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Bloomer MJ, Saffer L, Hewitt J, Johns L, McAuliffe D, Bonner A. Maybe for unbearable suffering: Diverse racial, ethnic and cultural perspectives of assisted dying. A scoping review. Palliat Med 2024:2692163241268449. [PMID: 39126283 DOI: 10.1177/02692163241268449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
BACKGROUND Assisted dying, also commonly known as euthanasia and physician-assisted suicide, is legal in many countries. Interest in assisted dying is growing due to evolving societal understandings of a good death and a desire for choice. Ethico-legal perspectives are well-known, but as societies become more heterogenous, a greater understanding of the perspectives of people from diverse racial, ethnic, and cultural backgrounds is needed. AIM To explore perspectives of people from diverse racial, ethnic and cultural backgrounds about assisted dying. DESIGN Scoping review with narrative synthesis. The protocol was registered with Open Science Framework. DATA SOURCES Medline, CINAHL Complete, PsycINFO and ProQuest Dissertations & Theses Global were searched from inception to May 2023. Citations were independently assessed against inclusion and exclusion criteria. RESULTS Of the 17 included studies, perspectives of assisted dying were presented according to religion, religiosity, spirituality, race, ethnicity and ancestry. Perspectives were diverse, presenting more as a spectrum, with multiple intersections and interconnections. Support and/or opposition for assisted dying differed according to cultural attributes, but even amongst those with similar cultural attributes, perspectives differed according to life experiences and notions of suffering. CONCLUSION Perspectives on assisted dying are dynamic and evolving. Even where assisted dying is legalised, individual's cultural attributes contribute to unique perspectives of assisted dying as an end-of-life option. Thus, understanding a person's culture, beliefs, expectations and choices in illness, treatment goals and care is fundamental, extending beyond what may be already considered as part of clinician-patient care relationships and routine advance care planning.
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Affiliation(s)
- Melissa J Bloomer
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Health and Hospital Service, Woolloongabba, QLD, Australia
| | - Laurie Saffer
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Intensive Care Unit, Epworth HealthCare, Richmond, VIC, Australia
| | - Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Queen Elizabeth II Hospital, Metro South Health and Hospital Service, Coopers Plains, QLD, Australia
- Law Futures Centre, Griffith University, Nathan, QLD, Australia
| | - Lise Johns
- School of Health Sciences and Social Work, Griffith University, Nathan, QLD, Australia
| | - Donna McAuliffe
- School of Health Sciences and Social Work, Griffith University, Nathan, QLD, Australia
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Kidney Health Service, Metro North Hospital and Health Service, Herston, QLD, Australia
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Patuzzo S, Pulice E, Orsi L. Palliative Care against Medically Assisted Death? Misunderstanding and Instrumental Objections. Am J Hosp Palliat Care 2024; 41:853-858. [PMID: 37607388 DOI: 10.1177/10499091231196302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
CONTEXT Palliative Care (PC) and Medically Assisted Death (MAD), specifically assisted suicide and euthanasia, are distinct practices characterized by differing objectives, methods, implementation and outcomes. Representatives of PC, including scientific societies or physicians, may, in certain cases, adopt a critical stance towards MAD. OBJECTIVES The study aims to explore the underlying reasons for such opposition. METHODS To this end, the philosophical underpinnings and legal conditions of PC and MAD will be analyzed. RESULTS The ethical and philosophical landscape of PC and MAD leads us to identify, on one hand, the Hippocratic paradigm and, on the other hand, what we call Socratic medicine. From a legal analysis perspective, the presence of intolerable suffering serves as a common ground between the two practices, albeit risking being the subject of misunderstandings and instrumental objections. CONCLUSION Preventing an instrumental use of PC in relation to MAD is crucial to enable the respect and the coexistence of the two practices.
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Affiliation(s)
- Sara Patuzzo
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | | | - Luciano Orsi
- Editor in Chief of Italian Journal of Palliative Care (Riv. It. Cure Palliative), Milano, Italy
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Gringart E, Adams C, Woodward F. Older Adults' Perspectives on Voluntary Assisted Death: An In-Depth Qualitative Investigation in Australia. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:1026-1046. [PMID: 35422170 DOI: 10.1177/00302228221090066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Interest in voluntary assisted death (VAD) has been growing among researchers, policy makers and the public. This study aimed to explore older adults' perspectives on VAD in Australia. Using purposive sampling, 15 adults ≥65 years participated in in-depth semi-structured interviews. Interpretative phenomenological analysis identified four themes: cultural reflections; beliefs and worldviews; health aspects; and fabric of life. Participants expressed a desire to have control over end-of-life options, challenged by religious beliefs. Participants expressed concern that VAD legislation could leave people vulnerable to coercion and saw a need for safeguards. Reasons for and against supporting and utilising VAD were discussed. Physical illness was seen a more compelling reason for VAD than mental ill-health. Finally, connections to life and other were discussed, and being able to do the things one loved were named aspects of what it meant to live a good life. Implications are discussed along with future research directions.
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Affiliation(s)
- Eyal Gringart
- School of Arts and Humanities, Edith Cowan University, Joondalup, WA, Australia
| | - Claire Adams
- School of Arts and Humanities, Edith Cowan University, Joondalup, WA, Australia
| | - Faye Woodward
- School of Arts and Humanities, Edith Cowan University, Joondalup, WA, Australia
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Lachowski S, Lachowska B, Florek-Łuszczki M. Acceptance of euthanasia by students of selected study disciplines at universities in Lublin, Poland. BMC Med Ethics 2024; 25:83. [PMID: 39060951 PMCID: PMC11282810 DOI: 10.1186/s12910-024-01071-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 06/12/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND In the context of discussions between supporters and opponents of euthanasia, and legal regulations regarding this type of practices, the attitude of young people with respect to this phenomenon is a very interesting issue. According to Polish law, euthanasia is prohibited. The aim of this study was to determine the degree of acceptance of euthanasia among students from Polish universities across three different fields of study: psychology, medicine, and economic-technical disciplines, and to identify the factors associated with the acceptance of this phenomenon. METHODS The study included 627 persons studying in Lublin, Poland: medicine (280), psychology (170), and economic-technical studies (177). The study was conducted as a survey using questionnaire containing items concerning students' attitudes towards euthanasia. The analysis of the collected data was conducted using the SPSS software (version 29) with the following methods: Chi2, Student's t-test, Phi test, Cramer's V test, Kolmogorov-Smirnov test, one-way ANOVA with Dunnett's post hoc test, linear regression analysis, and categorical regression analysis using optimal scaling (CATREG). RESULTS Nearly half of the students participating in the study (45.9%) rated the practice of euthanasia as decidedly negative. The highest number of strongly negative evaluations was found among psychology students, and the least among students of economic-technical disciplines. The level of acceptance of euthanasia is significantly associated with religious involvement and studying psychology. Being religious and being a psychology student both contribute to lower acceptance of euthanasia and a lower willingness to consent to euthanasia. Consent to euthanasia is more commonly declared by individuals with experience of living with elderly people. CONCLUSIONS Although nearly half of the respondents expressed a negative attitude towards euthanasia, considering the secularization process among Polish youth, it can be assumed that the level of acceptance of euthanasia in this social group will increase. The lower level of acceptance of euthanasia among psychology and medical students compared to students of economic-technical disciplines suggests that the curricula of these studies present alternative solutions to the problems of terminally ill patients other than euthanasia.
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Goyarrola R, Lamminmäki A, Sipola V, Karvinen I, Peake M, Saarelainen SM, Santavirta N, Niemi-Murola L, Pöyhiä R. Finnish Palliative Care Nurses' and Physicians' Perceptions of Spirituality and Spiritual Care Related to Their Attitudes toward End-of-Life Care. Palliat Med Rep 2024; 5:247-257. [PMID: 39044759 PMCID: PMC11262586 DOI: 10.1089/pmr.2023.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 07/25/2024] Open
Abstract
Background Spiritual care constitutes an indispensable aspect of palliative care (PC). Health care professionals encounter challenges when addressing spiritual care at the end of life. Developing appropriate attitudes toward end-of-life care can facilitate the acquisition of competencies needed for effective delivery of spiritual care. Aim To explore the perceptions of spiritual care and attitudes toward end-of-life care among PC professionals. Design The Finnish version of the "Spirituality and Spiritual Care Rating Scale" (SSCRS-FIN) and a newly developed "Attitudes toward End-of-Life Issues" (AEOLI) questionnaire were validated and utilized. Setting/Participants Both questionnaires were distributed to PC professionals involved in PC through an online survey. Exploratory and confirmatory factor analyses were conducted. The newly derived factors were subsequently examined for their associations with age, gender, profession, affiliation with a religious community, personal interpretation of spirituality, and years of professional experience. Results A total of 204 participants took part in the study (163 nurses, 19 nursing students, and 22 physicians). Exploratory factor analysis demonstrated satisfactory internal consistency, as indicated by Cronbach's alpha coefficients, for the five factors of SSCRS-FIN: "Spirituality" (0.733), "Existential" (0.614), "Spiritual Needs" (0.599), "Passive Spiritual Care" (0.750), and "Active Spiritual Care" (0.665); and for the seven factors of AEOLI: "Anxiety" (0.823), "Discussion" (0.924), "End-of-Life" (0.573), "Education" (0.692), "Medically Induced Death" (0.859), "Suffering" (0.671), and "Knowledge" (0.444). Confirmatory factor analysis demonstrated satisfactory fit values for both questionnaires. Significant positive correlations were observed between end-of-life care and the factors "Existential," "Spiritual Needs," and spiritual care factors, whereas an inverse correlation was found among "Anxiety," "Medically Induced Death," and all factors of SSCRS-FIN. Conclusions Valid and reliable questionnaires for assessing spiritual care (SSCRS-FIN) and attitudes toward end-of-life care (AEOLI) were developed. Attitudes toward end-of-life care were positively correlated with perceptions of spiritual care.
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Affiliation(s)
- Raimo Goyarrola
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Virpi Sipola
- Evangelical-Lutheran Church of Finland, Helsinki, Finland
| | - Ikali Karvinen
- Faculty of Health & Finn Church Aid (FCA), University of Eastern Finland, Kuopio, Finland
| | - Minna Peake
- Palliative Care Center Siun Sote, University of Eastern Finland, Joensuu, Finland
| | - Suvi-Maria Saarelainen
- School of Theology, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | - Nina Santavirta
- Faculty of Educational Sciences, University of Helsinki, Finland
| | - Leila Niemi-Murola
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, University of Helsinki (Clinicum), Helsinki, Finland
| | - Reino Pöyhiä
- School of Medicine, University of Eastern Finland, Kuopio, Finland
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Vogelstein E. Medically Assisted Death and the Ends of Medicine. JOURNAL OF BIOETHICAL INQUIRY 2024; 21:249-259. [PMID: 37884764 DOI: 10.1007/s11673-023-10288-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/20/2023] [Indexed: 10/28/2023]
Abstract
This paper aims to refute a common line of argument that it is immoral for physicians to engage in medical assistance in death (MAiD), i.e., the practices of euthanasia and physician-assisted suicide. The argument in question is based on the notion that participating in MAiD is contrary to the professional-role obligations of physicians, due to MAiD's putative inconsistency with the ends of medicine. The paper describes several major flaws from which that argument suffers.
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Affiliation(s)
- Eric Vogelstein
- Duquesne University, 525 Fisher Hall, 600 Forbes Ave, Pittsburgh, PA, 15282, USA.
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Mercadante S. Palliative Care Aspects in Multiple Sclerosis. J Pain Symptom Manage 2024; 67:e425-e437. [PMID: 38219965 DOI: 10.1016/j.jpainsymman.2024.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
CONTEXT Multiple sclerosis (MS) is an inflammatory, chronic, demyelinating, and neurodegenerative disorder of central nervous system, determined by an auto-immune dysfunction. Severe disability generally occurs in patients with progressive forms of MS that typically develop either after an earlier relapsing phase or less commonly from disease onset. Despite advances in research to slow the progression of MS, this condition remains a life-limiting disease with symptoms impacting negatively the lives of patients and caregivers. OBJECTIVES To analyze the difefrent aspects of palliative cae in patients with MS. METHODS To analyse selected literature assessing several palliative care aspects in patients with MS. RESULTS People with MS have complex symptoms and different needs. These demands include how to deal with the burden of physical disability, how to organise daily life, restructuring social roles in the family and at work, keeping self-sufficiency in personal care, and preserving personal identity and community roles. CONCLUSION An early palliative care approach aims to improve the palliative care skills and competencies of health professionals caring for the patients since the early stage of disease, including those who are actively undergoing disease-targeted therapies, rather than merely providing end-of-life care.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center of Pain Relief and Supportive/Palliative Care (S.M.), La Maddalena Cancer Center, Regional Home care program, SAMOT, Palermo, Italy.
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Forycka M, Liberacka-Dwojak M, Leppert W, Suchecki P, Suchecka N, Ast B. Psychological Factors Influencing Attitudes towards Euthanasia, Assisted Suicide and Palliative Care among Medical Students and Doctors in Training. Healthcare (Basel) 2024; 12:833. [PMID: 38667594 PMCID: PMC11050125 DOI: 10.3390/healthcare12080833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: This study aimed to analyse the attitudes of medical students, Polish and classical philology students and trainee doctors towards the legalisation and practice of euthanasia and assisted suicide, to explore their beliefs about palliative care and to identify the cognitive, behavioural and emotional factors influencing these attitudes. Methods: An anonymous 22-question survey was sent by email to 670 participants, who comprised students of medicine, students of Polish and classical philology and trainee physicians. Results: Out of the 670 people invited to the survey, 313 (46.72%) responded; 215 (68.69%) and 112 (35.80%) participants supported the legalisation of euthanasia and assisted suicide, respectively. No differences were found between the respondent groups studied. The respondents' attitudes were influenced by religion, place of residence and professed values in the doctor-patient relationship. Among the medical students and trainee doctors surveyed, the declared willingness to perform euthanasia was lower, with 90 (43.7%) people, than the support for its legalisation, with 135 (65.5%) people. Significantly higher support for palliative care was expressed by fifth- and sixth-year medical students and trainee doctors, with 88 respondents (89.89%), less support was expressed by first- and fourth-year medical students, with 74 respondents (68.5%), and the lowest support was observed among Polish and classical philology students, with 63 respondents (58.9%). Conclusions: The legalisation of euthanasia and assisted suicide was supported by more than two-thirds and one-third of all the respondents, respectively, with the majority of medical students and trainee doctors surveyed expressing uncertainty or lack of readiness towards their practice. More than 70% of all the respondents showed a positive opinion towards palliative care, with the lowest support being among Polish and classical philology students.
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Affiliation(s)
- Maria Forycka
- Department of Palliative Medicine, Institute of Medical Sciences, Collegium Medicum, University of Zielona Góra, ul. Zyty 28, 65-046 Zielona Góra, Poland;
| | | | - Wojciech Leppert
- Department of Palliative Medicine, Institute of Medical Sciences, Collegium Medicum, University of Zielona Góra, ul. Zyty 28, 65-046 Zielona Góra, Poland;
- University Hospital in Poznań, Osiedla Rusa 55, 61-245 Poznań, Poland
| | - Paweł Suchecki
- MediCenter Primary Care Physicians, ul. 3 Maja 13, 99-400 Łowicz, Poland; (P.S.); (N.S.)
| | - Natalia Suchecka
- MediCenter Primary Care Physicians, ul. 3 Maja 13, 99-400 Łowicz, Poland; (P.S.); (N.S.)
| | - Bartłomiej Ast
- Department of Care and Treatment Facility, Józef Struś Multispecialist Municipal Hospital, ul. Szwajcarska 3, 61-285 Poznań, Poland;
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Chutarattanakul L, Jarusukthavorn V, Dejkriengkraikul N, Oo MZ, Tint SS, Angkurawaranon C, Wiwatkunupakarn N. Misconception between palliative care and euthanasia among Thai general practitioners: a cross-sectional study. BMC Palliat Care 2024; 23:96. [PMID: 38600512 PMCID: PMC11007896 DOI: 10.1186/s12904-024-01430-6] [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: 01/04/2024] [Accepted: 04/08/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Palliative care lower medical expenses and enhances quality of life, but misconception with euthanasia delays timely care and makes inappropriate patient management. OBJECTIVE To examine the magnitude of misconceptions between palliative care and euthanasia among Thai general practitioners, explore the association with knowledge, attitudes, and practical experience, and assess the association between misconception and confidence in practicing and referring patients to palliative care centers. METHODS All 144 general practitioners who were going to start residency training at Maharaj Nakorn Chiang Mai Hospital in 2021 participated in this observational cross-sectional study. A chi-square test was utilized to examine the relationship between misconception and knowledge, attitude, practical experience, confidence to practice, and confidence to refer patients. Multivariable logistic regression was carried out while controlling for age, sex, knowledge, attitude, and experience to examine the relationship between misconception and confidence to practice and refer patients for palliative care. Statistical significance was defined at p < 0.05. RESULTS About 41% of general physicians had misconceptions regarding palliative care and euthanasia. High knowledge was associated with a lower level of misconception (p = 0.01). The absence of misconceptions was weakly associated with a higher level of confidence in practicing palliative care, with an adjusted odds ratio of 1.51 (95% confidence interval 0.73 to 3.10, p = 0.07). CONCLUSION High misconception rates between palliative care and euthanasia among young Thai physicians might impact their confidence in delivering palliative care. Training initiatives for medical students and practitioners can mitigate misconceptions, fostering better palliative care utilization in Thailand.
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Affiliation(s)
- Lalita Chutarattanakul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
| | - Viriya Jarusukthavorn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
| | - Nisachol Dejkriengkraikul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
| | - Myo Zin Oo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Soe Sandi Tint
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand.
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand.
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Tsemach R, Aharon AA. Decision-making process regarding passive euthanasia: Theory of planned behavior framework. Nurs Ethics 2024:9697330241238346. [PMID: 38449448 DOI: 10.1177/09697330241238346] [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: 03/08/2024]
Abstract
BACKGROUND Nurses have an essential role in caring for end-of-life patients. Nevertheless, the nurse's involvement in the passive euthanasia decision-making process is insufficient and lower than expected. OBJECTIVES To explore factors associated with nurses' intention to be involved in non-treatment decisions (NTD) regarding passive euthanasia decision-making versus their involvement in the palliative care of patients requesting euthanasia, using the Theory of Planned Behavior (TPB) framework. DESIGN A cross-sectional study utilizing a random sample. PARTICIPANTS AND RESEARCH CONTEXT The study was conducted in one of the largest hospitals in Israel among 125 nurses employed in internal and surgical care wards. Data was collected through face-to-face interviews between March and April 2019. METHOD A closed structured questionnaire was developed according to TPB instructions. A paired sample t test and two multiple hierarchical regressions were conducted. Variance explained (R2) and the significance of F change were calculated for each regression. The study used the STROBE statement guideline. ETHICAL CONSIDERATIONS The study was approved by the hospital's Helsinki Committee (#20.11.2017). FINDINGS A paired sample t test revealed that nurses' involvement in the palliative care of patients requesting passive euthanasia was significantly higher than in NTD regarding euthanasia. Regression analyses revealed that nurses' position and attitudes explain their intention to be involved in decision-making; attitudes and perceived behavioral control explain nurses' intention to be involved in the care of patients requesting euthanasia. CONCLUSIONS According to the TPB, nurses' attitudes explained their intention to participate in decision-making regarding passive euthanasia. It is recommended to enhance open discussion of this complex issue to encourage nurses' willingness to participate in NTD decision-making regarding euthanasia.
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Volberg C, Schmidt-Semisch H, Maul J, Nadig J, Gschnell M. Pain management in German hospices: a cross-sectional study. BMC Palliat Care 2024; 23:7. [PMID: 38172899 PMCID: PMC10763107 DOI: 10.1186/s12904-023-01291-5] [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: 01/10/2023] [Accepted: 10/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Pain management is a necessary component of palliative care as most patients suffer from pain during the final phase of life. Due to the complex causation of pain in the last phase of life, it is important to utilize methods other than pharmacotherapeutic options in order to achieve adequate pain control. As little is known about treatment of pain in German hospices, a nationwide survey was conducted. MATERIALS AND METHODS All German hospices (259) were contacted by post in June 2020 and asked to participate in an anonymous cross-sectional survey. RESULTS A total of 148 (57%) German hospices took part in the survey. A broad variety of medication is used in the hospice setting. Metamizole is the most commonly used non-opiod analgesic , hydromorphone the most commonly used opioid, and pregabalin is the most commonly prescribed co-analgesic drug. The pain medication is usually prescribed as an oral slow-release substance. Standardized treatment schemes are rare among the responding hospices. Most of the respondents also use complementary treatment options, such as aroma (oil) therapy or music therapy, in the treatment of pain. Palliative sedation is used by nearly all responding hospices if all other treatment options fail. CONCLUSION This survey provides an overview of the treatment options for pain management in German hospices. A broad variety of pain medication is used. Compared to international literature, it is debatable whether such a large variety of different types of pain medication is necessary, or whether a reduction in the type of medication available and the use of standardized treatment schemes could benefit everyone involved.
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Affiliation(s)
- Christian Volberg
- Department of Anesthesia and Intensive Care, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany.
- Research Group Medical Ethics, Department of Medicine, Philipps University of Marburg, Marburg, Germany.
| | - Henning Schmidt-Semisch
- Institute of Public Health and Nursing Research, Department of Health and Society, University of Bremen, Bremen, Germany
| | - Julian Maul
- Department of Anesthesia and Intensive Care, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany
| | - Jens Nadig
- University Children's Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Martin Gschnell
- Department of Dermatology und Allergology, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany
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Ortega-Galán ÁM, Ibáñez-Masero O, Fernández-Martínez E, Ortiz-Amo R, Fernández-Santos L, Ruiz-Fernández MD. The paradoxical position of nurses regarding euthanasia and its legalisation: A descriptive quantitative study. J Clin Nurs 2023; 32:8007-8016. [PMID: 37715363 DOI: 10.1111/jocn.16869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/04/2023] [Accepted: 08/21/2023] [Indexed: 09/17/2023]
Abstract
AIMS AND OBJECTIVES To learn about the attitudes of nurses working in the Andalusian Public Health System regarding euthanasia and its legalisation. BACKGROUND Euthanasia often finds itself in the crosshairs of ethical and political debate on an international scale. Currently, the Spanish Organic Law 3/2021 of 24 March, 2021, recognises euthanasia as a fundamental right in Spain. It is of particular interest to know about the views, attitudes and stances that Andalusian nurses have of euthanasia as they are key players within the framework of euthanasia and administration of life-ending drugs. They play a central role in guiding patients through the euthanasia application process. DESIGN Observational descriptive study. METHODS A study of Andalusian Public Health System nurses was carried out using non-probability convenience sampling. 518 nurses with an average age of 44.75 years answered in a questionnaire that was distributed on an online platform. Socio-demographic and occupational variables were assessed, together with the Death Anxiety Scale and the Euthanasia Attitude Scale. A bivariate analysis and a multivariate linear regression model were performed. The STROBE checklist was used. RESULTS The mean score obtained on the Euthanasia Attitude Scale was 75.95 (SD = 16.53). The mean score obtained on the Death Anxiety Scale was 7.56 (SD = 3.05). The variables age and work experience were negatively correlated with the total scores of the Euthanasia Attitude Scale and the categories 'Ethical considerations', 'Practical considerations' and 'Treasuring life'. On the other hand, there was a significant positive correlation between age and work experience and 'Spiritual beliefs' category. CONCLUSIONS The current situation shows a worrying paradox. There is a stark difference between positive professional attitudes towards euthanasia and the desire to participate in its application. RELEVANCE TO CLINICAL PRACTICE It is vital that educational and healthcare institutions make the necessary efforts to ensure that nurses develop sound moral judgement, displaying the moral conscience and ethical commitment required of this established profession. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
| | | | | | - Rocío Ortiz-Amo
- Department of Psychology, Area of Social Work and Social Services, University of Almería, Almería, Spain
| | | | - María Dolores Ruiz-Fernández
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almería, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
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Peisah C, Sheppard A, Leung KC. Objections to assisted dying within institutions: systemic solutions for rapprochement. BMC Med Ethics 2023; 24:100. [PMID: 37974178 PMCID: PMC10655327 DOI: 10.1186/s12910-023-00981-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
In this Matters Arising article, we outline how the recent article "The impact on patients of objections by institutions to assisted dying: a qualitative study of family caregivers' perceptions" (White et al., 2023 Mar 13;24(1):22) informed Voluntary Assisted Dying (VAD) implementation in our large Australian public health setting, where objections do not emanate from, but within, the institution. In reporting the harms to patients and caregivers created by institutional objection, White et al. provide an evidenced-based road map for potential potholes or risks associated with VAD implementation. We discuss the complexities emerging from the diverse views of health professionals and the ethical tensions arising from such, especially within certain specialties, and how we developed systemic strategies that support patients, caregivers and staff alike. We highlighted the need to shift from "Do you support VAD?" to "How can we support you as healthcare professionals to integrate VAD into your practice, in a way that complies with the legislation, meets the needs of patients and caregivers, and feels safe and does not compromise your moral stance?"
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Affiliation(s)
- Carmelle Peisah
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- Capacity Australia, Sydney, Australia.
| | - Adrianna Sheppard
- Research and Education Network, Westmead Hospital, Sydney, NSW, 2145, Australia
| | - Kelvin Cy Leung
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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14
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Smaling HJ, Jingyuan X, Nakanishi M, Shinan-Altman S, Mehr DR, Radbruch L, Gaertner J, Werner P, Achterberg WP, van der Steen JT. Interventions that may increase control at the end of life in persons with dementia: the cross-cultural CONT-END acceptability study protocol and pilot-testing. BMC Palliat Care 2023; 22:142. [PMID: 37752467 PMCID: PMC10523619 DOI: 10.1186/s12904-023-01249-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Interventions such as advance care planning (ACP), technology, or access to euthanasia may increase the sense of control over the end of life. In people with advanced dementia, the loss of cognitive and physical function limits the ability to control care. To date, little is known about the acceptability of these interventions from the perspective of persons with dementia and others involved. This study will examine the cross-cultural acceptability, and factors associated with acceptability, of four end-of-life interventions in dementia which contain an element of striving for control. Also, we report on the development and pilot testing of animation video vignettes that explain the interventions in a standardized manner. METHODS Cross-sectional mixed-methods vignette study. We assess acceptability of two ACP approaches, technology use at the end of life and euthanasia in persons with dementia, their family caregivers and physicians in six countries (Netherlands, Japan, Israel, USA, Germany, Switzerland). We aim to include 80 participants per country, 50 physicians, 15 persons with dementia, and 15 family caregivers. After viewing each animation video, participants are interviewed about acceptability of the intervention. We will examine differences in acceptability between group and country and explore other potentially associated factors including variables indicating life view, personality, view on dementia and demographics. In the pilot study, participants commented on the understandability and clarity of the vignettes and instruments. Based on their feedback, the scripts of the animation videos were clarified, simplified and adapted to being less slanted in a specific direction. DISCUSSION In the pilot study, the persons with dementia, their family caregivers and other older adults found the adapted animation videos and instruments understandable, acceptable, feasible, and not burdensome. The CONT-END acceptability study will provide insight into cross-cultural acceptability of interventions in dementia care from the perspective of important stakeholders. This can help to better align interventions with preferences. The study will also result in a more fundamental understanding as to how and when having control at the end of life in dementia is perceived as beneficial or perhaps harmful. TRIAL REGISTRATION The CONT-END acceptability study was originally registered at the Netherlands Trial Register (NL7985) at 31 August, 2019, and can be found on the International Clinical Trials Registry Platform.
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Affiliation(s)
- Hanneke J.A. Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Xu Jingyuan
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
| | - Miharu Nakanishi
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - David R. Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, MO USA
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
- Centre for Palliative Medicine, Helios Hospital Bonn/Rhein-Sieg, Bonn, Germany
| | - Jan Gaertner
- Palliative Care Center Hildegard, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Wilco P. Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands
- Center for Old Age Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
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15
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Van Bulck L, Quenot JP, Seronde MF, Ecarnot F. Medically assisted dying in Western Europe: legislation review - what has changed in 5 years? BMJ Support Palliat Care 2023; 13:305-308. [PMID: 35835544 DOI: 10.1136/spcare-2022-003768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Liesbet Van Bulck
- Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- EA3920, Université de Franche-Comté, Besancon, France
- Research Foundation Flanders - FWO, Brussels, Belgium
| | - Jean Pierre Quenot
- Service de Médecine Intensive-Réanimation, University Hospital Centre Dijon Bourgogne, Dijon, France
- INSERM Research Centre LNC-UMR1231, University of Burgundy, Dijon, France
| | - Marie France Seronde
- EA3920, Université de Franche-Comté, Besancon, France
- Department of Cardiology, Besançon Regional University Hospital Center, Besancon, France
| | - Fiona Ecarnot
- EA3920, Université de Franche-Comté, Besancon, France
- Department of Cardiology, Besançon Regional University Hospital Center, Besancon, France
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16
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Tomczyk M, Andorno R, Jox RJ. 'How is it possible that at times we can be physicians and at times assistants in suicide?' Attitudes and experiences of palliative care physicians in respect of the current legal situation of suicide assistance in Switzerland. JOURNAL OF MEDICAL ETHICS 2023; 49:594-601. [PMID: 36609360 DOI: 10.1136/jme-2022-108546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Switzerland lacks specific legal regulation of assistance in suicide. The practice has, however, developed since the 1980s as a consequence of a gap in the Swiss Criminal Code and is performed by private right-to-die organisations. Traditionally, assistance in suicide is considered contrary to the philosophy of palliative care. Nonetheless, Swiss palliative care physicians regularly receive patient requests for suicide assistance. Their attitudes towards the legal regulations of this practice and their experience in this context remain unclear. OBJECTIVES Our study aimed to explore and describe the attitudes and experiences of Swiss palliative care physicians concerning the legal situation of suicide assistance. METHODS In 2019, we performed an exploratory interview study with 12 Swiss palliative care physicians on palliative sedation as an alternative to assisted suicide. In this paper, we present the results that emerged from a thematic subanalysis of the data. RESULTS Participants stated that assistance in suicide and palliative care are based on opposing philosophies, but they admitted a shift in paradigm over the last years in the sense that one practice does not necessarily exclude the other. They reported various roles in suicide assistance and considered that the current activities of Swiss right-to-die organisations were problematic and needed to be regulated by law. DISCUSSION AND CONCLUSION These results could enrich national and international reflection on suicide assistance in the context of palliative care by reducing confusion between the two practices and strengthening the confidence of patients and their relatives.
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Affiliation(s)
- Martyna Tomczyk
- Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Roberto Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Ralf J Jox
- Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Palliative and Supportive Care Service, Chair in Geriatric Palliative Care, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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17
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Economos G, Moulin P, Perceau-Chambard É, Xavier M, Marion B, Cécile B, Van Lander A, Mathilde L, Vincent M, Sahut-Dizarn M, Claire F. Legalised active assistance in dying: palliative care stakeholders' national e-consultation. BMJ Support Palliat Care 2023:spcare-2022-004081. [PMID: 37055158 DOI: 10.1136/spcare-2022-004081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/29/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES There is a growing debate surrounding the legalisation of medical assistance in dying (MAID). MAID is currently prohibited by the French law; however, the debate has recently been reinvigorated in France. This study aims to collect opinions of palliative care stakeholders (PCS) regarding the legalisation of MAID and to identify the factors associated with their opinions. METHODS We performed a transversal survey between 26 June 2021 and 25 July 2021, on PCS who were on the French national scientific society for palliative care. Participants were invited by email. RESULTS 1439 PCS took part and expressed an opinion about the legalisation of MAID. 1053 (69.7%) were against the legalisation of MAID. When forced to choose which option should be privileged if the law had to change, 3.7% favoured euthanasia, 10.1% favoured assisted suicide with provision of lethal drug by a professional, 27.5% favoured assisted suicide with prescription of a lethal drug and 29.5% favoured assisted suicide with provision of a lethal drug by an association. The opinion regarding legalisation of MAID was statistically different depending on the participant profession (p<0.001) and when comparing clinical and non-clinical positions (p<0.001). A quarter of participants (26.7%) believe that legalising MAID might lead them to change their current position. CONCLUSIONS Overall, French palliative care professionals are against a modification of the current legal framework for legalising MAID but some might change their current position if a law was voted. This might destabilise the PCS demography that is already worrying.
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Affiliation(s)
- Guillaume Economos
- Palliative Care Center, Hospices Civils de Lyon, Auvergne-Rhône-Alpes, France
- Centre pour l'Innovation en Cancérologie de Lyon - EA3738, faculté de médecne Lyon Sud, Université Claude Bernard Lyon 1, Oullins, France
| | - Pierre Moulin
- Centre de recherche sur les médiations (Crem, UR 3476), Université de Lorraine, Nancy, Grand Est, France
| | | | - Mattelaer Xavier
- Palliative Care Unit, Clinique de la Toussaint, Strasbourg, France
| | - Broucke Marion
- Mobile Palliative Care Consultation Service, Paris-Saclay University, Gif-sur-Yvette, Île-de-France, France
| | - Barbaret Cécile
- Palliative Care Services, Grenoble University Hospital, Grenoble, France
| | - Axelle Van Lander
- Research Unit ACCePPT Self-Medication, Multi-Professional Support for Patients, University of Clermont Auvergne, Clermont-Ferrand, Auvergne-Rhône-Alpes, France
| | - Ledoux Mathilde
- Mobile Palliative Care Consultation Service, Centre de Santé Armor-Argoat, Guingamp, France
| | - Morel Vincent
- Palliative Care Unit, University Hospital Centre Rennes, Rennes, Bretagne, France
| | - Marine Sahut-Dizarn
- Mobile Palliative Care Consultation Service, AP-HP, Paris, Île-de-France, France
| | - Fourcade Claire
- Palliative Care Center, Grand Narbonne Private Hospital, Montredon des Corbières, France
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18
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Serey A, Tricou C, Phan-Hoang N, Legenne M, Perceau-Chambard É, Filbet M. Deep continuous patient-requested sedation until death: a multicentric study. BMJ Support Palliat Care 2023; 13:70-76. [PMID: 31005881 DOI: 10.1136/bmjspcare-2018-001712] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/18/2019] [Accepted: 02/27/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES In 2016, a new law was adopted in France granting patients the right, under specific conditions, to continuous deep sedation until death (CDSUD). The goal of this study was to measure the frequency of requests for CDSUD from patients in palliative care. METHODS The data collected from the medical records of patients in palliative care units (PCU) or followed by palliative care support teams (PCST) in the Rhône-Alpes area, who died after CDSUD, focused on the patient's characteristics, the drugs used (and compliance with regulatory processes). RESULTS All 12 PCU and 12 of the 24 PCST were included. Among the 8500 patients followed, 42 (0.5%) requested CDSUD until death. The patients were: 65.7 (SD=13.7) years old, highly educated (69%), had cancer (81%), refractory symptoms (98%) and mostly psychoexistential distress (69%). The request was rejected for 2 (5%) patients and delayed for 31 (74%) patients. After a delay of a mean 8 days, 13 (31%) patients were granted CDSUD. The drug used was midazolam at 115 mg/24 hours (15-480), during a mean of 3 days. PCUs used lower dosages than PCSTs (83 vs 147), with significantly lower initial doses (39 mg vs 132 mg, p=0.01). A life-threatening condition was recorded in 13 cases (31%) and a collegial decision was taken in 25 cases (60%). CONCLUSION This study highlights the low rate of request and the even lower rate of CDSUD in specialised palliative care. However, the sedation for psychoexistential distress and the lack of procedure records raise ethical questions.
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Affiliation(s)
- Adrien Serey
- Department of Palliative Care, Hospices Civils de Lyon, Lyon, France
| | - Colombe Tricou
- Department of Palliative Care, Hospices Civils de Lyon, Lyon, France
| | | | - Myriam Legenne
- Department of Palliative Care, Hospices Civils de Lyon, Lyon, France
| | | | - Marilene Filbet
- Department of Palliative Care, Hospices Civils de Lyon, Lyon, France
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19
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Volberg C, Corzilius J, Maul J, Morin A, Gschnell M. [Pain management in German specialized outpatient palliative care : A cross-sectional study to present the current pain management of palliative patients in the home environment]. Schmerz 2023:10.1007/s00482-023-00693-x. [PMID: 36752874 DOI: 10.1007/s00482-023-00693-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 12/18/2022] [Accepted: 12/28/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND With the help of specialized outpatient palliative care teams (German abbreviation: SAPV), seriously ill and dying patients in Germany can be adequately cared for in their home environment until the end of their lives; however, there are no uniform standards or guidelines for well-executed pain management right now. OBJECTIVE This approach serves as basic research in the field of public health research. This is intended to present which methods (use of different professional groups, use of pain medications, alternative medical treatment etc.) the individual SAPV teams use for pain management. From this it can be deduced which procedures can be considered particularly effective. MATERIAL AND METHODS This cross-sectional study was conducted in May 2021. All German SAPV teams (n = 307) listed on the homepage of the German Association for Palliative Medicine (DGP) were contacted by post and invited to participate. A total of 175 teams (57%) responded to the request and were included in the evaluation. A descriptive data analysis was performed. RESULTS Pain management in the German outpatient care of palliative patients is based on several components. All common pain medications are used, but primarily metamizole (99.4%) as a non-opioid analgesic, morphine (98.3%) from the opiate series and pregabalin (96.6%) as a co-analgesic are mainly prescribed. If pain therapy fails, 22.5% of the SAPV teams perform palliative sedation for symptom control on a regular basis. CONCLUSION This cross-sectional study is the first of its kind to provide a general overview of the treatment options for pain management in German outpatient palliative care. In comparison with international studies, the question arises as to whether uniform therapy schemes and a reduction in the medication available in the individual SAPV teams could lead to an improvement in patient care.
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Affiliation(s)
- Christian Volberg
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg, Deutschland.
- AG Ethik in der Medizin, Fachbereich 20, Dekanat Humanmedizin, Philipps-Universität Marburg, Marburg, Deutschland.
| | - Julien Corzilius
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - Julian Maul
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - Astrid Morin
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - Martin Gschnell
- Klinik für Dermatologie und Allergologie, Hauttumorzentrum, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg, Deutschland
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20
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Kőmüves S. Palliative Care and Physician Assisted Death. ETHICS IN PROGRESS 2022. [DOI: 10.14746/eip.2022.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
In the recent decade quite a few countries and regions legalised physician assisted death. While palliative care is already or becoming the standard end of life care in many countries, the increased availability of physician assisted death coupled with the secularisation of hospice in more settings require – where this has not happened yet – a clear response of palliative care specialists to patients’ requests for physician assisted death. The paper analyses the World Health Organisation’s current description of palliative care with a special focus on its prohibition of hastening death. Some palliative care professionals do not agree with the ban on hastening death, and these professionals’ non-conventional interpretation of palliative care actually seems to meet the wishes of some patients.
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21
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Attitudes of university hospital staff towards in-house assisted suicide. PLoS One 2022; 17:e0274597. [PMID: 36301971 PMCID: PMC9612505 DOI: 10.1371/journal.pone.0274597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/31/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To investigate staff attitudes toward assisted suicide in the hospital setting in Switzerland. Design Cross-sectional study. Setting Two University Hospitals in French speaking regions of Switzerland. Participants 13’834 health care professionals, including all personnel caring for patients, were invited to participate. Main outcome measures and other variables Attitudes towards the participation of hospital health care professionals in assisted suicide were investigated with an online questionnaire. Results Among all invited professionals, 5’127 responded by filling in the survey at least partially (response rate 37.0%), and 3’683 completed the entire survey (26.6%). 73.0% of participants approved that this practice should be authorized in their hospital and saw more positive than negative effects. 57.6% would consider assisted suicide for themselves. Non-medical professionals were 1.28 to 5.25 times more likely to approve assisted suicide than physicians (p<0.001). 70.7% of respondents indicated that each professional should have the choice of whether to assist in suicide. Conclusions This multiprofessional survey sheds light on hospital staff perceptions of assisted suicide happening within hospital walls, which may inform the development of rules considering their wishes but also their reluctances. Further research using a mixed-methods approach could help reach an in-depth understanding of staff’s attitudes and considerations towards assisted suicide practices.
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22
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Cheng EY, Mah K, Al-Awamer A, Pope A, Swami N, Wong JL, Mathews J, Howell D, Hannon B, Rodin G, Shapiro GK, Li M, Le LW, Zimmermann C. Public interest in medical assistance in dying and palliative care. BMJ Support Palliat Care 2022; 12:448-456. [PMID: 36171108 DOI: 10.1136/spcare-2022-003910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Medical assistance in dying (MAiD) is legal in an increasing number of countries, but there are concerns that its availability may compromise access to palliative care. We assessed public interest in MAiD, palliative care, both, or neither, and examined characteristics associated with this interest. METHODS We surveyed a representative sample of the adult Canadian public, accessed through a panel from May to June 2019. Weighted generalised multinomial logistic regression analyses were used to determine characteristics associated with interest in referral to palliative care, MAiD, or both, in the event of diagnosis with a serious illness. RESULTS Of 1362 participants who had heard of palliative care, 611 (44.8% weighted (95% CI 42.1% to 47.5%)) would be interested in both MAiD and palliative care, 322 (23.9% (95% CI 21.5% to 26.2%)) palliative care alone, 171 (12.3% (95% CI 10.5% to 14.1%)) MAiD alone and 258 (19.0% (95% CI 16.9% to 21.2%)) neither. In weighted multinomial logistic regression analyses, interest in both MAiD and palliative care (compared with neither) was associated with better knowledge of the definition of palliative care, older age, female gender, higher education and less religiosity; interest in palliative care alone was associated with better knowledge of the definition of palliative care, older age, female gender and being married/common law; interest in MAiD alone was associated with less religiosity (all p<0.05). CONCLUSIONS There is substantial public interest in potential referral to both MAiD and palliative care. Simultaneous availability of palliative care should be ensured in jurisdictions where MAiD is legal, and education about palliative care should be a public health priority.
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Affiliation(s)
- Emily YiQin Cheng
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ahmed Al-Awamer
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Pope
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nadia Swami
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Joanne L Wong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jean Mathews
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Palliative Medicine, Departments of Medicine and Oncology, Queen's University, Kingston, Ontario, Canada
| | - Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lisa W Le
- Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada .,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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23
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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.
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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
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Ortega-Galán ÁM, Ruiz-Fernández MD, Roldán-Rodríguez L, Ramos-Pichardo JD, Cabrera-Troya J, Gómez-Beltrán PA, Ortiz-Amo R. Unbearable Suffering: A Concept Analysis. J Hosp Palliat Nurs 2022; 24:159-166. [PMID: 35135981 DOI: 10.1097/njh.0000000000000844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To understand and analyze the concept of "unbearable suffering" using a concept analysis method and to propose a new nursing diagnosis, the Walker and Avant method of concept analysis was used. Following the concept analysis method in 8 steps, a literature search was carried out in the MEDLINE, Dialnet, WOS, and PsycINFO databases between 2016 and 2020. Articles of theoretical or empirical nature, written in English, with the abstract available were included. As a result, 11 articles (4 theoretical and 7 empirical) were included. In addition, 2 cases were developed. The proposed new diagnosis, "unbearable suffering," refers to the situation of an individual who, because of a variety of factors, regardless of the cause, feels that he/she is unable to bear the suffering he/she is experiencing. The diagnosis is proposed for inclusion in "Domain 9: Coping/Stress Tolerance" and "Class 2: Coping Responses" of the North American Nursing Diagnosis Association taxonomy. Recognition of a nursing diagnosis for unbearable suffering could be key in identifying this type of suffering and facilitating interventions to reduce or mitigate it. Nurses play a fundamental role in situations of high levels of end-of-life suffering.
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25
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Fang C, Tanaka M. An exploration of person-centred approach in end-of-life care policies in England and Japan. BMC Palliat Care 2022; 21:68. [PMID: 35538473 PMCID: PMC9092845 DOI: 10.1186/s12904-022-00965-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Increasing evidence has suggested that a person-centred approach (PCA) is beneficial not only for improving care outcomes but also for mitigating the pressure on public health systems. However, policy implementation gaps have prevented the translation of this complex framework into useful practical, ethical and moral stances for end-of-life care (EOLC). This article aims to explore the meaning and implications of person-centredness in EOLC policy discourses. Methods By perceiving policy documents as a medium embodied with socio-political and cultural norms, we analysed how PCA in EOLC is constructed within specific socio-cultural contexts and the implications of these contexts on resultant care. Focusing on England and Japan, we conducted a critical policy analysis to examine and compare key policy and legal documents released between 2000 and 2019 in these two post-industrial and socio-culturally distinctive countries. Results Our analysis found that the PCA is mobilised in policy discourses primarily through three interconnected dimensions: individual, relational and existential. While acknowledging that both countries have developed varied policy and legal mechanisms to emphasise holistic and integrated care with respect to these three dimensions, we also identified significant gaps in the pol icies both within and between England and Japan. They include ambiguity in defining patients’ best interests, fragmented support for social and family care and the neglect of existential needs. Conclusions This cross-cultural analysis has revealed the complex nature of discourses around PCA in English and Japanese EOLC policies, which often concentrate on the multifaceted aspects of experiences as one approaches the end of life. Despite this, we argue that a more holistic construction of PCA is needed in EOLC policies not only in England and Japan but also more broadly, to encapsulate the richness of end-of-life experiences.
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Affiliation(s)
- Chao Fang
- Department of Social and Policy Sciences and Centre for Death and Society, University of Bath, Bath, BA2 7AY, UK.
| | - Miho Tanaka
- Japan Medical Association Research Institute, 2-28-16 Honkomagome, Bunkyo-ku, Tokyo, 113-8621, Japan.,Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, 56-1 Tojiin Kitamachi, Kita Ward, 603-8577, Kyoto, Japan
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26
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Cocker A, Singy P, Jox RJ. How should health care providers inform about palliative sedation? A qualitative study with palliative care professionals. Eur J Cancer Care (Engl) 2022; 31:e13602. [PMID: 35488398 PMCID: PMC9541839 DOI: 10.1111/ecc.13602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/24/2021] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Abstract
Objective In Switzerland, palliative sedation consists of using sedatives to relieve terminally ill patients. It is divided into several steps, with one of them consisting of informing patients and relatives about the procedure. In the current recommendations, there is a lack of orientation about how and when this discussion should take place. Hence, we aim to explore perceptions and experiences of palliative care professionals regarding these questions. Methods Qualitative semi‐structured interviews with five physicians and five nurses working in specialised palliative care were conducted. They were then analysed with thematic analysis. Results Results showed a uniformity around definition, goals and indications of palliative sedation. However, there was a lack of consistency regarding the process of delivering this information to patients and relatives. Finally, some participants strongly opposed the idea of systematically informing patients in specialised palliative care, while others were more divided on this question. Conclusion Despite a common understanding of the concept of palliative sedation, there is no standard practice when informing patients on palliative sedation among palliative care professionals. Therefore, this study demonstrates the need for further guidelines on this question and calls for a better understanding and knowledge of palliative sedation among health professionals outside palliative care.
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Affiliation(s)
- Allan Cocker
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pascal Singy
- Liaison Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Ralf J Jox
- Geriatric Palliative Care, CHUV, University of Lausanne, Lausanne, Switzerland.,Institute of Humanities in Medicine, CHUV, University of Lausanne, Lausanne, Switzerland
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27
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Cohen J, Chambaere K. Increased legalisation of medical assistance in dying: relationship to palliative care. BMJ Support Palliat Care 2022; 13:178-180. [PMID: 35428654 DOI: 10.1136/bmjspcare-2022-003573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/26/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels/Ghent, Belgium
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels/Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Gent, Belgium
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28
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Frey R, Balmer D. The views of Aotearoa/New Zealand adults over 60 years regarding the End of Life Choice Act 2019. JOURNAL OF RELIGION AND HEALTH 2022; 61:1605-1620. [PMID: 34355303 PMCID: PMC8340805 DOI: 10.1007/s10943-021-01359-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 06/13/2023]
Abstract
This study described the views of older New Zealand adults toward assisted dying and specifically the End of Life Choice Act (2019), an Act making assisted dying legal. An anonymous postal and online survey of 636 adults 60 years and older was conducted. The majority of respondents did not support legalization (85.7%), while 8.8% were in favor (5.5% did not specify a view). Weighted binary logistic regression indicated that the odds of support for legalization were lower in those respondents with a religious affiliation (OR = .020, S.E. = 0.60, p = .00), and there were 2.66 times greater odds in those identifying as male (S.E. = 0.34, p = .005). On the other hand, those respondents under 65 years had increased odds of supporting legalization (OR = 1.89, S.E. = .029, p = .045). Results indicate that most participants were concerned about potential abuses and coercive practices if assisted dying became legally available in New Zealand.
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Affiliation(s)
- Rosemary Frey
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand.
| | - Deborah Balmer
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
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29
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Selter F, Persson K, Risse J, Kunzmann P, Neitzke G. Dying like a dog: the convergence of concepts of a good death in human and veterinary medicine. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2022; 25:73-86. [PMID: 34524576 PMCID: PMC8857141 DOI: 10.1007/s11019-021-10050-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 05/09/2023]
Abstract
Standard views of good death in human and veterinary medicine considerably differ from one another. Whereas the good death ideal in palliative medicine emphasizes the positive aspects of non-induced dying, veterinarians typically promote a quick and painless killing with the aim to end suffering. Recent developments suggest a convergence of both professions and professional attitudes, however. Palliative physicians are confronted with patients wishing to be 'put to sleep', while veterinarians have begun to integrate principles and practices from hospice care. We will argue that the discourses on good human and animal deaths are not distinct, but that they interact and influence each other. On the one hand, veterinary medicine adapts techniques like chemotherapy or sedation from palliative end-of-life care. On the other hand, philosophers, veterinarians, pet owners, patients and the general public alike make certain assumptions about the (dis)analogy of human and animal dying or killing. Unfortunately, these interactions have only scarcely been reflected normatively, especially on the part of human medicine. Conflicts and misattributions with potential serious negative consequences for the (animal and human) patients' wellbeing are provoked. For these reasons, palliative physicians and veterinarians are invited to engage in the debate around human and animal end-of-life care.
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Affiliation(s)
- Felicitas Selter
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hanover, Germany.
| | - Kirsten Persson
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviour, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Johanna Risse
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviour, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Peter Kunzmann
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviour, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Gerald Neitzke
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hanover, Germany
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30
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Leboul D, Bousquet A, Chassagne A, Mathieu-Nicot F, Ridley A, Cretin E, Guirimand F, Aubry R. Understanding why patients request euthanasia when it is illegal: a qualitative study in palliative care units on the personal and practical impact of euthanasia requests. Palliat Care Soc Pract 2022; 16:26323524211066925. [PMID: 35036915 PMCID: PMC8755925 DOI: 10.1177/26323524211066925] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/26/2021] [Indexed: 11/17/2022] Open
Abstract
Context Some patients in palliative care units request euthanasia regardless of legislation. Although studies have explored the reasons for these requests, little is known about the subjective, relational, and contextual repercussions for the patient. Objectives The aim of this study is to understand the purpose of euthanasia requests from the patient's viewpoint and their personal and practical impact. Methods We conducted in-depth interviews with patients requesting euthanasia, their family members, and health care providers in 11 French palliative care units. A thematic analysis of the data was performed. Results In total, 18 patients were interviewed within 48 h of the request being made; 1 week later, 9 patients were interviewed again. Five main themes emerged: assuming the possibility of transgressing the forbidden, a call for unbearable suffering to be recognized, encouragement to change clinical practice, reclaiming a sense of freedom over medical constraints, and imagining a desirable future for oneself. Conclusions A request for euthanasia appears to be a willful means to remove oneself from the impasse of an existence paralyzed by suffering. It creates a space for discussion, which promotes negotiation with patients on care practices and therapeutics, and strengthens patients' sense of autonomy. Investigating the relationship between the evolution of euthanasia requests within the palliative care setting could be beneficial. It is important to encourage health care professionals to adopt a readiness to listen by interacting with patients in a way that is not momentarily action-oriented but rather focused on proactive discussion.
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Affiliation(s)
- Danièle Leboul
- Pôle recherche et enseignement universitaire 'Soins palliatifs en société' (SPES), Maison Médicale Jeanne Garnier, Paris, France
| | - Anne Bousquet
- Pôle recherche et enseignement universitaire 'Soins palliatifs en société' (SPES), Maison Médicale Jeanne Garnier, Paris, France
| | - Aline Chassagne
- Clinical Investigation Center (Inserm U1431), University Hospital of Besançon, Besançon, France
| | - Florence Mathieu-Nicot
- Clinical Investigation Center (Inserm U1431), University Hospital of Besançon, Besançon, France
| | - Ashley Ridley
- University Bourgogne Franche-Comté, Besançon, France
| | - Elodie Cretin
- Clinical Investigation Center (Inserm U1431), University Hospital of Besançon, Besançon, France
| | - Frédéric Guirimand
- Pôle recherche et enseignement universitaire 'Soins palliatifs en société' (SPES), Maison Médicale Jeanne Garnier, Paris 75015, France
| | - Régis Aubry
- Clinical Investigation Center (Inserm U1431), University Hospital of Besançon, Besançon, France
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31
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Richards AM, McGauran MJ. Voluntary assisted dying in gynaecological cancers: A discussion of the history, ethical principles and international perspectives. Aust N Z J Obstet Gynaecol 2022; 62:214-218. [PMID: 34994397 DOI: 10.1111/ajo.13475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
Voluntary assisted dying (VAD) is a provocative and ethically charged subject that will potentially be an increasing component of our clinical practice. This paper aims to give the history of VAD, ethical principles, controversies and international perspectives regarding the laws in each jurisdiction. It provides a discussion on the topic with respect to gynaecological oncology to enable clinicians to feel more comfortable with this difficult subject.
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Affiliation(s)
- Anthony M Richards
- Department of Obstetrics and Gynaecology, Joan Kirner Women's and Children's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Level 7, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Melissa J McGauran
- Department of Gynaecology Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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32
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Oliver D. Neuropalliative care: Defining an emerging field. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:17-31. [PMID: 36055714 DOI: 10.1016/b978-0-323-85029-2.00008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Palliative care is increasingly becoming an established part of medical care, providing the holistic assessment and management of the person at the center of care-physical, psychological, social, and spiritual. This had originally been primarily provided for people with terminal cancers but in the last 50 years, this care has extended to caring for people with issues throughout disease progression and for all diagnoses, including neurologic diseases. Palliative care in fact is now included within guidelines and standards for many neurologic diseases. Palliative care may be delivered as an approach provided by all health and social care professionals; by focused care provided within neurology; and through the involvement of specialist palliative care and neuropalliative care for more complex issues. The education of neurologists and palliative care specialists is essential to enable all to be aware of the issues faced by patients and their families and provide adequate support for patients, families, and healthcare professionals. In this way, the quality of life can be maintained as much as possible and patients are able to die with as little distress as possible, with their families and carers supported.
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Affiliation(s)
- David Oliver
- Tizard Centre, University of Kent, Canterbury, United Kingdom.
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33
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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.
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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
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34
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Shapiro GK, Tong E, Nissim R, Zimmermann C, Allin S, Gibson J, Li M, Rodin G. Exploring key stakeholders' attitudes and opinions on medical assistance in dying and palliative care in Canada: a qualitative study protocol. BMJ Open 2021; 11:e055789. [PMID: 34862301 PMCID: PMC8646969 DOI: 10.1136/bmjopen-2021-055789] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/24/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Canadians have had legal access to medical assistance in dying (MAiD) since 2016. However, despite substantial overlap in populations who request MAiD and who require palliative care (PC) services, policies and recommended practices regarding the optimal relationship between MAiD and PC services are not well developed. Multiple models are possible, including autonomous delivery of these services and formal or informal coordination, collaboration or integration. However, it is not clear which of these approaches are most appropriate, feasible or acceptable in different Canadian health settings in the context of the COVID-19 pandemic and in the post-pandemic period. The aim of this qualitative study is to understand the attitudes and opinions of key stakeholders from the government, health system, patient groups and academia in Canada regarding the optimal relationship between MAiD and PC services. METHODS AND ANALYSIS A qualitative, purposeful sampling approach will elicit stakeholder feedback of 25-30 participants using semistructured interviews. Stakeholders with expertise and engagement in MAiD or PC who hold leadership positions in their respective organisations across Canada will be invited to provide their perspectives on the relationship between MAiD and PC; capacity-building needs; policy development opportunities; and the impact of the COVID-19 pandemic on the relationship between MAiD and PC services. Transcripts will be analysed using content analysis. A framework for integrated health services will be used to assess the impact of integrating services on multiple levels. ETHICS AND DISSEMINATION This study has received ethical approval from the University Health Network Research Ethics Board (No 19-5518; Toronto, Canada). All participants will be required to provide informed electronic consent before a qualitative interview is scheduled, and to provide verbal consent prior to the start of the qualitative interview. Findings from this study could inform healthcare policy, the delivery of MAiD and PC, and enhance the understanding of the multilevel factors relevant for the delivery of these services. Findings will be disseminated in conferences and peer-reviewed publications.
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Affiliation(s)
- Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
| | - Eryn Tong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Gibson
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Turillazzi E, Maiese A, Frati P, Scopetti M, Di Paolo M. Physician-Patient Relationship, Assisted Suicide and the Italian Constitutional Court. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:671-681. [PMID: 34674155 DOI: 10.1007/s11673-021-10136-w] [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: 08/09/2020] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
In 2017, Italy passed a law that provides for a systematic discipline on informed consent, advance directives, and advance care planning. It ranges from decisions contextual to clinical necessity through the tool of consent/refusal to decisions anticipating future events through the tools of shared care planning and advance directives. Nothing is said in the law regarding the issue of physician assisted suicide. Following the DJ Fabo case, the Italian Constitutional Court declared the constitutional illegitimacy of article 580 of the criminal code in the part in which it does not exclude the punishment of those who facilitate the suicide when the decision has been freely and autonomously made by a person kept alive by life-support treatments and suffering from an irreversible pathology, the source of physical or psychological suffering that he/she considers intolerable, but fully capable of making free and conscious decisions. Such conditions and methods of execution must be verified by a public structure of the national health service, after consulting the territorially competent ethics committee. This statement admits, within strict and regulated bounds, physician assisted suicide, so widening the range of end-of-life decisions for Italian patients. Future application and critical topics will be called into question by the Italian legislator.
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Affiliation(s)
- E Turillazzi
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126, Pisa, Italy.
| | - A Maiese
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126, Pisa, Italy
| | - P Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - M Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - M Di Paolo
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126, Pisa, Italy
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The Attitude of Iranian Critical Care Nurses Toward Euthanasia: A Multicenter Cross-sectional Study. Crit Care Nurs Q 2021; 45:62-73. [PMID: 34818299 DOI: 10.1097/cnq.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Today, one of the major ethical challenges facing the world's health care system, and in particular nurses in the intensive care unit, is euthanasia or death out of pity. The aim of this study was to investigate the attitude of Iranian nurses in the intensive care unit toward euthanasia. This was an analytical cross-sectional study using census sampling. The data collection tool was the Euthanasia Attitude Scale. A total of 206 nurses working in the intensive care unit in 4 hospitals in the Mazandaran province of Iran were included in this study. The mean of total Euthanasia Attitude Scale score in intensive care unit nurses was 2.96. The mean euthanasia dimensions were ethical consideration, practical considerations, treasuring life, and naturalistic beliefs, 3.03, 2.92, 2.98, and 2.99, respectively. There was significant but low negative correlation between age and total Euthanasia Attitude Scale score, ethical considerations, and practical considerations. Male nurses exhibited significantly higher Euthanasia Attitude Scale scores, specifically in regard to ethical and practical considerations compared with female nurses. The most Iranian nurses in the intensive care unit had a negative attitude toward euthanasia for patients in the later stages of the disease. However, this opposition was less than similar studies in Iran in the past.
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de Vries E, Leal Arenas FA, van der Heide A, Gempeler Rueda FE, Murillo R, Morales O, Diaz-Amado E, Rodríguez N, Gonzalez BJ, Castilblanco Delgado DS, Calvache JA. Medical decisions concerning the end of life for cancer patients in three Colombian hospitals - a survey study. BMC Palliat Care 2021; 20:161. [PMID: 34657613 PMCID: PMC8520825 DOI: 10.1186/s12904-021-00853-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background Cancer patients’ end-of-life care may involve complex decision-making processes. Colombia has legislation regarding provision of and access to palliative care and is the only Latin American country with regulation regarding euthanasia. We describe medical end-of-life decision-making practices among cancer patients in three Colombian hospitals. Methods Cancer patients who were at the end-of-life and attended in participating hospitals were identified. When these patients deceased, their attending physician was invited to participate. Attending physicians of 261 cancer patients (out of 348 identified) accepted the invitation and answered a questionnaire regarding end-of-life decisions: a.) decisions regarding the withdrawal or withholding of potentially life-prolonging medical treatments, b.) intensifying measures to alleviate pain or other symptoms with hastening of death as a potential side effect, and c.) the administration, supply or prescription of drugs with an explicit intention to hasten death. For each question addressing the first two decision types, we asked if the decision was fully or partially made with the intention or consideration that it may hasten the patient’s death. Results Decisions to withdraw potentially life-prolonging treatment were made for 112 (43%) patients, 16 of them (14%) with an intention to hasten death. For 198 patients (76%) there had been some decision to not initiate potentially life-prolonging treatment. Twenty-three percent of patients received palliative sedation, 97% of all patients received opioids. Six patients (2%) explicitly requested to actively hasten their death, for two of them their wish was fulfilled. In another six patients, medications were used with the explicit intention to hasten death without their explicit request. In 44% (n = 114) of all cases, physicians did not know if their patient had any advance care directives, 26% (n = 38) of physicians had spoken to the patient regarding the possibility of certain treatment decisions to hasten death where this applied. Conclusions Decisions concerning the end of life were common for patients with cancer in three Colombian hospitals, including euthanasia and palliative sedation. Physicians and patients often fail to communicate about advance care directives and potentially life-shortening effects of treatment decisions. Specific end-of-life procedures, patients’ wishes, and availability of palliative care should be further investigated. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00853-9.
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Affiliation(s)
- Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Cra. 7 No 40-62 Edificio Hospital San Ignacio, Piso 2, Bogota, Colombia.
| | - Fabián Alexander Leal Arenas
- Instituto Nacional de Cancerología, Cl. 1 No 9-85, Bogota, Colombia.,Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Carrera 7ª No. 40-62 Edificio Santacoloma (No 30), Bogota, Colombia
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Fritz E Gempeler Rueda
- Anesthesiology Department, Pontificia Universidad Javeriana, Cra. 7 No 40-62 Edificio Hospital San Ignacio, Bogota, Colombia.,Clinical Ethics Service, Hospital Universitario San Ignacio, Cra. 7 No 40-62, Bogota, Colombia
| | - Raul Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Carrera 7ª No. 40-62 Edificio Santacoloma (No 30), Bogota, Colombia.,Department of Internal Medicine, Pontificia Universidad Javeriana, Cra. 7 No 40-62 Edificio Hospital San Ignacio, Bogotá, Colombia
| | - Olga Morales
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Carrera 7ª No. 40-62 Edificio Santacoloma (No 30), Bogota, Colombia
| | - Eduardo Diaz-Amado
- Instituto de Bioética, Pontificia Universidad Javeriana, Tv. 4 #42, Bogota, Colombia
| | - Nelcy Rodríguez
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Cra. 7 No 40-62 Edificio Hospital San Ignacio, Piso 2, Bogota, Colombia
| | - Beatriz Juliana Gonzalez
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Carrera 7ª No. 40-62 Edificio Santacoloma (No 30), Bogota, Colombia
| | - Danny Steven Castilblanco Delgado
- Instituto Nacional de Cancerología, Cl. 1 No 9-85, Bogota, Colombia.,Universidad Militar Nueva Granada, Carrera 11 n.° 101-80, Bogota, Colombia
| | - Jose A Calvache
- Department of Anesthesiology, Universidad del Cauca, Cl 5 #4-70, Popayán, Cauca, Colombia.,Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
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Kremeike K, Dojan T, Rosendahl C, Jünger S, Romotzky V, Boström K, Frerich G, Voltz R. "Withstanding ambivalence is of particular importance"-Controversies among experts on dealing with desire to die in palliative care. PLoS One 2021; 16:e0257382. [PMID: 34559828 PMCID: PMC8462710 DOI: 10.1371/journal.pone.0257382] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/01/2021] [Indexed: 11/28/2022] Open
Abstract
In order to investigate controversies surrounding the desire to die phenomenon in palliative care by analyzing expert opinions on the topic, we carried out a secondary qualitative data analysis of free text comments collected during a Delphi survey that was designed to develop a conversation aid for dealing with desire to die in everyday clinical practice. Between 01/2018 and 03/2018, a two-round Delphi survey was carried out with national (German) and international palliative care experts. Free text comments were reinvestigated to identify controversies surrounding the desire to die phenomenon. An additional in-depth analysis focused on statements expressing attitudes towards proactively addressing (potential) desires to die. Within the Delphi survey, 103 of 149 multi-professional participants (almost all of them with practical and only six with exclusively theoretical expertise in palliative care) generated 444 free text comments. Thereof, we identified three main categories related to dealing with desire to die: "outer framework", "extended care system" and "health-professional-patient-relationship". Ambivalences, taboos and uncertainties surrounding desire to die in palliative care became apparent. Experts are divided concerning the practice of proactively addressing desire to die. Even if these conversations-especially the proactive approach-are also viewed critically, we conclude that open-ended and respectful communication about desire to die between health professionals and patients can be understood as an eligible intervention in palliative care. Proactively addressing the topic is a possible way to open up such conversations.
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Affiliation(s)
- Kerstin Kremeike
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Thomas Dojan
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Carolin Rosendahl
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Saskia Jünger
- Department of Community Health, University of Applied Health Sciences, Bochum, Germany
| | - Vanessa Romotzky
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kathleen Boström
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Gerrit Frerich
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Cologne / Bonn (CIO), University of Cologne, Cologne, Germany
- Center for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
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Huemer M, Jahn-Kuch D, Hofmann G, Andritsch E, Farkas C, Schaupp W, Masel EK, Jost PJ, Pichler M. Trends and Patterns in the Public Awareness of Palliative Care, Euthanasia, and End-of-Life Decisions in 3 Central European Countries Using Big Data Analysis From Google: Retrospective Analysis. J Med Internet Res 2021; 23:e28635. [PMID: 34542419 PMCID: PMC8491122 DOI: 10.2196/28635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/25/2021] [Accepted: 07/05/2021] [Indexed: 12/25/2022] Open
Abstract
Background End-of-life decisions, specifically the provision of euthanasia and assisted suicide services, challenge traditional medical and ethical principles. Austria and Germany have decided to liberalize their laws restricting assisted suicide, thus reigniting the debate about a meaningful framework in which the practice should be embedded. Evidence of the relevance of assisted suicide and euthanasia for the general population in Germany and Austria is limited. Objective The aim of this study is to examine whether the public awareness documented by search activities in the most frequently used search engine, Google, on the topics of palliative care, euthanasia, and advance health care directives changed with the implementation of palliative care services and new governmental regulations concerning end-of-life decisions. Methods We searched for policies, laws, and regulations promulgated or amended in Austria, Germany, and Switzerland between 2004 and 2020 and extracted data on the search volume for each search term topic from Google Trends as a surrogate of public awareness and interest. Annual averages were analyzed using the Joinpoint Regression Program. Results Important policy changes yielded significant changes in search trends for the investigated topics. The enactment of laws regulating advance health care directives coincided with a significant drop in the volume of searches for the topic of euthanasia in all 3 countries (Austria: −24.48%, P=.02; Germany: −14.95%, P<.001; Switzerland: −11.75%, P=.049). Interest in palliative care increased with the availability of care services and the implementation of laws and policies to promote palliative care (Austria: 22.69%, P=.01; Germany: 14.39, P<.001; Switzerland: 17.59%, P<.001). The search trends for advance health care directives showed mixed results. While interest remained steady in Austria within the study period, it increased by 3.66% (P<.001) in Switzerland and decreased by 2.85% (P<.001) in Germany. Conclusions Our results demonstrate that legal measures securing patients’ autonomy at the end of life may lower the search activities for topics related to euthanasia and assisted suicide. Palliative care may be a meaningful way to raise awareness of the different options for end-of-life care and to guide patients in their decision-making process regarding the same.
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Affiliation(s)
- Matthias Huemer
- Division of Oncology with affiliated Unit of Palliative Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Daniela Jahn-Kuch
- Division of Oncology with affiliated Unit of Palliative Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Guenter Hofmann
- Division of Oncology with affiliated Unit of Palliative Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Elisabeth Andritsch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Clemens Farkas
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Walter Schaupp
- Institute of Moral Theology, University of Graz, Graz, Austria
| | - Eva Katharina Masel
- Clinical Division of Palliative Care, Department of Medicine I and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Philipp J Jost
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Department of Internal Medicine III - Hematooncology, Technical University of Munich School of Medicine, Technical University of Munich, Munich, Germany
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Lynøe N, Lindblad A, Engström I, Sandlund M, Juth N. Trends in Swedish physicians' attitudes towards physician-assisted suicide: a cross-sectional study. BMC Med Ethics 2021; 22:86. [PMID: 34215231 PMCID: PMC8252981 DOI: 10.1186/s12910-021-00652-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
AIMS To examine attitudes towards physician-assisted suicide (PAS) among physicians in Sweden and compare these with the results from a similar cross-sectional study performed in 2007. PARTICIPANTS A random selection of 250 physicians from each of six specialties (general practice, geriatrics, internal medicine, oncology, surgery and psychiatry) and all 127 palliative care physicians in Sweden were invited to participate in this study. SETTING A postal questionnaire commissioned by the Swedish Medical Society in collaboration with Karolinska Institute in Stockholm. RESULTS The total response rate was 59.2%. Slightly fewer than half [47.1% (95% CI 43.7-50.5)] of the respondents from the six specialties accepted PAS, which is significantly more than accepted PAS in the 2007 study [34.9% (95% CI 31.5-38.3)]. Thirty-three percent of respondents were prepared to prescribe the needed drugs. When asked what would happen to the respondent's own trust in healthcare, a majority [67.1% (95% CI 63.9-70.3)] stated that legalizing PAS would either not influence their own trust in healthcare, or that their trust would increase. This number is an increase compared to the 2007 survey, when just over half [51.9% (95% CI 48.0-55.2)] indicated that their own trust would either not be influenced, or would increase. CONCLUSIONS The study reveals a shift towards a more accepting attitude concerning PAS among physicians in Sweden. Only a minority of the respondents stated that they were against PAS, and a considerable proportion reported being prepared to prescribe the needed drugs for patient self-administration if PAS were legalized.
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Affiliation(s)
- Niels Lynøe
- Centre for Healthcare Ethics, Karolinska Institute, 171 77, Stockholm, Sweden.
| | - Anna Lindblad
- Centre for Healthcare Ethics, Karolinska Institute, 171 77, Stockholm, Sweden
| | - Ingemar Engström
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mikael Sandlund
- Department of Clinical Science/Psychiatry, Umeå University, 90185, Umeå, Sweden
| | - Niklas Juth
- Centre for Healthcare Ethics, Karolinska Institute, 171 77, Stockholm, Sweden
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Affiliation(s)
- Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Birgit Jaspers
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
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Laranjeira C, Dixe MDA, Gueifão L, Caetano L, Passadouro R, Querido A. Awareness and Attitudes towards Advance Care Directives (ACDs): An Online Survey of Portuguese Adults. Healthcare (Basel) 2021; 9:healthcare9060648. [PMID: 34072558 PMCID: PMC8227883 DOI: 10.3390/healthcare9060648] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Evidence shows that facilitated advance decisions can increase the number of meaningful and valid Advance Care Directives (ACDs) and improve the quality of care when End-Of-Life (EOL) is near. Little is known about the awareness and attitudes of Portuguese adults towards ACDs. The present study aims to assess the knowledge, attitudes, and preferences of a sample of Portuguese adults regarding EOL care decisions and ACDs. (2) Methods: A total of 1024 adults were assessed with an online cross-sectional survey collecting information on sociodemographic factors, knowledge, attitudes and preferences regarding advance decisions and EOL care. (3) Results: Participants had a mean age of 40.28 ± 11.41 years. Most were female and had a professional background related to healthcare. While 76.37% of participants had heard of ACDs, only a small percentage (2.34%) had actually ever made an ACD. Knowledge levels were weakly correlated with attitudes regarding ACDs (r = -0.344; p < 0.01). (4) Conclusions: Participants lacked a comprehensive understanding about ACDs, but revealed positive attitudes towards their use and usefulness. Further research can inform efforts to improve ACD engagement in this population. The discussion about ACDs should be part of health promotion education with a focus on planning for a comfortable and peaceful death.
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Affiliation(s)
- Carlos Laranjeira
- School of Health Sciences of Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal;
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal;
- Research in Education and Community Intervention (RECI I & D), Piaget Institute, 3515-776 Viseu, Portugal
- Correspondence: (C.L.); (A.Q.)
| | - Maria dos Anjos Dixe
- School of Health Sciences of Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal;
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal;
| | - Luís Gueifão
- Intensive Care Unit, Leiria Hospital Center, R. de Santo André, 2410-197 Leiria, Portugal; (L.G.); (L.C.)
| | - Lina Caetano
- Intensive Care Unit, Leiria Hospital Center, R. de Santo André, 2410-197 Leiria, Portugal; (L.G.); (L.C.)
| | - Rui Passadouro
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal;
| | - Ana Querido
- School of Health Sciences of Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal;
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal;
- Center for Research in Health and Information Systems (CINTESIS), NursID, University of Porto, 4200-450 Porto, Portugal
- Correspondence: (C.L.); (A.Q.)
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Thurn T, Anneser J. Assisted Suicide: A Future Task for Physicians? A Survey of 271 German Medical Students. J Palliat Med 2021; 24:1051-1055. [PMID: 33685251 DOI: 10.1089/jpm.2020.0731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background: In February 2020, the German Federal Constitutional Court revoked a law that had made assisted suicide (AS) a potentially punishable offense. As a result, appropriate legal regulations for AS, including physician-assisted suicide (PAS), must be made. The medical curriculum should be adapted correspondingly. Objective: To explore medical students' knowledge of the legal situation, attitudes toward PAS and wishes regarding PAS education. Design: A cross-sectional survey was conducted. Setting: A questionnaire was distributed to all fourth-year students (n = 331) at a German medical school. Results: Students had a predominantly favorable attitude toward PAS. A majority considered AS to be a task that should be assigned to doctors (71%) and were willing to perform PAS (68%). Education on PAS was explicitly desired. Most participants had only limited knowledge of the legal situation. Conclusions: Medical students are largely in favor of PAS. A structured and interdisciplinary approach to PAS education is needed.
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Affiliation(s)
- Tamara Thurn
- Palliative Care Unit, Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Johanna Anneser
- Palliative Care Unit, Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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Castelli Dransart DA, Lapierre S, Erlangsen A, Canetto SS, Heisel M, Draper B, Lindner R, Richard-Devantoy S, Cheung G, Scocco P, Gusmão R, De Leo D, Inoue K, De Techterman V, Fiske A, Hong JP, Landry M, Lepage AA, Marcoux I, Na PJ, Neufeld E, Ummel D, Winslov JH, Wong C, Wu J, Wyart M. A systematic review of older adults' request for or attitude toward euthanasia or assisted-suicide. Aging Ment Health 2021; 25:420-430. [PMID: 31818122 DOI: 10.1080/13607863.2019.1697201] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over. METHOD The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times from February 2016 until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded. RESULTS This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures. CONCLUSION Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions.
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Affiliation(s)
| | - Sylvie Lapierre
- Department of Psychology, Université du Québec à Trois Rivières, Trois Rivières, Canada
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre, Copenhagen, Denmark
| | | | - Marnin Heisel
- Department of Psychiatry, Western University, Canada
| | - Brian Draper
- School of Psychiatry, University of NSW, Sidney Australia, and Eastern Suburbs Older Person's Mental Health Prince of Wales Hospital Randwick, Australia
| | | | - Stephane Richard-Devantoy
- Department of Psychiatry, McGill University, and Douglas Mental Health University Institute, Montreal, Canada
| | - Gary Cheung
- Department of Psychological Medecine, School of Medecine, University of Auckland, New Zealand
| | | | | | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
| | - Ken Inoue
- Research and Education Faculty, Medical Sciences Cluster Health Service Center, Kochi University, Japan
| | - Vincent De Techterman
- School of Social Work Fribourg, HES-SO University of Applied Sciences and Art Western Switzerland, Switzerland
| | - Amy Fiske
- Department of Psychology, West Virginia University, USA
| | - Jin Pyo Hong
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Marjolaine Landry
- Department of Nursing, Université du Québec à Trois Rivières, Canada
| | - Andrée-Anne Lepage
- Department of Psychology, Université du Québec à Trois Rivières, Trois Rivières, Canada
| | - Isabelle Marcoux
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Peter Jongho Na
- Department of Psychiatry, New York University Langone Health, USA
| | | | - Deborah Ummel
- Department of Psychoeducation, Université de Sherbrooke, Montréal, Canada
| | | | | | - Jing Wu
- Department of Sociology and Work Science, University of Gothenburg, Sweden
| | - Marilyn Wyart
- Unit of Geropsychiatry, Clinique Saint Antoine, Montarnaud, France
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Bahník Š, Vranka MA. Consistency and contrast effects in moral evaluation of euthanasia. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-018-0012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mathews JJ, Hausner D, Avery J, Hannon B, Zimmermann C, Al-Awamer A. Impact of Medical Assistance in Dying on palliative care: A qualitative study. Palliat Med 2021; 35:447-454. [PMID: 33126842 DOI: 10.1177/0269216320968517] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Medical Assistance in Dying comprises interventions that can be provided by medical practitioners to cause death of a person at their request if they meet predefined criteria. In June 2016, Medical Assistance in Dying became legal in Canada, sparking intense debate in the palliative care community. AIM This study aims to explore the experience of frontline palliative care providers about the impact of Medical Assistance in Dying on palliative care practice. DESIGN Qualitative descriptive design using semi-structured interviews and thematic analysis. SETTINGS/PARTICIPANTS We interviewed palliative care physicians and nurses who practiced in settings where patients could access Medical Assistance in Dying for at least 6 months before and after its legalization. Purposeful sampling was used to recruit participants with diverse personal views and experiences with assisted death. Conceptual saturation was achieved after interviewing 23 palliative care providers (13 physicians and 10 nurses) in Southern Ontario. RESULTS Themes identified included a new dying experience with assisted death; challenges with symptom control; challenges with communication; impact on palliative care providers personally and on their relationships with patients; and consumption of palliative care resources to support assisted death. CONCLUSION Medical Assistance in Dying has had a profound impact on palliative care providers and their practice. Communication training with access to resources for ethical decision-making and a review of legislation may help address new challenges. Further research is needed to understand palliative care provider distress around Medical Assistance in Dying, and additional resources are necessary to support palliative care delivery.
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Affiliation(s)
- Jean Jacob Mathews
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David Hausner
- Palliative Care Service, Oncology Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Jonathan Avery
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ahmed Al-Awamer
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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47
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Affiliation(s)
- Margaret O’Connor
- Monash University, Peninsula Campus, Melbourne, Victoria, Australia
- Melbourne City Mission Palliative Care, Victoria, Australia
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O'Connor M, Philips J. Challenges of implementing voluntary assisted dying in Victoria, Australia. Int J Palliat Nurs 2020; 26:425-430. [DOI: 10.12968/ijpn.2020.26.8.425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Staff working in community palliative care services are accustomed to the intimate conversations that a patient being at home can engender. Being at home can provide a safe space for a patient to express difficulties, including expressing a desire for hastened death. With the implementation of voluntary assisted dying in Victoria in mid-2019, palliative care services have needed to review and adapt policies and practices to incorporate this new procedure. While it was anticipated that a small percentage of people would request access to voluntary assisted dying, in the wake of such significant change, there were numerous implications for palliative care services to consider. This paper describes both the organisational and individual changes undertaken by one community-based palliative care service, in anticipation of legalised assistance in dying. The range of responses to the issues raised are discussed, in preparation for, and in the early days of, voluntary assisted dying.
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Affiliation(s)
- Margaret O'Connor
- Research Consultant, Melbourne City Mission Emeritus Professor of Nursing, Monash University, Melbourne
| | - Janet Philips
- Chief Executive Officer, Peninsula Home Hospice, Mornington Manager, Palliative Care Service, Melbourne City Mission (formerly)
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Solari A, Giordano A, Sastre-Garriga J, Köpke S, Rahn AC, Kleiter I, Aleksovska K, Battaglia MA, Bay J, Copetti M, Drulovic J, Kooij L, Mens J, Murillo ERM, Milanov I, Milo R, Pekmezovic T, Vosburgh J, Silber E, Veronese S, Patti F, Voltz R, Oliver DJ. EAN Guideline on Palliative Care of People with Severe, Progressive Multiple Sclerosis. J Palliat Med 2020; 23:1426-1443. [PMID: 32469284 PMCID: PMC7583337 DOI: 10.1089/jpm.2020.0220] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background and Purpose: Patients with severe, progressive multiple sclerosis (MS) have complex physical and psychosocial needs, typically over several years. Few treatment options are available to prevent or delay further clinical worsening in this population. The objective was to develop an evidence-based clinical practice guideline for the palliative care of patients with severe, progressive MS. Methods: This guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Formulation of the clinical questions was performed in the Patients-Intervention-Comparator-Outcome format, involving patients, carers and healthcare professionals (HPs). No uniform definition of severe MS exists: in this guideline, constant bilateral support required to walk 20 m without resting (Expanded Disability Status Scale score >6.0) or higher disability is referred to. When evidence was lacking for this population, recommendations were formulated using indirect evidence or good practice statements were devised. Results: Ten clinical questions were formulated. They encompassed general and specialist palliative care, advance care planning, discussing with HPs the patient's wish to hasten death, symptom management, multidisciplinary rehabilitation, interventions for caregivers and interventions for HPs. A total of 34 recommendations (33 weak, 1 strong) and seven good practice statements were devised. Conclusions: The provision of home-based palliative care (either general or specialist) is recommended with weak strength for patients with severe, progressive MS. Further research on the integration of palliative care and MS care is needed. Areas that currently lack evidence of efficacy in this population include advance care planning, the management of symptoms such as fatigue and mood problems, and interventions for caregivers and HPs.
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Affiliation(s)
- Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain, Germany
| | - Sascha Köpke
- Institute of Clinical Nursing Science, University of Cologne, Cologne, Germany
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne C. Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | | | | | - Jette Bay
- Multiple Sclerosis International Federation, People with MS Advisory Committee, Copenhagen, Denmark
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Jelena Drulovic
- Clinic of Neurology, CCS, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - John Mens
- Nieuw Unicum, Zandvoort, The Netherlands
| | - Edwin R. Meza Murillo
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain, Germany
| | | | - Ron Milo
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | - Eli Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Francesco Patti
- Neurology Clinic, Multiple Sclerosis Centre, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Health Services Research (ZVFK), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - David J. Oliver
- The Tizard Centre, University of Kent, Canterbury, United Kingdom
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Kumbhare S. A Reconceptualization of Suicide and Social Workers' Duty to Report. OMEGA-JOURNAL OF DEATH AND DYING 2020; 86:157-173. [PMID: 33028144 DOI: 10.1177/0030222820963773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper examines how history and psychiatry have shaped social work approaches to suicide prevention. Current social work intervention strategies rely on the following four positivist assumptions: (1) suicide is the result of mental illness, (2) suicidal individuals are irrational, (3) social workers have more knowledge about suicide than their clients, and (4) that preserving life is the least harmful outcome. Analysis reveals that these assumptions hold little validity and cannot be generalised to all cases. Discussion encourages intervention strategies that are informed by the experiences of attempt survivors and a broader sociopolitical context. Social workers are encouraged to use methods that are not only life-preserving, but life affirming. Finally, community specific initiatives to increase resources and decrease isolation and marginalization are posited as potential ways to reduce suicide ideation.
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Affiliation(s)
- Shaila Kumbhare
- Faculty of Social Work, McMaster University, Hamilton, Ontario, Canada.,Faculty of Social Work, Ryerson University, Toronto, Ontario, Canada
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