (N = 22) and mood disorders accompanied by another psychiatric disorder (N = 12). The proportion of euthanasia cases with a psychiatric disorder or dementia diagnosis was 0.5% of all cases reported in the period 2002-2007, increasing from 2008 onwards to 3.0% of all cases reported in 2013. The increase in the absolute number of cases is particularly evident in cases with a mood disorder diagnosis. The majority of cases concerned women (58.1% in dementia to 77.1% in mood disorders). All cases were judged to have met the legal requirements by the Committee. CONCLUSIONS While euthanasia on the grounds of unbearable suffering caused by a psychiatric disorder or dementia remains a comparatively limited practice in Belgium, its prevalence has risen since 2008. If, as this study suggests, people with psychiatric conditions or dementia are increasingly seeking access to euthanasia, the development of practice guidelines is all the more desirable if physicians are to respond adequately to these highly delicate requests.
Collapse
Affiliation(s)
- Sigrid Dierickx
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
| |
Collapse
|
23
|
Sheahan L. Exploring the interface between 'physician-assisted death' and palliative care: cross-sectional data from Australasian palliative care specialists. Intern Med J 2017; 46:443-51. [PMID: 26762669 DOI: 10.1111/imj.13009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 12/10/2015] [Accepted: 12/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Legalisation of physician-assisted dying (PAD) remains a highly contested issue. In the Australasian context, the opinion and perspective of palliative care specialists have not been captured empirically, and are required to inform better the debate around this issue, moving forward. AIM To identify current attitudes and experiences of palliative care specialists in Australasia regarding requests for physician-assisted suicide and voluntary euthanasia, and to capture the opinion of palliative care specialists on the legalisation of these practices in the Australasian context. METHOD An anonymous, cross-sectional, online survey of Australasian specialists in palliative care, addressing the following six areas: (i) demographics; (ii) frequency of requests, and response given; (iii) understanding of the term 'voluntary euthanasia'; (iv) opinion regarding legalisation of physician-assisted suicide and voluntary euthanasia in Australasia, and willingness to participate if legal; (v) identification of the most important values guiding this opinion; and (vi) anticipated impact that legalisation of assisted death would have on palliative care practice. RESULTS Important findings include: (i) palliative care specialists are largely opposed to the legalisation of PAD; (ii) the proportional titration of opioids is not understood by any palliative care specialist studied to be 'voluntary euthanasia'; and (iii) there is a wide variation in frequency of requests, and one-third of palliative care specialists express discomfort in dealing with requests for assisted suicide or euthanasia. CONCLUSION Key areas for future research at the interface between PAD and best practice end-of-life care are identified, including exploration into why palliative care specialists are largely opposed to PAD, and consideration of the impact 'the opioid misconception' may have on the literature informing this debate.
Collapse
Affiliation(s)
- L Sheahan
- St George and Calvary Hospitals, Sydney, New South Wales, Australia.,Centre for Values Ethics and the Law in Medicine, University of Sydney, Sydney, New South Wales, Australia.,Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada.,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
24
|
The impact of a belief in life after death on health-state preferences: True difference or artifact? Qual Life Res 2016; 25:2997-3008. [PMID: 27444779 DOI: 10.1007/s11136-016-1356-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE In most religions, the preservation of one's own, God-given, life is considered obligatory, while the time trade-off method (TTO) forces one to voluntarily forego life years. We sought to verify how this conflict impacts TTO-results among the religious. METHODS We used the data from the only EQ-5D valuation in Poland (2008, three-level, 321 respondents, 23 states each)-a very religious, mostly Catholic country. We measured the religiosity with the belief in afterlife question on two levels: strong (definitely yes) and some (also rather yes), both about a third of the sample. RESULTS The religious more often are non-traders, unwilling to give up any time in exchange for quality of life: odds ratio (OR) equal to 1.97 (strong religiosity), OR 1.55 (some religiosity); and less often consider a state worse than death: OR 0.67 (strong), OR 0.81 (some). These associations are statistically significant ([Formula: see text]) and hold when controlling for possible demographic confounders. Strong religiosity abates the utility loss: in the additive approach by 0.14, in the multiplicative approach by the factor of 2.1 (both [Formula: see text]), especially among the older. Removing the effect of religiosity from the value set reduces the utility by 0.05 on average. CONCLUSION The results may stem from a true difference in preferences or be a TTO-artifact and would vanish for other elicitation methods. Juxtaposing our findings with comments from respondents in other studies suggests the latter. Therefore, this Weltanschauung effect should be removed in cost-utility analysis.
Collapse
|
25
|
Zenz J, Tryba M, Zenz M. Palliative care professionals' willingness to perform euthanasia or physician assisted suicide. BMC Palliat Care 2015; 14:60. [PMID: 26572742 PMCID: PMC4647811 DOI: 10.1186/s12904-015-0058-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/06/2015] [Indexed: 12/17/2022] Open
Abstract
Background Euthanasia and physician assisted suicide (PAS) are highly debated upon particularly in the light of medical advancement and an aging society. Little is known about the professionals’ willingness to perform these practices particularly among those engaged in the field of palliative care and pain management. Thus a study was performed among those professionals. Methods An anonymous questionnaire was handed out to all participants of a palliative care congress and a pain symposium in 2013. The questionnaire consisted of 8 questions regarding end of life decisions. Proposed patient vignettes were used. Results A total of 470 eligible questionnaires were returned, 198 by physicians, 272 by nurses. The response rate was 64 %. The majority of professionals were reluctant to perform euthanasia or PAS: 5.3 % of the respondents would be willing to perform euthanasia on a patient with a terminal illness if asked to do so. The reluctance grew in case of a patient with a non-terminal illness. The respondents were more willing to perform PAS than euthanasia. Nurses were more reluctant to take action as opposed to the physicians. The majority of the respondents would attempt to treat the patient’s symptoms first before considering life-ending measures. As regards any decision making process the majority would consult with a colleague. Conclusions This is the first German study to ask about the willingness of professionals to take action as regards euthanasia and PAS without biased phrasing. As opposed to the general acceptance that is respectively high, the actual willingness to perform life-ending measures is low. The German debate on physician assisted suicide and its possible legalization should also incorporate clarifications regarding the responsibility who should eventually perform these acts.
Collapse
Affiliation(s)
- Julia Zenz
- Ruhr-University Bochum, Universitätstr. 150, D 44801, Bochum, Germany.
| | - Michael Tryba
- Clinic for Anaesthesiology, Intensive Care and Pain Medicine, Moenchebergstraße 41-43, D 34125, Kassel, Germany.
| | - Michael Zenz
- Ruhr-University Bochum, Universitätstr. 150, D 44801, Bochum, Germany.
| |
Collapse
|
26
|
Mullock A. The Assisted Dying Bill and the role of the physician. JOURNAL OF MEDICAL ETHICS 2015; 41:621-624. [PMID: 25575506 DOI: 10.1136/medethics-2014-102418] [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] [Received: 08/06/2014] [Accepted: 12/13/2014] [Indexed: 06/04/2023]
Abstract
This article explores the role of the physician in the Assisted Dying Bill, which is currently progressing through the House of Lords. The Supreme Court decision in Nicklinson and Others has alerted Parliament to the possibility that the current prohibition against assisted suicide may breach Article 8 of the European Convention in relation to the right to choose how to end one's life. In this article, the role of healthcare professionals in the proposed legalisation of physician-assisted suicide is examined, together with consideration of key ethical concerns over who might be permitted to access assisted dying. Whether the proposed law presents an ethically sound alternative to the current prohibition against assisting in suicide is not clear, but Parliament must now respond in order to address human rights issues and the call to legalise medically assisted suicide.
Collapse
|
27
|
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: 18] [Impact Index Per Article: 2.0] [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.
Collapse
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:
| |
Collapse
|
28
|
|
29
|
Zenz J, Tryba M, Zenz M. Physician-Assisted Dying: Acceptance by Physicians Only for Patients Close to Death. Pain Ther 2014; 3:103-12. [PMID: 25501920 PMCID: PMC4269613 DOI: 10.1007/s40122-014-0029-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Indexed: 02/03/2023] Open
Abstract
This study reports on German physicians' views on legalization of euthanasia and physician-assisted suicide, comparing this with a similar survey of UK doctors. A questionnaire was handed out to attendants of a palliative care and a pain symposium. Complete answers were obtained from 137 physicians. Similar to the UK study, about 30% of the physicians surveyed support euthanasia in case of terminal illness and more support physician-assisted suicide. In contrast, in both countries, a great majority of physicians oppose medical involvement in hastening death in non-terminal illnesses. The public and parliamentary discussion should face this opposition to assisted suicide by pain and palliative specialists.
Collapse
Affiliation(s)
- Julia Zenz
- Ruhr-University Bochum, Kemnaderstr. 342, 44797 Bochum, Germany
| | - Michael Tryba
- Clinic for Anaesthesiology, Intensive Care and Pain Medicine, Moenchebergstraße 41-43, 34125 Kassel, Germany
| | - Michael Zenz
- Ruhr-University Bochum, Henkenbergstr. 63, 44797 Bochum, Germany
| |
Collapse
|
30
|
Rathor MY, Abdul Rani MF, Shahar MA, Jamalludin AR, Che Abdullah STB, Omar AMB, Mohamad Shah ASB. Attitudes toward Euthanasia and Related Issues among Physicians and Patients in a Multi-cultural Society of Malaysia. J Family Med Prim Care 2014; 3:230-7. [PMID: 25374860 PMCID: PMC4209678 DOI: 10.4103/2249-4863.141616] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Due to globalization and changes in the health care delivery system, there has been a gradual change in the attitude of the medical community as well as the lay public toward greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As euthanasia has gained world-wide prominence, the objectives of our study therefore were to explore the attitude of physicians and chronically ill patients toward euthanasia and related issues. Concomitantly, we wanted to ascertain the frequency of requests for assistance in active euthanasia. MATERIALS AND METHODS Questionnaire based survey among consenting patients and physicians. RESULTS The majority of our physicians and patients did not support active euthanasia or physician-assisted suicide (EAS), no matter what the circumstances may be P < 0.001. Both opposed to its legalization P < 0.001. Just 15% of physicians reported that they were asked by patients for assistance in dying. Both physicians 29.2% and patients 61.5% were in favor of withdrawing or withholding life-sustaining treatment to a patient with no chances of survival. Among patients no significant differences were observed for age, marital status, or underlying health status. CONCLUSIONS A significant percentage of surveyed respondents were against EAS or its legalization. Patient views were primarily determined by religious beliefs rather than the disease severity. More debates on the matter are crucial in the ever-evolving world of clinical medicine.
Collapse
Affiliation(s)
- Mohammad Yousuf Rathor
- Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Mohammad Fauzi Abdul Rani
- Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Mohammad Arif Shahar
- Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - A Rehman Jamalludin
- Department of Community Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | | | - Ahmad Marzuki Bin Omar
- Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | | |
Collapse
|
31
|
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.
Collapse
|
32
|
Wilkinson DJC, de Crespigny L, Lees C, Savulescu J, Thiele P, Tran T, Watkins A. Perinatal management of trisomy 18: a survey of obstetricians in Australia, New Zealand and the UK. Prenat Diagn 2014; 34:42-9. [PMID: 24122837 PMCID: PMC3963474 DOI: 10.1002/pd.4249] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/20/2013] [Accepted: 09/29/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to explore the attitudes of obstetricians in Australia, New Zealand and the UK towards prenatally diagnosed trisomy 18 (T18). METHOD Obstetricians were contacted by email and invited to participate in an anonymous electronic survey. RESULTS Survey responses were obtained from 1018/3717 (27%) practicing obstetricians/gynaecologists. Most (60%) had managed a case of T18 in the last 2 years. Eighty-five per cent believed that T18 was a 'lethal malformation', although 38% expected at least half of liveborn infants to survive for more than 1 week. Twenty-one per cent indicated that a vegetative existence was the best developmental outcome for surviving children. In a case of antenatally diagnosed T18, 95% of obstetricians would provide a mother with the option of termination. If requested, 99% would provide maternal-focused obstetric care (aimed at maternal wellbeing rather than fetal survival), whereas 80% would provide fetal-oriented obstetric care (to maximise fetal survival). Twenty-eight per cent would never discuss the option of caesarean; 21% would always discuss this option. Management options, attitudes and knowledge of T18 were associated with location, practice type, gender and religion of obstetricians. CONCLUSION There is variability in obstetricians' attitudes towards T18, with significant implications for management of affected pregnancies.
Collapse
Affiliation(s)
- D J C Wilkinson
- Robinson Institute, University of AdelaideAdelaide, Australia
- Oxford Uehiro Centre for Practical Ethics, University of OxfordOxford, UK
| | - L de Crespigny
- Oxford Uehiro Centre for Practical Ethics, University of OxfordOxford, UK
| | - C Lees
- Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS TrustDu Cane Rd, London, W12 0HS
| | - J Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of OxfordOxford, UK
| | - P Thiele
- Monash UniversityFrankston, Australia
| | - T Tran
- Robinson Institute, University of AdelaideAdelaide, Australia
| | - A Watkins
- Mercy Hospital for WomenMelbourne, Australia
| |
Collapse
|
33
|
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.
Collapse
Affiliation(s)
- Willibald J Stronegger
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstrasse 6/I, 8010, Graz, Austria.
| | | | | | | |
Collapse
|
34
|
Khan F, Tadros G. Physician-assisted Suicide and Euthanasia in Indian Context: Sooner or Later the Need to Ponder! Indian J Psychol Med 2013; 35:101-5. [PMID: 23833354 PMCID: PMC3701348 DOI: 10.4103/0253-7176.112220] [Citation(s) in RCA: 6] [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] [Indexed: 11/30/2022] Open
Abstract
Physician-assisted suicide (PAS) is a controversial subject which has recently captured the interest of media, public, politicians, and medical profession. Although active euthanasia and PAS are illegal in most parts of the world, with the exception of Switzerland and the Netherlands, there is pressure from some politicians and patient support groups to legalize this practice in and around Europe that could possibly affect many parts of the world. The legal status of PAS and euthanasia in India lies in the Indian Penal Code, which deals with the issues of euthanasia, both active and passive, and also PAS. According to Penal Code 1860, active euthanasia is an offence under Section 302 (punishment for murder) or at least under Section 304 (punishment for culpable homicide not amounting to murder). The difference between euthanasia and physician assisted death lies in who administers the lethal dose; in euthanasia, this is done by a doctor or by a third person, whereas in physician-assisted death, this is done by the patient himself. Various religions and their aspects on suicide, PAS, and euthanasia are discussed. People argue that hospitals do not pay attention to patients' wishes, especially when they are suffering from terminally ill, crippling, and non-responding medical conditions. This is bound to change with the new laws, which might be implemented if PAS is legalized. This issue is becoming relevant to psychiatrists as they need to deal with mental capacity issues all the time.
Collapse
Affiliation(s)
- Farooq Khan
- Consultant Psychiatrist, Mental Helath Services for Older People, Staffordshire University, BL 167 Blackhealth Lane, Stafford ST18 0AD, UK
| | | |
Collapse
|
35
|
Kamath S, Bhate P, Mathew G, Sashidharan S, Daniel AB. Attitudes Toward Euthanasia Among Doctors in a Tertiary Care Hospital in South India: A Cross Sectional study. Indian J Palliat Care 2012; 17:197-201. [PMID: 22346044 PMCID: PMC3276816 DOI: 10.4103/0973-1075.92336] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Context: Advances in expertise and equipment have enabled the medical profession to exercise more control over the processes of life and death, creating a number of moral and ethical dilemmas. People may live for extended periods with chronic painful or debilitating conditions that may be incurable. Aim: This study attempts to study the attitudes of doctors toward euthanasia and the possible factors responsible for these attitudes. Settings and Design: A cross-sectional survey of 213 doctors working at a tertiary care hospital was conducted to determine their attitudes toward euthanasia. Materials and Methods: A self-administered questionnaire was used to assess attitudes and personal perceptions about euthanasia. Statistical Analysis Used: The Chi square test was used to assess factors influencing attitudes toward euthanasia. Results: A majority of the respondents (69.3%) supported the concept of euthanasia. Relief from unbearable pain and suffering was the most commonly (80.3%) cited reason for being willing to consider the option of euthanasia. Majority of those who were against euthanasia (66.2%) felt that the freedom to perform euthanasia could easily be misused. Disapproval of euthanasia was associated with religious affiliation (P<0.001) and speciality (P<0.001). Conclusions: A majority of the doctors in this study supported euthanasia for the relief of unbearable pain and suffering. Religion and speciality appear to be significant in determining attitudes toward euthanasia.
Collapse
Affiliation(s)
- Sneha Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, India
| | | | | | | | | |
Collapse
|
36
|
Cohen J, Van Wesemael Y, Smets T, Bilsen J, Deliens L. Cultural differences affecting euthanasia practice in Belgium: one law but different attitudes and practices in Flanders and Wallonia. Soc Sci Med 2012; 75:845-53. [PMID: 22682367 DOI: 10.1016/j.socscimed.2012.04.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 04/11/2012] [Accepted: 04/13/2012] [Indexed: 11/24/2022]
Abstract
Since 2002, Belgium has had a national law legalising euthanasia. The law prescribes several substantive due care requirements and two procedural due care requirements, i.e. consultation with an independent physician and reporting of euthanasia to a Federal Control Committee. A large discrepancy in reporting rates between the Dutch-speaking (Flanders) and the French-speaking (Wallonia) parts of Belgium has led to speculation about cultural differences affecting the practice of euthanasia in both regions. Using Belgian data from the European Values Study conducted in 2008 among a representative sample of the general public and data from a large-scale mail questionnaire survey on euthanasia of 480 physicians from Flanders and 305 from Wallonia (conducted in 2009), this study presents empirical evidence of differences between both regions in attitudes towards and practice of euthanasia. Acceptance of euthanasia by the general population was found to be slightly higher in Flanders than in Wallonia. Compared with their Flemish counterparts, Walloon physicians held more negative attitudes towards performing euthanasia and towards the reporting obligation, less often labelled hypothetical cases correctly as euthanasia, and less often defined a case of euthanasia having to be reported. A higher proportion of Flemish physicians had received a euthanasia request since the introduction of the law. In cases of a euthanasia request, Walloon physicians consulted less often with an independent physician. Requests were more often granted in Flanders than in Wallonia (51% vs 38%), and performed euthanasia cases were more often reported (73% vs 58%). The study points out some significant differences between Flanders and Wallonia in practice, knowledge and attitudes regarding euthanasia and its legal requirements which are likely to explain the discrepancy between Wallonia and Flanders in the number of euthanasia cases reported. Cultural factors seem to play an important role in the practice of (legal) euthanasia and the extent to which legal safeguards are followed.
Collapse
Affiliation(s)
- Joachim Cohen
- End-of Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.
| | | | | | | | | |
Collapse
|
37
|
McCormack R, Clifford M, Conroy M. Attitudes of UK doctors towards euthanasia and physician-assisted suicide: a systematic literature review. Palliat Med 2012; 26:23-33. [PMID: 22190615 DOI: 10.1177/0269216310397688] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To review studies over a 20-year period that assess the attitudes of UK doctors concerning active, voluntary euthanasia (AVE) and physician-assisted suicide (PAS), assess efforts to minimise bias in included studies, determine the effect of subgroup variables (e.g. age, gender) on doctors' attitudes, and make recommendations for future research. DATA SOURCES Three electronic databases, four pertinent journals, reference lists of included studies. REVIEW METHODS Literature search of English articles between January 1990 and April 2010. Studies were excluded if they did not present independent data (e.g. commentaries) or if they related to doctors outside the UK, patients younger than 18 years old, terminal sedation, withdrawing or withholding treatment, or double-effect. Quantitative and qualitative data were extracted. RESULTS Following study selection and data extraction, 15 studies were included. UK doctors oppose the introduction of both AVE and PAS in the majority of studies. Degree of religiosity appeared as a statistically significant factor in influencing doctors' attitudes. The top three themes in the qualitative analysis were the provision of palliative care, adequate safeguards in the event of AVE or PAS being introduced, and a profession to facilitate AVE or PAS that does not include doctors. CONCLUSIONS UK doctors appear to oppose the introduction of AVE and PAS, even when one considers the methodological limitations of included studies. Attempts to minimise bias in included studies varied. Further studies are necessary to establish if subgroup variables other than degree of religiosity influence attitudes, and to thoroughly explore the qualitative themes that appeared.
Collapse
Affiliation(s)
- Ruaidhri McCormack
- Department of Palliative Medicine, Milford Care Centre, Castletroy, Limerick, Ireland.
| | | | | |
Collapse
|
38
|
Kühne F, Behmann M, Bisson S, Walter U, Schneider N. Non-response in a survey of physicians on end-of-life care for the elderly. BMC Res Notes 2011; 4:367. [PMID: 21943379 PMCID: PMC3189129 DOI: 10.1186/1756-0500-4-367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 09/26/2011] [Indexed: 11/20/2022] Open
Abstract
Background Physicians are quite often surveyed with the aim to investigate their opinions regarding provision and improvement of health care. However, in many cases response rates tend to be rather low. The aim of the study is to reflect methodological aspects regarding survey conduction and to analyse factors that cause physicians to take part in a study on delivering end-of-life care for the elderly. Methods N = 4,727 physicians in Lower Saxony, Germany, received a standardised questionnaire on their attitudes about end-of-life care for the elderly. Non-responders were asked to state the reasons for non-participation. Comparison of the sociodemographic characteristics between responders and non-responders, and evaluation of the reasons for non-participation were made. Results The response rate to the questionnaire on end-of-life care for the elderly was 40% (n = 1,892). Of the non-responders to the questionnaire, 12.8% (n = 364) stated the reasons for non-participation. Overall, the response rate to the questionnaire varied with specialty and location of the practice: radiotherapists answered significantly more frequently than other categories of physician (e.g. general practitioners) and physicians in rural areas significantly more frequently than their colleagues in urban areas. The reasons most frequently given for non-participation were "Not concerned with the subject" and "No time". Conclusions The varying rates of response indicate that the survey was not sufficiently relevant to all groups of physicians, or that the awareness of the topic may be partly underdeveloped.
Collapse
Affiliation(s)
- Franziska Kühne
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Healthcare Systems Research, Carl-Neuberg-Str,1, 30625 Hannover, Germany.
| | | | | | | | | |
Collapse
|
39
|
Baeke G, Wils JP, Broeckaert B. 'We are (not) the master of our body': elderly Jewish women's attitudes towards euthanasia and assisted suicide. ETHNICITY & HEALTH 2011; 16:259-278. [PMID: 21660785 DOI: 10.1080/13557858.2011.573538] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES In Belgium, dominant ideological traditions--Christianity and non-religious humanism--have the floor in debates on euthanasia and hardly any attention is paid to the practices and attitudes of ethnic and religious minorities, for instance, Jews. This article aims to meet this lacuna. DESIGN Qualitative empirical research was performed in the Orthodox Jewish community of Antwerp (Belgium) with a purposive sample of elderly Jewish (non-)Hasidic and secularised Orthodox women. In-depth interviews were conducted to elicit their attitudes towards (non-)voluntary euthanasia and assisted suicide. RESULTS The research reveals diverse views among women in the community on intentionally terminating a patient's life. Absolute rejection of every act which deliberately terminates life is found among the overwhelming majority of (religiously observant) Orthodox (Hasidic and non-Hasidic) women, as they have an unconditional faith and trust in God's sovereign power over the domain of life and death. On the other hand, the views of secularised Orthodox women--mostly irreligious women, who do not consider themselves Orthodox, thus not following Jewish law, yet say they belong to the Orthodox Jewish community--show an acceptance of voluntary euthanasia and assisted suicide but non-voluntary euthanasia is approached more negatively. As they perceive illness and death as merely profane facts, they stress a patient's absolute right towards self-determination, in particular with regard to one's end of life. Among non-Hasidic Orthodox respondents, more openness is found for cultivating a personal opinion which deviates from Jewish law and for the right of self-determination with regard to questions concerning life and death. In this study, these participants occupy an intermediate position. CONCLUSION Our study reveals an interplay between ethical attitudes on euthanasia and religious convictions. The image one has of a transcendental reality, or of God, has a stronger effect on one's (dis)approval of euthanasia than being (ir)religious.
Collapse
Affiliation(s)
- Goedele Baeke
- Faculty of Theology, Interdisciplinary Centre for the Study of Religion and World View, Katholieke Universiteit Leuven, Leuven, Belgium.
| | | | | |
Collapse
|
40
|
Smets T, Cohen J, Bilsen J, Van Wesemael Y, Rurup ML, Deliens L. Attitudes and experiences of Belgian physicians regarding euthanasia practice and the euthanasia law. J Pain Symptom Manage 2011; 41:580-93. [PMID: 21145197 DOI: 10.1016/j.jpainsymman.2010.05.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/27/2010] [Accepted: 05/28/2010] [Indexed: 11/22/2022]
Abstract
CONTEXT Since the legalization of euthanasia, physicians in Belgium may, under certain conditions, administer life-ending drugs at the explicit request of a patient. OBJECTIVES To study the attitudes of Belgian physicians toward the use of life-ending drugs and euthanasia law, factors predicting attitudes, and factors predicting whether a physician has ever performed euthanasia. METHODS In 2009, we sent a questionnaire to a representative sample of 3006 Belgian physicians who, because of their specialty, were likely to be involved in the care of the dying. RESULTS Response rate was 34%. Ninety percent of physicians studied were accepting of euthanasia for terminal patients who had extreme uncontrollable pain/symptoms. Sixty-six percent agreed that the euthanasia law contributes to the carefulness of physicians' end-of-life behavior; 10% agreed that the law impedes the development of palliative care. Religious beliefs and geographic region were strong determinants of attitude. Training in palliative care did not influence attitudes regarding euthanasia, but trained physicians were less likely to agree that the euthanasia law impedes the development of palliative care than were nontrained physicians. One in five physicians had performed euthanasia; they were more likely to be nonreligious, older, specialist, trained in palliative care, and to have had more experience in treating the dying. CONCLUSION Most physicians studied support euthanasia for terminal patients with extreme uncontrollable pain/symptoms and agree that euthanasia can be part of good end-of-life care. Although physicians had little involvement in the process of legalizing euthanasia, they now generally endorse the euthanasia law.
Collapse
Affiliation(s)
- Tinne Smets
- End-of-Life Care Research Group, Faculty of Medicine and Pharmacy,Vrije Universiteit Brussel, Brussels, Belgium.
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
There is an increasing appetite for a change in the law to allow assisted suicide. This editorial suggests that psychiatrists should engage in the debate because the issues at stake will affect us, and we are likely to have a significant part to play were the law to be changed. We suggest that there are three main areas where psychiatrists' expertise may be informative: (a) the extent to which safeguards to limit the availability of assisted dying to target groups can be applied safely and fairly, including to individuals with psychiatric disorders; (b) the complexities inherent in assessing mental capacity; and (c) the degree to which individuals adapt or change their desires, particularly in relation to suicidal behaviours.
Collapse
|
42
|
Silvoniemi M, Vasankari T, Vahlberg T, Clemens KE, Salminen E. Physicians' attitudes towards euthanasia in Finland: would training in palliative care make a difference? Palliat Med 2010; 24:744-6. [PMID: 20921095 DOI: 10.1177/0269216310376556] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Silvoniemi
- Department of Respiratory Medicine, Turku University Hospital P.O. Box 52, Savitehtaankatu 1, 20521 Turku, Finland
| | - T. Vasankari
- Department of Respiratory Medicine, Turku University Hospital P.O. Box 52, Savitehtaankatu 1, 20521 Turku, Finland
| | - T. Vahlberg
- Institute of Clinical Medicine, Biostatistics University of Turku, Turku, Finland
| | - KE Clemens
- Department of Science and Research, Centre for Palliative Medicine, University of Bonn, Department of Palliative Medicine and Pain Therapy, Malteser Hospital Bonn/Rhein-Sieg von-Hompesch-Strasse 1, 53123 Bonn, Germany
| | - E. Salminen
- Department of Oncology and Radiotherapy, Turku University Hospital, P.O. Box 52, Savitehtaankatu 1, 20521 Turku, Finland
| |
Collapse
|
43
|
Abstract
It is widely assumed by the general public that if assisted suicide (AS) or euthanasia (VE) were legalised doctors must be essentially involved in the whole process including prescribing the medication and (in euthanasia) administering it. This paper explores some reasons for this assumption and argues that it flatly contradicts what it means to be a doctor. The paper is thus not mainly concerned with the ethics of AS/VE but rather with the concept of a doctor that has evolved since the time of Hippocrates to current professional guidance reflected in healthcare law. The paper argues that the most common recent argument for AS/VE--that patients have a right to control when and how they die--in fact points to the involvement not of doctors but of legal agencies as decision makers plus technicians as agents.
Collapse
Affiliation(s)
- Fiona Randall
- Royal Bournemouth Christchurch Hospitals NHS Foundation Trust.
| | | |
Collapse
|
44
|
How the mass media report social statistics: a case study concerning research on end-of-life decisions. Soc Sci Med 2010; 71:861-8. [PMID: 20609508 DOI: 10.1016/j.socscimed.2010.05.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 05/21/2010] [Accepted: 05/28/2010] [Indexed: 11/23/2022]
Abstract
The issue of whether it is right to be concerned about the accuracy with which mass media report social scientific research is explored through a detailed case study of media reporting of two surveys of UK doctors' end-of-life decision-making. Data include press releases, emails and field notes taken during periods of media interest supplemented by a collection of print and broadcast media reports. The case study contributes to existing knowledge about the ways in which mass media establish, exaggerate and otherwise distort the meaning of statistical findings. Journalists ignored findings that did not fit into existing media interest in the 'assisted dying' story and were subject to pressure from interest groups concerned to promote their own interpretations and viewpoints. Rogue statistics mutated as they were set loose from their original research report context and were 'laundered' as they passed from one media report to another. Yet media accounts of the research, fuelling an already heated public debate about ethical issues in end-of-life care, arguably acted as a conduit for introducing new considerations into this debate, such as the role played by sedation at the end of life, the extent to which euthanasia is practiced outside the law, and the extent of medical opposition to the legalisation of assisted dying. The expectation that accuracy and comprehensiveness should be the sole criteria for judging journalists' reports is, finally, considered to be unrealistic and it is argued that social scientists need to understand and adapted to the conditions under which mass media reporting operates if they are to succeed in introducing the findings of social research into public debates.
Collapse
|
45
|
Bartram DJ, Baldwin DS. Veterinary surgeons and suicide: a structured review of possible influences on increased risk. Vet Rec 2010; 166:388-97. [PMID: 20348468 DOI: 10.1136/vr.b4794] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Veterinary surgeons are known to be at a higher risk of suicide compared with the general population. There has been much speculation regarding possible mechanisms underlying the increased suicide risk in the profession, but little empirical research. A computerised search of published literature on the suicide risk and influences on suicide among veterinarians, with comparison to the risk and influences in other occupational groups and in the general population, was used to develop a structured review. Veterinary surgeons have a proportional mortality ratio (PMR) for suicide approximately four times that of the general population and around twice that of other healthcare professions. A complex interaction of possible mechanisms may occur across the course of a veterinary career to increase the risk of suicide. Possible factors include the characteristics of individuals entering the profession, negative effects during undergraduate training, work-related stressors, ready access to and knowledge of means, stigma associated with mental illness, professional and social isolation, and alcohol or drug misuse (mainly prescription drugs to which the profession has ready access). Contextual effects such as attitudes to death and euthanasia, formed through the profession's routine involvement with euthanasia of companion animals and slaughter of farm animals, and suicide 'contagion' due to direct or indirect exposure to suicide of peers within this small profession are other possible influences.
Collapse
Affiliation(s)
- D J Bartram
- Division of Clinical Neurosciences, School of Medicine, University of Southampton, RSH Hospital, Brintons Terrace, Southampton SO14 0YG.
| | | |
Collapse
|
46
|
Seale C. Continuous deep sedation in medical practice: a descriptive study. J Pain Symptom Manage 2010; 39:44-53. [PMID: 19854611 DOI: 10.1016/j.jpainsymman.2009.06.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 06/20/2009] [Accepted: 06/22/2009] [Indexed: 11/24/2022]
Abstract
CONTEXT Continuous deep sedation (CDS) until death can form an effective part of palliative care. In The Netherlands and Belgium, CDS is sometimes regarded as an alternative to euthanasia, and the involvement of palliative care specialists is low. Provision of CDS through opioids alone is not recommended. OBJECTIVES This study investigates the use of CDS in the United Kingdom. METHODS A survey of 8,857 doctors, of whom 3,733 (42%) replied, with 2,923 reporting on their last patient who died. RESULTS In total, 18.7% (17.3-20.1) of the doctors attending a dying patient reported the use of CDS. CDS was more likely when patients were younger or were dying of cancer. Specialists in care of the elderly were least likely to report the use of CDS; doctors in other hospital specialties were most likely to report its use. CDS was associated with a higher rate of requests from patients or relatives for a hastened death and with a greater incidence of other end-of-life decisions containing some intent to end life by the doctor. Doctors supporting legalization of euthanasia or physician-assisted suicide, or who were nonreligious, were more likely to report using CDS. There was palliative care team involvement in half of all CDS cases, and prescription of opioids alone for sedation occurred in one-fifth of the cases but was not reported by specialists in palliative care. CONCLUSION This study provides baseline data for monitoring future trends in the United Kingdom and highlights the need for a fuller understanding of the circumstances in which CDS occurs in particular care settings.
Collapse
Affiliation(s)
- Clive Seale
- Centre for Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom.
| |
Collapse
|
47
|
Seale C. Hastening death in end-of-life care: A survey of doctors. Soc Sci Med 2009; 69:1659-66. [DOI: 10.1016/j.socscimed.2009.09.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Indexed: 12/22/2022]
|
48
|
Our debt to those who are dying: the UK medical establishment should reconsider its stance on assisted suicide. Br J Gen Pract 2009; 59:809-10. [DOI: 10.3399/bjgp09x472863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
49
|
Grogan E, Beattie R, Campbell C, George R, Harlow T, MacGregor B, Oliver D, Thorns A, Noble B. End-of-life decisions in the United Kingdom involving medical practitioners and legalisation of euthanasia or physician-assisted suicide: survey of doctors' attitudes. Palliat Med 2009; 23:569. [PMID: 19460833 DOI: 10.1177/0269216309106458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- E Grogan
- Palliative Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields; On behalf of the Ethics Committee of the Association of Palliative Medicine
| | - R Beattie
- Palliative Medicine, St John’s Hospice, Lancaster, UK
| | | | - R George
- Guy’s & St Thomas’ Hospital, London, UK; Biomedical Ethics, UCL
| | | | - B MacGregor
- Specialist Registrar Palliative Medicine, Myton Hamlet Hospice, Warwick, UK
| | - D Oliver
- Consultant and Honorary Senior Lecturer Palliative Medicine, Wisdom Hospice, Rochester, Kent, UK
| | - A Thorns
- Consultant and Honorary Senior Lecturer Palliative Medicine, Pilgrims Hospice and East Kent NHS Trust, Margate, Kent, UK
| | - B Noble
- Macmillan Senior Lecturer in Palliative Medicine, Sykes House, Sheffield Sykes House, Sheffield
| |
Collapse
|
50
|
Affiliation(s)
- W Lee
- Kings College London, Institute of Psychiatry, Psychological Medicine, London, UK
| | - A Price
- Kings College London, Institute of Psychiatry, Psychological Medicine, London, UK
| | - L Rayner
- Kings College London, Palliative Care, Policy and Rehabilitation, London, UK
| | - M Hotopf
- Kings College London, Institute of Psychiatry, Psychological Medicine, London, UK
| |
Collapse
|