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Arreciado Marañón A, García-Sierra R, Busquet-Duran X, Tort-Nasarre G, Feijoo-Cid M. Nursing students' attitude toward euthanasia following its legalization in Spain. Nurs Ethics 2024:9697330241238342. [PMID: 38491560 DOI: 10.1177/09697330241238342] [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: 03/18/2024]
Abstract
BACKGROUND Euthanasia is a controversial practice in many countries. Since Spain's Euthanasia Law came into effect on March 24, 2021, healthcare providers have faced a new challenge since they must inform patients, provide care, accompany them, and implement the law. It also represents a new stumbling block at universities, which must adapt to regulatory changes and educate future professionals accordingly. Little is known about the attitude of nursing students in Spain toward euthanasia since this law was implemented. OBJECTIVE This study aims to answer the following research questions: What is the attitude of nursing students toward euthanasia? What factors influence this attitude? RESEARCH DESIGN A cross-sectional study was conducted using an online questionnaire. PARTICIPANTS AND RESEARCH CONTEXT The study population comprised all nursing students at a public university in Barcelona (n = 444), Spain, during the 2022-2023 academic year. The validated Spanish version of the Euthanasia Attitude Scale was employed. A bivariate analysis was performed. ETHICAL CONSIDERATIONS The university Ethics Committee (CEEAH 6247) approved this study. All participating students signed an informed consent form. Participation was voluntary, and data anonymity and confidentiality were guaranteed. RESULTS Two hundred and forty-four nursing students responded to the questionnaire. The mean total score was 79.64. Participants with religious beliefs presented lower scores, indicating a more negative attitude toward euthanasia. Participants in their second, third, or fourth year of the nursing degree scored higher, demonstrating a more positive attitude. CONCLUSIONS The attitude of nursing students toward euthanasia was remarkably positive. Working on ethical content during the degree course and clinical practice are factors that help to develop a more positive attitude. In addition, nursing education should encourage professional aspects to prevail over religious beliefs in euthanasia situations.
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Affiliation(s)
| | - Rosa García-Sierra
- Primary Care Research Institut Jordi Gol (IDIAPJGol)
- Universitat Autònoma de Barcelona
- Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS)
| | - Xavier Busquet-Duran
- Catalan Institute of Health
- Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS)
- University Foundation of Bages (FUB), University of Vic. Central University of Catalunya
| | - Gloria Tort-Nasarre
- University of Lleida
- Autonomous University of Barcelona
- Institut Català de la Salut (ICS)
| | - Maria Feijoo-Cid
- Universitat Autònoma de Barcelona
- Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS)
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Fasse L, Roche N, Flahault C, Garrouste-Orgeas M, Ximenes M, Pages A, Evin A, Dauchy S, Scotte F, Le Provost JB, Blot F, Mateus C. The APSY-SED study: protocol of an observational, longitudinal, mixed methods and multicenter study exploring the psychological adjustment of relatives and healthcare providers of patients with cancer with continuous deep sedation until death. BMC Palliat Care 2022; 21:217. [PMID: 36464684 PMCID: PMC9720978 DOI: 10.1186/s12904-022-01106-z] [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: 07/05/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Since 2016, France is the only country in the World where continuous deep sedation until death (CDSUD) is regulated by law. CDSUD serves as a response to refractory suffering in palliative situations where the patients' death is expected to occur in the following hours or days. Little is known on the psychological adjustment surrounding a CDSUD procedure for healthcare providers (HCPs) and relatives. Our study aims to gather qualitative and quantitative data on the specific processes behind the psychological adjustment of both relatives and HCPs, after the administration of CDSUD for patients with cancer. METHODS The APSY-SED study is a prospective, longitudinal, mixed-methods and multicenter study. Recruitment will involve any French-speaking adult cancer patient for who a CDSUD is discussed, their relatives and HCPs. We plan to include 150 patients, 150 relatives, and 50 HCPs. The evaluation criteria of this research are: 1/ Primary criterion: Psychological adjustment of relatives and HCPs 6 and 13 months after the death of the patient with cancer (psychological adjustment = intensity of anxiety, depression and grief reactions, CDSUD-related distress, job satisfaction, Professional Stress and Professional experience). Secondary criteria: a)occurrence of wish for a CDSUD in patients in palliative phase; b)occurrence of wish for hastened death in patients in palliative phase; c)potential predictors of adjustment assessed after the discussion concerning CDSUD as an option and before the setting of the CDSUD; d) Thematic analysis and narrative account of meaning-making process concerning the grief experience. DISCUSSION The APSY-SED study will be the first to investigate the psychological adjustment of HCPs and relatives in the context of a CDSUD procedure implemented according to French law. Gathering data on the grief process for relatives can help understand bereavement after CDSUD, and participate in the elaboration of specific tailored interventions to support HCPs and relatives. Empirical findings on CDSUD among patients with cancer in France could be compared with existing data in other countries and with results related to other medical fields where CDSUD is also conducted. TRIAL REGISTRATION This protocol received the National Registration Number: ID-RCB2021-A03042-39 on 14/12/2021.
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Affiliation(s)
- L Fasse
- DIOPP, Gustave Roussy Hospital, Villejuif, France.
- Institut de Psychologie Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, 71 avenue E. Vaillant, F-92100, Boulogne- Billancourt, France.
| | - N Roche
- DIOPP, Gustave Roussy Hospital, Villejuif, France
| | - C Flahault
- DIOPP, Gustave Roussy Hospital, Villejuif, France
- Institut de Psychologie Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, 71 avenue E. Vaillant, F-92100, Boulogne- Billancourt, France
| | - M Garrouste-Orgeas
- IAME, INSERM, Université de Paris, F-75018, Paris, France
- Palliative Care unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
- Medical unit, French British Hospital, Levallois-Perret, France
| | - M Ximenes
- Maison Médicale Marie Galène, Bordeaux, France
| | - A Pages
- Biostatistical Unit, Gustave Roussy Hospital, Villejuif, France
| | - A Evin
- Palliative Care unit, CHU, Nantes, France
| | - S Dauchy
- DMU Psychiatry and Addictology, AP-HP.Centre, Université de Paris, Paris, France
| | - F Scotte
- DIOPP, Gustave Roussy Hospital, Villejuif, France
| | | | - F Blot
- DIOPP, Gustave Roussy Hospital, Villejuif, France
| | - C Mateus
- DIOPP, Gustave Roussy Hospital, Villejuif, France
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Warton C, McDougall RJ. Fertility preservation for transgender children and young people in paediatric healthcare: a systematic review of ethical considerations. JOURNAL OF MEDICAL ETHICS 2022; 48:1076-1082. [PMID: 34980674 PMCID: PMC9726968 DOI: 10.1136/medethics-2021-107702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/03/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND While fertility preservation is recommended practice for paediatric oncology patients, it is increasingly being considered for transgender children and young people in paediatric care. This raises ethical issues for clinicians, particularly around consent and shared decision-making in this new area of healthcare. METHODS A systematic review of normative literature was conducted across four databases in June 2020 to capture ethical considerations related to fertility counselling and preservation in paediatric transgender healthcare. The text of included publications was analysed inductively, guided by the Qualitative Analysis Guide of Leuven. RESULTS Twenty-four publications were identified for inclusion. Four key ethical considerations emerged from this literature: access to fertility preservation, conscientious objection, decision-making capacity of children and young people, and shared decision-making. CONCLUSION In the identified literature, there is consensus that transgender children and young people should not be refused access to fertility preservation services solely due to their gender identity, and that clinicians with conscientious objections to fertility preservation for this group have an obligation to refer on to willing providers. Factors that create ethical complexity in this area of paediatric care include the child's age, mental health, and parents' views.
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Affiliation(s)
- Chanelle Warton
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rosalind J McDougall
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Ortega-Galán ÁM, Ruiz-Fernández MD, Alcaraz-Córdoba A, Gómez-Beltrán PA, Díaz-Morales D, Ortiz-Amo R. Nursing students' perceptions of euthanasia legislation: A qualitative study. NURSE EDUCATION TODAY 2022; 116:105466. [PMID: 35834867 DOI: 10.1016/j.nedt.2022.105466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/19/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Affiliation(s)
| | - María Dolores Ruiz-Fernández
- Department of Nursing, Physiotherapy, and Medicine, University of Almeria, Almería, Spain; Facultad Ciencias de la Salud, Universidad Autónoma de Chile, Providencia, Chile.
| | - Andrea Alcaraz-Córdoba
- Department of Nursing, Physiotherapy, and Medicine, University of Almeria, Almería, Spain
| | | | | | - Rocío Ortiz-Amo
- Department of Nursing, Physiotherapy, and Medicine, University of Almeria, Almería, Spain
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Wright DK, Chan LS, Fishman JR, Macdonald ME. "Reflection and soul searching": Negotiating nursing identity at the fault lines of palliative care and medical assistance in dying. Soc Sci Med 2021; 289:114366. [PMID: 34624622 DOI: 10.1016/j.socscimed.2021.114366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 08/22/2021] [Accepted: 09/01/2021] [Indexed: 12/29/2022]
Abstract
Authorities within the field of palliative care frequently espouse that assisted death is - and must remain - separate from palliative care. This fault line, between palliative care and assisted death, has important implications for how we enact end-of-life care, particularly in jurisdictions where assisted death is legal. And yet little is known about how direct-care clinicians providing palliative care navigate this demarcation in everyday practice. This qualitative study reports on semi-structured interviews with 22 palliative care nurses from across Canada, where assisted death was legalized in 2016. Although a minority of participants did express categorical opinions around the (non) legitimacy of assisted death as an ethical end-of-life care option, most engaged in an ongoing and sometimes painful process of questioning and self-examination. Their ethical reflections were more nuanced than simply dismissing MAiD as incompatible with palliative care philosophy; yet this idea of incompatibility weighed heavily as they reasoned through their experiences and questioned their own perspectives. Nurses described grappling with the finality of assisted death, which contradicts their belief in the telos of palliative care; when adequately resourced, palliative care should be available to support people to live well before death. At the same time, commitment to important palliative care values such as the non-abandonment of dying people and respecting peoples' individual end-of-life choices reveal the possibility of overlap between the ethos of assisted death and that of palliative care nursing. Drawing on scholarship in feminist ethics, our study sheds light on the moral identity work that assisted dying catalyzes amongst palliative care nurses. We highlight what is at stake for them as they navigate a delicate tension in responding ethically to patients whose suffering motivates an interest in assisted death, from within a wider professional collective that upholds a master narrative about the incompatibility of assisted death and palliative care.
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Affiliation(s)
- David Kenneth Wright
- School of Nursing, University of Ottawa, Roger Guindon Hall, 1480C-451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.
| | - Lisa S Chan
- Palliative Care and Nursing Ethics Hub, Centre for Research on Health and Nursing, University of Ottawa, Roger Guindon Hall, 1118C-451, Smyth Rd, Ottawa, Ontario, K1H 8M5, Canada.
| | - Jennifer R Fishman
- Biomedical Ethics Unit and Department of the Social Studies of Medicine, McGill University, 307-3647, Peel Street, Montréal, Québec, H3A 1X1, Canada.
| | - Mary Ellen Macdonald
- Faculty of Dentistry, McGill University, 530-2001 McGill College Avenue, Montréal, Québec, H3A 1G1, Canada.
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Dieudonné Rahm N, Morawska G, Pautex S, Elia N. Monitoring nociception and awareness during palliative sedation: A systematic review. Palliat Med 2021; 35:1407-1420. [PMID: 34109873 DOI: 10.1177/02692163211022943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Providing unawareness and pain relief are core elements of palliative sedation. In addition to clinical scales, nociception and electroencephalogram-based depth of sedation monitoring are used to assess the level of consciousness and analgesia during sedation in intensive care units and during procedures. AIM To determine whether reported devices impact the outcomes of palliative sedation. DESIGN Systematic review and narrative synthesis of research published between January 2000 and December 2020. DATA SOURCES Embase, Google Scholar, PubMed, CENTRAL, and the Cochrane Library. All reports describing the use of any monitoring device to assess the level of consciousness or analgesia during palliative sedation were screened for inclusion. Data concerning safety and efficacy were extracted. Patient comfort was the primary outcome of interest. Articles reporting sedation but that did not meet guidelines of the European Association for Palliative Care were excluded. RESULTS Six reports of five studies were identified. Four of these were case series and two were case reports. Together, these six reports involved a total of 67 sedated adults. Methodological quality was assessed fair to good. Medication regimens were adjusted to bispectral index monitoring values in two studies, which found poor correlation between monitoring values and observational scores. In another study, high nociception index values, representing absence of pain, were used to detect opioid overdosing. Relatives and caregivers found the procedures feasible and acceptable.
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Affiliation(s)
- Nathalie Dieudonné Rahm
- Division of Palliative Medicine, Department of Geriatrics and Rehabilitation, Geneva University Hospitals, Hôpital de Bellerive, Collonge-Bellerive, Geneva, Switzerland
| | - Ghizlaine Morawska
- Division of Palliative Medicine, Department of Geriatrics and Rehabilitation, Geneva University Hospitals, Hôpital de Bellerive, Collonge-Bellerive, Geneva, Switzerland
| | - Sophie Pautex
- Division of Palliative Medicine, Department of Geriatrics and Rehabilitation, Geneva University Hospitals, Hôpital de Bellerive, Collonge-Bellerive, Geneva, Switzerland
| | - Nadia Elia
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
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