1
|
Jiraphan A, Pitanupong J. General population-based study on preferences towards end-of-life care in Southern Thailand: a cross-sectional survey. Palliat Care 2022; 21:36. [PMID: 35287652 PMCID: PMC8919914 DOI: 10.1186/s12904-022-00926-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/04/2022] [Indexed: 12/21/2022] Open
Abstract
Background End-of-life care preferences are potentially due to individual choice and feature variation due to culture and beliefs. This study aims to examine end-of-life care preferences and any associated factors, among the general Thai population. This could inform physicians in regards to how to optimize the quality of life for patients that are near the end of their lives. Methods A cross-sectional study surveyed the general population in the Thai province of Songkhla; from January to April 2021. The questionnaires inquired about: 1) demographic information, 2) experiences with end-of-life care for their relatives, and 3) end-of-life care preferences. To determine end-of-life preferences, the data were analyzed using descriptive statistics. The data concerning patient demographics and end-of-life care preferences were compared using Fisher’s exact test. Results The majority of the 1037 participants (67.6%) were female. The mean age among the adult and older adult groups were 40.9 ± 12.2, 70.0 ± 5.1, respectively. Half of them (48%) had an experience of observing someone die and 58% were satisfied with the care that their relatives had received. Most participants identified the following major end-of-life care preferences: having loved ones around (98.1%), being free from distressing symptoms (95.8%), receiving the full truth (95.0%), and having meaning in their lives (95.0%). There were no statistically significant differences in regards to end-of-life care preferences apart from being involved in treatment decisions, between adult and older adult groups. Conclusion There was only one difference between the end-of-life preferences of the adult group versus the older adult group in regards to the topic of patient involvement in treatment decisions. Furthermore, receiving the full truth regarding their illness, being free from distressing symptoms, having loved ones around, and living with a sense of meaning were important end-of-life care preferences for both groups. Therefore, these should be taken into account when developing strategies towards improving patient life quality during their end-of-life period.
Collapse
|
2
|
Rutherford J, Willmott L, White BP. What the Doctor Would Prescribe: Physician Experiences of Providing Voluntary Assisted Dying in Australia. OMEGA-JOURNAL OF DEATH AND DYING 2021:302228211033109. [PMID: 34282961 DOI: 10.1177/00302228211033109] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Like many countries where voluntary assisted dying (VAD) is legal, eligible doctors in Victoria, Australia, have sole legal authority to provide it. Doctors' attitudes towards legalised VAD have direct bearing on their willingness to participate in VAD and consequently, on whether permissive laws can effectively facilitate access to VAD. The study aimed to explore how some Victorian doctors are perceiving and experiencing the provision of legalised VAD under a recently commenced law. METHODS Semi-structured interviews with 25 Victorian doctors with no in-principle objection to legalised VAD were conducted between July 2019-February 2020. Interviews were recorded, transcribed, and analysed using thematic analysis. Ethical approval from the relevant institution was obtained. RESULTS Doctors perceive or experience VAD to fundamentally challenge traditional medical practice. Barriers to access to VAD derive from applicant, communication, and doctor-related factors. Doctors' willingness to participate in VAD is situation specific.
Collapse
Affiliation(s)
- Jodhi Rutherford
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| | - Ben P White
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
3
|
Pentaris P, Jacobs L. UK Public's Views and Perceptions About the Legalisation of Assisted Dying and Assisted Suicide. OMEGA-JOURNAL OF DEATH AND DYING 2020; 86:203-217. [PMID: 32746764 DOI: 10.1177/0030222820947254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Current debates about assisted dying and assisted suicide cover a series of medical, legal, moral, ethical and religious aspects. Yet, public views on the subject remain underexplored and, therefore, not always accounted for in the formation of public policy. This paper reports on empirical data from a cross-sectional study in the UK in 2019, which examines public views about the legalisation of assisted dying and assisted suicide, by means of a self-administered Qualtrics-based survey (self-devised vignettes). A combination of simple random and convenience sampling was used. Participants (n = 297) state their preference that both assisted dying and assisted suicide should be legalised in the UK (n = 70%), while doctors should be legally allowed to support such wishes of patients with an incurable and painful illness from which they will die (n = 62.22%). The paper concludes that public opinion needs to be further accounted for in policymaking and discourses regarding patient autonomy and dignity of care.
Collapse
Affiliation(s)
- Panagiotis Pentaris
- School of Human Sciences & Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Lucy Jacobs
- Social Work Alumni, School of Human Sciences, University of Greenwich, London, UK
| |
Collapse
|
4
|
Rutherford J, Willmott L, White BP. Physician attitudes to voluntary assisted dying: a scoping review. BMJ Support Palliat Care 2020; 11:200-208. [PMID: 32563993 DOI: 10.1136/bmjspcare-2020-002192] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/07/2020] [Accepted: 05/18/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Voluntary assisted dying (VAD) became legal in the Australian state of Victoria on 19 June 2019 and will be legal in Western Australia from 2021. Other Australian states are progressing similar law reform processes. In Australia and internationally, doctors are central to the operation of all legal VAD regimes. It is broadly accepted that doctors, as a profession, are less in favour of VAD law reform than the rest of the community. To date, there has been little analysis of the factors that motivate doctors' support or opposition to legalised VAD in Australia. AIM To review all studies reporting the attitudes of Australian doctors regarding the legalisation of VAD, including their willingness to participate in it, and to observe and record common themes in existing attitudinal data. DESIGN Scoping review and thematic analysis of qualitative and quantitative data. DATA SOURCES CINAHL, Embase, Scopus, PubMed and Informit were searched from inception to June 2019. RESULTS 26 publications detailing 19 studies were identified. Thematic analysis of quantitative and qualitative findings was performed. Three overarching themes emerged. 'Attitudes towards regulation' encompassed doctors' orientation towards legalisation, the shortcomings of binary categories of support or opposition and doctors' concerns about additional regulation of their professional practices. 'Professional and personal impact of legalisation' described tensions between palliative care and VAD, and the emotional and social impact of being providers of VAD. 'Practical considerations regarding access' considered doctors' concerns about eligibility criteria and their willingness to provide VAD. CONCLUSION A detailed understanding of medical perspectives about VAD would facilitate the design of legislative models that take better account of doctors' concerns. This may facilitate their greater participation in VAD and help address potential access issues arising from availability of willing doctors.
Collapse
Affiliation(s)
- Jodhi Rutherford
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ben P White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
5
|
Dombrecht L, Deliens L, Chambaere K, Baes S, Cools F, Goossens L, Naulaers G, Roets E, Piette V, Cohen J, Beernaert K. Neonatologists and neonatal nurses have positive attitudes towards perinatal end-of-life decisions, a nationwide survey. Acta Paediatr 2020; 109:494-504. [PMID: 30920064 DOI: 10.1111/apa.14797] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/06/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
AIM Perinatal death is often preceded by an end-of-life decision (ELD). Disparate hospital policies, complex legal frameworks and ethically difficult cases make attitudes important. This study investigated attitudes of neonatologists and nurses towards perinatal ELDs. METHODS A survey was handed out to all neonatologists and neonatal nurses in all eight neonatal intensive care units in Flanders, Belgium in May 2017. Respondents indicated agreement with statements regarding perinatal ELDs on a Likert-scale and sent back questionnaires via mail. RESULTS The response rate was 49.5% (302/610). Most neonatologists and nurses found nontreatment decisions such as withholding or withdrawing treatment acceptable (90-100%). Termination of pregnancy when the foetus is viable in cases of severe or lethal foetal problems was considered highly acceptable in both groups (80-98%). Physicians and nurses do not find different ELDs equally acceptable, e.g. nurses more often than physicians (74% vs 60%, p = 0.017) agree that it is acceptable in certain cases to administer medication with the explicit intention of hastening death. CONCLUSION There was considerable support for both prenatal and neonatal ELDs, even for decisions that currently fall outside the Belgian legal framework. Differences between neonatologists' and nurses' attitudes indicate that both opinions should be heard during ELD-making.
Collapse
Affiliation(s)
- Laure Dombrecht
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel (VUB) Brussel Belgium
| | - Luc Deliens
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel (VUB) Brussel Belgium
| | - Kenneth Chambaere
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel (VUB) Brussel Belgium
| | - Saskia Baes
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel (VUB) Brussel Belgium
| | - Filip Cools
- Department of Neonatology Universitair Ziekenhuis Brussel Vrije Universiteit Brussel Brussel Belgium
| | - Linde Goossens
- Department of Neonatology Ghent University Hospital Ghent Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration KU Leuven Leuven Belgium
| | - Ellen Roets
- Department of Obstetrics Women's Clinic University Hospital Ghent Ghent Belgium
| | - Veerle Piette
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel (VUB) Brussel Belgium
| | - Joachim Cohen
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel (VUB) Brussel Belgium
| | - Kim Beernaert
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel (VUB) Brussel Belgium
| | | |
Collapse
|
6
|
Easterly B, Tatalovich R. The people have spoken: Post-materialism and ballot measure voting on physician aid in dying (PAD). DEATH STUDIES 2019; 45:817-826. [PMID: 31809647 DOI: 10.1080/07481187.2019.1696425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
For decades, public opinion polls have shown that most Americans favor physician aid in dying (PAD) but little is known about those who support PAD ballot measures. With its emphasis on self-fulfillment, personal choice, and civic and political engagement, post-materialists would argue that adopting states tend to have younger, educated, and more secular populations. County-level votes on all nine ballot measures to legalize death with dignity were subjected to multiple regression analysis. The results largely confirm the hypotheses derived from post-materialist theory, namely that education, religion, and more problematically age significant indicators of PAD ballot measure voting.
Collapse
Affiliation(s)
- Bianca Easterly
- Department of Political Science, Lamar University, Beaumont, TX, USA
| | - Raymond Tatalovich
- Department of Political Science, Loyola University Chicago, Chicago, IL, USA
| |
Collapse
|
7
|
Thurn T, Borasio GD, Chiò A, Galvin M, McDermott CJ, Mora G, Sermeus W, Winkler AS, Anneser J. Physicians' attitudes toward end-of-life decisions in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:74-81. [PMID: 30789031 DOI: 10.1080/21678421.2018.1536154] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aims (1) to assess physicians' attitudes toward different palliative end-of-life (EOL) practices in amyotrophic lateral sclerosis (ALS) care, including forgoing artificial nutrition and hydration (FANH), continuous sedation until death (CSD), and withdrawing invasive ventilation (WIV), and toward physician-assisted dying (PAD) including physician-assisted suicide and euthanasia and (2) to explore variables influencing these attitudes. METHODS We used two clinical vignettes depicting ALS patients in different stages of their disease progression to assess the influence of suffering (physical/psycho-existential) on attitudes toward WIV and the influence of suffering and prognosis (short-term/long-term) on attitudes toward FANH, CSD, and PAD. RESULTS 50 physicians from European ALS centers and neurological departments completed our survey. Short-term prognosis had a positive impact on attitudes toward offering FANH (p = 0.014) and CSD (p = 0.048) as well as on attitudes toward performing CSD (p = 0.036) and euthanasia (p = 0.023). Predominantly psycho-existential suffering was associated with a more favorable attitude toward WIV but influenced attitudes toward performing CSD negatively. Regression analysis showed that religiosity was associated with more reluctant attitudes toward palliative EOL practices and PAD, whereas training in palliative care was associated with more favorable attitudes toward palliative EOL practices only. CONCLUSION ALS physicians seem to acknowledge psycho-existential suffering as a highly acceptable motive for WIV but not CSD. Physicians appear to be comfortable with responding to the patient's requests, but more reluctant to assume a proactive role in the decision-making process. Palliative care training may support ALS physicians in these challenging situations.
Collapse
Affiliation(s)
- Tamara Thurn
- a Palliative Care Team, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar , Technical University Munich , Munich , Germany
| | - Gian Domenico Borasio
- b Palliative and Supportive Care Service, Centre Hospitalier Universitaire Vaudois (CHUV) , University of Lausanne , Lausanne , Switzerland
| | - Adriano Chiò
- c Department of Neuroscience "Rita Levi Montalcini" , University of Turin , Turin , Italy
| | - Miriam Galvin
- d Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Dublin , Ireland
| | - Christopher J McDermott
- e Sheffield Institute for Translational Neuroscience , University of Sheffield , Sheffield , United Kingdom
| | | | - Walter Sermeus
- g Leuven Institute for Healthcare Policy , KU Leuven , Leuven , Belgium
| | - Andrea S Winkler
- h Department of Neurology, Klinikum rechts der Isar , Technical University Munich , Munich , Germany.,i Centre for Global Health, Institute of Health and Society , University of Oslo , Oslo , Norway
| | - Johanna Anneser
- a Palliative Care Team, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar , Technical University Munich , Munich , Germany
| |
Collapse
|
8
|
Velan B, Ziv A, Kaplan G, Rubin C, Connelly Y, Karni T, Tal O. Truth-telling and doctor-assisted death as perceived by Israeli physicians. BMC Med Ethics 2019; 20:13. [PMID: 30777058 PMCID: PMC6380017 DOI: 10.1186/s12910-019-0350-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/31/2019] [Indexed: 11/22/2022] Open
Abstract
Background Medicine has undergone substantial changes in the way medical dilemmas are being dealt with. Here we explore the attitude of Israeli physicians to two debatable dilemmas: disclosing the full truth to patients about a poor medical prognosis, and assisting terminally ill patients in ending their lives. Methods Attitudes towards medico-ethical dilemmas were examined through a nationwide online survey conducted among members of the Israeli Medical Association, yielding 2926 responses. Results Close to 60% of the respondents supported doctor-assisted death, while one third rejected it. Half of the respondents opposed disclosure of the full truth about a poor medical prognosis, and the others supported it. Support for truth-telling was higher among younger physicians, and support for doctor-assisted death was higher among females and among physicians practicing in hospitals. One quarter of respondents supported both truth-telling and assisted death, thereby exhibiting respect for patients’ autonomy. This approach characterizes younger doctors and is less frequent among general practitioners. Another quarter of the respondents rejected truth-telling, yet supported assisted death, thereby manifesting compassionate pragmatism. This was associated with medical education, being more frequent among doctors educated in Israel, than those educated abroad. All this suggests that both personal attributes and professional experience affect attitudes of physicians to ethical questions. Conclusions Examination of attitudes to two debatable medical dilemmas allowed portrayal of the multi-faceted medico-ethical scene in Israel. Moreover, this study, demonstrates that one can probe the ethical atmosphere of a given medical community, at various time points by using a few carefully selected questions. Electronic supplementary material The online version of this article (10.1186/s12910-019-0350-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Baruch Velan
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel. .,Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel.
| | - Arnona Ziv
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Giora Kaplan
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.,Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Carmit Rubin
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Yaron Connelly
- Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Tami Karni
- Comprehensive Breast Care Institute, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Orna Tal
- Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| |
Collapse
|
9
|
Yun YH, Kim KN, Sim JA, Yoo SH, Kim M, Kim YA, Kang BD, Shim HJ, Song EK, Kang JH, Kwon JH, Lee JL, Nam EM, Maeng CH, Kang EJ, Do YR, Choi YS, Jung KH. Comparison of attitudes towards five end-of-life care interventions (active pain control, withdrawal of futile life-sustaining treatment, passive euthanasia, active euthanasia and physician-assisted suicide): a multicentred cross-sectional survey of Korean patients with cancer, their family caregivers, physicians and the general Korean population. BMJ Open 2018; 8:e020519. [PMID: 30206075 PMCID: PMC6144336 DOI: 10.1136/bmjopen-2017-020519] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study determined attitudes of four groups-Korean patients with cancer, their family caregivers, physicians and the general Korean population-towards five critical end-of-life (EOL) interventions-active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide. DESIGN AND SETTING We enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a 'good death' with critical interventions at EoL care. RESULTS All participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling 'life was meaningful' (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing 'freedom from pain' negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, 'not being a burden to the family' was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89). CONCLUSION Groups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.
Collapse
Affiliation(s)
- Young Ho Yun
- Department of Biomedical Science, College of Medicine, Seoul National University, Seoul, Korea
- Department of Biomedical Informatics, College of Medicine, Seoul National University, Seoul, Korea
| | - Kyoung-Nam Kim
- Public Health Medical Service, Seoul National University Hospital, Seoul, Korea
| | - Jin-Ah Sim
- Department of Biomedical Science, College of Medicine, Seoul National University, Seoul, Korea
| | - Shin Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ae Kim
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Beo Deul Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun-Jeong Shim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, School of Medicine, Chonbuk National University, Jeonju, Korea
| | - Eun-Kee Song
- Division of Hematology/Oncology, Chonbuk National University Medical School, Jeonju, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Postgraduate Medical School, Gyeongsang National University, Jinju, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jung Lim Lee
- Department of Hemato-oncology, Daegu Fatima Hospital, Daegu, Korea
| | - Eun Mi Nam
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Chi Hoon Maeng
- Department of Medical Oncology and Hematology, Kyung Hee University Hospital, Seoul, Korea
| | - Eun Joo Kang
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Rok Do
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yoon Seok Choi
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Abstract
SummaryAssisted suicide is an emotive issue that will undoubtedly continue to grab media headlines, especially as medical science is able to prolong survival in chronic medical disorders. The law in the UK as applied under the Suicide Act 1961 is currently very sympathetic to cases of assisted suicide, whereby the individual has travelled abroad to a country where it is lawful to end their life, in that people assisting them and thus committing an offence have not been prosecuted. This article analyses a recent High Court case pertaining to the Suicide Act 1961 demonstrating the central importance of the Human Rights Act 1998 in such cases. It then discusses implications for clinicians and the future of the Suicide Act itself.
Collapse
|
11
|
Bator EX, Philpott B, Costa AP. This moral coil: a cross-sectional survey of Canadian medical student attitudes toward medical assistance in dying. BMC Med Ethics 2017; 18:58. [PMID: 29078769 PMCID: PMC5658957 DOI: 10.1186/s12910-017-0218-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 10/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In February, 2015, the Supreme Court of Canada struck down the ban on medical assistance in dying (MAiD). In June, 2016, the federal government passed Bill C-14, permitting MAiD. Current medical students will be the first physician cohort to enter a system permissive of MAiD, and may help to ensure equitable access to care. This study assessed medical student views on MAiD, factors influencing these views, and opportunities for medical education. METHODS An exploratory cross-sectional survey was developed and distributed to medical students across all years of a three-year Canadian undergraduate medical program. The investigators administered the survey to participants during academic sessions from November to December, 2015. Analysis of the results included summary descriptive statistics, Pearson's chi-square test of independence to identify differences between participants by year of study, logistic regression to identify factors that influence students' stances on MAiD, and Wilcoxon signed rank test to measure changes in student support for MAiD and comfort discussing MAiD. RESULTS There were 405 participants for a response rate of 87%. The majority of students (88%) supported the Supreme Court's decision, 61% would provide the means for a patient to end their life, and 38% would personally administer a lethal medication. Students who were more willing to provide the means for MAiD found medical education/clinical experience and patient autonomy to be important contributors to their stances on MAiD. Those students who were less willing to provide the means for MAiD found religious/spiritual beliefs and teachings, as well as concern about potential negative consequences, to be important contributors to their stances on MAiD. Educational training desired by participants included medicolegal (91%), communication skills (80%), technical skills (75%), and religious (49%). CONCLUSIONS Medical students generally supported and would provide the means for MAiD to patients. They also indicated a desire for directed medical education on MAiD.
Collapse
Affiliation(s)
- Eli Xavier Bator
- Michael G. DeGroote School of Medicine, Waterloo Regional Campus, McMaster University, 10B Victoria St S, Kitchener, ON, N2G 1C5, Canada.
| | - Bethany Philpott
- Michael G. DeGroote School of Medicine, Waterloo Regional Campus, McMaster University, 10B Victoria St S, Kitchener, ON, N2G 1C5, Canada
| | - Andrew Paul Costa
- Michael G. DeGroote School of Medicine, Waterloo Regional Campus, McMaster University, 10B Victoria St S, Kitchener, ON, N2G 1C5, Canada
| |
Collapse
|
12
|
Determinants of favourable opinions about euthanasia in a sample of French physicians. BMC Palliat Care 2015; 14:59. [PMID: 26542685 PMCID: PMC4635994 DOI: 10.1186/s12904-015-0055-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/27/2015] [Indexed: 12/03/2022] Open
Abstract
Background The question whether euthanasia should be legalised has led to substantial public debate in France. The objective of this study in a sample of French physicians was to establish the potential determinants of a favourable opinion about euthanasia in general and when faced with a specific situation as embodied in the Humbert affair. Methods The study was a cross-sectional survey investigating two different samples of medical doctors: (1) those specialised in palliative care and affiliated to the French Society for Patient Accompaniment and Palliative Care; (2) medical interns (medical doctors in training course) in a French medical university (Marseille). A questionnaire was sent (email) to each voluntary participant including sociodemographics, professional status, mention of believing in God, and opinion about euthanasia (the question was designed to assess the general opinion about euthanasia and the opinion about a specific case, the Vincent Humbert’ case (a man who was rendered quadriplegic, blind, and mute after an accident and has requested euthanasia). Results A total of 413 physicians participated in the research (participation rate: 48.5 %). Less than half of the population were favourable to euthanasia in general and almost two-thirds of the population were favourable to Vincent Humbert’s request for euthanasia. Based on the multivariate analysis, individuals believing in God and being a medical intern were significant independent factors linked to having a favourable opinion about euthanasia in general and about the Vincent Humbert’s request. Discussion There is still no study in France on the development of opinion about euthanasia and its impact. The issue goes beyond the strictly professional sphere and involves broader socio-political stakes. These stakes do not necessarily take into account medical practices and experiences or the desires of end-of-life patients. The professional upheaval that the future French legal framework will doubtlessly trigger will require further research. Conclusion The professional upheaval that the future French legal framework will doubtlessly trigger will require further research.
Collapse
|
13
|
Lavoie M, Godin G, Vézina-Im LA, Blondeau D, Martineau I, Roy L. Psychosocial determinants of physicians' intention to practice euthanasia in palliative care. BMC Med Ethics 2015; 16:6. [PMID: 25609036 PMCID: PMC4417253 DOI: 10.1186/1472-6939-16-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/12/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Euthanasia remains controversial in Canada and an issue of debate among physicians. Most studies have explored the opinion of health professionals regarding its legalization, but have not investigated their intentions when faced with performing euthanasia. These studies are also considered atheoretical. The purposes of the present study were to fill this gap in the literature by identifying the psychosocial determinants of physicians' intention to practice euthanasia in palliative care and verifying whether respecting the patient's autonomy is important for physicians. METHODS A validated anonymous questionnaire based on an extended version of the Theory of Planned Behavior was mailed to a random sample of 445 physicians from the province of Quebec, Canada. RESULTS The response rate was 38.3% and the mean score for intention was 3.94 ± 2.17 (range: 1 to 7). The determinants of intention among physicians were: knowing patients' wishes (OR = 10.77; 95%CI: 1.33-86.88), perceived behavioral control-physicians' evaluation of their ability to adopt a given behavior-(OR = 4.35; 95%CI: 1.44-13.15), moral norm-the appropriateness of adopting a given behavior according to one's personal and moral values-(OR = 3.22; 95%CI: 1.29-8.00) and cognitive attitude-factual consequences of the adoption of a given behavior-(OR = 3.16; 95%CI: 1.20-8.35). This model correctly classified 98.8% of physicians. Specific beliefs that might discriminate physicians according to their level of intention were also identified. For instance, physicians' moral norm was related to the ethical principle of beneficence. CONCLUSIONS Overall, physicians have weak intentions to practice euthanasia in palliative care. Nevertheless, respecting patients' final wishes concerning euthanasia seems to be of particular importance to them and greatly affects their motivation to perform euthanasia.
Collapse
Affiliation(s)
- Mireille Lavoie
- Faculty of Nursing, Laval University, Québec, G1V 0A6, Canada.
- Équipe de Recherche Michel-Sarrazin en Oncologie psychosociale et Soins palliatifs (ERMOS), Centre de recherche du CHU de Québec - Hôtel-Dieu de Québec, Québec, Canada.
| | - Gaston Godin
- Faculty of Nursing, Laval University, Québec, G1V 0A6, Canada.
| | | | | | | | - Louis Roy
- CHU de Québec - Hôpital Enfant-Jésus, Quebec, Canada.
| |
Collapse
|
14
|
Grimholt TK, Haavet OR, Jacobsen D, Sandvik L, Ekeberg O. Perceived competence and attitudes towards patients with suicidal behaviour: a survey of general practitioners, psychiatrists and internists. BMC Health Serv Res 2014; 14:208. [PMID: 24886154 PMCID: PMC4048050 DOI: 10.1186/1472-6963-14-208] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 05/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background Competence and attitudes to suicidal behaviour among physicians are important to provide high-quality care for a large patient group. The aim was to study different physicians’ attitudes towards suicidal behaviour and their perceived competence to care for suicidal patients. Methods A random selection (n = 750) of all registered General Practitioners, Psychiatrists and Internists in Norway received a questionnaire. The response rate was 40%. The Understanding of Suicidal Patients Scale (USP; scores < 23 = positive attitude) and items about suicide in case of incurable illness from the Attitudes Towards Suicide Questionnaire were used. Five-point Likert scales were used to measure self-perceived competence, level of commitment, empathy and irritation felt towards patients with somatic and psychiatric diagnoses. Questions about training were included. Results The physicians held positive attitudes towards suicide attempters (USP = 20.3, 95% CI: 19.6–20.9). Internists and males were significantly less positive. There were no significant differences in the physicians in their attitudes toward suicide in case of incurable illness according to specialty. The physicians were most irritated and less committed to substance misuse patients. Self perceived competence was relatively high. Forty-three percent had participated in courses about suicide assessment and treatment. Conclusions The physicians reported positive attitudes and relatively high competence. They were least committed to treat patients with substance misuse. None of the professional groups thought that patients with incurable illness should be given help to commit suicide. Further customized education with focus on substance misuse might be useful.
Collapse
Affiliation(s)
- Tine K Grimholt
- Department of Acute Medicine, Oslo University Hospital, Pb, 4950 Nydalen, Oslo 0424, Norway.
| | | | | | | | | |
Collapse
|
15
|
Vézina-Im LA, Lavoie M, Krol P, Olivier-D’Avignon M. Motivations of physicians and nurses to practice voluntary euthanasia: a systematic review. BMC Palliat Care 2014; 13:20. [PMID: 24716567 PMCID: PMC4021095 DOI: 10.1186/1472-684x-13-20] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 03/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While a number of reviews have explored the attitude of health professionals toward euthanasia, none of them documented their motivations to practice euthanasia. The objective of the present systematic review was to identify physicians' and nurses' motives for having the intention or for performing an act of voluntary euthanasia and compare findings from countries where the practice is legalized to those where it is not. METHODS The following databases were investigated: MEDLINE/PubMed (1950+), PsycINFO (1806+), CINAHL (1982+), EMBASE (1974+) and FRANCIS (1984+). Proquest Dissertations and Theses (1861+) was also investigated for gray literature. Additional studies were included by checking the references of the articles included in the systematic review as well as by looking at our personal collection of articles on euthanasia. RESULTS This paper reviews a total of 27 empirical quantitative studies out of the 1 703 articles identified at the beginning. Five studies were in countries where euthanasia is legal and 22 in countries where it is not. Seventeen studies were targeting physicians, 9 targeted nurses and 1 both health professionals. Six studies identified the motivations underlying the intention to practice euthanasia, 16 the behavior itself and 5 both intention and behavior. The category of variables most consistently associated with euthanasia is psychological variables. All categories collapsed, the four variables most frequently associated with euthanasia are past behavior, medical specialty, whether the patient is depressed and the patient's life expectancy. CONCLUSIONS The present review suggests that physicians and nurses are motivated to practice voluntary euthanasia especially when they are familiar with the act of euthanasia, when the patient does not have depressive symptoms and has a short life expectancy and their motivation varies according to their medical specialty. Additional studies among nurses and in countries where euthanasia is legal are needed.
Collapse
Affiliation(s)
| | - Mireille Lavoie
- Faculty of Nursing, Laval University, Québec, Canada
- Équipe de Recherche Michel-Sarrazin en Oncologie psychosociale et Soins palliatifs (ERMOS), Centre de recherche du CHU de Québec - Hôtel-Dieu de Québec, Québec, Canada
| | - Pawel Krol
- Faculty of Nursing, Laval University, Québec, Canada
| | | |
Collapse
|
16
|
Kouwenhoven PSC, Raijmakers NJH, van Delden JJM, Rietjens JAC, Schermer MHN, van Thiel GJMW, Trappenburg MJ, van de Vathorst S, van der Vegt BJ, Vezzoni C, Weyers H, van Tol DG, van der Heide A. Opinions of health care professionals and the public after eight years of euthanasia legislation in the Netherlands: a mixed methods approach. Palliat Med 2013; 27:273-80. [PMID: 22695742 DOI: 10.1177/0269216312448507] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The practice of euthanasia and physician-assisted suicide (PAS) in the Netherlands has been regulated since 2002 by the Euthanasia Act. In the ongoing debate about the interpretation of this Act, comparative information about the opinions of the different stakeholders is needed. AIM To evaluate the opinions of Dutch physicians, nurses and the general public on the legal requirements for euthanasia and PAS. DESIGN A cross-sectional survey among Dutch physicians and nurses in primary and secondary care and members of the Dutch general public, followed by qualitative interviews among selected respondents. The participants were: 793 physicians, 1243 nurses and 1960 members of the general public who completed the questionnaire; 83 were interviewed. RESULTS Most respondents agreed with the requirement of a patient request (64-88%) and the absence of a requirement concerning life expectancy (48-71%). PAS was thought acceptable by 24-39% of respondents for patients requesting it because of mental suffering due to loss of control, chronic depression or early dementia. In the case of severe dementia, one third of physicians, 58% of nurses and 77% of the general public agreed with performing euthanasia based on an advance directive. Interviewees illustrated these findings and supported the Act. CONCLUSIONS Health care professionals and the general public mostly support the legal requirements for euthanasia and PAS. The law permits euthanasia or PAS for mental suffering but this possibility is not widely endorsed. The general public is more liberal towards euthanasia for advanced dementia than health care professionals. We conclude that there is ample support for the law after eight years of legal euthanasia.
Collapse
|
17
|
Chong AML, Fok SY. Validation of the Chinese expanded Euthanasia Attitude Scale. DEATH STUDIES 2013; 37:89-98. [PMID: 24600722 DOI: 10.1080/07481187.2011.623214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article reports the validation of the Chinese version of an expanded 31-item Euthanasia Attitude Scale. A 4-stage validation process included a pilot survey of 119 college students and a randomized household survey with 618 adults in Hong Kong. Confirmatory factor analysis confirmed a 4-factor structure of the scale, which can therefore be used to examine attitudes toward general, active, passive, and non-voluntary euthanasia. The scale considers the role effect in decision-making about euthanasia requests and facilitates cross-cultural comparison of attitudes toward euthanasia. The new Chinese scale is more robust than its Western predecessors conceptually and measurement-wise.
Collapse
Affiliation(s)
| | - Shiu-Yeu Fok
- School of Continuing and Professional Education, City University of Hong Kong, Hong Kong
| |
Collapse
|
18
|
Hendry M, Pasterfield D, Lewis R, Carter B, Hodgson D, Wilkinson C. Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying. Palliat Med 2013; 27:13-26. [PMID: 23128904 DOI: 10.1177/0269216312463623] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Assisted dying is legal in four European countries and three American states. Elsewhere, particularly in more affluent or mainly Protestant countries, it remains controversial. Dominant headlines feature professional (medical, legal, religious) arguments versus celebrity campaigners; ordinary people are less clearly represented. AIM To synthesise the international evidence of people's views and attitudes towards assisted dying in order to inform current debate about this controversial issue. DESIGN Systematic review and mixed method synthesis of qualitative and survey data. DATA SOURCES Eleven electronic databases from inception to October 2011; bibliographies of included studies. REVIEW METHODS Two reviewers independently screened papers and appraised quality. Qualitative results were extracted verbatim; survey results were summarised in a table. Qualitative data were synthesised using framework methods and survey results integrated where they supported, contrasted or added to the themes identified. RESULTS Sixteen qualitative studies and 94 surveys were included; many participants considered the immediate relevance of assisted dying for them. Themes related to poor quality of life, a good quality of death, potential abuse of assisted dying and the importance of individual stance. People valued autonomy in death as much as in life. Attitudes were diverse, complex and related to definitions of unbearable suffering including physical, psycho-social and existential factors and were consistent regardless of social, economic, legal and health-care contexts. CONCLUSION Our review sheds light on ordinary people's perspectives about assisted dying, when they are ill or disabled. Unbearable suffering is a key construct, and common factors are revealed that lead people to ask for help to die. The consistency of international views indicates a mandate for legislative and medical systems worldwide to listen and understand this.
Collapse
Affiliation(s)
- Maggie Hendry
- North Wales Centre for Primary Care Research, Bangor University, Wrexham Technology Park, Wrexham, UK.
| | | | | | | | | | | |
Collapse
|
19
|
Macleod S. Assisted dying in liberalised jurisdictions and the role of psychiatry: a clinician's view. Aust N Z J Psychiatry 2012; 46:936-45. [PMID: 23028195 DOI: 10.1177/0004867411434714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Assisted dying is a contentious and topical issue. Mental disorder is a relevant influence on requests of hastened death. The psychiatry of dying is not a prominent component in the assessment of euthanasia and physician-assisted suicide (PAS) in jurisdictions with liberalised assisted dying laws. The literature on the assessment processes, with particular reference to mental status, involved in euthanasia requests is considered. METHODS An experienced palliative medicine specialist and psychiatrist selectively reviewed the recent literature published about the mental health issues involved in euthanasia and PAS. RESULTS Assessments of competency, sustained wish to die prematurely, depressive disorder, demoralisation and 'unbearable suffering' in the terminally ill are clinically uncertain and difficult tasks. There is a growing psychiatric and psychological literature on the mental status of the terminally ill. As yet psychiatry does not have the expertise to 'select' those whose wish for hastened death is rational, humane and 'healthy'. Rarely in those societies with liberalised assisted dying laws are psychiatrists involved in the decision-making for individuals requesting early death. This role is fulfilled by non-specialists. CONCLUSIONS There remain significant concerns about the accuracy of psychiatric assessment in the terminally ill. Mental processes are more relevant influences on a hastened wish to die than are the physical symptoms of terminal malignant disease. Psychiatric review of persons requesting euthanasia is relevant. It is not obligatory or emphasised in those legislations allowing assisted dying. Psychiatry needs to play a greater role in the assessment processes of euthanasia and PAS.
Collapse
Affiliation(s)
- Sandy Macleod
- Health Sciences Centre, University of Canterbury, Christchurch, New Zealand.
| |
Collapse
|
20
|
Madeira N, Albuquerque E, Santos T, Mendes A, Roque M. Death ideation in cancer patients: contributing factors. J Psychosoc Oncol 2012; 29:636-42. [PMID: 22035536 DOI: 10.1080/07347332.2011.615381] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Advances in cancer research and therapy have improved prognosis and the quality of life of many patients. However, previous epidemiological studies in oncologic patients have shown an increased risk of suicide. Suicidal thoughts, relatively well known in those terminally ill, may be just as important for cancer patients who are survivors or are living with the disease. Nonetheless, there is a relative paucity of data about suicidality in this setting. The authors conducted a prospective observational study to identify death thoughts and to explore the factors associated with suicidal ideation in cancer patients. A sample of 130 patients referred for psychiatric consultation was obtained following informed consent and authorization from the local ethics committee. A semistructured interview assessed sociodemographic data, psychosocial support, and information regarding the cancer process and its treatment. Psychometric instruments were used to evaluate psychopathology, namely the Hospital Anxiety and Depression Scale, the Beck Hopelessness Scale, and the Beck Scale for Suicide Ideation. Psychiatric diagnoses were obtained through the application of the Mini International Neuropsychiatric Interview. Death ideation was identified in 34.6% of patients, yet only 10% had active suicidal thoughts. Risk of suicide was associated with female gender, a psychiatric diagnosis (major depressive disorder, panic disorder, or dysthymia), difficult interpersonal relationships, associated pain, high hopelessness, and depressive and anxiety symptoms. Although suicidal thoughts are frequent in cancer patients at different stages of disease, most are transitory. Risk factors for suicidal ideation have been identified, such as depression, hopelessness, uncontrolled pain, and difficult interpersonal relationships. Further assessment is necessary to identify those at higher risk of attempting suicide, and underlying psychiatric disorders should be vigorously treated.
Collapse
Affiliation(s)
- Nuno Madeira
- Serviço de Psiquiatria-Hospitais da Universidade de Coimbra, Portugal.
| | | | | | | | | |
Collapse
|
21
|
Sher L. What should we tell medical students and residents about euthanasia and assisted suicide? Aust N Z J Psychiatry 2012; 46:87-91. [PMID: 22311524 DOI: 10.1177/0004867411433894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Leo Sher
- Psychiatry Department, Mount Sinai School of Medicine, New York, New York, USA.
| |
Collapse
|
22
|
McCormack R, Clifford M, Conroy M. Attitudes of UK doctors towards euthanasia and physician-assisted suicide: a systematic literature review. Palliat Med 2012; 26:23-33. [PMID: 22190615 DOI: 10.1177/0269216310397688] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To review studies over a 20-year period that assess the attitudes of UK doctors concerning active, voluntary euthanasia (AVE) and physician-assisted suicide (PAS), assess efforts to minimise bias in included studies, determine the effect of subgroup variables (e.g. age, gender) on doctors' attitudes, and make recommendations for future research. DATA SOURCES Three electronic databases, four pertinent journals, reference lists of included studies. REVIEW METHODS Literature search of English articles between January 1990 and April 2010. Studies were excluded if they did not present independent data (e.g. commentaries) or if they related to doctors outside the UK, patients younger than 18 years old, terminal sedation, withdrawing or withholding treatment, or double-effect. Quantitative and qualitative data were extracted. RESULTS Following study selection and data extraction, 15 studies were included. UK doctors oppose the introduction of both AVE and PAS in the majority of studies. Degree of religiosity appeared as a statistically significant factor in influencing doctors' attitudes. The top three themes in the qualitative analysis were the provision of palliative care, adequate safeguards in the event of AVE or PAS being introduced, and a profession to facilitate AVE or PAS that does not include doctors. CONCLUSIONS UK doctors appear to oppose the introduction of AVE and PAS, even when one considers the methodological limitations of included studies. Attempts to minimise bias in included studies varied. Further studies are necessary to establish if subgroup variables other than degree of religiosity influence attitudes, and to thoroughly explore the qualitative themes that appeared.
Collapse
Affiliation(s)
- Ruaidhri McCormack
- Department of Palliative Medicine, Milford Care Centre, Castletroy, Limerick, Ireland.
| | | | | |
Collapse
|
23
|
Baeke G, Wils JP, Broeckaert B. 'We are (not) the master of our body': elderly Jewish women's attitudes towards euthanasia and assisted suicide. ETHNICITY & HEALTH 2011; 16:259-278. [PMID: 21660785 DOI: 10.1080/13557858.2011.573538] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES In Belgium, dominant ideological traditions--Christianity and non-religious humanism--have the floor in debates on euthanasia and hardly any attention is paid to the practices and attitudes of ethnic and religious minorities, for instance, Jews. This article aims to meet this lacuna. DESIGN Qualitative empirical research was performed in the Orthodox Jewish community of Antwerp (Belgium) with a purposive sample of elderly Jewish (non-)Hasidic and secularised Orthodox women. In-depth interviews were conducted to elicit their attitudes towards (non-)voluntary euthanasia and assisted suicide. RESULTS The research reveals diverse views among women in the community on intentionally terminating a patient's life. Absolute rejection of every act which deliberately terminates life is found among the overwhelming majority of (religiously observant) Orthodox (Hasidic and non-Hasidic) women, as they have an unconditional faith and trust in God's sovereign power over the domain of life and death. On the other hand, the views of secularised Orthodox women--mostly irreligious women, who do not consider themselves Orthodox, thus not following Jewish law, yet say they belong to the Orthodox Jewish community--show an acceptance of voluntary euthanasia and assisted suicide but non-voluntary euthanasia is approached more negatively. As they perceive illness and death as merely profane facts, they stress a patient's absolute right towards self-determination, in particular with regard to one's end of life. Among non-Hasidic Orthodox respondents, more openness is found for cultivating a personal opinion which deviates from Jewish law and for the right of self-determination with regard to questions concerning life and death. In this study, these participants occupy an intermediate position. CONCLUSION Our study reveals an interplay between ethical attitudes on euthanasia and religious convictions. The image one has of a transcendental reality, or of God, has a stronger effect on one's (dis)approval of euthanasia than being (ir)religious.
Collapse
Affiliation(s)
- Goedele Baeke
- Faculty of Theology, Interdisciplinary Centre for the Study of Religion and World View, Katholieke Universiteit Leuven, Leuven, Belgium.
| | | | | |
Collapse
|
24
|
Broeckaert B, Gielen J, van Iersel T, Van den Branden S. Euthanasia and Palliative Care in Belgium: The Attitudes of Flemish Palliative Care Nurses and Physicians Toward Euthanasia. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/21507716.2010.505900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
25
|
CQ Sources/Bibliography. Camb Q Healthc Ethics 2010. [DOI: 10.1017/s0963180110000186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
These CQ Sources were compiled by Bette Anton.
Collapse
|
26
|
Gielen J, Van den Branden S, Broeckaert B. The operationalisation of religion and world view in surveys of nurses' attitudes toward euthanasia and assisted suicide. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2009; 12:423-431. [PMID: 19629746 DOI: 10.1007/s11019-009-9217-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 07/06/2009] [Indexed: 05/28/2023]
Abstract
Most quantitative studies that survey nurses' attitudes toward euthanasia and/or assisted suicide, also attempt to assess the influence of religion on these attitudes. We wanted to evaluate the operationalisation of religion and world view in these surveys. In the Pubmed database we searched for relevant articles published before August 2008 using combinations of search terms. Twenty-eight relevant articles were found. In five surveys nurses were directly asked whether religious beliefs, religious practices and/or ideological convictions influenced their attitudes, or the respondents were requested to mention the decisional basis for their answers on questions concerning end-of-life issues. In other surveys the influence of religion and world view was assessed indirectly through a comparison of the attitudes of different types of believers and/or non-believers toward euthanasia or assisted suicide. In these surveys we find subjective religious or ideological questions (questions inquiring about the perceived importance of religion or world view in life, influence of religion or world view on life in general, or how religious the respondents consider themselves) and objective questions (questions inquiring about religious practice, acceptance of religious dogmas, and religious or ideological affiliation). Religious or ideological affiliation is the most frequently used operationalisation of religion and world view. In 16 surveys only one religious or ideological question was asked. In most articles the operationalisation of religion and world view is very limited and does not reflect the diversity and complexity of religion and world view in contemporary society. Future research should pay more attention to the different dimensions of religion and world view, the religious plurality of Western society and the particularities of religion in non-Western contexts.
Collapse
Affiliation(s)
- Joris Gielen
- Interdisciplinary Centre for the Study of Religion and World View, Catholic University of Leuven, Sint-Michielsstraat 6 - Bus 3102, 3000, Leuven, Belgium.
| | | | | |
Collapse
|
27
|
Gonçalves F. Attitudes toward assisted death amongst Portuguese oncologists. Support Care Cancer 2009; 18:359-66. [PMID: 19484484 DOI: 10.1007/s00520-009-0661-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Accepted: 05/13/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND The attitudes and practise of doctors concerning euthanasia and assisted suicide have been the subject of studies performed in many countries. However, these issues have not been studied properly in Portugal. MATERIALS AND METHOD This study is a survey of 450 Portuguese oncologists by postal means and personal contact. RESULTS The response rate was 33% (143). Only 13% would practise euthanasia with the present law in force forbidding such practise, and 24% would do so if it were legalised; 39% favoured its legalisation and 36% would like to have the option of euthanasia if they had a terminal disease. About assisted suicide, 15% would do it with the current law in force forbidding such action and 25% would do so if it were made legal; 32% favoured its legalisation and 24% would like to have that option if they had a terminal disease. There was one case of euthanasia and no cases of assisted suicide. The most important factor related with the acceptance of euthanasia and assisted suicide was religion, with non-practising Catholics accepting such practises more often than practising Catholics. The Portuguese oncologists have a very positive view on the potential role of palliative care in preventing many requests for euthanasia and assisted suicide. CONCLUSION Portuguese oncologists are mainly against the practise of euthanasia and assisted suicide and the number of requests is also relatively low; consequently, the number of episodes of assisted death is also apparently very low.
Collapse
Affiliation(s)
- Ferraz Gonçalves
- Instituto Português de Oncologia, UCP-R, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
| |
Collapse
|