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Gringart E, Adams C, Woodward F. Older Adults' Perspectives on Voluntary Assisted Death: An In-Depth Qualitative Investigation in Australia. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:1026-1046. [PMID: 35422170 DOI: 10.1177/00302228221090066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Interest in voluntary assisted death (VAD) has been growing among researchers, policy makers and the public. This study aimed to explore older adults' perspectives on VAD in Australia. Using purposive sampling, 15 adults ≥65 years participated in in-depth semi-structured interviews. Interpretative phenomenological analysis identified four themes: cultural reflections; beliefs and worldviews; health aspects; and fabric of life. Participants expressed a desire to have control over end-of-life options, challenged by religious beliefs. Participants expressed concern that VAD legislation could leave people vulnerable to coercion and saw a need for safeguards. Reasons for and against supporting and utilising VAD were discussed. Physical illness was seen a more compelling reason for VAD than mental ill-health. Finally, connections to life and other were discussed, and being able to do the things one loved were named aspects of what it meant to live a good life. Implications are discussed along with future research directions.
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Affiliation(s)
- Eyal Gringart
- School of Arts and Humanities, Edith Cowan University, Joondalup, WA, Australia
| | - Claire Adams
- School of Arts and Humanities, Edith Cowan University, Joondalup, WA, Australia
| | - Faye Woodward
- School of Arts and Humanities, Edith Cowan University, Joondalup, WA, Australia
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Komesaroff PA, Chapman M, Lamba G, Kerridge IH, Stewart CL, Holmes A, Lewis S, Philip J. Should voluntary assisted dying in Victoria be extended to encompass people with dementia? Med J Aust 2024; 220:452-454. [PMID: 38571369 DOI: 10.5694/mja2.52273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/22/2024] [Indexed: 04/05/2024]
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Graves T. Voluntary assisted dying in Queensland, the first year. Emerg Med Australas 2024; 36:326-328. [PMID: 38413383 DOI: 10.1111/1742-6723.14386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Timothy Graves
- Emergency Department, Bundaberg Base Hospital, Bundaberg, Queensland, Australia
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Scopetti M, Morena D, Padovano M, Manetti F, Di Fazio N, Delogu G, Ferracuti S, Frati P, Fineschi V. Assisted Suicide and Euthanasia in Mental Disorders: Ethical Positions in the Debate between Proportionality, Dignity, and the Right to Die. Healthcare (Basel) 2023; 11:healthcare11101470. [PMID: 37239756 DOI: 10.3390/healthcare11101470] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/27/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
The admission of people suffering from psychiatric and neurocognitive disorders to euthanasia and physician-assisted suicide (E/PAS) in some European and non-European countries represents a controversial issue. In some countries, the initial limitation of E/PAS to cases of severe physical illness with poor prognosis in the short term has been overcome, as it was considered discriminatory; thus, E/PAS has also been made available to subjects suffering from mental disorders. This decision has raised significant ethical questions regarding the capacity and freedom of self-determination; the family, social, and economic contexts; the social consideration of the sense of dignity and the pressure on the judgment of one's personal value; the contextual therapeutic possibilities; the identification of figures involved in the validation and application; as well as the epistemological definitions of the clinical conditions in question. To these issues must be added the situation of legislative vacuum peculiar to different countries and the widespread lack of effective evaluation and control systems. Nonetheless, pessimistic indicators on global health status, availability of care and assistance, aging demographics, and socioeconomic levels suggest that there may be further pressure toward the expansion of such requests. The present paper aims to trace an international overview with the aim of providing ethical support to the debate on the matter. Precisely, the goal is the delimitation of foundations for clinical practice in the complex field of psychiatry between the recognition of the irreversibility of the disease, assessment of the state of physical and mental suffering, as well as the possibility of adopting free and informed choices.
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Affiliation(s)
- Matteo Scopetti
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Donato Morena
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Martina Padovano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
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Asai A, Okita T, Shimakura Y, Tanaka M, Fukuyama M. Japan should initiate the discussion on voluntary assisted dying legislation now. BMC Med Ethics 2023; 24:5. [PMID: 36726120 PMCID: PMC9890417 DOI: 10.1186/s12910-023-00886-0] [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: 04/01/2022] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND No laws or official guidelines govern voluntary assisted dying (VAD) in Japan. A legislative bill on the termination of life-sustaining measures has yet to be sent to deliberations for legislation, due to strong opposition that has prevented it from being submitted to the Diet. However, Japan has recently witnessed several cases involving VAD. MAIN TEXT Against this backdrop, we argue that Japan should begin discussion on VAD legislation, referring to the Voluntary Assisted Dying Act 2017 (VADA2017), which was established in 2017 in Victoria, Australia. VADA2017 puts in place a wide range of stringent safeguards and is considered worldwide to be the safest and most conservative policy on a physician offering assisted dying based on the patient's premeditated request. We consider what opposing opinions from society would arise in response to the VADA2017. Among these will include arguments against VAD itself, those against the validation of this act, and opinions that oppose even the initiation of the dialogue on VAD. CONCLUSIONS We conclude that to protect the right to life among those placed in vulnerable positions and, at the same time, to respect decision-making of those who wish for immediate death due to unbearable suffering, the dialogue must immediately begin with that on introducing a policy more conservative than that of the VADA2017, which solidly considers arguments against VAD.
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Affiliation(s)
- Atsushi Asai
- grid.69566.3a0000 0001 2248 6943Department of Medical Ethics, Tohoku University Graduate School of Medicine, School of Public Health, 2-1 Seiryo, Aoba-Ku, Sendai, Miyagi 980-8575 Japan
| | - Taketoshi Okita
- grid.69566.3a0000 0001 2248 6943Department of Medical Ethics, Tohoku University Graduate School of Medicine, School of Public Health, 2-1 Seiryo, Aoba-Ku, Sendai, Miyagi 980-8575 Japan
| | - Yoko Shimakura
- grid.69566.3a0000 0001 2248 6943Department of Medical Ethics, Tohoku University Graduate School of Medicine, School of Public Health, 2-1 Seiryo, Aoba-Ku, Sendai, Miyagi 980-8575 Japan
| | - Masashi Tanaka
- grid.69566.3a0000 0001 2248 6943Department of Medical Ethics, Tohoku University Graduate School of Medicine, School of Public Health, 2-1 Seiryo, Aoba-Ku, Sendai, Miyagi 980-8575 Japan ,KARADA Internal Medicine Clinic, Tokyo, Japan ,grid.416239.bDivision of Clinical Epidemiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Miki Fukuyama
- grid.274841.c0000 0001 0660 6749Course of Nursing, Faculty of Life Sciences, Kumamoto University, Kumamoto City, Japan
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Hewitt J, Lawson C, Verrall B, Grealish L. Implementing voluntary assisted dying laws in healthcare: Exploring beliefs to identify implementation hurdles. Res Nurs Health 2023; 46:113-126. [PMID: 36538345 PMCID: PMC10107130 DOI: 10.1002/nur.22287] [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: 04/29/2022] [Revised: 11/20/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
The number of countries introducing voluntary assisted dying (VAD) laws is increasing. Actively taking steps to end a person's life is contentious so implementing these laws into healthcare services presents unique challenges. Theoretically underpinned by the Advocacy Coalition Framework, this study identified the beliefs of classes of stakeholders who engaged with the parliamentary process associated with the introduction of VAD laws in Queensland, Australia. Submissions about VAD made to a parliamentary inquiry were allocated to a class and qualitatively analysed to identify underlying beliefs. The data were then subjected to statistical analysis including nonmetric dimensional scaling and one-way analysis of similarity. Data visualisation techniques were used to generate a chord map and heatmap, to identify the belief types, as well as similarities and differences between beliefs and among classes. Fourteen different beliefs were identified in the 91 reviewed submissions. Six were deep core beliefs and eight were policy core beliefs. Beliefs could be associated with a positive or negative sentiment toward VAD. In this study, the class of Health Services expressed more negative sentiments to VAD than neutral or positive sentiments. The sentiments expressed by the class of Health Professionals were equally divided between positive, neutral and negative. These findings provide important insights for implementors as laws become operational. In particular, for organisations that provide health services, clear articulation of their stance in relevant policy and guidance documents is recommended.
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Affiliation(s)
- Jayne Hewitt
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- Griffith Law SchoolGriffith UniversityQueenslandAustralia
| | - Charles Lawson
- Griffith Law SchoolGriffith UniversityQueenslandAustralia
| | - Brodie Verrall
- Centre for Planetary Health and Food SecurityGriffith UniversityQueenslandAustralia
| | - Laurie Grealish
- Gold Coast University HospitalQueenslandAustralia
- Menzies Health Institute QueenslandGriffith UniversityQueenslandAustralia
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De Hert M, Thys E, Catthoor K, Van den Broeck K, Matthys F, Vansteelandt K, Detraux J. Media coverage of Belgium's first criminal case concerning euthanasia for psychiatric patients: A content analysis of Flemish newspapers and magazines. Front Psychiatry 2022; 13:1050086. [PMID: 36684025 PMCID: PMC9845880 DOI: 10.3389/fpsyt.2022.1050086] [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: 09/21/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Belgium is one of the few countries worldwide where euthanasia on the grounds of unbearable suffering caused by a psychiatric disorder is legally possible. In April 2010 euthanasia was carried out on a 38-year-old Belgian woman with borderline personality disorder and/or autism. After a complaint by the family, three physicians were referred to the Court of Assizes on the charge of "murder by poisoning". METHODS A content analysis of print and online news coverage of the euthanasia case in a selected sample of Flemish newspapers and magazines, published between December 1, 2019 and March 1, 2020, was conducted to analyze the prominence and framing of the euthanasia case, as well as the portrayal of key figures in this case. A quantitative analysis, as well as an in-depth qualitative analysis (with the aid of NVivo 1.0 software) was performed. RESULTS One thousand two hundred fifteen news articles were identified through database searching. Of these, 789 articles were included after screening for relevance and eligibility. Mean prominence scores were moderate and did not statistically significantly differ between newspapers with a different historical ideological background or form (elite versus popular). The most frequent headline topics featured legal aspects (relating to the Belgian Euthanasia Law or the course of the trial). Headlines and content of most articles (90 and 89%, respectively) did not contain an essential standpoint on the euthanasia case itself or, if they did, were neutral. Historical ideological background, nor form of newspaper (elite versus popular) significantly influenced headline tone or article direction toward the euthanasia case. Despite this, our qualitative analysis showed some subtle differences in selection, statement or tonality of reports between certain newspapers with a different historical ideological background. CONCLUSION Although major Flemish newspapers and magazines generally were neutral in their coverage of the judicial case, major points of contention discussed were: the need for an evaluation and possible amendments to the existing Euthanasia Law, including a revision of the Belgian Control Commission and the system of penalties for physicians, and the absence of any consensus or guidance on how to define psychological suffering.
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Affiliation(s)
- Marc De Hert
- University Psychiatric Center KU Leuven, Leuven, Belgium.,Department of Biomedical Sciences, Research Group Psychiatry, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium.,Antwerp Health Law and Ethics Chair - AHLEC University Antwerpen, Antwerp, Belgium
| | - Erik Thys
- Psycho-Sociaal Centrum, St.-Alexius-Elsene Vzw, Ixelles, Belgium
| | - Kirsten Catthoor
- Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium.,The Collaborative Antwerp Psychiatric Research Institute (CAPRI) and Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.,Flemish Psychiatric Association, Kortenberg, Belgium
| | - Kris Van den Broeck
- The Collaborative Antwerp Psychiatric Research Institute (CAPRI) and Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.,Flemish Psychiatric Association, Kortenberg, Belgium
| | - Frieda Matthys
- Flemish Psychiatric Association, Kortenberg, Belgium.,Department of Psychiatry, University Hospital Brussels, Brussels, Belgium
| | - Kristof Vansteelandt
- Department of Biomedical Sciences, Research Group Psychiatry, KU Leuven, Leuven, Belgium
| | - Johan Detraux
- Department of Biomedical Sciences, Research Group Psychiatry, Public Health Psychiatry, KU Leuven, Leuven, Belgium
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