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Locatelli M, Flahault C, Roche N, Mateus C, Blot F, Lucile Montalescot, Le Provost JB, Fasse L. [PAL-PRAT study: Healthcare workers' knowledge and perception of palliative practices in a Cancer Center]. Bull Cancer 2024; 111:554-565. [PMID: 38458927 DOI: 10.1016/j.bulcan.2023.12.009] [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: 09/20/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 03/10/2024]
Abstract
INTRODUCTION The issue of end-of-life care is the subject of a sensitive debate in French society, particularly regarding the possibility for certain patients to have access to medical assistance in dying. The aim of this study was to assess the knowledge and opinion of healthcare providers on the care practices for patients at the end of life, as well as to highlight any specificities in their discourse. METHOD A survey of healthcare providers' opinions, composed of closed and open questions, that were analyzed using a lexicometric approach, was distributed in a cancer center. RESULTS The results of the study reveal a good knowledge of the different procedures. Professionals considered that advance directives should be systematically collected; a majority of them differentiated euthanasia from deep continuous sedation and perceived the latter as a means of relieving patients' suffering without inducing death. The different procedures related to the active assistance in dying were known by a majority of professionals and the survey did not identify a dominant trend concerning the will to practice euthanasia if the legal framework allowed it. Half of the participants considered their training insufficient, indicating the need to fill this gap. DISCUSSION This survey underlines the importance of training and support for the professionals caring for patients in palliative situation and their relatives in France.
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Affiliation(s)
- Marie Locatelli
- LPPS (UR 4057), université Paris cité, 71, avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France.
| | - Cécile Flahault
- LPPS (UR 4057), université Paris cité, 71, avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France; Unité de psycho-oncologie, hôpital Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Nicolas Roche
- Unité de psycho-oncologie, hôpital Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Christine Mateus
- Département interdisciplinaire d'organisation du parcours patient (DIOPP), hôpital Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - François Blot
- Département interdisciplinaire d'organisation du parcours patient (DIOPP), hôpital Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Lucile Montalescot
- Laboratoire APSY-V, université de Nîmes, rue du Dr-G.-Salan, 30021 Nîmes, France
| | - Jean-Bernard Le Provost
- Unité de psycho-oncologie, hôpital Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Léonor Fasse
- LPPS (UR 4057), université Paris cité, 71, avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France; Unité de psycho-oncologie, hôpital Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
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Piili RP, Hökkä M, Vänskä J, Tolvanen E, Louhiala P, Lehto JT. Facing a request for assisted death - views of Finnish physicians, a mixed method study. BMC Med Ethics 2024; 25:50. [PMID: 38702731 PMCID: PMC11067268 DOI: 10.1186/s12910-024-01051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/28/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Assisted death, including euthanasia and physician-assisted suicide (PAS), is under debate worldwide, and these practices are adopted in many Western countries. Physicians' attitudes toward assisted death vary across the globe, but little is known about physicians' actual reactions when facing a request for assisted death. There is a clear gap in evidence on how physicians act and respond to patients' requests for assisted death in countries where these actions are not legal. METHODS A survey including statements concerning euthanasia and PAS and an open question about their actions when facing a request for assisted death was sent to all Finnish physicians. Quantitative data are presented as numbers and percentages. Statistical significance was tested by using the Pearson chi-square test, when appropriate. The qualitative analysis was performed by using an inductive content analysis approach, where categories emerge from the data. RESULTS Altogether, 6889 physicians or medical students answered the survey, yielding a response rate of 26%. One-third of participants agreed or partly agreed that they could assist a patient in a suicide. The majority (69%) of the participants fully or partly agreed that euthanasia should only be accepted due to difficult physical symptoms, while 12% fully or partly agreed that life turning into a burden should be an acceptable reason for euthanasia. Of the participants, 16% had faced a request for euthanasia or PAS, and 3033 answers from 2565 respondents were achieved to the open questions concerning their actions regarding the request and ethical aspects of assisted death. In the qualitative analysis, six main categories, including 22 subcategories, were formed regarding the phenomenon of how physicians act when facing this request. The six main categories were as follows: providing an alternative to the request, enabling care and support, ignoring the request, giving a reasoned refusal, complying with the request, and seeing the request as a possibility. CONCLUSIONS Finnish physicians' actions regarding the requests for assisted death, and attitudes toward euthanasia and PAS vary substantially. Open discussion, education, and recommendations concerning a request for assisted death and ethics around it are also highly needed in countries where euthanasia and PAS are not legal.
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Affiliation(s)
- Reetta P Piili
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Palliative Care Centre, Tampere University Hospital, Palliative Care Unit, Sädetie 6, R-building, Tampere, 33520, Finland.
| | - Minna Hökkä
- Diaconia University of Applied Sciences, Helsinki, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | | | - Elina Tolvanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Tampere University Hospital, Palliative Care Unit, Sädetie 6, R-building, Tampere, 33520, Finland
| | - Pekka Louhiala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Tampere University Hospital, Palliative Care Unit, Sädetie 6, R-building, Tampere, 33520, Finland
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Shlobin NA, Garcia RM, Bernstein M. Neuropalliative care for the neurosurgeon: a primer. J Neurosurg 2022; 137:850-858. [PMID: 34920433 DOI: 10.3171/2021.9.jns211872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/16/2021] [Indexed: 11/06/2022]
Abstract
Many neurosurgical conditions are incurable, leading to disability or severe symptoms, poor quality of life, and distress for patients and families. The field of neuropalliative care (NPC) addresses the palliative care (PC) needs of individuals living with neurological conditions. Neurosurgeons play an important role within multidisciplinary NPC teams because of their understanding of the natural history of and treatment strategies for neurosurgical conditions, longitudinal patient-physician relationships, and responsibility for neurosurgical emergencies. Moreover, patients with neurosurgical conditions have unique PC needs given the trajectories of neurosurgical diseases, the realities of prognostication, psychosocial factors, communication strategies, and human behavior. PC improves outcomes among neurosurgical patients. Despite the importance of NPC, neurosurgeons often lack formal training in PC skills, which include identifying patients who require PC, assessing a patient's understanding and preferences regarding illness, educating patients, building trust, managing symptoms, addressing family and caregiver needs, discussing end-of-life care, and recognizing when to refer patients to specialists. The future of NPC involves increasing awareness of the approach's importance, delineating priorities for neurosurgeons with regard to NPC, increasing emphasis on PC skills during training and practice, expanding research efforts, and adjusting reimbursement structures to incentivize the provision of NPC by neurosurgeons.
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Affiliation(s)
- Nathan A Shlobin
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Roxanna M Garcia
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark Bernstein
- 2Division of Neurosurgery, Toronto Western Hospital, University of Toronto; and
- 3Temmy Latner Center for Palliative Care, Mount Sinai Hospital, University of Toronto, Ontario, Canada
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Velasco Sanz TR, Cabrejas Casero AM, Rodríguez González Y, Barbado Albaladejo JA, Mower Hanlon LF, Guerra Llamas MI. Opinions of nurses regarding Euthanasia and Medically Assisted Suicide. Nurs Ethics 2022; 29:1721-1738. [PMID: 35786045 DOI: 10.1177/09697330221109940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Safeguarding the right to die according to the principles of autonomy and freedom of each person has become more important in the last decade, therefore increasing regulation of Euthanasia and Medically Assisted Suicide (MAS). AIMS To learn the opinions that the nurses of the autonomous region of Madrid have regarding Euthanasia and Medically Assisted Suicide. RESEARCH DESIGN Cross-sectional descriptive study. PARTICIPANTS AND RESEARCH CONTEXT All registered nurses in Madrid. The study was done by means of a self-completed anonymous questionnaire. The variables studied were social-demographic, giving opinions about Euthanasia and MAS. ETHICAL CONSIDERATIONS Each participant was assured maximum confidentiality and anonymity, ensuring the ethical principles set out in the Declaration of Helsinki, as well as in the Organic Law 3/2018, on Personal Data Protection and guarantee of digital rights. FINDINGS A total of 489 nurses answered the questionnaire. In total, 75.7% of the nurses confirmed that Euthanasia should be regulated in Spain. 66.3% indicated that information on Euthanasia should be provided jointly by doctors and nurses, and 42.3% considered that it could be applied by both medical and nursing professionals. A total of 87.2% advocated the participation of nurses in health policy, influencing the drafting of the law. In the face of possible regulation, 35% would request Conscientious Objection, being closely related to their religious beliefs. DISCUSSION Different authors point out that nurses' perceptions and attitudes towards Euthanasia are conditioned by different factors, such as religion, gender, poor palliative care, legality and the patient's right to die. CONCLUSION Nurses are positioned in favour of the regulation and practice of Euthanasia and MAS, depending on their age, years of experience, training, model of care and especially religious beliefs.
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Affiliation(s)
- Tamara Raquel Velasco Sanz
- Department of Nursing, Faculty of Nursing, Physioterapy and Podology, University Complutense of Madrid, Spain; Critical Care Department, San Carlos University Hospital, Madrid, Spain; Ethics Commission College of Nursing of Madrid, Madrid, Spain
| | - Ana María Cabrejas Casero
- Ethics Commission College of Nursing of Madrid, Madrid, Spain; Oncology Department, Alcorcón University Hospital, Madrid, Spain
| | | | | | | | - María Isabel Guerra Llamas
- Department of Nursing, Faculty of Nursing, Physioterapy and Podology, 16734Univerity Complutense of Madrid, Spain; Ethics Commission College of Nursing of Madrid, Spain
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Turillazzi E, Maiese A, Frati P, Scopetti M, Di Paolo M. Physician-Patient Relationship, Assisted Suicide and the Italian Constitutional Court. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:671-681. [PMID: 34674155 DOI: 10.1007/s11673-021-10136-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
In 2017, Italy passed a law that provides for a systematic discipline on informed consent, advance directives, and advance care planning. It ranges from decisions contextual to clinical necessity through the tool of consent/refusal to decisions anticipating future events through the tools of shared care planning and advance directives. Nothing is said in the law regarding the issue of physician assisted suicide. Following the DJ Fabo case, the Italian Constitutional Court declared the constitutional illegitimacy of article 580 of the criminal code in the part in which it does not exclude the punishment of those who facilitate the suicide when the decision has been freely and autonomously made by a person kept alive by life-support treatments and suffering from an irreversible pathology, the source of physical or psychological suffering that he/she considers intolerable, but fully capable of making free and conscious decisions. Such conditions and methods of execution must be verified by a public structure of the national health service, after consulting the territorially competent ethics committee. This statement admits, within strict and regulated bounds, physician assisted suicide, so widening the range of end-of-life decisions for Italian patients. Future application and critical topics will be called into question by the Italian legislator.
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Affiliation(s)
- E Turillazzi
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126, Pisa, Italy.
| | - A Maiese
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126, Pisa, Italy
| | - P Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - M Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - M Di Paolo
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126, Pisa, Italy
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The Attitude of Iranian Critical Care Nurses Toward Euthanasia: A Multicenter Cross-sectional Study. Crit Care Nurs Q 2021; 45:62-73. [PMID: 34818299 DOI: 10.1097/cnq.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Today, one of the major ethical challenges facing the world's health care system, and in particular nurses in the intensive care unit, is euthanasia or death out of pity. The aim of this study was to investigate the attitude of Iranian nurses in the intensive care unit toward euthanasia. This was an analytical cross-sectional study using census sampling. The data collection tool was the Euthanasia Attitude Scale. A total of 206 nurses working in the intensive care unit in 4 hospitals in the Mazandaran province of Iran were included in this study. The mean of total Euthanasia Attitude Scale score in intensive care unit nurses was 2.96. The mean euthanasia dimensions were ethical consideration, practical considerations, treasuring life, and naturalistic beliefs, 3.03, 2.92, 2.98, and 2.99, respectively. There was significant but low negative correlation between age and total Euthanasia Attitude Scale score, ethical considerations, and practical considerations. Male nurses exhibited significantly higher Euthanasia Attitude Scale scores, specifically in regard to ethical and practical considerations compared with female nurses. The most Iranian nurses in the intensive care unit had a negative attitude toward euthanasia for patients in the later stages of the disease. However, this opposition was less than similar studies in Iran in the past.
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Clarke C, Cannon M, Skokauskas N, Twomey P. The debate about physician assisted suicide and euthanasia in Ireland - Implications for psychiatry. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 79:101747. [PMID: 34689096 DOI: 10.1016/j.ijlp.2021.101747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/03/2021] [Accepted: 10/10/2021] [Indexed: 06/13/2023]
Abstract
At present, Physician-Assisted Suicide and Euthanasia are illegal in Ireland, and are forbidden under the Irish Medical Council's ethical guidelines. With the recent introduction of a Bill in the Irish Dáil (Parliament) which would have permitted Physicial-Assisted Suicide in that country, Physician-Assisted Suicide and Euthanasia (PAS-E) has become the subject of debate, both within the medical profession and in the wider community. Geographical and historical considerations mean that the Irish situation may have relevance to many other countries, which have apparently little similarity among themselves. PAS-E is becoming more widespread and more acceptable in many countries throughout the world. There are ramifications for many aspects of medical care, and matters such as the broadening of euthanasia criteria beyond terminal illness, attitudes toward suicide, and the determination of capacity and voluntariness, suggest that it will be an important issue, not only for psychiatrists, but for the wider medical community as well, in the coming years.
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Affiliation(s)
- Ciaran Clarke
- University College Dublin Health Sciences Centre, Dublin D04 C7X2, Ireland.
| | - Mary Cannon
- Royal College of Surgeons in Ireland, Dept of Psychiatry, Education and Research Centre, Beaumont Hospital, Dublin D09 V2N0, Ireland.
| | - Norbertas Skokauskas
- NTNU Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine and Health Sciences, Trondheim, Norway.
| | - Pauline Twomey
- Health Service Executive, Phoenix Care Centre, Grangegorman Campus, North Circular Road, Dublin 7 D07 VPT0, Ireland.
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Attitudes and opinions towards suicidality in professionals working with oncology patients: results from an online survey. Support Care Cancer 2021; 30:1775-1786. [PMID: 34599381 PMCID: PMC8727409 DOI: 10.1007/s00520-021-06590-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022]
Abstract
Objective To explore and describe attitudes and opinions towards suicidality in healthcare professionals (HCPs) working with oncological patients. Methods A 48-item online questionnaire was developed and distributed to HCPs working with cancer patients. Three hundred fifty-four answered questionnaires were analyzed. Results The majority of HCPs reported that they were able to understand why a cancer patient would commit suicide (87.8%) or would seek help from an assisted suicide organization (ASO; 83.9%). The understandable reasons were pain and physical impairments (51.4%), social isolation (19.8%), loss of control and autonomy (18.1%), terminal disease (17.2%), loss of meaning (15.3%), desperation (14.7%), and psychic distress (9.3%). Personal experiences with suicidality lead only 44.8% of HCPs to believe that thereby they would be better able to understand a patients’ wish for suicide. Religion was negatively associated with understanding of suicide and why a cancer patient would seek help from an ASO. Knowledge of suicidality was positively associated with why a cancer patient would seek help from an ASO. Conclusions There is still little knowledge in oncology about the relation of HCPs’ attitudes toward suicidality in their patients and how those attitudes influence their behavior, especially care and treatment of patients. More research on this topic is needed. It stands to reason that more education about suicidality in cancer patients seems likely to improve understanding and attitudes and thereby influence care for cancer patients.
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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.
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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
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Crusat-Abelló E, Fernández-Ortega P. Nurses knowledge and attitudes about euthanasia at national and international level: A review of the literature. ENFERMERÍA CLÍNICA (ENGLISH EDITION) 2021; 31:268-282. [PMID: 34120871 DOI: 10.1016/j.enfcle.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 01/16/2021] [Indexed: 10/21/2022]
Abstract
AIM To review the available evidence on nurses' attitudes to and knowledge about euthanasia. METHODS A literature review was carried out in the databases: PubMed (including Medline), CINAHL, Scopus, PsycINFO, Web of Science and CUIDEN, with inclusive terms of nurses' attitudes and knowledge regarding euthanasia both nationally and internationally. The selection criteria were articles in Spanish, English, Catalan or French published from January 2012 to September 2019 and studies that analysed the nurses' attitudes and knowledge regarding euthanasia and articles that were full available for analysis. RESULTS Initially a total of 566 articles were found, and finally 8 met the inclusion criteria of the research question in the review. The total number of nurses participating in the studies was 3,571. Most of the nurses, both at international and national level, have a positive attitude towards the legalization of euthanasia; however, all studies report a lack in nurses' knowledge on the specific theme of euthanasia. DISCUSSION The results show that nurses describe their attitude as positive towards the practice of euthanasia. In terms of knowledge, nurses reported the need to have more specific training on this subject is conclusive. In addition, this review provides a global and current vision that can serve as a necessary starting point for further work and progress in nurse training and for future research.
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Affiliation(s)
| | - Paz Fernández-Ortega
- Institut Català d'Oncologia, Hospitalet, Barcelona, Spain; Universitat de Barcelona, Hospitalet, Barcelona, Spain
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Akbayram HT. Medical Faculty Students' Views on Euthanasia: Does It Change With Medical Education? ALPHA PSYCHIATRY 2021; 22:113-117. [PMID: 36425933 PMCID: PMC9590629 DOI: 10.5455/apd.126615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/20/2020] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Euthanasia is the decision to terminate the lives of patients who do not improve with medical treatment at their explicit request. This study was carried out to determine the opinions of medical students regarding euthanasia and to evaluate the effect of medical education on this issue. METHODS This cross-sectional study was conducted among first and sixth-year students of the Gaziantep University School of Medicine during the 2018-2019 academic years. RESULTS Of the 242 students who participated in the study, 54.1% (131) were first-year and 45.9% (111) were sixth-year students. Overall, 39.7% of the first-year students and 31.5% of the sixth-year students supported active euthanasia. The percentage of students who were against passive euthanasia and physician-assisted suicide (PAS) was 63.4% and 53.4% for first-year students and 49.5% and 54.1% for sixth-year students, respectively. CONCLUSION Approximately half of the first and the sixth-year students were opposed to active euthanasia, passive euthanasia, and PAS, and there was no significant difference between these two groups of students in their being against euthanasia. However, there were significant differences between these two groups with respect to their reasons against euthanasia.
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Affiliation(s)
- Hatice Tuba Akbayram
- Department of Family Medicine, Gaziantep University School of Medicine, Gaziantep, Turkey
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Crusat-Abelló E, Fernández-Ortega P. Nurses knowledge and attitudes about euthanasia at national and international level: A review of the literature. ENFERMERIA CLINICA 2021; 31:S1130-8621(21)00029-2. [PMID: 33648838 DOI: 10.1016/j.enfcli.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 12/27/2020] [Accepted: 01/16/2021] [Indexed: 11/25/2022]
Abstract
AIM To review the available evidence on nurses' attitudes to and knowledge about euthanasia. METHODS A literature review was carried out in the databases: PubMed (including Medline), CINAHL, Scopus, PsycINFO, Web of Science and CUIDEN, with inclusive terms of nurses' attitudes and knowledge regarding euthanasia both nationally and internationally. The selection criteria were articles in Spanish, English, Catalan or French published from January 2012 to September 2019 and studies that analysed the nurses' attitudes and knowledge regarding euthanasia and articles that were full available for analysis. RESULTS Initially a total of 566 articles were found, and finally 8 met the inclusion criteria of the research question in the review. The total number of nurses participating in the studies was 3,571. Most of the nurses, both at international and national level, have a positive attitude towards the legalization of euthanasia; however, all studies report a lack in nurses' knowledge on the specific theme of euthanasia. DISCUSSION The results show that nurses describe their attitude as positive towards the practice of euthanasia. In terms of knowledge, nurses reported the need to have more specific training on this subject is conclusive. In addition, this review provides a global and current vision that can serve as a necessary starting point for further work and progress in nurse training and for future research.
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Affiliation(s)
| | - Paz Fernández-Ortega
- Institut Català d'Oncologia, Hospitalet, Barcelona, España; Universitat de Barcelona, Hospitalet, Barcelona, España
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Jahn-Kuch D, Domke A, Bitsche S, Stöger H, Avian A, Jeitler K, Posch N, Siebenhofer A. End-of-life decision making by Austrian physicians - a cross-sectional study. BMC Palliat Care 2020; 19:4. [PMID: 31901225 PMCID: PMC6942327 DOI: 10.1186/s12904-019-0509-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Austria has recently been embroiled in the complex debate on the legalization of measures to end life prematurely. Empirical data on end-of-life decisions made by Austrian physicians barely exists. This study is the first in Austria aimed at finding out how physicians generally approach and make end-of-life therapy decisions. METHODS The European end-of-life decisions (EURELD) questionnaire, translated and adapted by Schildmann et al., was used to conduct this cross-sectional postal survey. Questions on palliative care training, legal issues, and use of and satisfaction with palliative care were added. All Austrian specialists in hematology and oncology, a representative sample of doctors specialized in internal medicine, and a sample of general practitioners, were invited to participate in this anonymous postal survey. RESULTS Five hundred forty-eight questionnaires (response rate: 10.4%) were evaluated. 88.3% of participants had treated a patient who had died in the previous 12 months. 23% of respondents had an additional qualification in palliative medicine. The cause of death in 53.1% of patients was cancer, and 44.8% died at home. In 86.3% of cases, pain relief and / or symptom relief had been intensified. Further treatment had been withheld by 60.0%, and an existing treatment discontinued by 49.1% of respondents. In 5 cases, the respondents had prescribed, provided or administered a drug which had resulted in death. 51.3% of physicians said they would never carry out physician-assisted suicide (PAS), while 30.3% could imagine doing so under certain conditions. 38.5% of respondents supported the current prohibition of PAS, 23.9% opposed it, and 33.2% were undecided. 52.4% of physicians felt the legal situation with respect to measures to end life prematurely was ambiguous. An additional qualification in palliative medicine had no influence on measures taken, or attitudes towards PAS. CONCLUSIONS The majority of doctors perform symptom control in terminally ill patients. PAS is frequently requested but rarely carried out. Attending physicians felt the legal situation was ambiguous. Physicians should therefore receive training in current legislation relating to end-of-life choices and medical decisions. The data collected in this survey will help political decision-makers provide the necessary legal framework for end-of-life medical care.
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Affiliation(s)
- D Jahn-Kuch
- Palliative Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - A Domke
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - S Bitsche
- Palliative Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - H Stöger
- Palliative Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - A Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - K Jeitler
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria.,Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - N Posch
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - A Siebenhofer
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria. .,Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany.
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14
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Rosenberg LJ, Butler JM, Caprio AJ, Rhodes RL, Braun UK, Vitale CA, Telonidis J, Periyakoil VS, Farrell TW. Results From a Survey of American Geriatrics Society Members' Views on Physician‐Assisted Suicide. J Am Geriatr Soc 2019; 68:23-30. [DOI: 10.1111/jgs.16245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Lisa J. Rosenberg
- Southwest Medical Hospice and Palliative Care Las Vegas Nevada
- Roseman University of Health Sciences Henderson Nevada
| | - Jorie M. Butler
- Division of Geriatrics, Department of Internal MedicineUniversity of Utah Salt Lake City Utah
- Geriatrics Research Education and Clinical Center, IDEAS HSR&D COINVeterans Affairs Medical Center Salt Lake City Utah
| | - Anthony J. Caprio
- Department of Family MedicineAtrium Health Charlotte North Carolina
- Department of Family MedicineUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Ramona L. Rhodes
- Division of Geriatric Medicine, Department of Internal MedicineUT Southwestern Medical Center Dallas Texas
| | - Ursula K. Braun
- Section of Geriatrics, Department of MedicineBaylor College of Medicine Houston Texas
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical Center Houston Texas
| | - Caroline A. Vitale
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Michigan Ann Arbor Michigan
- Geriatrics Research Education and Clinical CenterVA Ann Arbor Healthcare System Ann Arbor Michigan
| | - Jacqueline Telonidis
- Division of Geriatrics, Department of Internal MedicineUniversity of Utah Salt Lake City Utah
| | - Vyjeyanthi S. Periyakoil
- Stanford University School of Medicine Stanford California
- VA Palo Alto Health Care System Palo Alto California
| | - Timothy W. Farrell
- Division of Geriatrics, Department of Internal MedicineUniversity of Utah Salt Lake City Utah
- VA Salt Lake City Geriatric Research, Education, and Clinical Center Salt Lake City Utah
- University of Utah Health Interprofessional Education Program Salt Lake City Utah
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15
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Strupp J, Köneke V, Rietz C, Voltz R. Perceptions of and Attitudes Toward Death, Dying, Grief, and the Finitude of Life-A Representative Survey Among the General Public in Germany. OMEGA-JOURNAL OF DEATH AND DYING 2019; 84:157-176. [PMID: 31615342 DOI: 10.1177/0030222819882220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Some end-of-life aspects have become a significant political and social issue such as elderly care and euthanasia. But hardly anything is known about how the general public in Germany thinks about death and dying more generally. Therefore, we conducted a representative online survey (N = 997) regarding 21 end-of-life aspects. Differences between subgroups were analyzed by conducting analyses of variance and Tukey honestly significance difference post hoc tests and by performing t tests. The findings revealed that the general public is open to engaging with topics of death, dying, and grief and that death education might even be promoted for children. Most participants appraised dealing with the finitude of life as part of a good life, but few have contemplated death and dying themselves so far. Attitudes and perceptions were related to age, subjective health, religious denomination, and gender. The survey provides useful implications for community palliative care, death education, and communication with dying people.
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Affiliation(s)
- Julia Strupp
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Germany
| | - Vanessa Köneke
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Germany.,Cologne Graduate School in Management, Economics and Social Sciences, University of Cologne, Germany
| | - Christian Rietz
- Department of Educational and Social Sciences, University of Education Heidelberg, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital, University of Cologne, Germany.,Clinical Trials Center (ZKS), Faculty of Medicine and University Hospital, University of Cologne, Germany.,Center for Health Services Research, Faculty of Medicine and University Hospital, University of Cologne, Germany
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16
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Wright AC, Shaw JC. The spectrum of end of life care: an argument for access to medical assistance in dying for vulnerable populations. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:211-219. [PMID: 30099667 DOI: 10.1007/s11019-018-9860-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Medical assistance in dying (MAiD) was legalized by the Supreme Court of Canada in June 2016 and became a legal, viable end of life care (EOLC) option for Canadians with irremediable illness and suffering. Much attention has been paid to the balance between physicians' willingness to provide MAiD and patients' legal right to request medically assisted death in certain circumstances. In contrast, very little attention has been paid to the challenge of making MAiD accessible to vulnerable populations. The purpose of this paper was to examine the extant literature and resources that are available on the provision of MAiD in Canada. We found that the provision of EOLC in Canada offers insufficient access to palliative and EOLC options for Canadians and that vulnerable Canadians experience disproportional barriers to accessing these already limited resources. Consequently, we argue that palliative care, hospice care and MAiD must be considered a spectrum of EOLC that is inclusive and accessible to all Canadians. We conclude by imploring Canadian healthcare professionals, policy makers and legislators to consider MAiD as a viable EOLC option for all Canadians.
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Affiliation(s)
- Alysia C Wright
- Faculty of Social Work, University of Calgary, Calgary, Canada.
| | - Jessica C Shaw
- Faculty of Social Work, University of Calgary, Calgary, Canada
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17
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Bélanger E, Towers A, Wright DK, Chen Y, Tradounsky G, Macdonald ME. Of dilemmas and tensions: a qualitative study of palliative care physicians' positions regarding voluntary active euthanasia in Quebec, Canada. JOURNAL OF MEDICAL ETHICS 2019; 45:48-53. [PMID: 30377217 DOI: 10.1136/medethics-2017-104339] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/22/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES In 2015, the Province of Quebec, Canada passed a law that allowed voluntary active euthanasia (VAE). Palliative care stakeholders in Canada have been largely opposed to euthanasia, yet there is little research about their views. The research question guiding this study was the following: How do palliative care physicians in Quebec position themselves regarding the practice of VAE in the context of the new provincial legislation? METHODS We used interpretive description, an inductive methodology to answer research questions about clinical practice. A total of 18 palliative care physicians participated in semistructured interviews at two university-affiliated hospitals in Quebec. RESULTS Participants positioned themselves in opposition to euthanasia. Their justifications were framed within their professional commitment to not hasten death, which sat in tension with the value of patients' autonomy to choose how to die. Participants described VAE as unacceptable if it impeded opportunities to evaluate and alleviate suffering. Further, they contested government rhetoric that positioned VAE as a way to improve end-of-life care. Participants felt that VAE would diminish the potential of palliative care to relieve suffering. Dilemmas were apparent in their narratives, about reconciling respect for patient autonomy with broader palliative care values, and the value of accompanying and not abandoning patients who make requests for VAE while being committed to neither prolonging nor hastening death. CONCLUSIONS This study provides insight into nuanced positions of experienced palliative care physicians in Quebec and confirms expected tensions between an important stakeholder and the practice of VAE as guided by the new legislation.
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Affiliation(s)
- Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Anna Towers
- Department of Oncology, McGill University, Montreal, Quebec, Canada
| | | | - Yuexi Chen
- Palliative Care McGill, McGill University Montreal, Montreal, Quebec, Canada
| | - Golda Tradounsky
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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18
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Mercadante S, Masedu F, Degan G, Marinangeli F, Aielli F. Physicians' Attitudes Toward Euthanasia and Assisted Suicide in Italy. J Pain Symptom Manage 2018; 56:e1-e3. [PMID: 30236790 DOI: 10.1016/j.jpainsymman.2018.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy
| | - Giulia Degan
- Anesthesiology and Pain Medicine, Department of Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Franco Marinangeli
- Anesthesiology and Pain Medicine, Department of Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federica Aielli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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19
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Englar RE, Show-Ridgway A, Noah DL, Appelt E, Kosinski R. Perceptions of the Veterinary Profession among Human Health Care Students before an Inter-Professional Education Course at Midwestern University. JOURNAL OF VETERINARY MEDICAL EDUCATION 2017; 45:423-436. [PMID: 29099320 DOI: 10.3138/jvme.1016-161r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Conflicts among health care professionals often stem from misperceptions about each profession's role in the health care industry. These divisive tendencies impede progress in multidisciplinary collaborations to improve human, animal, and environmental health. Inter-professional education (IPE) may repair rifts between health care professions by encouraging students to share their professional identities with colleagues in unrelated health care disciplines. An online survey was conducted at Midwestern University (MWU) to identify baseline perceptions about veterinary medicine among entry-level human health care students before their enrollment in an inter-professional course. Participation was anonymous and voluntary. The survey included Likert-type scales and free-text questions. Survey participants expressed their interest in and respect for the discipline of veterinary medicine, but indicated that their unfamiliarity with the profession hindered their ability to collaborate. Twenty percent of human health care students did not know the length of a Doctor of Veterinary Medicine (DVM) program and 27.6% were unaware that veterinarians could specialize. Although 83.2% of participants agreed that maintaining the human-animal bond is a central role of the veterinary profession, veterinary contributions to stem cell research, food and water safety, public health, environmental conservation, and the military were infrequently recognized. If IPE is to successfully pave the way for multidisciplinary collaboration, it needs to address these gaps in knowledge and broaden the definition of veterinary practice for future human health care providers.
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Affiliation(s)
- Ryane E Englar
- Assistant Professor and Clinical Education Coordinator, Kansas State University College of Veterinary Medicine, 1710 Denison Ave., Manhattan, KS 66506 USA.
| | - Alyssa Show-Ridgway
- Midwestern University College of Veterinary Medicine, 19555 N. 59th Ave., Glendale, AZ 85308 USA
| | - Donald L Noah
- Director, One Health Center, and Associate Professor, Public Health, Midwestern University College of Veterinary Medicine, 19555 N. 59th Ave., Glendale, AZ 85308 USA
| | - Erin Appelt
- Student Academic Counselor, Midwestern University Student Services, 19555 N. 59th Ave., Glendale, AZ 85308 USA
| | - Ross Kosinski
- Dean of Students, Midwestern University Student Services, 19555 N. 59th Ave., Glendale, AZ 85308 USA
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20
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Rousseau S, Turner S, Chochinov HM, Enns MW, Sareen J. A National Survey of Canadian Psychiatrists' Attitudes toward Medical Assistance in Death. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:787-794. [PMID: 28548865 PMCID: PMC5697624 DOI: 10.1177/0706743717711174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bill C-14 allows for medical assistance in dying (MAID) for patients who have intolerable physical or psychological suffering that occurs in the context of a reasonably foreseeable death. In Canada, psychiatrist support for MAID on the basis of mental illness and beliefs influencing level of support are unknown. The objectives of this research were to 1) determine if psychiatrists are supportive of MAID under certain conditions and on the basis of mental illness and 2) determine what factors are related to psychiatrist support for MAID on the basis of mental illness. METHODS This cross-sectional study was conducted among 528 psychiatrists in Canada using an online survey platform (February 19 to March 11, 2016). RESULTS The response rate was 20.9% ( n = 528). Most psychiatrists supported the legalisation of MAID in some circumstances (72%); however, only 29.4% supported MAID on the basis of mental illness. Factors correlating with decreased support for MAID for mental illness were the belief that MAID for mental illness would change the psychiatrists' commitment to their patients through enduring suffering, having a personal faith, and having had past patients who would have received MAID for mental illness were it legal but instead went on to recover. INTERPRETATION This study found that most psychiatrists do not support the legalisation of MAID for mental illness, despite being quite supportive of MAID in general. Objections seemed to be based upon concern for vulnerable patients, personal moral objections, and concern for the effect it would have on the therapeutic alliance.
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Affiliation(s)
- Skye Rousseau
- 1 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Sarah Turner
- 1 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Harvey Max Chochinov
- 1 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba.,2 Manitoba Palliative Care Research Unit, CancerCare Manitoba, Manitoba, Winnipeg, Manitoba
| | - Murray W Enns
- 1 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Jitender Sareen
- 1 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
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21
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Survey on German Palliative Care Specialists' Experiences with Advance Directives. Pain Ther 2016; 6:17-28. [PMID: 27900726 PMCID: PMC5447540 DOI: 10.1007/s40122-016-0063-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction Advance directives (AD) play a central role in end-of-life treatments, intensive care, and palliative care. However, little is known about the experiences of healthcare professionals with ADs. This study reports on palliative care professionals’ views on advance directives (AD). Methods A questionnaire was handed out to attendants of a palliative care symposium. Results Complete answers were obtained from 126 physicians and 276 nurses. Almost all physicians and nurses had treated patients with an AD, and the majority more than 10 patients. The most frequent refusal by the patients was resuscitation (87.8%) followed by intensive care (79.1%), artificial ventilation, and nutrition. The most frequent wish was pain therapy (92.3%) followed by allowing the natural course of the illness (64.4%). The wish for hospice treatment (44.8%) or spiritual care (39.3%) was less frequent. Discussion The results hint at fears and deficits in the care of patients at the end of life. Often the quality of life and not the quantity of days remaining is in the center of a patient’s will and points to the growing importance of palliative care. Conclusion ADs are well established among palliative care professionals and regarded as helpful for patients at the end of life.
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