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Fowler WC, Koenig HG. Should Physician-Assisted Suicide or Euthanasia be Legalized in the United States? A Medically Informed Perspective. JOURNAL OF RELIGION AND HEALTH 2024; 63:1058-1074. [PMID: 37938413 DOI: 10.1007/s10943-023-01939-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
There is a pressing debate in the United States concerning the implied physicians' obligation to do no harm and the status of legalizing physician-assisted suicide (PAS). Key issues that underpin the debate are important to consider. These include: (1) foundational medical beginnings; (2) euthanasia's historical and legal background context; and (3) the key arguments held by those for and against legalization of PAS. This paper reviews the major claims made by proponents for the legalization of PAS and the associated complexities and concerns that help underscore the importance of conscience freedoms. Relief of suffering, respect for patient autonomy, and public policy arguments are discussed in these contexts. We argue here that the emphasis by healthcare providers should be on high quality and compassionate care for those at the end of life's journey who are questioning whether to prematurely end their lives. If medicine loses its chief focus on the quality of caring-even when a cure is not possible-it betrays its objective and purpose. In this backdrop, legalization of PAS harms not only healthcare professionals, but also the medical profession's mission itself. Medicine's foundation is grounded in the concept of never intentionally to inflict harm. Inflicting death by any means is not professional or proper, and is not trustworthy medicine.
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Affiliation(s)
- W Craig Fowler
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Harold G Koenig
- Department of Psychiatry, Duke University Medical Center, Box 3400, Durham, NC, 27710, USA.
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
- Ningxia Medical University, Yinchuan, People's Republic of China.
- Shiraz University of Medical Sciences, Shiraz, Iran.
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Lewis S, La Brooy C, Kerridge I, Holmes A, Olver I, Hudson P, Dooley M, Komesaroff P. Choreographing a good death: Carers' experiences and practices of enacting assisted dying. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 38386331 DOI: 10.1111/1467-9566.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/31/2024] [Indexed: 02/23/2024]
Abstract
The proliferation of assisted dying legislative reforms globally is a significant change in the social and medico-legal landscape of end-of-life care. Understanding the impacts of these legislative reforms on family members who care for a dying person is vital, yet under-theorised in research. In this article, drawing on semi-structured interviews with 42 carers for a person who has sought assisted dying in Australia, and extending ideas of ontological choreography we explore the new and complex choreographies enacted by carers in their endeavour to arrange a 'good death' for the dying person. We find that desires to fulfil the dying person's wishes are often accompanied by normative pressures, affective tensions and complexities in bereavement. Enacting assisted dying requires carers to perform a repertoire of highly-staged practices. Yet, institutional obstacles and normative cultural scripts of dying can constrain carer assisted dying practices. Understanding the nuances of carers' experiences and how they navigate this new end-of-life landscape, we argue, provides critical insights about how assisted dying legislation is producing new cultural touchpoints for caring at the end of life. Moreover, we show how emerging cultural scripts of assisted dying are impacting in the lives of these carers.
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Affiliation(s)
- Sophie Lewis
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Ian Kerridge
- Sydney Health Ethics, University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Alex Holmes
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Dooley
- Alfred Health, Prahran, Victoria, Australia
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
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Philip J, Le B, La Brooy C, Olver I, Kerridge I, Komesaroff P. Voluntary Assisted Dying/Euthanasia: Will This Have an Impact on Cancer Care in Future Years? Curr Treat Options Oncol 2023; 24:1351-1364. [PMID: 37535255 PMCID: PMC10547610 DOI: 10.1007/s11864-023-01126-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/04/2023]
Abstract
OPINION STATEMENT In considering the impact of medically hastened death (MHD) on cancer care, a wide range of variables needs to be considered including demographic factors, diagnoses, local cultural factors, and the legislative frameworks in place. Here, we present a synthesis of recently available published literature and empirical data collected following legislative change to enable MHD in Victoria, Australia to explore in detail the potential impact of MHD on cancer care with a focus on patients/families and professional groups. Our findings reveal that for patients and families, both physical and existential distress frequently underlie MHD requests, with the latter less readily recognised by health professionals. The responses of those around the patient making the request may have a very significant impact on relationships within families and upon the nature of the subsequent bereavement. For palliative care, while differing views may remain, it appears that there has been some accommodation of MHD into or alongside practice over time. The recognition of a shared commitment to relief of suffering of palliative care and MHD appears a helpful means of establishing how these practices may co-exist. In cancer practice more broadly, as individual professionals reflect upon their own roles, new relationships and pathways of patient movement (or referral) must be established in response to patients' requests. Our findings also highlight many unanswered questions in understanding the impact of MHD, including that upon those dying who choose not to access MHD, First Nations peoples, the participating health professionals' longer term, and the relief of suffering itself. A systematic approach to the evaluation of MHD legislation must be adopted in order to understand its full impact. Only then could it be determined if the aspirations for such legislative change were being met.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, University of Melbourne, Victoria Pde, Fitzroy 3065, Melbourne, Victoria, Australia.
- Palliative Care Service, St Vincent's Hospital, Melbourne, Victoria, Australia.
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | - Brian Le
- Department of Medicine, University of Melbourne, Victoria Pde, Fitzroy 3065, Melbourne, Victoria, Australia
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Camille La Brooy
- Public Health & Preventive Medicine, Monash University, Monash, Victoria, Australia
| | - Ian Olver
- University of Notre Dame of Australia, Sydney, NSW, Australia
| | - Ian Kerridge
- Haematology Department, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sydney Health Ethics, University of Sydney, Sydney, NSW, Australia
- Department of Philosophy, Macquarie University, Macquarie, NSW, Australia
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Kirchhoffer DG, Lui CW, Ho A. Moral uncertainty and distress about voluntary assisted dying prior to legalisation and the implications for post-legalisation practice: a qualitative study of palliative and hospice care providers in Queensland, Australia. BMJ Open 2023; 13:e065964. [PMID: 37160397 PMCID: PMC10410955 DOI: 10.1136/bmjopen-2022-065964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 04/04/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVES There is little research on moral uncertainties and distress of palliative and hospice care providers (PHCPs) working in jurisdictions anticipating legalising voluntary assisted dying (VAD). This study examines the perception and anticipated concerns of PHCPs in providing VAD in the State of Queensland, Australia prior to legalisation of the practice in 2021. The findings help inform strategies to facilitate training and support the health and well-being of healthcare workers involved in VAD. DESIGN The study used a qualitative approach to examine and analyse the perception and anticipated concerns of PHCPs regarding challenges of providing assisted dying in Queensland. Fourteen PHCPs were recruited using a purposive sampling strategy to obtain a broad representation of perspectives including work roles, geographical locations and workplace characteristics. Data were collected via one in-depth interview per participant. The transcripts were coded for patterns and themes using an inductive analysis approach following the tradition of Grounded Theory. SETTING The study was conducted in hospital, hospice, community and residential aged care settings in Queensland, Australia. These included public and private facilities, secular and faith-based facilities, and regional/rural and urban facilities. PARTICIPANTS Interviews were conducted with fourteen PHCPs: 10 nurses and 4 physicians; 11 female and 3 male. The median number of years of palliative care practice was 17, ranging from 2 to 36 years. For inclusion, participants had to be practising palliative and hospice care providers. RESULTS PHCPs are divided on whether VAD should be considered part of palliative care. Expectations of moral distress and uncertainty about practising VAD were identified in five areas: handling requests, assessing patient capacity, arranging patient transfers and logistical issues, managing unsuccessful attempts, and dealing with team conflicts and stigma. CONCLUSIONS The possibility of having to practise VAD causes moral distress and uncertainty for some PHCPs. Procedural clarity can address some uncertainties; moral and psychological distress, however, remains a source of tension that needs support to ensure ongoing care of both patients and PHCPs. The introduction of VAD post-legalisation may present an occasion for further moral education and development of PHCPs.
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Affiliation(s)
- David G Kirchhoffer
- Queensland Bioethics Centre, Australian Catholic University, Brisbane, Queensland, Australia
| | - Chi-Wai Lui
- Queensland Bioethics Centre, Australian Catholic University, Brisbane, Queensland, Australia
| | - Anita Ho
- Centre for Applied Ethics, University of British Columbia, Vancouver, British Columbia, Canada
- Bioethics Program, University of California, San Francisco (UCSF), San Francisco, California, USA
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Shah R, Luu S, Claridad A, Dellit M. From request to withdrawal: a palliative care patient's changing desire for voluntary assisted dying. Intern Med J 2022; 52:1095-1096. [PMID: 35718730 DOI: 10.1111/imj.15814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Rajvi Shah
- Palliative Care Service, Monash Health, Melbourne, Victoria, Australia.,School of Medicine, Sydney Campus, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Sarah Luu
- Palliative Care Service, Monash Health, Melbourne, Victoria, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - Antonio Claridad
- Palliative Care Service, Monash Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Matthew Dellit
- Palliative Care Service, Monash Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Yun YH, Sim JA, Choi Y, Yoon H. Attitudes toward the Legalization of Euthanasia or Physician-Assisted Suicide in South Korea: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095183. [PMID: 35564575 PMCID: PMC9105789 DOI: 10.3390/ijerph19095183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/16/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the general South Korean public attitudes toward the legalization of euthanasia or physician-assisted suicide (EAS) and examine the reasons underpinning these attitudes. From March–June 2021, we conducted a cross-sectional survey of a representative national sample of 1000 South Koreans aged 19 years or older. Three in four participants (76.4%) expressed positive attitudes toward the legalization of EAS. Participants who agreed with this legalization reported “meaninglessness of the rest of life” and “right to a good death” as their main reasons. Participants who disagreed with the legalization of EAS reported “respect for life”, “violation of the right to self-determination”, “risk of abuse or overuse”, and “violation of human rights” as theirs. In the multivariate logistic regression analyses, participants with poor physical status (adjusted odds ratio [aOR]: 1.41, 95%; confidence interval [CI]: 1.02–1.93) or comorbidity (aOR: 1.84, 95%; CI: 1.19–2.83) showed positive attitudes toward the legalization of EAS. In summary, most of the general South Korean population regards the legalization of EAS positively, especially participants with poor physical status or comorbidity.
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Affiliation(s)
- Young Ho Yun
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; (Y.C.); (H.Y.)
- Department of Family Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-740-8417
| | - Jin-Ah Sim
- School of AI Convergence, Hallym University, Chuncheon 200160, Korea;
| | - Yeani Choi
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; (Y.C.); (H.Y.)
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Hyejeong Yoon
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; (Y.C.); (H.Y.)
- College of Liberal Studies, Seoul National University, Seoul 03080, Korea
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Attitudes and Arguments in the Voluntary Assisted Dying Debate in Australia: What Are They and How Have They Evolved Over Time? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312327. [PMID: 34886053 PMCID: PMC8656893 DOI: 10.3390/ijerph182312327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022]
Abstract
This paper provides a broad discussion about voluntary assisted dying (VAD) in Australia. The discussion examines the history of the VAD debate in Australia and whether public support for VAD and the arguments that have provided the framework for the VAD debate have evolved over time. This seems a prudent time to have such a discussion, given the very recent rush by all Australian states to bring about or attempt to bring about VAD legislation. This rush, inexplicably perhaps, comes after decades of attempted but failed progress in the legalisation of VAD in Australia. The authors attempted to undertake a systematic literature review for this paper, but the paucity of academic research and the lack of consistent terminology in this area made such a search untenable. Instead, the authors examined parliamentary documentation and then widened the search via the sources found within this documentation. The examination of available data showed that VAD has enjoyed significant public support from Australians over time and that the arguments in the VAD debate in Australia have been consistent over time.
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Wilson M, Ostroff C, Wilson ME, Wiechula R, Cusack L. Profiles of intended responses to requests for assisted dying: A cross-sectional study. Int J Nurs Stud 2021; 124:104069. [PMID: 34592533 DOI: 10.1016/j.ijnurstu.2021.104069] [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: 04/15/2021] [Revised: 07/07/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Responding to legal medically assisted dying requests may become the most frequent form of nurses' participation in that service. Recent research has explored nurses' discrete responses to requests about or for assisted dying; however, nurses likely hold intentions for multiple responses to these requests. These intentions form patterns shaped by individual factors such as attitude and beliefs. No research has investigated patterns of multiple responses to requests for assisted dying, how these patterns form profiles of nurses and factors that might explain these response profiles. OBJECTIVES Identify patterns of multiple responses that nurses intend for requests for assisted dying. Explore how these patterns form profiles of nurses' who share similar patterns of intended responses. Finally, investigate how attitude, norms and beliefs distinguish response profiles. DESIGN Cross-sectional survey SETTINGS: Online survey of Australian nurses PARTICIPANTS: 365 experienced registered nurses (years in nursing mean = 23, SD = 14.21) working primarily with adults across various practice settings. METHODS Principal components analysis identified five types of intended responses. K-means cluster analysis was then used to develop profiles of nurses' intended responses across these five responses. Multinomial logit regression was utilised to examine psychosocial variables that distinguished different profiles RESULTS: Cluster analysis resulted in five profiles that reflect different patterns of intended responses by nurses - Facilitator, Complier, Expediter, Objector, and Detached. Logit regressions of explanatory variables indicated that nurses' attitude toward assisted dying, ethical beliefs, and social norms predicted nurses' membership in intended response profiles. The overall model was statistically significant, χ2(20) = 106.527, p < .001, and the predictors accounted for 25.3% of the variance in the profiles (Cox and Snell test: Pseudo R2 = 0.253). CONCLUSION Nurses intended responses have been usefully constructed as five patterns or profiles of multiple responses. These profiles represent different types and levels of engagement with requests. Further, attitude and social expectations distinguish profiles with stronger intentions to engage positively. Using a cluster analysis methodology provides a more holistic understanding of nurses' intended responses to assisted dying requests by focusing on various responses and demonstrating that nurses have distinctive patterns of responses.
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Affiliation(s)
- Michael Wilson
- Adelaide Nursing School, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia.
| | - Cheri Ostroff
- UniSA Business, University of South Australia, City West Campus, Adelaide, South Australia 5000, Australia.
| | - Marie E Wilson
- The Chancellery, University of South Australia, City West Campus, Adelaide, South Australia 5000, Australia.
| | - Richard Wiechula
- Adelaide Nursing School, Medical and Health Sciences Faculty, North Terrace, Adelaide, South Australia 5000, Australia.
| | - Lynette Cusack
- Adelaide Nursing School, Medical and Health Sciences Faculty, North Terrace, Adelaide, South Australia 5000, Australia.
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Kirchhoffer DG, Lui C. Public reasoning about voluntary assisted dying: An analysis of submissions to the Queensland Parliament, Australia. BIOETHICS 2021; 35:105-116. [PMID: 32812655 PMCID: PMC7818170 DOI: 10.1111/bioe.12777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/14/2020] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
The use of voluntary assisted dying as an end-of-life option has stimulated concerns and debates over the past decades. Although public attitudes towards voluntary assisted dying (including euthanasia and physician-assisted suicide) are well researched, there has been relatively little study of the different reasons, normative reasoning and rhetorical strategies that people invoke in supporting or contesting voluntary assisted dying in everyday life. Using a mix of computational textual mining techniques, keyword study and qualitative thematic coding to analyse public submissions to a parliamentary inquiry into voluntary assisted dying in Australia, this study critically examines the different reasons, normative reasoning and rhetorical strategies that people invoke in supporting or contesting voluntary assisted dying in everyday life. The analysis identified complex and potentially contradictory ethical principles being invoked on both sides of the debate. These findings deepen our understanding of the moral basis of public reasoning about end-of-life matters and will help to inform future discussions on policy and law reform. The findings underscore the importance of sound normative reasoning and the use of caution when interpreting opinion polls to inform policy.
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Affiliation(s)
| | - Chi‐Wai Lui
- Queensland Bioethics CentreAustralian Catholic UniversityBrisbaneAustralia
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