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Gula AL, Walter JK, Morrison W, Kirschen MP. Exploring Ethical Dimensions in Neuropalliative Care. Semin Neurol 2024. [PMID: 38914125 DOI: 10.1055/s-0044-1787775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Neurologic illnesses can be challenging to diagnose, involve changes in consciousness, and are often complicated by prognostic uncertainty. These disorders can affect how individuals interact with their environment, and as a result, many ethical concerns may arise related to their medical care. Key ethical issues in neuropalliative care include shared decision-making, evolving autonomy and capacity, best interest and harm principles, beneficence and nonmaleficence, futile and inappropriate care, justice and equity, and ableism. The four core principles of medical ethics, beneficence, nonmaleficence, justice, and autonomy, are foundational in considering approaches to these ethical challenges. Shared decision-making is rooted in the principle of autonomy. Evolving autonomy and capacity evoke autonomy, beneficence, and nonmaleficence. The best interest and harm principles are rooted in beneficence and nonmaleficence. Questions of futility and inappropriate care are founded in the principles of nonmaleficence, autonomy, and justice. Ableism invokes questions of nonmaleficence, autonomy, and justice. Practitioners of neurology will encounter ethical challenges in their practice. Framing decisions around the core ethical principles of beneficence, nonmaleficence, autonomy, and justice will help clinicians navigate challenging situations while acknowledging and respecting each patient's individual story.
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Affiliation(s)
- Annie L Gula
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer K Walter
- Department of Medical Ethics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wynne Morrison
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medical Ethics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew P Kirschen
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Sharma A. Palliative Care and Care Partner Support in Neuro-oncology. Continuum (Minneap Minn) 2023; 29:1872-1895. [PMID: 38085902 DOI: 10.1212/con.0000000000001353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
ABSTRACT The journey for a patient with a brain tumor and their loved ones can be extremely challenging due to the high burden of physical symptoms and the emotional distress caused by the diagnosis. Optimizing quality of life by addressing symptoms and reducing this emotional distress can improve treatment tolerance and outcomes and alleviate care partner distress and burden. Symptoms in patients with central nervous system (CNS) tumors can vary in onset and intensity, ranging from headaches, seizures, and focal weakness to emotional distress and cognitive dysfunction. Additionally, care partners may demonstrate distress due to the high burden of care and need appropriate support structures and access to resources to alleviate this stress. Evidence-based recommendations are unfortunately limited given the lack of high-quality research in this area, but patients living with CNS tumors and their loved ones can benefit from early and routine symptom identification and management, compassionate and transparent communication, and practical guidance for the future. These principles are part of palliative care, a field of medicine focused on alleviating suffering in patients with serious, chronic illness. Clinicians involved in the care of patients with CNS tumors must be educated in these important primary palliative care principles. This article focuses on key symptom management, strategies for high-quality communication, a discussion of advance care planning, and an overview of end-of-life care.
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Kious BM. Medical Assistance in Dying in Neurology. Neurol Clin 2023; 41:443-454. [PMID: 37407098 DOI: 10.1016/j.ncl.2023.03.002] [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: 07/07/2023]
Abstract
An increasing number of jurisdictions have legalized medical assistance in dying (MAID) with significant variation in the procedures and eligibility criteria used. In the United States, MAID is available for persons with terminal illnesses but is frequently sought by persons with neurologic conditions. Persons with conditions that cause cognitive impairment, such as Alzheimer dementia, are often ineligible for MAID, as their illness is not considered terminal in its early stages, whereas in later stages, they may have impaired decision-making capacity.
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Affiliation(s)
- Brent M Kious
- Department of Psychiatry, Center for Bioethics and Health Humanities, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA.
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Mazzola MA, Russell JA. Neurology ethics at the end of life. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:235-257. [PMID: 36599511 DOI: 10.1016/b978-0-12-824535-4.00012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ethical challenges in medical decision making are commonly encountered by clinicians caring for patients afflicted by neurological injury or disease at the end of life (EOL). In many of these cases, there are conflicting opinions as to what is right and wrong originating from multiple sources. There is a particularly high prevalence of impaired patient judgment and decision-making capacity in this population that may result in a misrepresentation of their premorbid values and goals. Conflict may originate from a discordance between what is legal or from stakeholders who view and value life and existence differently from the patient, at times due to religious or cultural influences. Promotion of life, rather than preservation of existence, is the goal of many patients and the foundation on which palliative care is built. Those who provide EOL care, while being respectful of potential cultural, religious, and legal stakeholder perspectives, must at the same time recognize that these perspectives may conflict with the optimal ethical course to follow. In this chapter, we will attempt to review some of the more notable ethical challenges that may arise in the neurologically afflicted at the EOL. We will identify what we believe to be the most compelling ethical arguments both in support of and opposition to specific EOL issues. At the same time, we will consider how ethical analysis may be influenced by these legal, cultural, and religious considerations that commonly arise.
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Physicians' Attitudes and Experiences with Medical Aid in Dying in Colorado: a "Hidden Population" Survey. J Gen Intern Med 2022; 37:3310-3317. [PMID: 35018562 PMCID: PMC8751472 DOI: 10.1007/s11606-021-07300-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/23/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Approximately 20% of the US population live in states where MAiD is a legal, though highly contentious, practice. Little generalizable data exists on the experiences of MAiD providers who comprise a small, and intentionally hidden, population. OBJECTIVE To examine the nature, extent, and consequences of physicians' participation in MAiD. DESIGN An anonymous, multi-wave, mailed survey (RR= 55%). PARTICIPANTS An enriched sample (n=583) of Colorado physicians caring for potential MAiD patients. MAIN MEASURES Physician willingness, preparedness, and participation in a continuum of MAiD activities. Other outcomes include the effects of providing MAiD and the barriers physicians face related to MAiD. KEY RESULTS Overall, 81.1% of respondents were willing to discuss MAiD with a patient, 88.3% to refer for MAiD, 46.3% to be a consultant, and 28.1% to be an attending. Fewer felt prepared to discuss MAiD (54.4%), provide a MAiD referral (62.8%), be a consultant (30.7%), or be an attending (18.0%). More than half of respondents (52.3%) had discussed MAiD with a patient, 27.3% provided a MAiD referral, 12.8% had been a MAiD consultant, and 8.5% had been a MAiD attending. Among MAiD consultants and attendings, 75% reported that their most recent MAiD case was emotionally fulfilling and professionally rewarding, though 75% also reported that it was time consuming and 46.9% reported that it was ethically challenging. Common barriers to physician participation in MAiD include lack of knowledge about MAiD (46.8%), the emotional (45.6%) and time (41.7%) investments, and ethical concerns (41.7%). CONCLUSIONS Many physicians in our sample are both willing and prepared to discuss MAiD with patients and to provide MAiD referrals. Fewer are prepared and willing to serve as an attending or consultant and fewer have provided these services. MAID consultants and attendings largely report the experience to be emotionally fulfilling and professionally rewarding, but all respondents reported multiple barriers to participation.
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Katz M. Palliative Care and Movement Disorders. Continuum (Minneap Minn) 2022; 28:1520-1529. [DOI: 10.1212/con.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Russell JA. Advanced Directives for Hastened-Death? Mov Disord 2022; 37:667-668. [PMID: 35429049 DOI: 10.1002/mds.28966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/07/2022] Open
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Taylor LP, Besbris JM, Graf WD, Rubin MA, Cruz-Flores S, Epstein LG. Clinical Guidance in Neuropalliative Care: An AAN Position Statement. Neurology 2022; 98:409-416. [PMID: 35256519 DOI: 10.1212/wnl.0000000000200063] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lynne P Taylor
- From the Department of Neurology (L.P.T.), University of Washington, Seattle; Department of Supportive Care Medicine and Neurology (J.M.B.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Pediatrics (Division of Neurology) (W.D.G.), Connecticut Children's, University of Connecticut, Farmington; Department of Neurology (M.A.R.), University of Texas Southwestern Medical Center, Dallas; Department of Neurology (S.C.C.-F.), Texas Tech University Center, El Paso; and Department of Pediatrics and Neurology (L.G.E.), Northwestern University School of Medicine, Chicago, IL.
| | - Jessica M Besbris
- From the Department of Neurology (L.P.T.), University of Washington, Seattle; Department of Supportive Care Medicine and Neurology (J.M.B.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Pediatrics (Division of Neurology) (W.D.G.), Connecticut Children's, University of Connecticut, Farmington; Department of Neurology (M.A.R.), University of Texas Southwestern Medical Center, Dallas; Department of Neurology (S.C.C.-F.), Texas Tech University Center, El Paso; and Department of Pediatrics and Neurology (L.G.E.), Northwestern University School of Medicine, Chicago, IL
| | - William D Graf
- From the Department of Neurology (L.P.T.), University of Washington, Seattle; Department of Supportive Care Medicine and Neurology (J.M.B.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Pediatrics (Division of Neurology) (W.D.G.), Connecticut Children's, University of Connecticut, Farmington; Department of Neurology (M.A.R.), University of Texas Southwestern Medical Center, Dallas; Department of Neurology (S.C.C.-F.), Texas Tech University Center, El Paso; and Department of Pediatrics and Neurology (L.G.E.), Northwestern University School of Medicine, Chicago, IL
| | - Michael A Rubin
- From the Department of Neurology (L.P.T.), University of Washington, Seattle; Department of Supportive Care Medicine and Neurology (J.M.B.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Pediatrics (Division of Neurology) (W.D.G.), Connecticut Children's, University of Connecticut, Farmington; Department of Neurology (M.A.R.), University of Texas Southwestern Medical Center, Dallas; Department of Neurology (S.C.C.-F.), Texas Tech University Center, El Paso; and Department of Pediatrics and Neurology (L.G.E.), Northwestern University School of Medicine, Chicago, IL
| | - Salvador Cruz-Flores
- From the Department of Neurology (L.P.T.), University of Washington, Seattle; Department of Supportive Care Medicine and Neurology (J.M.B.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Pediatrics (Division of Neurology) (W.D.G.), Connecticut Children's, University of Connecticut, Farmington; Department of Neurology (M.A.R.), University of Texas Southwestern Medical Center, Dallas; Department of Neurology (S.C.C.-F.), Texas Tech University Center, El Paso; and Department of Pediatrics and Neurology (L.G.E.), Northwestern University School of Medicine, Chicago, IL
| | - Leon G Epstein
- From the Department of Neurology (L.P.T.), University of Washington, Seattle; Department of Supportive Care Medicine and Neurology (J.M.B.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Pediatrics (Division of Neurology) (W.D.G.), Connecticut Children's, University of Connecticut, Farmington; Department of Neurology (M.A.R.), University of Texas Southwestern Medical Center, Dallas; Department of Neurology (S.C.C.-F.), Texas Tech University Center, El Paso; and Department of Pediatrics and Neurology (L.G.E.), Northwestern University School of Medicine, Chicago, IL
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Sinnarajah A, Feldstain A, Wasylenko E. Responding to requests for hastened death in patients living with advanced neurologic disease. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:217-237. [PMID: 36055717 DOI: 10.1016/b978-0-323-85029-2.00002-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A request for hastened death can mean many things, from an emotional plea for help with unmet needs to a request for legal provision of chemically induced hastened death. Regardless of whether the clinician supports legally available hastened death, knowing how to respond to requests for hastened death is important. Responding in an empathic and open manner will strengthen the therapeutic relationship between the patient and clinician. Suggested scripts on how to respond are provided. A framework for assessing the patient's preparation at various stages in the decisional journey is suggested. Additional factors including caring for the family and involving other healthcare providers are discussed. Last, there is some exploration of ethics considerations and a summary of legal chemically induced hastened death availability internationally.
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Affiliation(s)
- Aynharan Sinnarajah
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - Andrea Feldstain
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Department of Psychosocial Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Eric Wasylenko
- Department of Oncology, University of Calgary, Calgary, AB, Canada; John Dossetor Health Ethics Centre, University of Alberta, Edmonton, AB, Canada
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Mukhopadhyay S, Banerjee D. Physician assisted suicide in dementia: A critical review of global evidence and considerations from India. Asian J Psychiatr 2021; 64:102802. [PMID: 34388669 DOI: 10.1016/j.ajp.2021.102802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dementias are a group of gradually progressing neurodegenerative conditions, leading to significant impairment in cognition, functioning, decision-making, capacity and autonomy. With the rise of human rights and patient-centred perspectives in psychogeriatric management, physician-assisted suicide (PAS) has emerged as an important and integral part of end-of-life care in advanced dementias. METHODS With only few original studies in the area, this paper takes a narrative and critical approach to review the global legislations, treatment decisions, debates as well as perspectives from patients, families and medical professionals. RESULTS PAS and euthanasia are legally allowed in countries like Belgium, Netherlands, Switzerland and few states of the United States (U.S.). Germany has fewer clearer legislations in this regard. The Oregon state requirement and care criteria of the Dutch euthanasia act form the basis of most such laws. Even in the presence of these provisions, PAS is fraught with multiple medical, ethical, moral and legal dilemmas and physicians as well as caregivers are quite heterogenous in their outlook. While right to live with dignity and need to end incurable suffering form the main arguments for PAS, several arguments against it are possibility of undue influence, impaired judgement leading to biased decision-making such as depression and suicidality, inappropriate assessment of capacity, and that all deaths are not necessarily painful. These dilemmas are critically discussed in light of autonomy, decision-making and advanced directives in people living with dementia as well as the rationality of ending life and 'right to live vs right to die'. Based on the findings, certain balanced strategies are highlighted for the health professionals. CONCLUSION The 'slippery slope' of PAS needs to be carefully evaluated from a social justice and human rights perspective to improve dignified end-of-life care in dementia. Considerations are also discussed from India, a rapidly-ageing nation with no current provisions for PAS.
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Affiliation(s)
- Sanchari Mukhopadhyay
- Geriatric Unit and Clinical Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Near Dairy Circle, Hosur Road, Bangalore 560029, India
| | - Debanjan Banerjee
- Geriatric Unit and Clinical Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Near Dairy Circle, Hosur Road, Bangalore 560029, India.
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Russell JA, Hutchins JC, Epstein LG. American Academy of Neurology Code of Professional Conduct. Neurology 2021; 97:489-495. [PMID: 34489340 DOI: 10.1212/wnl.0000000000012447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/03/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- James A Russell
- From the American Academy of Neurology (J.C.H.), Minneapolis, MN; and Department of Pediatrics (L.G.E.), Northwestern University Feinberg School of Medicine, Chicago, IL. Dr. Russell is retired.,The American Academy of Neurology Code of Professional Conduct became official AAN policy when it was approved by the AAN Board of Directors on March 18, 2021
| | - John C Hutchins
- From the American Academy of Neurology (J.C.H.), Minneapolis, MN; and Department of Pediatrics (L.G.E.), Northwestern University Feinberg School of Medicine, Chicago, IL. Dr. Russell is retired. .,The American Academy of Neurology Code of Professional Conduct became official AAN policy when it was approved by the AAN Board of Directors on March 18, 2021.
| | - Leon G Epstein
- From the American Academy of Neurology (J.C.H.), Minneapolis, MN; and Department of Pediatrics (L.G.E.), Northwestern University Feinberg School of Medicine, Chicago, IL. Dr. Russell is retired.,The American Academy of Neurology Code of Professional Conduct became official AAN policy when it was approved by the AAN Board of Directors on March 18, 2021
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Grogan J, Simmons Z. Physician-hastened death in California for patients with amyotrophic lateral sclerosis: Part of a bigger picture. Muscle Nerve 2021; 64:381-384. [PMID: 34368965 DOI: 10.1002/mus.27388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 11/05/2022]
Affiliation(s)
- James Grogan
- Department of Neurology, Penn State University, Hershey, Pennsylvania, USA
| | - Zachary Simmons
- Department of Neurology, Penn State University, Hershey, Pennsylvania, USA
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Chiong W, Tsou AY, Simmons Z, Bonnie RJ, Russell JA. Ethical Considerations in Dementia Diagnosis and Care: AAN Position Statement. Neurology 2021; 97:80-89. [PMID: 34524968 DOI: 10.1212/wnl.0000000000012079] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 03/08/2021] [Indexed: 11/15/2022] Open
Abstract
Alzheimer disease and other dementias present unique practical challenges for patients, their families, clinicians, and health systems. These challenges reflect not only the growing public health effect of dementia in an aging global population, but also more specific ethical complexities including early loss of patients' capacity to make decisions regarding their own care, the stigma often associated with a dementia diagnosis, the difficulty of balancing concern for patients' welfare with respect for patients' remaining independence, and the effect on the physical, emotional, and financial well-being of family caregivers. Caring for patients with dementia requires respecting patient autonomy while acknowledging progressively diminishing decisional capacity and continuing to provide care in accordance with other core ethical principles (beneficence, justice, and nonmaleficence). Whereas these ethical principles remain unchanged, neurologists must reconsider how to apply them given changes across multiple domains including our understanding of disease, clinical and legal tools for addressing manifestations of illness, our expanding awareness of the crucial role of family caregivers in providing care and maintaining patient quality of life, and societal conceptions of dementia and individuals' personal expectations for aging. This revision to the American Academy of Neurology's 1996 position statement summarizes ethical considerations that often arise in caring for patients with dementia; although it addresses how such considerations influence patient management, it is not a clinical practice guideline.
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Affiliation(s)
- Winston Chiong
- From the Department of Neurology (W.C.), University of California San Francisco; Evidence-Based Practice Center (A.Y.T.), ECRI, Plymouth Meeting, PA; Division of Neurology (A.Y.T.), Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; Department of Neurology (Z.S.), The Pennsylvania State University, Hershey; School of Law (R.J.B.), University of Virginia, Charlottesville; and Department of Neurology (J.A.R.), Lahey Medical Center, Burlington, MA.
| | - Amy Y Tsou
- From the Department of Neurology (W.C.), University of California San Francisco; Evidence-Based Practice Center (A.Y.T.), ECRI, Plymouth Meeting, PA; Division of Neurology (A.Y.T.), Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; Department of Neurology (Z.S.), The Pennsylvania State University, Hershey; School of Law (R.J.B.), University of Virginia, Charlottesville; and Department of Neurology (J.A.R.), Lahey Medical Center, Burlington, MA
| | - Zachary Simmons
- From the Department of Neurology (W.C.), University of California San Francisco; Evidence-Based Practice Center (A.Y.T.), ECRI, Plymouth Meeting, PA; Division of Neurology (A.Y.T.), Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; Department of Neurology (Z.S.), The Pennsylvania State University, Hershey; School of Law (R.J.B.), University of Virginia, Charlottesville; and Department of Neurology (J.A.R.), Lahey Medical Center, Burlington, MA
| | - Richard J Bonnie
- From the Department of Neurology (W.C.), University of California San Francisco; Evidence-Based Practice Center (A.Y.T.), ECRI, Plymouth Meeting, PA; Division of Neurology (A.Y.T.), Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; Department of Neurology (Z.S.), The Pennsylvania State University, Hershey; School of Law (R.J.B.), University of Virginia, Charlottesville; and Department of Neurology (J.A.R.), Lahey Medical Center, Burlington, MA
| | - James A Russell
- From the Department of Neurology (W.C.), University of California San Francisco; Evidence-Based Practice Center (A.Y.T.), ECRI, Plymouth Meeting, PA; Division of Neurology (A.Y.T.), Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; Department of Neurology (Z.S.), The Pennsylvania State University, Hershey; School of Law (R.J.B.), University of Virginia, Charlottesville; and Department of Neurology (J.A.R.), Lahey Medical Center, Burlington, MA
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Barsness JG, Regnier CR, Hook CC, Mueller PS. US medical and surgical society position statements on physician-assisted suicide and euthanasia: a review. BMC Med Ethics 2020; 21:111. [PMID: 33143695 PMCID: PMC7640655 DOI: 10.1186/s12910-020-00556-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An analysis of the position statements of secular US medical and surgical professional societies on physician-assisted suicide (PAS) and euthanasia have not been published recently. Available statements were evaluated for position, content, and sentiment. METHODS In order to create a comprehensive list of secular medical and surgical societies, the results of a systematic search using Google were cross-referenced with a list of societies that have a seat on the American Medical Association House of Delegates. Societies with position statements were identified. These statements were divided into 5 categories: opposed to PAS and/or euthanasia, studied neutrality, supportive, acknowledgement without statement, and no statement. Linguistic analysis was performed using RapidMinder in order to determine word frequency and sentiment respective to individual statements. To ensure accuracy, only statements with word counts > 100 were analyzed. A 2-tailed independent t test was used to test for variance among sentiment scores of opposing and studied neutrality statements. RESULTS Of 150 societies, only 12 (8%) have position statements on PAS and euthanasia: 11 for PAS (5 opposing and 4 studied neutrality) and 9 for euthanasia (6 opposing and 2 studied neutrality). Although the most popular words used in opposing and studied neutrality statements are similar, notable exceptions exist (suicide, medicine, and treatment appear frequently in opposing statements, but not in studied neutrality statements, whereas psychologists, law, and individuals appear frequently in studied neutrality statements, but not in opposing statements). Sentiment scores for opposing and studied neutrality statements do not differ (mean, 0.094 vs. 0.104; P = 0.90). CONCLUSIONS Few US medical and surgical societies have position statements on PAS and euthanasia. Among them, opposing and studied neutrality statements share similar linguistic sentiment. Opposing and studied neutrality statements have clear differences, but share recommendations. Both opposing and studied neutrality statements cite potential risks of PAS legalization and suggest that good palliative care might diminish a patient's desire for PAS.
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Affiliation(s)
| | | | | | - Paul S Mueller
- Department of Internal Medicine, Mayo Clinic Health System-Franciscan Healthcare in La Crosse, 800 West Ave S, La Crosse, WI, 54601, USA.
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Russell JA, Epstein LG, Bonnie RJ, Conwit R, Graf WD, Kirschen M, Kurek JA, Larriviere DG, Pascuzzi RM, Rizzo M, Sattin JA, Simmons Z, Taylor L, Williams MA. In defense of the AAN position on lawful physician-hastened death. Neurology 2020; 94:641-643. [PMID: 32179699 DOI: 10.1212/wnl.0000000000009237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/15/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- James A Russell
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle.
| | - Leon G Epstein
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Richard J Bonnie
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Robin Conwit
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - William D Graf
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Matthew Kirschen
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Julie A Kurek
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Daniel G Larriviere
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Robert M Pascuzzi
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Matthew Rizzo
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Justin A Sattin
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Zachary Simmons
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Lynne Taylor
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Michael A Williams
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
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Recent Literature Feature Editor: Paul C. Rousseau. J Palliat Med 2018. [DOI: 10.1089/jpm.2018.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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