Health professionals' attitude toward euthanasia: a cross-sectional study from Turkey

Knowledge and attitudes toward euthanasia among final year pharmacy and law students: a cross-sectional study

BACKGROUND

Euthanasia is the last resort for those living with untreatable and terminable diseases which cause pain and suffering. However, the concept of euthanasia resulted in many dilemmas and controversy around life extension and death.

OBJECTIVE

The aim of this study was to evaluate the knowledge and attitudes of final year pharmacy and law students concerning euthanasia.

METHODS

A descriptive cross-sectional study was carried out among all final year law and pharmacy undergraduate students. The data were collected using self-administered structured questionnaire and analyzed by SPSS version 22. Multivariate logistic regression was used to assess the influence of socio-demographic characteristics of participant's on acceptance of euthanasia.

RESULT

72 (61.5%) of the students were declared that euthanasia is administration of lethal drugs to a patient at the explicit request of that patient. Majority 87 (74.4%) of the students knew that euthanasia is active shortening of the dying process. Most participants 95(81.2%) awared that there is no legalized euthanasia in Ethiopia. On the other hand, 47(40.2%) believed the patient has the right to choose to end his/her own life. Around 45% had the view that euthanasia should be legalized in some circumstances. Only 27.3% (n = 32) of the respondents endorsed legalization of euthanasia in Ethiopia. 35 (29.9%) said euthanasia should be performed. The acceptance of euthanasia was greater for pharmacy students compared to law students [adjusted odds ratio (AOR) = 3.490; 95% CI 1.346-9.049; p = 0.010] and lower for Muslim students compared to Orthodox students (AOR = 0.186; 95% CI 0.044-0.783; p = 0.022).

CONCLUSION

The final year law and pharmacy students were aware of euthanasia. However, majority of students did not reveal favorable attitude toward euthanasia and its acceptance was low. Participants' field of study and religion were significantly affect acceptance of euthanasia As the current study limited to pharmacy and law students, the authors suggest that future studies should involve various segments of societies to investigate more about euthanasia in Ethiopia.

Understanding the Reasons Behind Healthcare Providers' Conscientious Objection to Voluntary Assisted Dying in Victoria, Australia

During the debates about the legalization of Voluntary Assisted Dying (VAD) in Victoria, Australia, the presence of anti-VAD health professionals in the medical community and reported high rates of conscientious objection (CO) to VAD suggested access may be limited. Most empirical research on CO has been conducted in the sexual and reproductive health context. However, given the fundamental differences in the nature of such procedures and the legislation governing it, these findings may not be directly transferable to VAD. Accordingly, we sought to understand how CO operates in the context of VAD. Prior to the implementation of the VAD legislation in June 2019, we conducted semi-structured interviews with seventeen health professionals with a self-declared CO to VAD, to explore what motivated their CO. Participants identified multiple motivations, which can be broadly categorized as: concerns for oneself; concerns for patients; concerns about the current Victorian legislation; and concerns for the medical profession. Participants' moral commitments included personal, professional, and political commitments. In some cases, one's CO was specific to Victoria's current legislation rather than VAD more broadly. Our findings suggest CO motivations extend beyond those traditionally cited and suggest a need to better understand and manage CO in the healthcare context.

Medical Faculty Students' Views on Euthanasia: Does It Change With Medical Education?

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.

Grave new world: The conspiracy of silence surrounding non-voluntary euthanasia

The scholarship of euthanasia indicates that in most cases, to date, non-voluntary euthanasia has been studied where euthanasia is legalized. Findings of these studies demonstrate the 'slippery slope' and reveal that non-voluntary euthanasia is pervasive in these countries. The research is aimed at answering two questions: (1) What are the common death hastening methods? (2) Is the acceptance of active non-voluntary euthanasia related to the legal status of euthanasia? A qualitative study was conducted in ICUs with 15 nurses. All of the interviewees refused to take part in the death hastening cases and did not obey any doctor's instruction that could hasten or cause death. Therefore, doctors who conducted NVE did it by themselves. The present study provides evidence of the phenomenon of illegal non-voluntary euthanasia as a routine practice by physicians in palliative care units in Israel. Interviews with 15 nurses employed in these units shed light on the means and methods used by these doctors to hasten terminal patients' death. We conclude that Nurses in various end-of-life care units persist in preserving their professional integrity and refuse to obey doctors' instructions for non-voluntary euthanasia. The slippery slope argument has been refuted in this context.

Finnish nurses’ attitudes towards their role in the euthanasia process

Background:

Nurses’ voices remain unheard in most debates about euthanasia, although their crucial role in the euthanasia process is widely acknowledged. Moreover, in Canadian euthanasia law, nurses have a more active role, which further highlights the need for knowledge about nurses’ attitudes towards their role in the euthanasia process.

Research questions:

What are Finnish nurses’ attitudes towards their potential role in the euthanasia process? Which characteristics are associated with those attitudes?

Research design:

Cross-sectional web-based survey.

Participants and research context:

1003 nurses, recruited via social media and the members’ bulletin of the Finnish Nurses Association.

Ethical considerations:

Ethical approval was obtained from the Committee on Research Ethics of the university to which the first author was affiliated.

Findings:

The great majority (85.2%) of nurses felt that their perspective should be considered in decision-making related to euthanasia. Furthermore, most of the participants (74.7%) reported willingness to participate in the euthanasia process if it were legal, and 88.6% agreed that a nurse should be present when euthanasia is performed if the patient wishes so. Furthermore, over half agreed that some of the preparatory tasks were part of their job description. However, a minority (32.9%) agreed with a possible obligation to participate based on their profession. Nurses’ age, religiosity and educational level influenced their attitudes in the current results.

Discussion:

Despite the strong agreement on decision-making concerning euthanasia and participation in the euthanasia process, obligation to participate based on the profession was rejected by most participants. Nurses regarded themselves as consultants in the decision-making process, which may indicate their unwillingness to share the responsibility for the decision itself.

Conclusion:

Specific safety mechanisms should be considered to protect nurses who refuse to be involved in the euthanasia process due to harm that involuntary participation might cause.

Nurses’ attitudes towards euthanasia in conflict with professional ethical guidelines

Background:

Despite the significant role of nurses in end-of-life care, their attitudes towards euthanasia are under-represented both in the current literature and the controversial debate that is ongoing in several countries.

Research questions:

What are the attitudes towards euthanasia among Finnish nurses? Which characteristics are associated with those attitudes?

Research design:

Cross-sectional web-based survey.

Participants and research context:

A total of 1003 nurses recruited via the members’ bulletin of the Finnish Nurses Association and social media.

Ethical considerations:

Ethical approval was obtained from the Committee on Research Ethics of the university to which the authors were affiliated.

Findings:

The majority (74.3%) of the participants would accept euthanasia as part of Finnish healthcare, and 61.8% considered that Finland would benefit from a law permitting euthanasia. Most of the nurses (89.9%) thought that a person must have the right to decide on his or her own death; 77.4% of them considered it likely that they would themselves make a request for euthanasia in certain situations.

Discussion:

The value of self-determination and the ability to choose the moment and manner of one’s death are emphasized in the nurses’ attitudes towards euthanasia.

Conclusion:

A continuous dialogue about euthanasia and nurses’ shared values is crucial due to the conflict between nurses’ attitudes and current ethical guidelines on nursing.

Nursing Students' Approaches Toward Euthanasia

Background:

In Turkey, which is a secular, democratic nation with a majority Muslim population, euthanasia is illegal and regarded as murder. Nurses and students can be faced with ethical dilemmas and a lack of a legal basis, with a conflict of religious beliefs and social and cultural values concerning euthanasia. The aim of this study was to investigate undergraduate nursing students' attitudes towards euthanasia.

Method:

The study, which had a descriptive design, was conducted with 600 students. The 1st, 2nd, 3rd, and 4th year nursing students at a school of nursing were contacted in May 2009, and 383 students (63.8% of the study population of a total of 600 students) gave informed consent. Two tools were used in accordance with questionnaire preparation rules.

Results:

The majority of students were female and single (96.9%), and their mean age was 21.3 ± 1.5 years. A majority (78.9%) stated they had received no training course/education on the concept of euthanasia. Nearly one-third (32.4%) of the students were against euthanasia; 14.3% of the students in the study agreed that if their relatives had an irreversible, lethal condition, passive euthanasia could be performed. In addition, 24.8% of the students agreed that if they themselves had an irreversible, lethal condition, passive euthanasia could be performed. Less than half (42.5%) of the students thought that discussions about euthanasia could be useful. There was a significant relation between the study year and being against euthanasia ( p < 0.05), the idea that euthanasia could be abused ( p < 0.05), and the idea that euthanasia was unethical ( p < 0.05).

Conclusion:

It was concluded that the lack of legal regulations, ethical considerations, religious beliefs, and work experience with dying patients affect nursing students' attitudes towards euthanasia.

Euthanasia: the perceptions of nurses in India

Euthanasia provokes controversies in various domains, such as the moral, ethical, legal, religious, scientific, and economic. India legalised passive euthanasia (withdrawal of life support) for patients with brain death or who are in a permanent vegetative state in 2011, but research on perceptions of euthanasia among people in India is limited. This study aimed to examine nurses' perceptions of the practice of euthanasia as well as factors influencing those perceptions. A non-probability quantitative, cross-sectional design was adopted for a sample of 214 nurses working at a tertiary care centre. Data was collected through self-reported questionnaires at the nurses workplace.The findings revealed mixed opinions on euthanasia among the nurses. However, the majority of the participants did not agree with the practice of euthanasia. Nonetheless, further research is needed on this issue across the country among various health professionals in the context of current legislation.

Opinions of health care professionals and the public after eight years of euthanasia legislation in the Netherlands: a mixed methods approach

BACKGROUND

The practice of euthanasia and physician-assisted suicide (PAS) in the Netherlands has been regulated since 2002 by the Euthanasia Act. In the ongoing debate about the interpretation of this Act, comparative information about the opinions of the different stakeholders is needed.

AIM

To evaluate the opinions of Dutch physicians, nurses and the general public on the legal requirements for euthanasia and PAS.

DESIGN

A cross-sectional survey among Dutch physicians and nurses in primary and secondary care and members of the Dutch general public, followed by qualitative interviews among selected respondents. The participants were: 793 physicians, 1243 nurses and 1960 members of the general public who completed the questionnaire; 83 were interviewed.

RESULTS

Most respondents agreed with the requirement of a patient request (64-88%) and the absence of a requirement concerning life expectancy (48-71%). PAS was thought acceptable by 24-39% of respondents for patients requesting it because of mental suffering due to loss of control, chronic depression or early dementia. In the case of severe dementia, one third of physicians, 58% of nurses and 77% of the general public agreed with performing euthanasia based on an advance directive. Interviewees illustrated these findings and supported the Act.

CONCLUSIONS

Health care professionals and the general public mostly support the legal requirements for euthanasia and PAS. The law permits euthanasia or PAS for mental suffering but this possibility is not widely endorsed. The general public is more liberal towards euthanasia for advanced dementia than health care professionals. We conclude that there is ample support for the law after eight years of legal euthanasia.

Perspectives on care and communication involving incurably ill Turkish and Moroccan patients, relatives and professionals: a systematic literature review

Background

Our aim was to obtain a clearer picture of the relevant care experiences and care perceptions of incurably ill Turkish and Moroccan patients, their relatives and professional care providers, as well as of communication and decision-making patterns at the end of life. The ultimate objective is to improve palliative care for Turkish and Moroccan immigrants in the Netherlands, by taking account of socio-cultural factors in the guidelines for palliative care.

Methods

A systematic literature review was undertaken. The data sources were seventeen national and international literature databases, four Dutch journals dedicated to palliative care and 37 websites of relevant national and international organizations. All the references found were checked to see whether they met the structured inclusion criteria. Inclusion was limited to publications dealing with primary empirical research on the relationship between socio-cultural factors and the health or care situation of Turkish or Moroccan patients with an oncological or incurable disease. The selection was made by first reading the titles and abstracts and subsequently the full texts. The process of deciding which studies to include was carried out by two reviewers independently. A generic appraisal instrument was applied to assess the methodological quality.

Results

Fifty-seven studies were found that reported findings for the countries of origin (mainly Turkey) and the immigrant host countries (mainly the Netherlands). The central themes were experiences and perceptions of family care, professional care, end-of-life care and communication. Family care is considered a duty, even when such care becomes a severe burden for the main female family caregiver in particular. Professional hospital care is preferred by many of the patients and relatives because they are looking for a cure and security. End-of-life care is strongly influenced by the continuing hope for recovery. Relatives are often quite influential in end-of-life decisions, such as the decision to withdraw or withhold treatments. The diagnosis, prognosis and end-of-life decisions are seldom discussed with the patient, and communication about pain and mental problems is often limited. Language barriers and the dominance of the family may exacerbate communication problems.

Conclusions

This review confirms the view that family members of patients with a Turkish or Moroccan background have a central role in care, communication and decision making at the end of life. This, in combination with their continuing hope for the patient’s recovery may inhibit open communication between patients, relatives and professionals as partners in palliative care. This implies that organizations and professionals involved in palliative care should take patients’ socio-cultural characteristics into account and incorporate cultural sensitivity into care standards and care practices.

Attitudes to euthanasia in ICUs and other hospital departments

The aim of this study was to reveal doctors' and nurses' attitudes to euthanasia in intensive care units and surgical, internal medicine and paediatric units in Turkey. A total of 205 doctors and 206 nurses working in several hospitals in Istanbul participated. Data were collected by questionnaire and analysed using SPSS v. 12.0. Significantly higher percentages of doctors (35.3%) and nurses (26.6%) working in intensive care units encountered euthanasia requests than those working in other units. Doctors and nurses caring for terminally ill patients in intensive care units differed considerably in their attitudes to euthanasia and patient rights from other health care staff. Euthanasia should be investigated and put on the agenda for discussion in Turkey.

Turkish Health Professional's Attitude Toward Euthanasia

The cross-sectional study was administrated between April and September 2006. Participants are doctors, nurses, and midwives. Between these dates we met only 750 health staff (doctor, nurse, and midwife). Six hundred thirty-two of them responded to our questionnaire, 122 of them were in Manisa city, and 510 of them in Erciyes. We sought to identify variables that contribute to euthanasia attitude, including demographics, in order to demonstrate Turkish doctors', nurses', and midwives' attitudes toward euthanasia and to compare their attitudes in this regard. The data was collected by a two-part questionnaire. The first part included questions about the health personnel; the second part comprised the euthanasia (Medical Staff's Attitude toward Euthanasia) scale. The scale was developed by the researcher to measure the attitude of healthy staff euthanasia. The SPSS was used to analyze the data. Student t-test, ANOVA, Mann Whitney U, and Kruskal Wallis were used to evaluate the data. The p value 0.05 (95% confidence interval) was accepted as significant. In our study, professional groups are compared with all the factors but there is a significant difference only between social cost and professional groups.