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Curkovic M, Rubic F, Jozepovic A, Novak M, Filipovic-Grcic B, Mestrovic J, Lah Tomulic K, Peter B, Spoljar D, Grosek Š, Janković S, Vukovic J, Kujundžić Tiljak M, Štajduhar A, Borovecki A. Navigating the shadows: medical professionals' values and perspectives on end-of-life care within pediatric intensive care units in Croatia. Front Pediatr 2024; 12:1394071. [PMID: 39188642 PMCID: PMC11345198 DOI: 10.3389/fped.2024.1394071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 07/15/2024] [Indexed: 08/28/2024] Open
Abstract
Background and aim This study explores healthcare professionals' perspectives on end-of-life care in pediatric intensive care units (ICUs) in Croatia, aiming to illuminate their experiences with such practices, underlying attitudes, and major decision-making considerations. Amid the high variability, complexity, and emotional intensity of pediatric end-of-life decisions and practices, understanding these perspectives is crucial for improving care and policies. Methods The study utilized a cross-sectional survey intended for physicians and nurses across all pediatric ICUs in Croatia. It included healthcare professionals from six neonatal and four pediatric ICUs in total. As the data from neonatal and pediatric ICUs were examined jointly, the term pediatric ICU was used to denominate both types of ICUs. A statistical analysis was performed using Python and JASP, focusing on professional roles, professional experience, and regional differences. Results The study included a total of 103 participants (with an overall response rate-in relation to the whole target population-of 48% for physicians and 29% for nurses). The survey revealed diverse attitudes toward and experiences with various aspects of end-of-life care, with a significant portion of healthcare professionals indicating infrequent involvement in life-sustaining treatment (LST) limitation discussions and decisions, as well as somewhat ambiguous attitudes regarding such practices. Notably, discrepancies emerged between different professional roles and, in particular, regions, underscoring the high variability of LST limitation-related procedures. Conclusions The findings highlight a pressing need for more straightforward guidelines, legal frameworks, support mechanisms, and communication strategies to navigate the complex terrain of rather burdensome end-of-life pediatric care, which is intrinsically loaded with profound ethical quandaries.
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Affiliation(s)
- Marko Curkovic
- University Psychiatric Hospital Vrapče, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Filip Rubic
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ana Jozepovic
- Department of Anesthesiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Milivoj Novak
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Boris Filipovic-Grcic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Julije Mestrovic
- Department of Pediatrics, University Hospital Centre Split, Split, Croatia
| | | | - Branimir Peter
- Department of Gynecology and Obstetrics, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Diana Spoljar
- Palliative Care Service, Community Health Center Zagreb, Zagreb, Croatia
| | - Štefan Grosek
- Department of Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sunčana Janković
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Jurica Vukovic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mirjana Kujundžić Tiljak
- Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Andrija Štajduhar
- Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Borovecki
- Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
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Schneider K, Roll S, Tissen-Diabaté T, Bührer C, Garten L. Public Attitudes Toward Ethics and Practices in End-of-Life Decision-Making for Neonates. JAMA Netw Open 2024; 7:e2353264. [PMID: 38270948 PMCID: PMC10811557 DOI: 10.1001/jamanetworkopen.2023.53264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/05/2023] [Indexed: 01/26/2024] Open
Abstract
Importance Attitudes toward end-of-life decision-making in neonatology have been studied in physicians and other health care professionals and are mostly shaped by their clinical education and work experiences. In contrast, attitudes among the general public have not yet been investigated. Objective To assess (1) attitudes in the general public toward euthanasia and withdrawal of life-prolonging treatment in neonates with severe life-limiting conditions, (2) knowledge of current German recommendations, and (3) values in the German society regarding ethical issues and proxy decisions at the beginning of life. Design, Setting, and Participants This cross-sectional study was performed in Germany and used an exploratory design to analyze responses to an interview conducted by an independent, established commissioned polling institute in March and April 2022. Participants were 16 years or older, with German language fluency and comprehension and living in Germany. Main Outcomes and Measures Knowledge about recommendations for euthanasia and withdrawal of life-prolonging treatment as well as personal attitudes toward (1) euthanasia and withdrawal of life-prolonging treatment and (2) surrogate end-of-life decision-making for newborn infants were assessed. Results The study included 2116 participants (1077 females [50.9%]; mean [SD] age 52.1 [18.7] years). Of the participants, 16.8% (311 of 1851) reported knowing the German recommendations for euthanasia and withdrawal of life-prolonging treatment for neonates. Euthanasia and withdrawal of life-prolonging treatment were supported by 64.7% (1369 of 2116) and 77.9% (1649 of 2116) of respondents, respectively. Shared decision-making between parents and physicians for neonates in end-of-life situations was supported by 65.6% of participants (1388). In situations where shared decision-making was not possible, 73.4% of respondents (1019 of 1388) put the ultimate decision to the parents. The magnitude of the associations was low between sociodemographic factors and views on ethical issues and customary practices involved in end-of-life decisions for neonates. Conclusions and Relevance Results of this cross-sectional study suggested that most respondents were not aware of the national German recommendations for euthanasia and withdrawal of life-prolonging treatment for sick and extremely preterm newborns. When counseling parents of periviable newborns, clinicians may need to exert more effort in explaining the legal and ethical framework; a highly individualized approach is warranted.
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Affiliation(s)
- Katja Schneider
- Department of Neonatology, Gemeinnützige Gesellschaft der Franziskanerinnen zu Olpe, Marien-Hospital, Bonn, Germany
- Department of Neonatology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Stephanie Roll
- Institute of Social Medicine, Epidemiology and Health Economics, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Tatjana Tissen-Diabaté
- Institute of Social Medicine, Epidemiology and Health Economics, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Garten
- Department of Neonatology, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Batzler YN, Melching H, Schallenburger M, Schwartz J, Neukirchen M, Bausewein C. Reasons for Wanting Assisted Suicide. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:754-755. [PMID: 38014440 PMCID: PMC10722489 DOI: 10.3238/arztebl.m2023.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Yann-Nicolas Batzler
- Interdisciplinary Centre for Palliative Medicine, Düsseldorf University Hospital, Heinrich-Heine-University Düsseldorf, Germany
| | | | - Manuela Schallenburger
- Interdisciplinary Centre for Palliative Medicine, Düsseldorf University Hospital, Heinrich-Heine-University Düsseldorf, Germany
| | - Jacqueline Schwartz
- Interdisciplinary Centre for Palliative Medicine, Düsseldorf University Hospital, Heinrich-Heine-University Düsseldorf, Germany
| | - Martin Neukirchen
- *These authors share last authorship
- Interdisciplinary Centre for Palliative Medicine, Düsseldorf University Hospital, Heinrich-Heine-University Düsseldorf, Germany
- Department of Anesthesiology, Düsseldorf University Hospital, Heinrich-Heine-University Düsseldorf, Germany
| | - Claudia Bausewein
- *These authors share last authorship
- Department of Palliative Medicine, Munich University Hospital, Ludwig-Maximilians-University, München, Germany (Bausewein)
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Khosravi M. The impact of openness to experience personality trait on attitudes of medical students toward euthanasia: the moderating role of spiritual intelligence. Eur J Transl Myol 2023; 33:11845. [PMID: 37817649 PMCID: PMC10811635 DOI: 10.4081/ejtm.2023.11845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/12/2023] Open
Abstract
Euthanasia is the most important ethical challenges in the entire field of medicine. Various factors may influence the medical students' attitudes toward euthanasia, including personal beliefs, values, and personality traits. This research aimed at examining spiritual intelligence as a moderator of the relationship between openness to experience and attitude toward euthanasia. In this cross-sectional study, a total of 219 medical students (85 men and 134 women) in Zahedan, Iran, in 2022, were selected by convenience sampling method and evaluated using the socio-demographic information form (including age, gender, and medical education level), Spiritual Intelligence Self-Report Inventory, 24-item Brief HEXACO Inventory, and Euthanasia Attitude Scale, followed by using SPSS v25 for data analysis. The study results showed that openness to experience positively and spiritual intelligence negatively associated with attitude toward euthanasia. Also, the regression analysis revealed that spiritual intelligence had a moderating role in the relationship between openness to experience and attitude toward euthanasia. It seems that paying attention to personality differences and spiritual intelligence training among medical students can play an important role in changing their attitudes toward euthanasia.
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Affiliation(s)
- Mohsen Khosravi
- Department of Psychiatry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran; Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran, Zahedan University of Medical Sciences, Zahedan.
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Rahemi Z, Malatyali A, Wiese LAK, Dye CJ. End-of-Life Care Planning in Diverse Individuals Across Age Groups: A Proposed Conceptual Model of Nursing. J Nurs Care Qual 2023; 38:319-326. [PMID: 36947814 PMCID: PMC10442095 DOI: 10.1097/ncq.0000000000000705] [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] [Accepted: 02/15/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND End-of-life planning helps nurses meet the needs of their patients at a crucial time of life. PURPOSE This article presents a conceptual model of end-of-life care planning for nurses, especially those in palliative and hospice care, focusing on holistic nursing views. METHODS Based on a literature review, we developed a new conceptual model illustrating the concepts and dimensions of end-of-life care planning among diverse individuals across countries, life spans and age groups, ethnographies, and residential statuses. RESULTS This conceptual model includes 3 concepts: personal factors, stakeholders, and environmental and social factors. Each concept encompasses multiple dimensions. The concepts are interrelated and directly related to end-of-life care planning. CONCLUSION This work addresses the need for a comprehensive end-of-life care planning model and can help enhance the quality of end-of-life care. This article identifies implications for nursing education, practice, and research.
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Affiliation(s)
- Zahra Rahemi
- Clemson University School of Nursing, Greenville, South Carolina (Dr Rahemi); University of Central Florida College of Nursing, Orlando (Dr Malatyali); Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton (Dr Wiese); and Department of Psychology, Professor Emerita, Department of Public Health Sciences, Clemson University, Clemson, South Carolina (Dr Dye)
| | - Ayse Malatyali
- Clemson University School of Nursing, Greenville, South Carolina (Dr Rahemi); University of Central Florida College of Nursing, Orlando (Dr Malatyali); Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton (Dr Wiese); and Department of Psychology, Professor Emerita, Department of Public Health Sciences, Clemson University, Clemson, South Carolina (Dr Dye)
| | - Lisa Ann Kirk Wiese
- Clemson University School of Nursing, Greenville, South Carolina (Dr Rahemi); University of Central Florida College of Nursing, Orlando (Dr Malatyali); Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton (Dr Wiese); and Department of Psychology, Professor Emerita, Department of Public Health Sciences, Clemson University, Clemson, South Carolina (Dr Dye)
| | - Cheryl J. Dye
- Clemson University School of Nursing, Greenville, South Carolina (Dr Rahemi); University of Central Florida College of Nursing, Orlando (Dr Malatyali); Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton (Dr Wiese); and Department of Psychology, Professor Emerita, Department of Public Health Sciences, Clemson University, Clemson, South Carolina (Dr Dye)
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Bodas M, Ziv A, Rubin C, Oberman B, Tawil Y, Shaulov A, Kaplan G, Velan B. Polarization in public attitudes toward end-of-life decisions in Israel - A cross-sectional study. Palliat Support Care 2023:1-8. [PMID: 37365823 DOI: 10.1017/s1478951523000780] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVES End-of-life (EoL) processes are a complex socio-normative and ethical phenomenon. This study aimed to generate a database of public opinion in Israel concerning EoL processes and decisions and to identify differences in attitudes across subgroups in the population, particularly based on experience as a family caregiver of a dying patient. METHODS This cross-sectional study was performed in late March 2022. The study utilized an online sample of 605 adults over the age of 50 including those who accompanied a loved one to their death in the last 3 years. Participants were requested to provide their opinions and attitudes on several aspects of EoL decisions, including truth-telling, medically assisted dying, EoL procedures, pre-death actions, and family caregivers' engagement. RESULTS While only 27% and ∼30% of participants support artificial respiration or feeding (respectively) of terminally ill patients, 66% support analgesic treatment, even at the risk of shortening life. The data show an association between religiosity and agreement with life-extending procedures. For example, while 83% of seculars support medically assisted dying, only 59% and 26% of traditional and religious respondents support it. However, no statistically significant differences were observed in support of family involvement in EoL process in any sociodemographic variable. SIGNIFICANCE OF RESULTS The results of this study suggest that the Israeli public is relatively polarized on several issues about EoL processes, specifically patient autonomy and medically assisted dying. Yet, at the same time, there is a consensus among the Israeli public about certain EoL elements, particularly the importance of family caregivers in the EoL decision-making process.
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Affiliation(s)
- Moran Bodas
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-HaShomer, Israel
- The School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel
| | - Arnona Ziv
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-HaShomer, Israel
| | - Carmit Rubin
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-HaShomer, Israel
| | - Bernice Oberman
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-HaShomer, Israel
| | - Yoel Tawil
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-HaShomer, Israel
| | - Adir Shaulov
- Department of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Giora Kaplan
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-HaShomer, Israel
| | - Baruch Velan
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-HaShomer, Israel
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Wikstøl D, Horn MA, Pedersen R, Magelssen M. Citizen attitudes to non-treatment decision making: a Norwegian survey. BMC Med Ethics 2023; 24:20. [PMID: 36890542 PMCID: PMC9993678 DOI: 10.1186/s12910-023-00900-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/03/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Decisions about appropriate treatment at the end of life are common in modern healthcare. Non-treatment decisions (NTDs), comprising both withdrawal and withholding of (potentially) life-prolonging treatment are in principle accepted in Norway. However, in practice they may give rise to significant moral problems for health professionals, patients and next of kin. Here, patient values must be considered. It is relevant to study the moral views and intuitions of the general population on NTDs and special areas of contention such as the role of next of kin in decision-making. METHODS Electronic survey to members of a nationally representative panel of Norwegian adults. Respondents were presented with vignettes describing patients with disorders of consciousness, dementia, and cancer where patient preferences varied. Respondents answered ten questions about the acceptability of non-treatment decision making and the role of next of kin. RESULTS We received 1035 complete responses (response rate 40.7%). A large majority, 88%, supported the right of competent patients to refuse treatment in general. When an NTD was in line with the patient's previously expressed preferences, more respondents tended to find NTDs acceptable. More respondents would accept NTDs for themselves than for the vignette patients. In a scenario with an incompetent patient, clear majorities wanted the views of next of kin to be given some but not decisive weight, and more weight if concordant with the patient's wishes. There were, however, large variations in the respondents' views. CONCLUSION This survey of a representative sample of the Norwegian adult population indicates that attitudes to NTDs are often in line with national laws and guidelines. However, the high variance among the respondents and relatively large weight given to next of kin's views, indicate a need for appropriate dialogue among all stakeholders to prevent conflicts and extra burdens. Furthermore, the emphasis given to previously expressed opinions indicates that advance care planning may increase the legitimacy of NTDs and prevent challenging decision-making processes.
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Affiliation(s)
- David Wikstøl
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Pb. 1130, 0318, Blindern, Oslo, Norway
| | | | - Reidar Pedersen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Pb. 1130, 0318, Blindern, Oslo, Norway
| | - Morten Magelssen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Pb. 1130, 0318, Blindern, Oslo, Norway. .,MF Norwegian School of Theology, Religion and Society, Oslo, Norway.
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