-
BMC Medical Ethics Sep 2019Although euthanasia and assisted suicide (EAS) in people with psychiatric disorders is relatively rare, the increasing incidence of EAS requests has given rise to public...
BACKGROUND
Although euthanasia and assisted suicide (EAS) in people with psychiatric disorders is relatively rare, the increasing incidence of EAS requests has given rise to public and political debate. This study aimed to explore support of the public and physicians for euthanasia and assisted suicide in people with psychiatric disorders and examine factors associated with acceptance and conceivability of performing EAS in these patients.
METHODS
A survey was distributed amongst a random sample of Dutch 2641 citizens (response 75%) and 3000 physicians (response 52%). Acceptance and conceivability of performing EAS, demographics, health status and professional characteristics were measured. Multivariable logistic regression analyses were performed.
RESULTS
Of the general public 53% were of the opinion that people with psychiatric disorders should be eligible for EAS, 15% was opposed to this, and 32% remained neutral. Higher educational level, Dutch ethnicity, and higher urbanization level were associated with higher acceptability of EAS whilst a religious life stance and good health were associated with lower acceptability. The percentage of physicians who considered performing EAS in people with psychiatric disorders conceivable ranged between 20% amongst medical specialists and 47% amongst general practitioners. Having received EAS requests from psychiatric patients before was associated with considering performing EAS conceivable. Being female, religious, medical specialist, or psychiatrist were associated with lower conceivability. The majority (> 65%) of the psychiatrists were of the opinion that it is possible to establish whether a psychiatric patient's suffering is unbearable and without prospect and whether the request is well-considered.
CONCLUSION
The general public shows more support than opposition as to whether patients suffering from a psychiatric disorder should be eligible for EAS, even though one third of the respondents remained neutral. Physicians' support depends on their specialization; 39% of psychiatrists considered performing EAS in psychiatric patients conceivable. The relatively low conceivability is possibly explained by psychiatric patients often not meeting the eligibility criteria.
Topics: Cross-Sectional Studies; Decision Making; Educational Status; Euthanasia; Health Knowledge, Attitudes, Practice; Humans; Mental Disorders; Mentally Ill Persons; Netherlands; Physicians; Public Opinion; Quality of Life
PubMed: 31510976
DOI: 10.1186/s12910-019-0404-8 -
Cuadernos de Bioetica : Revista Oficial... 2019This article analyzes the issue of euthanasia, but under a concrete point of view, that of its social implications. It is defended here that euthanasia is not...
This article analyzes the issue of euthanasia, but under a concrete point of view, that of its social implications. It is defended here that euthanasia is not exclusively an individual decision, but has, above all, an important social repercussion. If euthanasia were accepted and legalized, the very nature of the medicine and the physician's own identity would undergo a profound transformation. The doctor-patient relationship based on trust would be broken. Also, if euthanasia were endorsed, it would be encouraged that the human being was not valued for his / her being, but for his capacity to produce. Now, vulnerable, fragile and weak people (dependent, old, sick ...) keep their dignity intact, because we have this because of the simple fact of being born as human beings. All human lives are worth living, however sick and deteriorated their bodies are. To admit the opposite is to enter a spiral where the dignity of the human being would become an object of weighting with respect to another value, which, in a hypothetical conflict could be postponed by another. However, Palliative Care takes into account the social dimension of the end of life of the human being. They take care of the sick human being in its entirety. That is why they are the option most in line with the dignity of the human being at the end of his life.
Topics: Euthanasia; Humans; Palliative Care; Sociological Factors; Spain
PubMed: 30742451
DOI: No ID Found -
Ciencia & Saude Coletiva Sep 2013There is currently widespread concern among researchers in debating questions that generate ethical conflicts within the scope of health care geared to the human being... (Review)
Review
There is currently widespread concern among researchers in debating questions that generate ethical conflicts within the scope of health care geared to the human being in the terminal phase, especially euthanasia, dysthanasia and orthothanasia. This study sought to characterize the scientific production at the national level on euthanasia, dysthanasia and orthothanasia. It involves an integrative review of the literature. The study universe consisted of 41 publications related to the theme in question by means of a survey conducted online in the Virtual Health Library in the Capes Portal and in the Bioethical Magazine. Of these, 25 articles comprised the sample taking into consideration the established inclusion and exclusion criteria. Data collection occurred in March 2013, by means of an instrument containing information pertinent to the proposed objective. The key words used were euthanasia, dysthanasia and orthothanasia. With respect to the focus of the publications, three themes emerged: Theme I - Euthanasia; Theme II - Dysthanasia and Theme III - Orthothanasia. The studies analyzed reflected the current concern in terms of ethical dilemmas concerning care of the human being in the end of life phase. Thus, it is hoped that this research can contribute to bolster the critical reading with respect to the theme.
Topics: Bibliometrics; Euthanasia; Humans; Withholding Treatment
PubMed: 23989581
DOI: 10.1590/s1413-81232013000900029 -
Cleveland Clinic Journal of Medicine 1992
Topics: Attitude to Death; Culture; Dehumanization; Euthanasia; Euthanasia, Active; Euthanasia, Active, Voluntary; Humans; Stress, Psychological; United States
PubMed: 1551216
DOI: 10.3949/ccjm.59.1.58 -
British Medical Journal (Clinical... May 1988
Topics: Ethics, Medical; Euthanasia; Euthanasia, Active; Humans; Personal Autonomy; Societies, Medical; United Kingdom
PubMed: 3134981
DOI: 10.1136/bmj.296.6633.1348 -
Journal of Pain and Symptom Management Feb 2023The debate on assisted dying and its components, euthanasia and physician-assisted suicide has evolved with the emergence of the right to dignity and the wish to hasten... (Review)
Review
INTRODUCTION
The debate on assisted dying and its components, euthanasia and physician-assisted suicide has evolved with the emergence of the right to dignity and the wish to hasten death (WTHD). Whilst shaped by local legal and sociocultural considerations, appreciation of how patients, healthcare professionals and lawmakers relate notions of dignity to self-concepts of personhood and the desire for assisted dying will better inform and direct support of patients.
METHODS
Guided by the Systematic Evidence Based Approach, a systematic scoping review (SSR in SEBA) on perspectives of dignity, WTHD and personhood featured in PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL, Scopus databases and four key Palliative Care journals was conducted. The review hinged on the following questions: "what is the relationship between dignity and the wish to hasten death (WTHD) in the assisted dying debate?", "how is dignity conceptualised by patients with WTHD?" and "what are prevailing perspectives on the role of assisted dying in maintaining a dying patient's dignity?"
RESULTS
6947 abstracts were identified, 663 full text articles reviewed, and 88 articles included. The four domains identified include 1) concepts of dignity through the lens of the Ring Theory of Personhood (RToP) including their various definitions and descriptions; 2) the relationship between dignity, WTHD and assisted dying with loss of dignity and autonomy foregrounded; 3) stakeholder perspectives for and against assisted dying including those of patient, healthcare provider and lawmaker; and 4) other dignity-conserving measures as alternatives to assisted dying.
CONCLUSION
Concepts of dignity constantly evolve throughout the patient's end of life journey. Understanding when and how these concepts of personhood change and trigger the fear of a loss of dignity or intractable suffering could direct timely, individualised and appropriate person-centred dignity conserving measures. We believe an RToP-based tool could fulfil this role and further study into the design of this tool is planned.
Topics: Humans; Euthanasia; Palliative Care; Personhood; Respect; Suicide, Assisted; Terminal Care
PubMed: 36244639
DOI: 10.1016/j.jpainsymman.2022.10.004 -
Journal of Pain and Symptom Management Mar 2011Since the legalization of euthanasia, physicians in Belgium may, under certain conditions, administer life-ending drugs at the explicit request of a patient.
CONTEXT
Since the legalization of euthanasia, physicians in Belgium may, under certain conditions, administer life-ending drugs at the explicit request of a patient.
OBJECTIVES
To study the attitudes of Belgian physicians toward the use of life-ending drugs and euthanasia law, factors predicting attitudes, and factors predicting whether a physician has ever performed euthanasia.
METHODS
In 2009, we sent a questionnaire to a representative sample of 3006 Belgian physicians who, because of their specialty, were likely to be involved in the care of the dying.
RESULTS
Response rate was 34%. Ninety percent of physicians studied were accepting of euthanasia for terminal patients who had extreme uncontrollable pain/symptoms. Sixty-six percent agreed that the euthanasia law contributes to the carefulness of physicians' end-of-life behavior; 10% agreed that the law impedes the development of palliative care. Religious beliefs and geographic region were strong determinants of attitude. Training in palliative care did not influence attitudes regarding euthanasia, but trained physicians were less likely to agree that the euthanasia law impedes the development of palliative care than were nontrained physicians. One in five physicians had performed euthanasia; they were more likely to be nonreligious, older, specialist, trained in palliative care, and to have had more experience in treating the dying.
CONCLUSION
Most physicians studied support euthanasia for terminal patients with extreme uncontrollable pain/symptoms and agree that euthanasia can be part of good end-of-life care. Although physicians had little involvement in the process of legalizing euthanasia, they now generally endorse the euthanasia law.
Topics: Adult; Age Factors; Aged; Attitude of Health Personnel; Belgium; Ethnicity; Euthanasia; Euthanasia, Active; Health Care Surveys; Humans; Middle Aged; Physicians; Suicide, Assisted; Surveys and Questionnaires
PubMed: 21145197
DOI: 10.1016/j.jpainsymman.2010.05.015 -
BMJ (Clinical Research Ed.) Oct 1992
Topics: Euthanasia; Humans; Patient Acceptance of Health Care
PubMed: 1458082
DOI: 10.1136/bmj.305.6859.951-c -
BMJ (Clinical Research Ed.) Sep 2005Doctors in the United Kingdom can accompany their patients every step of the way, up until the last. The law stops them helping their patients take the final step, even... (Review)
Review
Doctors in the United Kingdom can accompany their patients every step of the way, up until the last. The law stops them helping their patients take the final step, even if that is the patient's fervent wish. Next month's debate in the House of Lords could begin the process of changing the law. To help doctors decide where they stand we publish a range of opinions
Topics: Attitude of Health Personnel; Euthanasia; Humans; Netherlands; Professional Practice; Suicide, Assisted
PubMed: 16179708
DOI: 10.1136/bmj.331.7518.691 -
Journal of Pain and Symptom Management Nov 2011Since 2002, the administration of a lethal drug by a physician at the explicit request of the patient has been legal in Belgium. The incidence of euthanasia in Belgium...
CONTEXT
Since 2002, the administration of a lethal drug by a physician at the explicit request of the patient has been legal in Belgium. The incidence of euthanasia in Belgium has been studied, but the process and outcomes of euthanasia requests have not been investigated.
OBJECTIVES
To describe which euthanasia requests were granted, withdrawn, and rejected since the enactment of the euthanasia law in terms of the characteristics of the patient, treating physician, and aspects of the consultation with a second physician.
METHODS
A representative sample of 3006 Belgian physicians received a questionnaire investigating their most recent euthanasia request.
RESULTS
The response rate was 34%. Since 2002, 39% of respondents had received a euthanasia request. Forty-eight percent of requests had been carried out, 5% had been refused, 10% had been withdrawn, and in 23%, the patient had died before euthanasia could be performed. Physicians' characteristics associated with receiving a request were not being religious, caring for a high number of terminally ill patients, and having experience in palliative care. Patient characteristics associated with granting a request were age, having cancer, loss of dignity, having no depression, and suffering without prospect of improvement as a reason for requesting euthanasia. A positive initial position toward the request from the attending physician and positive advice from the second physician also contributed to having a request granted.
CONCLUSION
Under the Belgian Act on Euthanasia, about half of the requests are granted. Factors related to the reason for the request, position of the attending physician toward the request, and advice from the second physician influence whether a request is granted or not.
Topics: Adult; Aged; Aged, 80 and over; Belgium; Euthanasia; Euthanasia, Active, Voluntary; Female; Health Care Surveys; Humans; Logistic Models; Male; Middle Aged; Patients; Physicians; Selection Bias; Stress, Psychological; Surveys and Questionnaires
PubMed: 21570807
DOI: 10.1016/j.jpainsymman.2011.02.011