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Rahimian Z, Rahimian L, Lopez‐Castroman J, Ostovarfar J, Fallahi MJ, Nayeri MA, Vardanjani HM. What medical conditions lead to a request for euthanasia? A rapid scoping review. Health Sci Rep 2024; 7:e1978. [PMID: 38515545 PMCID: PMC10955044 DOI: 10.1002/hsr2.1978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
Background and Aims Euthanasia is a controversial issue related to the right to die. Although euthanasia is mostly requested by terminally sick individuals, even in societies where it is legal, it is unclear what medical conditions lead to euthanasia requests. In this scoping review, we aimed to compile medical conditions for which euthanasia has been requested or performed around the world. Methods The review was preferred reporting items for systematic reviews and meta-analysis for scoping reviews (PRISMA-ScR) checklist. Retrieved search results were screened and unrelated documents were excluded. Data on reasons for conducting or requesting euthanasia along with the study type, setting, and publication year were extracted from documents. Human development index and euthanasia legality were also extracted. Major medical fields were used to categorize reported reasons. Group discussions were conducted if needed for this categorization. An electronic search was undertaken in MEDLINE through PubMed for published documents covering the years January 2000 to September 2022. Results Out of 3323 records, a total of 197 papers were included. The most common medical conditions in euthanasia requests are cancer in a terminal phase (45.4%), Alzheimer's disease and dementia (19.8%), constant unbearable physical or mental suffering (19.8%), treatment-resistant mood disorders (12.2%), and advanced cardiovascular disorders (12.2%). Conclusion Reasons for euthanasia are mostly linked to chronic or terminal physical conditions. Psychiatric disorders also lead to a substantial proportion of euthanasia requests. This review can help to identify the features shared by conditions that lead to performing or requesting euthanasia.
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Affiliation(s)
- Zahra Rahimian
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
- MD‐MPH Department, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Leila Rahimian
- School of DentistryShiraz University of Medical SciencesShirazIran
| | - Jorge Lopez‐Castroman
- Department of Psychiatry, CHU Nîmes & IGFCNRS‐INSERMUniversity of MontpellierMontpellierFrance
- CIBERSAMMadridSpain
| | - Jeyran Ostovarfar
- MD‐MPH Department, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Mohammad J. Fallahi
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical SciencesShirazIran
| | - Mohammad A. Nayeri
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
- MD‐MPH Department, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Hossein M. Vardanjani
- MD‐MPH Department, School of Medicine, Research Center for Traditional Medicine and History of MedicineShiraz University of Medical SciencesShirazIran
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Mathieu-Nicot F, Chassagne A, Leboul D, Bousquet A, Trimaille H, Guirimand F, Godard-Marceau A, Bondier M, Cretin E, Aubry R. Euthanasia and assisted suicide requests of end-of-life patients hospitalised in palliative care units: A qualitative wording analysis study. MÉDECINE PALLIATIVE 2022. [DOI: 10.1016/j.medpal.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Liu YJ, Li XY, Wang YJ, Li XH. Dignity in nursing: A bibliometric and visual analysis of scientific publications. Scand J Caring Sci 2022; 37:384-396. [PMID: 36050888 DOI: 10.1111/scs.13118] [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: 01/27/2022] [Revised: 06/24/2022] [Accepted: 08/08/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Dignity-conserved nursing has been widely studied by scholars all over the world; however, there is no clear direction in which this field is trending. AIM To conduct a bibliometric analysis that systematically characterises publications on dignity research in the nursing field from 2011 to 2020. DESIGN Bibliometric and visual analysis of retrieved articles. METHODS The Web of Science Core Collection database was used to retrieve all articles which addressed dignity in nursing from 2011 to 2020. The WoSCC's own analysis tool, CiteSpace and VOSviewer, were used to obtain visual analysis results. Reporting follows the STROBE checklist. RESULTS A total of 1429 papers on dignity care are included in this study. We found that the number of papers on this topic increased steadily, and the United States topped the list with 366 articles in total. The institute with the most publications was King's College London, and the most widely published journal was Nursing Ethics. We were able to identify four major research topics, namely dignity in: (a) palliative care, (b) dementia and the elderly, (c) health care and (d) nursing ethics. Terminally ill patient, home, value, rehabilitation and psychological distress were the five keywords with the highest burst strength. CONCLUSIONS The interest in dignity care research has been steadily increasing from 2011 and is reflected in the number of published papers. The United States and Western Europe are leading in this field, both having a high number of cutting-edge researchers and high-level scientific research institutions. In the domain of dignity care, several stable and high-yield core author groups have been formed. While the existing research mainly focuses on four hot spots, psychological distress, advanced cancer, maternity care and content analysis may be the research frontiers.
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Affiliation(s)
- Yu-Jia Liu
- School of Nursing, China Medical University, Shenyang, China
| | - Xue-Ying Li
- School of Nursing, China Medical University, Shenyang, China
| | - Yan-Jie Wang
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Xiao-Han Li
- School of Nursing, China Medical University, Shenyang, China
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Oosterveld-Vlug MG, de Vet HC, Pasman HRW, van Gennip IE, Willems DL, Onwuteaka-Philipsen BD. Which characteristics of nursing home residents relate to factors influencing their dignity? Geriatr Nurs 2016; 37:365-370. [DOI: 10.1016/j.gerinurse.2016.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/02/2016] [Accepted: 05/07/2016] [Indexed: 10/21/2022]
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Evans N, Pasman HRW, Deeg DJH, Onwuteaka-Philipsen BD. Older Dutch People's Self-Reported Advance Euthanasia Directive Completion Before and After the Enactment of the Euthanasia Law: A Time Trend Study (1998-2011). J Am Geriatr Soc 2016; 63:2217-9. [PMID: 26480999 DOI: 10.1111/jgs.13697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Natalie Evans
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
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Zenz J, Tryba M, Zenz M. Physician-Assisted Dying: Acceptance by Physicians Only for Patients Close to Death. Pain Ther 2014; 3:103-12. [PMID: 25501920 PMCID: PMC4269613 DOI: 10.1007/s40122-014-0029-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Indexed: 02/03/2023] Open
Abstract
This study reports on German physicians' views on legalization of euthanasia and physician-assisted suicide, comparing this with a similar survey of UK doctors. A questionnaire was handed out to attendants of a palliative care and a pain symposium. Complete answers were obtained from 137 physicians. Similar to the UK study, about 30% of the physicians surveyed support euthanasia in case of terminal illness and more support physician-assisted suicide. In contrast, in both countries, a great majority of physicians oppose medical involvement in hastening death in non-terminal illnesses. The public and parliamentary discussion should face this opposition to assisted suicide by pain and palliative specialists.
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Affiliation(s)
- Julia Zenz
- Ruhr-University Bochum, Kemnaderstr. 342, 44797 Bochum, Germany
| | - Michael Tryba
- Clinic for Anaesthesiology, Intensive Care and Pain Medicine, Moenchebergstraße 41-43, 34125 Kassel, Germany
| | - Michael Zenz
- Ruhr-University Bochum, Henkenbergstr. 63, 44797 Bochum, Germany
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Shah A, Mushtaq A. The right to live or die? A perspective on voluntary euthanasia. Pak J Med Sci 2014; 30:1159-60. [PMID: 25225548 PMCID: PMC4163254 DOI: 10.12669/pjms.305.5777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/25/2014] [Indexed: 11/15/2022] Open
Abstract
"It is choice alone that is being honored, without regards for what is chosen." The debate on euthanasia in medical community stays unresolved. In this manuscript, we present arguments for and against euthanasia, review arguments from both the sides and conclude it with our opinion.
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Affiliation(s)
- Amber Shah
- Amber Shah, Final Year Medical Student, Sind Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ammara Mushtaq
- Ammara Mushtaq, Final Year Medical Student, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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8
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Evans N, Costantini M, Pasman HR, Van den Block L, Donker GA, Miccinesi G, Bertolissi S, Gil M, Boffin N, Zurriaga O, Deliens L, Onwuteaka-Philipsen B. End-of-life communication: a retrospective survey of representative general practitioner networks in four countries. J Pain Symptom Manage 2014; 47:604-619.e3. [PMID: 23932176 DOI: 10.1016/j.jpainsymman.2013.04.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 04/22/2013] [Accepted: 05/02/2013] [Indexed: 11/25/2022]
Abstract
CONTEXT Effective communication is central to high-quality end-of-life care. OBJECTIVES This study examined the prevalence of general practitioner (GP)-patient discussion of end-of-life topics (according to the GP) in Italy, Spain, Belgium, and The Netherlands and associated patient and care characteristics. METHODS This cross-sectional, retrospective survey was conducted with representative GP networks. Using a standardized form, GPs recorded the health and care characteristics in the last three months of life, and the discussion of 10 end-of-life topics, of all patients who died under their care. The mean number of topics discussed, the prevalence of discussion of each topic, and patient and care characteristics associated with discussions were estimated per country. RESULTS In total, 4396 nonsudden deaths were included. On average, more topics were discussed in The Netherlands (mean=6.37), followed by Belgium (4.45), Spain (3.32), and Italy (3.19). The topics most frequently discussed in all countries were "physical complaints" and the "primary diagnosis," whereas "spiritual and existential issues" were the least frequently discussed. Discussions were most prevalent in The Netherlands, followed by Belgium. The GPs from all countries tended to discuss fewer topics with older patients, noncancer patients, patients with dementia, patients for whom palliative care was not an important treatment aim, and patients for whom their GP had not provided palliative care. CONCLUSION The prevalence of end-of-life discussions varied across the four countries. In all countries, training priorities should include the identification and discussion of spiritual and social problems and early end-of-life discussions with older patients, those with cognitive decline if possible, and those with non-malignant diseases.
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Affiliation(s)
- Natalie Evans
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Massimo Costantini
- Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy
| | - H R Pasman
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Lieve Van den Block
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - Gé A Donker
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Guido Miccinesi
- Clinical and Descriptive Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy
| | | | - Milagros Gil
- Public Health Directorate, Ministry of Health, Castille and León, Spain
| | - Nicole Boffin
- Scientific Institute of Public Health, Brussels, Belgium
| | - Oscar Zurriaga
- Public Health and Research General Directorate, Valencian Regional Health Administration, Valencia, Spain; Higher Public Health Research Centre, Valencia, Madrid, Spain; Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
| | - Luc Deliens
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands; End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - Bregje Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
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Pols H, Oak S. Physician-assisted dying and psychiatry: recent developments in The Netherlands. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2013; 36:506-514. [PMID: 23816378 DOI: 10.1016/j.ijlp.2013.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The Netherlands was one of the first countries in the world to establish a legal framework for physician-assisted dying (PAD). In this article, we provide an overview of the public, political, legal, and medical debates on physician-assisted dying in The Netherlands, focusing on the role of psychiatry and mental illness. The number of individuals with chronic mental illness requesting PAD has been relatively small (although the number can be expected to increase because of the activities of various civic organizations advocating the right to die) and Dutch psychiatrists have been extremely reluctant to respond to such requests. Nevertheless, mental conditions have been central to the public debate on PAD by helping to define the nature and limits of current legislation and professional practice. Although a few Dutch psychiatrists have campaigned to increase the involvement of psychiatrists and many support PAD in principle, the majority has been hesitant to engage in PAD despite increasing public pressure.
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Affiliation(s)
- Hans Pols
- Unit for History and Philosophy of Science, Carslaw F07, University of Sydney, NSW 2006, Australia.
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10
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Evans N, Pasman HR, Vega Alonso T, Van den Block L, Miccinesi G, Van Casteren V, Donker G, Bertolissi S, Zurriaga O, Deliens L, Onwuteaka-Philipsen B. End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments. PLoS One 2013; 8:e57965. [PMID: 23472122 PMCID: PMC3589464 DOI: 10.1371/journal.pone.0057965] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 01/29/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Making treatment decisions in anticipation of possible future incapacity is an important part of patient participation in end-of-life decision-making. This study estimates and compares the prevalence of GP-patient end-of-life treatment discussions and patients' appointment of surrogate decision-makers in Italy, Spain, Belgium and the Netherlands and examines associated factors. METHODS A cross-sectional, retrospective survey was conducted with representative GP networks in four countries. GPs recorded the health and care characteristics in the last three months of life of 4,396 patients who died non-suddenly. Prevalences were estimated and logistic regressions were used to examine between country differences and country-specific associated patient and care factors. RESULTS GP-patient discussion of treatment preferences occurred for 10%, 7%, 25% and 47% of Italian, Spanish, Belgian and of Dutch patients respectively. Furthermore, 6%, 5%, 16% and 29% of Italian, Spanish, Belgian and Dutch patients had a surrogate decision-maker. Despite some country-specific differences, previous GP-patient discussion of primary diagnosis, more frequent GP contact, GP provision of palliative care, the importance of palliative care as a treatment aim and place of death were positively associated with preference discussions or surrogate appointments. A diagnosis of dementia was negatively associated with preference discussions and surrogate appointments. CONCLUSIONS The study revealed a higher prevalence of treatment preference discussions and surrogate appointments in the two northern compared to the two southern European countries. Factors associated with preference discussions and surrogate appointments suggest that delaying diagnosis discussions impedes anticipatory planning, whereas early preference discussions, particularly for dementia patients, and the provision of palliative care encourage participation.
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Affiliation(s)
- Natalie Evans
- Department of Public and Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.
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Recognising patients who will die in the near future: a nationwide study via the Dutch Sentinel Network of GPs. Br J Gen Pract 2011; 61:e371-8. [PMID: 21801517 DOI: 10.3399/bjgp11x578052] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Recognising patients who will die in the near future is important for adequate planning and provision of end-of-life care. GPs can play a key role in this. AIM To explore the following questions: How long before death do GPs recognise patients likely to die in the near future? Which patient, illness, and care-related characteristics are related to such recognition? How does recognising death in the near future, before the last week of life, relate to care in during this period? DESIGN AND SETTING One-year follow-back study via a surveillance GP network in the Netherlands. METHOD Registration of demographic and care-related characteristics. RESULTS Of 252 non-sudden deaths, 70% occurred in the home or care home and 30% in hospital. GP recognition of death in the near future was absent in 30%, and occurred prior to the last month in 15%, within the last month in 19%, and in the last week in 34%. Logistic regression analyses showed cancer and low functional status were positively associated with death in the near future; cancer and discussing palliative care options were positively associated with recognising death in the near future before the last week of life. Recognising death in the near future before patients' last week of life was associated with fewer hospital deaths, more GP-patient contacts in the last week, more deaths in a preferred place, and more-frequent GP-patient discussions about specific topics in the last 7 days of life. CONCLUSION Recognising death in the near future precedes several aspects of end-of-life care. The proportion in whom death in the near future is never recognised is large, suggesting GPs could be assisted in this process through training and implementation of care protocols that promote timely recognition of the dying phase.
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Abarshi E, Echteld MA, Van den Block L, Donker G, Bossuyt N, Meeussen K, Bilsen J, Onwuteaka-Philipsen B, Deliens L. Use of palliative care services and general practitioner visits at the end of life in The Netherlands and Belgium. J Pain Symptom Manage 2011; 41:436-48. [PMID: 20832983 DOI: 10.1016/j.jpainsymman.2010.04.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 04/09/2010] [Accepted: 04/20/2010] [Indexed: 10/19/2022]
Abstract
CONTEXT At the end of life, some personalized and specialized care is required. The way that general practitioner (GP) visits and palliative care services at the end of life are organized in different countries may impact the frequency of care provision. However, nationwide data on the prevalence of these interventions and comparisons among countries are scarce. OBJECTIVES To compare the frequency of GP visits and use of palliative care services at the end of life in two European countries and identify the associated factors. METHODS In 2007, two mortality follow-back studies were conducted simultaneously in The Netherlands and Belgium, using existing Sentinel GP networks and similar standardized procedures. Within the one-year period, all registered patients who died at home or in a care home were selected. RESULTS From the data of 543 registered patients, GP visits were more frequent at the end of life in The Netherlands than in Belgium: the mean number of GP visits in the last week of life was 5.1 vs. 3.2 (home) and 4.4 vs. 2.3 (care home). Conversely, palliative care services in the last three months of life were used more frequently in Belgium than in The Netherlands: 78% vs. 41% (home) and 39% vs. 5% (care homes). The differences between countries remained consistent despite correcting for possible confounders. Having more frequent GP visits at home was associated with cancer-related deaths both in The Netherlands and Belgium. CONCLUSION Independent of the differences in patient populations (at home and care home) between countries, there are more frequent GP visits at the end of life in The Netherlands and greater use of palliative care services in Belgium.
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Affiliation(s)
- Ebun Abarshi
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Kimsma GK. Death by request in The Netherlands: facts, the legal context and effects on physicians, patients and families. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2010; 13:355-61. [PMID: 20668949 PMCID: PMC2949557 DOI: 10.1007/s11019-010-9265-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards euthanasia or physician-assisted suicide. This article does not focus on the arguments for or against euthanasia and the ethical justification of physician-assisted dying. These arguments have been described extensively in Kimsma and Van Leeuwen (Asking to die. Inside the Dutch debate about euthanasia, Kluwer Academic Publishers, Dordrecht, 1998).
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Affiliation(s)
- G K Kimsma
- Vrije Universiteit Medical Center, Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
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Abstract
Pain and symptom management at the end of life remains suboptimal.Pain physicians are uniquely placed to provide interventions for patients with difficult to manage pain.Interventions such as acupuncture, radiofrequency ablation, neurolysis together with regional analgesia including neuraxial techniques and spinal cordotomy may provide the patient with improved analgesia.
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Affiliation(s)
- Michael Platt
- Consultant in Pain Medicine and Anaesthesia Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY
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