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Trejo-Gabriel-Galán JM. Euthanasia and assisted suicide in neurological diseases: a systematic review. Neurologia 2024; 39:170-177. [PMID: 38272260 DOI: 10.1016/j.nrleng.2024.01.007] [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: 01/06/2021] [Revised: 03/29/2021] [Accepted: 04/04/2021] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE To identify the neurological diseases for which euthanasia and assisted suicide are most frequently requested in the countries where these medical procedures are legal and the specific characteristics of euthanasia in some of these diseases, and to show the evolution of euthanasia figures. METHODS We conducted a systematic literature review. RESULTS Dementia, motor neuron disease, multiple sclerosis, and Parkinson's disease are the neurological diseases that most frequently motivate requests for euthanasia or assisted suicide. Requests related to dementia constitute the largest group, are growing, and raise additional ethical and legal issues due to these patients' diminished decision-making capacity. In some countries, the ratios of euthanasia requests to all cases of multiple sclerosis, motor neuron disease, or Huntington disease are higher than for any other disease. CONCLUSIONS After cancer, neurological diseases are the most frequent reason for requesting euthanasia or assisted suicide.
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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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Velasco Bernal C, Trejo-Gabriel-Galan JM. [Euthanasia laws in Spain and in the world: Medical aspects]. Aten Primaria 2021; 54:102170. [PMID: 34798415 PMCID: PMC8605061 DOI: 10.1016/j.aprim.2021.102170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
Objetivo Comparar la ley española de eutanasia y suicidio asistido con las que existen en otros países. Diseño Revisión sistemática de la bibliografía. Fuentes de datos Se buscaron en Medline/PubMed, EMBASE y Biblioteca Cochrane los estudios que contuvieran en su título o resumen los descriptores «eutanasia» o «suicidio asistido» y además «legislación» o «ley», entre 2002 y final de 2020. Selección de estudios La búsqueda encontró 1.647 estudios y tras su cribado se valoraron 663, de los cuales 30 se incluyeron en la revisión. Se rechazaron estudios en los que solo constaran opiniones o no aportaran datos sobre la eutanasia/suicidio asistido en los países que los tienen regulados. Extracción de datos Se registraron los criterios que regulan la aceptación o rechazo de una petición de eutanasia o suicidio asistido en España y en los demás países en que están despenalizados. Resultados Las regulaciones de la eutanasia en el mundo pueden agruparse en tres: leyes que permiten la eutanasia y el suicidio asistido (Países Bajos, Bélgica, Canadá, algunos estados de Australia, Nueva Zelanda, España), en las que la ley solo permite el suicidio asistido (EE. UU.) y en las que se admite únicamente el suicidio asistido y en base a sentencias judiciales, sin legislación específica (Suiza, Alemania). Conclusiones Aunque hay diferencias, las leyes a las que más se asemeja la ley española de eutanasia son las de Países Bajos y Bélgica, por lo que es previsible que la casuística de eutanasia y sus cifras en España se parezcan en el futuro a las de estos países.
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Trejo-Gabriel-Galán JM. Euthanasia and assisted suicide in neurological diseases: a systematic review. Neurologia 2021; 39:S0213-4853(21)00090-6. [PMID: 34090721 DOI: 10.1016/j.nrl.2021.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/29/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To identify the neurological diseases for which euthanasia and assisted suicide are most frequently requested in the countries where these medical procedures are legal and the specific characteristics of euthanasia in some of these diseases, and to show the evolution of euthanasia figures. METHODS We conducted a systematic literature review. RESULTS Dementia, motor neuron disease, multiple sclerosis, and Parkinson's disease are the neurological diseases that most frequently motivate requests for euthanasia or assisted suicide. Claims related to dementia constitute the largest group, are growing, and raise additional ethical and legal issues due to these patients' diminished decision-making capacity. In some countries, the ratios of euthanasia requests to all cases of multiple sclerosis, motor neuron disease, or Huntington disease are higher than for any other disease. CONCLUSIONS After cancer, neurological diseases are the most frequent reason for requesting euthanasia or assisted suicide.
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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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Fernández-Martínez E, Fernández-Muñoz JJ, Romero-Blanco C, Parra-Fernández ML, Onieva-Zafra MD. Spanish Version of the Attitude Towards Euthanasia Scale. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113855. [PMID: 32485846 PMCID: PMC7312573 DOI: 10.3390/ijerph17113855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/16/2022]
Abstract
Euthanasia is undoubtedly the protagonist of many of the debates around the end of life both among health staff and in the general population. Considering that nurses provide care for terminally ill patients and support families and patients in their final days, it is essential to know their attitudes towards euthanasia. The aims of the study were to adapt and validate the Attitude Towards Euthanasia scale to a Spanish context, to test the dimensionality and to estimate the reliability of the scale. A cross-sectional study was conducted with a non-probabilistic sample of Spanish health-workers of 201 in a University Hospital in Ciudad Real. A self-reported socio-demographic questionnaire and the Euthanasia Attitude Scale were used for data collection. The psychometric properties of the scale were assessed, including reliability and validity using an exploratory and confirmatory factor analysis. Cronbach's alpha of the Attitude Towards Euthanasia scale was α = 0.827 and McDonald's Omega = 0.903. The range of items of homogeneity was from 0.205 to 0.685. For the different exploratory factor analyses carried out, the Bartlett's test of sphericity was p < 0.001 and the sample index value of Kaiser-Meyer-Olkin was over 0.802. in all cases. We present the factorial weights for three models: The first one assumes a unidimensional solution, the second model was composed by three factors and the third model was composed by four factors. In the confirmatory factor analysis, the three models presented an acceptable fit index. The Attitude Towards Euthanasia scale adaptation to a sample of Spanish health workers has shown, with some limitations, appropriate psychometric properties. There have been several differences between the original factorial solution. It would be necessary to replicate the study to reinforce the findings about the number of factors of the scale.
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Affiliation(s)
| | | | - Cristina Romero-Blanco
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La-Mancha, Ciudad Real, 13071 Ciudad Real, Spain; (C.R.-B.); (M.D.O.-Z.)
| | - María Laura Parra-Fernández
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La-Mancha, Ciudad Real, 13071 Ciudad Real, Spain; (C.R.-B.); (M.D.O.-Z.)
- Correspondence:
| | - María Dolores Onieva-Zafra
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La-Mancha, Ciudad Real, 13071 Ciudad Real, Spain; (C.R.-B.); (M.D.O.-Z.)
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Religiosity and the Wish of Older Adults for Physician-Assisted Suicide. RELIGIONS 2018. [DOI: 10.3390/rel9030066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Terkamo-Moisio A, Pietilä AM, Lehto JT, Ryynänen OP. Attitudes of Nurses and the General Public Towards Euthanasia on Individuals with Dementia and Cognitive Impairment. DEMENTIA 2017; 18:1466-1478. [DOI: 10.1177/1471301217717063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Despite the increasing prevalence of dementia, little is known about individuals’ attitudes towards euthanasia on patients with dementia or cognitive impairment. Methods Nurses (n = 1003) and representatives of the general public (n = 2796), recruited via social media and the Finnish Nurses Association, completed an electronic questionnaire in 2014. Results Euthanasia due to severe dementia was approved by 54.6% of nurses and 64.4% of the general public. Depending on the age of the patient, between 50.0% and 54.7% of nurses and between 58.3% and 60.9% of the general public supported euthanasia on patients with severe cognitive impairment. Discussion The attitudes towards euthanasia due to dementia or cognitive impairment are slightly more accepting among the general public than among nurses. Apart from religiosity, none of the background factors were found to be reliable predictors of individuals’ attitudes. Additional research is needed to describe the underlying reasons for the attitudes.
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Affiliation(s)
- Anja Terkamo-Moisio
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland; Social and Health Care Services, Kuopio, Finland
| | - Juho T Lehto
- Department of Oncology, Palliative Care Unit, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Olli-Pekka Ryynänen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; General Practice Unit, Kuopio University Hospital, Primary Health Care, Kuopio, Finland
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Terkamo-Moisio A, Kvist T, Laitila T, Kangasniemi M, Ryynänen OP, Pietilä AM. The Traditional Model Does Not Explain Attitudes Toward Euthanasia. OMEGA-JOURNAL OF DEATH AND DYING 2016; 75:266-283. [DOI: 10.1177/0030222816652804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The debate about euthanasia is ongoing in several countries including Finland. However, there is a lack of information on current attitudes toward euthanasia among general Finnish public. The traditional model for predicting individuals’ attitudes to euthanasia is based on their age, gender, educational level, and religiosity. However, a new evaluation of religiosity is needed due to the limited operationalization of this factor in previous studies. This study explores the connections between the factors of the traditional model and the attitudes toward euthanasia among the general public in the Finnish context. The Finnish public’s attitudes toward euthanasia have become remarkably more positive over the last decade. Further research is needed on the factors that predict euthanasia attitudes. We suggest two different explanatory models for consideration: one that emphasizes the value of individual autonomy and another that approaches euthanasia from the perspective of fears of death or the process of dying.
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Affiliation(s)
- Anja Terkamo-Moisio
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Tarja Kvist
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Teuvo Laitila
- Department of Orthodox Studies, School of Theology, University of Eastern Finland, Joensuu, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Olli-Pekka Ryynänen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- General Practice Unit, Kuopio University Hospital, Primary Health Care, Kuopio, Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
- Social and Health Care Services, Kuopio, Finland
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Stolz E, Burkert N, Großschädl F, Rásky É, Stronegger WJ, Freidl W. Determinants of Public Attitudes towards Euthanasia in Adults and Physician-Assisted Death in Neonates in Austria: A National Survey. PLoS One 2015; 10:e0124320. [PMID: 25906265 PMCID: PMC4408035 DOI: 10.1371/journal.pone.0124320] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/27/2015] [Indexed: 11/29/2022] Open
Abstract
Background Euthanasia remains a controversial topic in both public discourses and legislation. Although some determinants of acceptance of euthanasia and physician-assisted death have been identified in previous studies, there is still a shortage of information whether different forms of euthanasia are supported by the same or different sub-populations and whether authoritarian personality dispositions are linked to attitudes towards euthanasia. Methods A large, representative face-to-face survey was conducted in Austria in 2014 (n = 1,971). Respondents faced three scenarios of euthanasia and one of physician assisted death differing regarding the level of specificity, voluntariness and subject, requiring either approval or rejection: (1) abstract description of euthanasia, (2) abstract description of physician-assisted suicide, (3) the case of euthanasia of a terminally-ill 79-year old cancer patient, and (4) the case of non-voluntary, physician assisted death of a severely disabled or ill neonate. A number of potential determinants for rejection ordered in three categories (socio-demographic, personal experience, orientations) including authoritarianism were tested via multiple logistic regression analyses. Results Rejection was highest in the case of the neonate (69%) and lowest for the case of the older cancer patient (35%). A consistent negative impact of religiosity on the acceptance across all scenarios and differential effects for socio-economic status, area of residence, religious confession, liberalism, and authoritarianism were found. Individuals with a stronger authoritarian personality disposition were more likely to reject physician-assisted suicide for adults but at the same time also more likely to approve of physician-assisted death of a disabled neonate. Conclusion Euthanasia in adults was supported by a partially different sub-population than assisted death of disabled neonates.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Nathalie Burkert
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Franziska Großschädl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Éva Rásky
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | | | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
- * E-mail:
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