Top PDF Palliative care professionals’ willingness to perform euthanasia or physician assisted suicide

Palliative care professionals’ willingness to perform euthanasia or physician assisted suicide

Palliative care professionals’ willingness to perform euthanasia or physician assisted suicide

A recent study among German physicians showed that already now without legalization of PAS or euthanasia both practices are performed by a minority [43]. This holds also true for members of the German Society for Palliative Care [38]. These findings are based on the EURELD-questionnaire, which focused on physicians’ and their colleagues’ experiences with patients that died within the last 12 months [33]. However, this question- naire combines questions regarding euthanasia or PAS—which are currently illegal - with questions regard- ing established end of life care measures such as “with- drawing”, “withholding”, or “intensifying” treatment thus making answers dubious. Several studies have demon- strated that physicians have difficulties in discriminat- ing between euthanasia and palliative sedation or euthanasia and intensified pain relief and lack know- ledge regarding the procedure [19, 44–46]. Unlike the Eureld-questionnaire we used concrete patient vi- gnettes to explore the willingness to act thus allowing a clear insight into the physicians’ willingness to actively end their patient’s life.
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Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study

Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study

The reported cases in 2005 represent a substantial amount (80%) of all euthanasia cases in the Netherlands in that year; studying the files therefore gives important insight in the practice of euthanasia [34]. Physicians substantiate the information provided to the patient and the perform- ance of euthanasia in a rather straightforward and uni- form way, but their substantiation is more variable for the patient's request, the patient's suffering, the absence of reasonable alternatives and the consultation. The varia- tion we found is firstly due to variation in clinical situa- tions, in particular with regard to the patient's suffering and the absence of reasonable alternatives. However, what physicians report may also be influenced by differ- ences in knowledge of and viewpoints on euthanasia and the Euthanasia Act, and by uncertainty about how to deal with these criteria. It should be stressed that problems with the interpretation of some criteria of due care are not necessarily a negative finding. In the Act, criteria related to the patient's request, the patient's suffering, and the absence of reasonable alternatives are purposefully framed in open general terms. As such, the Act allows phy- sicians and review committees to newly interpret the crite- ria in every new case, taking into account the specific circumstances of that case. Furthermore, the questions in the standard form concern both specific closed questions that call for straightforward answers, and open questions that often result in more variable answers. The standard form may thus also influence physicians' reports on the criteria of due care. It seems that there is room for improvement of this form, especially for questions con- cerning the reasonableness of the alternatives, and the independence of the consultation. For treatment alterna- tives for instance, the question should be formulated more clearly to be able to assess whether these alternatives were considered 'reasonable' by the physician him- or her- self. Recently, (June 2009), a new report form has become available [35]; the impact of these changes (which are partly in accordance with our recommendations) need to be awaited and studied.
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Washington v. Glucksberg: Influence of the Court in Care of the Terminally Ill and Physician Assisted Suicide

Washington v. Glucksberg: Influence of the Court in Care of the Terminally Ill and Physician Assisted Suicide

H.R. R EP . N O . 106-378, Part II, supra note 258, at 10 (The Act defines palliative care as the active, total care of patients whose disease or medical condition is not responsive to curative treatment or when the prognosis is limited to advanced stages of the disease. Under the Act, the goal of such care is to alleviate pain and other distressing symptoms of the disease, provide for enhancement of the quality of life for the patient while not hastening death. The Pain Promotion Relief Act directs the establishment of a program to develop and advance scientific understanding of palliative care with the collection and advance scientific understanding of palliative care. The bill also authorizes the collection and dissemination of palliative care protocols to public and private health care programs. The Act further authorizes the Secretary of Health and Human Services to award grants for the development and implementation of programs to provide education and training to professionals in palliative care. The legislation effectively packages needed palliative care legislation for use of controlled substances in pain management with a provision which will kill the Oregon experiment in assisted suicide.).
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The involvement of family in the Dutch practice of euthanasia and physician assisted suicide: a systematic mixed studies review

The involvement of family in the Dutch practice of euthanasia and physician assisted suicide: a systematic mixed studies review

This review raises the question how important family-related reasons are for Dutch patients who con- sider requesting euthanasia or assisted suicide, and how this should be studied. A relationship between the wish to hasten death and witnessing the suffering of others [99] or the feeling of being a burden [100] has been reported before. A recent review on the experiences of patients with a wish to hasten death also described how social-relational factors could be a source of suffering and a reason for expressing a wish to hasten death [101]. However, these social factors were among a range of sources of suffering like physical, psychological and existential factors, and among other reasons for and meanings of the wish to hasten death. Still, the results of this review raise some questions. The presence of family-related reasons in qualitative studies contrasts with the relative absence of them in quantitative studies on reasons for EAS, as recounted by physicians. This is perhaps just a consequence of methodological factors such as study type, included patients/cases, or the stage of decision-making. It may also reflect the physicians’ reluctance to perform EAS on social indication. On the other hand, we may wonder whether physicians recognize family-related reasons or social-relational origins of suffering, and whether patients feel free to speak about it when they have an explicit request for EAS. New qualitative studies with ethnographic or narrative approaches could shed light on how requests for EAS develop over time and in mutual interaction between patients, their significant others and professional care- givers. This approach might also be better suited to identify any cultural, political and existential views that may lie behind requests for EAS [102].
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STUDENTS� CORNER ORIGINAL ARTICLE Knowledge and attitude regarding Euthanasia among medical students in the public and private medical schools of Karachi

STUDENTS� CORNER ORIGINAL ARTICLE Knowledge and attitude regarding Euthanasia among medical students in the public and private medical schools of Karachi

Results: Out of the 493 students, 226 (46%) were from the matriculation system and 194 (39%) from the Cambridge system, while the remaining 15% were from the American High School. The male-female ratio was 1:3. There were 284 (58%) students from the private medical college. Majority of the private medical school students (n=284; 99.6%) knew about euthanasia, compared to the public-sector facility where only 161 (77%) knew of it. Of the total, 405 (82%) students agreed that it is physician-assisted suicide; 255 (52%) agreed to the idea of palliative care, claiming it was sufficient to maintain life; 226 (54%) disagreed that a doctor should not be allowed to administer a lethal dose while only 162 (33%) agreed to the idea of it; 285 (58%) disagreed that a law regarding the practice of euthanasia should not be introduced, whereas 134 (27%) agreed to it; 70 (14%) agreed to the practice of euthanasia, while 311 (63%) disagreed, mostly for religious reasons.
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When is hastened death considered suicide? A systematically conducted literature review about palliative care professionals’ experiences where assisted dying is legal

When is hastened death considered suicide? A systematically conducted literature review about palliative care professionals’ experiences where assisted dying is legal

A theme identified in the literature is that there are both challenges and opportunities to speak openly about issues of suicide among professionals of the same or dif- ferent disciplines and between professionals and those they serve [36, 50, 52–54, 57]. The included articles suggest that with assisted dying there is a tendency to view professionals’ conversations with patients as oppor- tunities to discuss what is relevant and important to the patient, thus improving end-of-life care. Studies of physicians assert that passage of the laws is associated with an increased sense of responsibility to provide optimal palliative care and serves as an opening for com- munication on important end of life issues [61]. Ganzini et al. [38] suggest that since passage of the DWDA in Oregon, physicians have increased referrals and access to hospice care, but relationships may have been altered when a physician does not agree to prescribe lethal med- ications. A Swiss study of physicians indicates that while few agree to prescribe lethal medications they assume a responsibility to discuss the origin of the patient’s re- quest and seek alternatives to assisted suicide [28].
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Euthanasia and assisted suicide: a physician’s and ethicist’s perspectives

Euthanasia and assisted suicide: a physician’s and ethicist’s perspectives

Another strategy to whitewash “death talk” is to figuratively wrap it within the white coat of medicine. Cloaking these acts in medical terms softens them and confers legitimacy. This has spawned a host of euphemisms such as “medically assisted death”, “medical-aid-in-dying”, and “death with dignity”. After all, we all want good medi- cal care when we are dying. A strategy that may escape scrutiny is to link assisted suicide with physicians; that is, PAS. However, assisted suicide and euthanasia are not necessarily glued to physicians. Nurses could perform these procedures, although most recoil at the prospect. In theory, almost anyone (ambulance drivers, veterinarians, pharmacists, lawyers) could be empowered and trained to euthanize. We have argued elsewhere that if society is going to legalize euthanasia (which we oppose it doing), it could equip itself with a new occupation of euthanology, 23
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Euthanasia and physician assisted suicide in patients suffering from psychiatric disorders: a cross sectional study exploring the experiences of Dutch psychiatrists

Euthanasia and physician assisted suicide in patients suffering from psychiatric disorders: a cross sectional study exploring the experiences of Dutch psychiatrists

Of the 500 selected psychiatrists, 75 did not meet the selec- tion criteria after all. Of the remaining 425 psychiatrists, 207 responded (response 49%). Some non-responders (29 of the 218) sent a response card providing the reason for not participating: lack of time ( n = 18), no experience with receiving EAS requests or performing EAS ( n = 9) and principal objections to EAS ( n = 2). No psychiatrists re- ported to have turned down a request due to lack of famil- iarity with the process or law. Of the 207 responding psychiatrists, 72.8% worked in a private practice, 29.6% in a mental health facility, 11.1% on a psychiatric ward in a general hospital, and 12.3% in another place (more than one answer possible). The mean age was 52 years (range 31–77). Sixty percent was male and 44% indi- cated that they were religious. The average years of work experience was 17 (range 1–45). Seven psychia- trists received training in palliative care and four were specially trained for the role of independent consultant in the EAS procedure (SCEN-physician).
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End of lifeExpert care and support, not physician‐hastened death

End of lifeExpert care and support, not physician‐hastened death

unless they know their patients well. Guidelines in juris- dictions allowing LPHD are intended to prevent events like the one described in the brief report 11 that sparked the dis- cussion on euthanasia in the late 1980s, in which a US gy- necology resident killed a young woman he had met for the first time only a few minutes before while on rounds that evening. Regarding the role of physicians in LPHD, data from LPHD‐legal jurisdictions are illuminating. From 2000, when coding of prescribers began, through 2016, 374 physicians in Oregon (fewer than 4% of all licensed physicians in the state) wrote prescriptions for assisted suicide, with 110 writing 2 to 5 prescriptions, 24 writing 6 to 19, and 10 writing more than 20 prescriptions. 12 LPHD seems to cluster around a small group of physicians, either because these physicians are more likely to suggest the practice of LPHD or because patients requesting LPHD are referred to them. If these physicians initiate the recommendation for LPHD to their patients, then these physicians become the main drivers of LPHD, regard- less of their patients’ acquiescence. If patients are referred to these providers with whom they do not have a preexisting relationship, they may find themselves in the care of physi- cians who are unaware of issues that an ongoing relationship would clarify. With LPHD the same physician is both healer and agent of death, roles that are fundamentally conflicted and irreconcilable. Society should not condone suicide or killing by anyone, especially not at the hands of physicians. To preserve patients’ safety, professionals entrusted with healing should not perform functions intended to cause death.
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Psychosocial determinants of physicians’ intention to practice euthanasia in palliative care

Psychosocial determinants of physicians’ intention to practice euthanasia in palliative care

Another ethical principle that had a significant impact on physicians’ intention to practice euthanasia was pa- tients’ autonomy. This was assessed by using the two versions of the questionnaire. When physicians answered the questionnaire in which the patient had requested euthanasia (version A), their motivation to perform this act was much greater compared to those who completed the questionnaire in which the patient’s wishes were not known (version B). In fact, knowing or not knowing the patient’s wishes was the main determinant of physicians’ intention to practice euthanasia. In addition, the behav- ioral belief underlying their cognitive attitude was that performing euthanasia would honor the patient’s wishes. Again, the score on this item was related to the version of questionnaire received. More physicians who received the questionnaire in which the patient’s wishes were known agreed with this item compared to the physicians who received the other version. Overall, these results indicate that the main reason why physicians would be motivated to practice euthanasia would be to respect pa- tients’ autonomy, by fulfilling their wish to die by a lethal injection. Similarly, in a previous review of European physicians’ attitudes towards euthanasia and physician- assisted suicide, the right of the patient to decide about his/her own life and death was one reason why they men- tioned being in favor of euthanasia [13]. Still, it is import- ant to note that almost one third of the physicians (32.2%) in our sample intended to practice euthanasia in the ab- sence of the patient’s wishes. This clearly emphasizes the importance of carefully controlling this practice, and to some extent, the validity of the slippery slope argument.
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How does legalization of physician assisted suicide affect rates of suicide?

How does legalization of physician assisted suicide affect rates of suicide?

The evidence from suicide rates in states that have legalized PAS is not consistent with Posner’s conjecture that such legal changes would lead to delays in, and net reductions in, suicide. Rather, the introduction of PAS seemingly induces more self-inflicted deaths than it inhibits. Furthermore, while a significant proportion of non-assisted suicides involve chronic or terminal illness, especially in the over 65s, the available evidence does not support the conjecture that legalising assisted suicide would lead to a reduction in non-assisted suicides. This suggests either that PAS does not inhibit (nor acts as an alternative to) non-assisted suicide, or that it acts in this way in some individuals but is associated with an increased inclination to suicide in other individuals.
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Physician Assisted Suicide: A Constitutional Crisis Resolved

Physician Assisted Suicide: A Constitutional Crisis Resolved

By the time the Court decided Roe v. Wad in 1973, Harlan's use of substantive due process adjudication to rein in legislative devi- ations from our tradition of res[r]

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Disability, vulnerability and assisted death: commentary on Tuffrey-Wijne, Curfs, Finlay and Hollins

Disability, vulnerability and assisted death: commentary on Tuffrey-Wijne, Curfs, Finlay and Hollins

While there are many disturbing questions raised by the Tagert and Foley cases, for our purposes the key issue, as with Rolland and Truchon, is the risk EAS poses to disabled persons when disability supports which would allow them to live a life they consider worth living are not readily available. This risk is arguably heighten in the context of austerity and concern with rising health and social care cost. While Foley has chosen to speak out and fight for what he see as his right, one must question how many other people with disabilities like Sean Tagert, out of despair, a lack of knowledge about other options or simply because they are weary of the struggle, will quietly chose to die by EAS.
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Survey of doctors' opinions of the legalisation of physician assisted suicide

Survey of doctors' opinions of the legalisation of physician assisted suicide

The proposed change in the law would affect the working practices of many senior doctors in England and Wales, but there are few peer-reviewed studies of their views. The most recent, published in 2006, surveyed the views of GPs in Wales. The response rate was 65%, the number responding was 1202, and 62% of these opposed a change in the law to allow physician assisted suicide [19]. In 1999 an attempt was made to survey all 742 members of the British Geriatrics Society and all 820 members of the Intensive Care Society. Participants were asked about their views on legalisation of assisted suicide and voluntary euthanasia, but only their opinions on the legalisation of active voluntary euthanasia were published. Eighty per- cent of geriatricians and 52% of intensive care doctors considered the deliberate administration of a treatment intended to kill as unjustified in any circumstance. The response rates were 45% and 37% in the two groups [20]. The views of the geriatricians from this survey had previ- ously been published separately [21]. In 1998, 322 (72%
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Intervention for depression among palliative care patients and their families: A study protocol for evaluation of a training program for professional care staff

Intervention for depression among palliative care patients and their families: A study protocol for evaluation of a training program for professional care staff

Due to the sensitive nature of research in the palliative care setting no data will be collected directly from patients. Outcomes for patients and their family mem- bers will be measured via two methods (refer to Table 1). Firstly, rates of referrals made to specialist health ser- vices for depression or suspected depression will be col- lected at pre-training, post-training, and three-month follow-up points from both the intervention and control facilities. This will allow any increase in patient referrals, compared to the control group, as an effect of staff training to be gauged. Secondly, 30 family members of patients receiving palliative care from the service before and after the training is implemented will be interviewed to determine any perceived changes in staff practices as a result of the training, and the associated outcomes on quality of life for those in their care. A semi-structured approach will be used for these interviews to target areas of potential change whilst also allowing for family members to discuss issues around the provision of depression-related care for their relatives and themselves.
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The politics of euthanasia and assisted suicide: A comparative case study of emerging criminal law and the criminal trials of Jack 'Dr  Death' Kevorkian

The politics of euthanasia and assisted suicide: A comparative case study of emerging criminal law and the criminal trials of Jack 'Dr Death' Kevorkian

69 The central reason People v. Roberts, 211 Mich. 187 (1920) was affirmed was because the defendant entered a plea o f guilty, to the charge o f murder in the first degree, in which he confessed to having mixed a poison (Paris green) with water and placed in wife Katie’s reach to enable her to end her own life. There are two most important aspects of the Roberts case.. First, Frank Roberts told the court in his plea colloquy (and in response to a direct inquiry from the court) that his wife had previously attempted suicide the summer before (211 Mich, at 192), and then knowingly drank the Paris green. This was in a way that would in today’s parlance and current Michigan law be deemed assisted suicide. I draw support for this conclusion from the coroner who performed the autopsy — who knew Katie Roberts while she was alive, had seen her “about three or four months before her death ... at her home where they lived ... [and that] she was a bed patient [with] her body considerably wasted” (211 Mich, at 190). Second, the issue in the challenge in Roberts was whether a murder trial was required subsequent to an allocuted guilty plea. The Michigan Supreme Court held that “there is no provision o f the constitution which prevents a defendant from pleading guilty to the indictment instead o f having a trial by jury. If he elects to plead guilty to the indictment the provision of the statute for determining the degree o f the guilt for the purpose of fixing the punishment does not deprive him o f any right of trial by jury” (211 Mich, at 194-195).
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End of life in the intensive care unit: should French law be adapted?

End of life in the intensive care unit: should French law be adapted?

contradictory statements of the code of medical ethics: one stipulating that prolongation of agony is forbidden and the other prohibiting the hastening of death [6]. The SRLF recommendations were updated in 2009 to include, among other things, items specific to the law [7]. On the occasion of media debates in 2008 regarding euthanasia, and when another law was tabled in the Senate on 8 June 2012 regarding medically assisted death and access to palliative care, the SRLF, through press releases, voiced its commitment to well-managed palliative care and underscored the need to heighten awareness and to improve application of Leonetti ’ s law, which offers a legal framework covering the great majority of end of life situations in intensive care [8,9]. In its 2012 pos- ition statement, the SRLF considered that the problem of euthanasia arises infrequently in intensive care, emphasized
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Exploring attitudes toward physician-assisted death in patients with life-limiting illnesses with varying experiences of palliative care: a pilot study

Exploring attitudes toward physician-assisted death in patients with life-limiting illnesses with varying experiences of palliative care: a pilot study

degrees of palliation by oncologists, internists, and family physicians in the past. For practical reasons, only formal consultation or involvement with specialized palliative care teams was considered as prior involvement with pal- liative care. Additionally, the new palliative care group may have had as few as one encounter with a palliative care provider during the 10-day period between surveys. This may not be an adequate amount of time to fully realize the impact of palliative care. As the main survey was not validated to ensure sensitivity to change or clarity and flow of questions, all answers should be interpreted as hypothetical desires only. We do not assume or infer any correlation of the hypothetical desires expressed by our participants with actual decisions to pursue or complete MAID. Finally, there was significant loss to follow-up pri- marily due to progressive morbidity and high rates of mortality in our population of interest.
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Physician-Assisted Suicide Legislation: Issues and Preliminary Responses

Physician-Assisted Suicide Legislation: Issues and Preliminary Responses

9 " The major- ity of bills also explicitly require the attending physician to review with the patient options for palliative care including hospice and/or pain contr[r]

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Family members' experiences of assisted dying:A systematic literature review with thematic synthesis

Family members' experiences of assisted dying:A systematic literature review with thematic synthesis

In relation to anticipating death, data indicate that families experienced an inner conflict between their wish for more life for the patient and their impotence in confronting the inevitability of the patient's death. The patients' death appeared to be anticipated, and it appeared that the circumstances of the death such as the rituals and place of death were decided with considerable attention and care. Families appeared to navigate between the awareness of the limited time left with the patients and the organisation of the farewell which sometimes disturbed them (7, 9, 24) . Some families valued the possibility of being aware of the farewell date well in advance, whereas Dees et al reported that Dutch families might be unfamiliar with the emotional task of organising the final farewell for someone who has limited time left to live (7). An important issue for families was that assisted dying allowed them to keep communication open with the patient until the death. Whereas data indicated that preparatory work in organising that day could be important; families in general, reported some uneasiness when required to choose the day when assisted dying should be performed. Dutch families perceived it as "unnatural" to leave the choice of the day of assisted dying to them (7, 25, 27). Dutch families seemed to rely on physicians to decide on the day of the death, rather than in Switzerland where they relied on the right to die association.
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