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Bosma F, Stoppelenburg A, van der Heide A, van de Vathorst S. Frequency of self-directed dying in the Netherlands: research protocol of a cross-sectional mixed-methods study. BMJ Open 2024; 14:e085240. [PMID: 38684276 PMCID: PMC11086523 DOI: 10.1136/bmjopen-2024-085240] [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: 02/09/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION In the Netherlands, assisting in suicide is allowed for physicians and regulated by the Termination of Life on Request and Assisted Suicide (review procedures) Act. However, some people decide to end their lives outside the medical domain, without a physician's help. Two approaches for such self-directed dying are voluntary stopping eating and drinking (VSED) and independently taking lethal medication attended by a confidant (ILMC). The frequency of deaths by either of these methods in the Netherlands was examined in 2007. Since then, there have been societal, political and healthcare developments which may have had an influence on the frequency of self-directed dying. The primary objective of this study is to estimate how many people in the Netherlands currently die by VSED or ILMC. Secondary objectives include providing insight in the characteristics and quality of dying of people who choose for self-directed dying. METHODS AND ANALYSIS This cross-sectional study consists of an online questionnaire study (January to February 2024) among a randomly drawn sample (n=37 500) from a representative panel of the Dutch adult population in which participants are asked about potential experiences of close relatives choosing for VSED or ILMC. A two-stage screening procedure will be used to determine whether the respondents' experiences represent a death by VSED or ILMC. Additional interviews (n=40) will be held with questionnaire respondents indicating their willingness to participate (May to September 2024). Quantitative data will be analysed using SPSS software, and qualitative data will be thematically analysed using NVivo software. ETHICS AND DISSEMINATION The study obtained approval from the Medical Research Ethics Committee of the Erasmus Medical Center, under number MEC-2023-0689. Informed consent will be sought from study participants in line with General Data Protection Regulation legislation. Results of the study will be disseminated through publications in scientific journals and conference presentations. TRIAL REGISTRATION NUMBER NCT06186791.
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Affiliation(s)
- Fenne Bosma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Arianne Stoppelenburg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Suzanne van de Vathorst
- Department of Medical Ethics, Philosophy, and History of Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
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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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McDougall R, Pratt B, Sellars M. Ethical Diversity and Practical Uncertainty: A Qualitative Interview Study of Clinicians' Experiences in the Implementation Period Prior to Voluntary Assisted Dying Becoming Available in their Hospital in Victoria, Australia. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:71-88. [PMID: 36800132 PMCID: PMC10126061 DOI: 10.1007/s11673-022-10224-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/01/2022] [Indexed: 05/04/2023]
Abstract
In the Australian state of Victoria, legislation allowing voluntary assisted dying (VAD) passed through parliament in November 2017. There was then an eighteen-month period before the start date for patient access to VAD, referred to as the "implementation period." The implementation period was intended to allow time for the relevant government department and affected organizations to develop processes before the Act came into effect in June 2019. This qualitative interview study investigates the perspectives of a multidisciplinary sample of twelve clinicians from a single metropolitan hospital during this implementation period. Maximum variation sampling was utilized to ensure breadth across discipline (medical, nursing, allied health), speciality, and stated level of support for the VAD legislation. Four key themes were identified from the interview data: preparing for the unknown, ethical diversity within the organization, building a respectful culture, and concerns about the inability of the legislated approach to capture clinical nuances. Overall, these clinicians' workplace experiences during the implementation period were shaped by the ethical diversity within their organization and a sense of uncertainty about how the VAD legislation would integrate with the practical realities of their clinical setting. The concept of "ethical diversity" could be a useful one for supporting staff in an organization during a VAD implementation period.
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Affiliation(s)
- Rosalind McDougall
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria 3010 Australia
| | - Bridget Pratt
- Queensland Bioethics Centre, Australian Catholic University, Brisbane, Queensland 4000 Australia
| | - Marcus Sellars
- Department of Health Services Research & Policy, Research School of Population Health, College of Health & Medicine, The Australian National University, Australia, Canberra, Australian Capital Territory 2600 Australia
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Riley S. Watching the watchmen: changing tides in the oversight of medical assistance in dying. JOURNAL OF MEDICAL ETHICS 2022:jme-2022-108470. [PMID: 36150893 DOI: 10.1136/jme-2022-108470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
The recent wave of medical assistance in dying legalisation raises questions about proper oversight of the practice as new systems for data collection, case assessment and public reporting emerge. Newer systems, such as in Spain, New Zealand and Colombia, are eschewing the retrospective approach used for case assessment in older systems, particularly those in the Netherlands, Belgium and the USA, in favour of an approach requiring more extensive review prior to the procedure. This shift aims to increase compliance with each jurisdiction's specific safeguards and legal criteria as well as to protect vulnerable patients, but also risks stifling access to the practice and increasing administrative burden on clinicians and patients. Newer systems also tend to favour more extensive data collection than older systems, while failing to be as transparent with public reporting. Inconsistency in data collection and public reporting make it difficult for researchers, policymakers and the public to assess the practice and help achieve a balance between access and compliance. Research on oversight activities is sparse, and there is a need for clarity to determine how best to handle violations of the law and how to create best practices.
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Affiliation(s)
- Sean Riley
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Bellon F, Mateos JT, Pastells-Peiró R, Espigares-Tribó G, Gea-Sánchez M, Rubinat-Arnaldo E. The Role of Nurses in Euthanasia: A Scoping Review. Int J Nurs Stud 2022; 134:104286. [DOI: 10.1016/j.ijnurstu.2022.104286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 05/13/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
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Lucena A, Yuguero O. Systematic Review of Common Refractory Symptoms in the End-Of-Life Situation and Its Relation With Euthanasia. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221089123. [PMID: 35441562 DOI: 10.1177/00302228221089123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To analyse the available evidence regarding refractory symptoms to treatment in patients receiving palliative/terminal healthcare. DESIGN A systematic review of various databases between September and December 2020; Pubmed; Cochrane; Scopus and ScienceDirect. Study eligibility criteria: Studies published between 1st January 2015 and 31st of March 2020, in Spanish, English or Catalan conducted in elderly people or terminal patients. The study included systematic reviews, clinical trials and interventions. RESULTS The search returned 782 articles, of which 22 articles were finally reviewed. Of the selected articles, 16 were systematic reviews and three were clinical trials. Three refractory symptoms are notable; breathlessness, delirium and existential suffering. There are various therapeutic approaches for the first two symptoms, but palliative sedation seems to be most effective for existential suffering. CONCLUSIONS Although palliative care enables controlling these symptoms effectively, and following a multidisciplinary approach, there remains a group of patients for whom euthanasia could save foreseeable suffering that is difficult to manage.
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Affiliation(s)
- Alba Lucena
- Surgery Department, Faculty of Medicine, 16739University of Lleida, Lleida, Spain
| | - Oriol Yuguero
- Surgery Department, Faculty of Medicine, 16739University of Lleida, Lleida, Spain
- 219654Institut de Recerca Biomèdica de Lleida (IRBLLEIDA), Lleida, Spain
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Picón-Jaimes YA, Orozco-Chinome JE, Lozada-Martínez ID, Mass-Ramirez S, Higuera-Cetina CI, Montaña-Gómez LM, Moscote-Salazar LR, Narvaez-Rojas AR. Perception of Physicians Working in Chile Toward Assisted Suicide and Euthanasia: A Nationwide Cross-Sectional Study. J Prim Care Community Health 2022; 13:21501319221121462. [PMID: 36112863 PMCID: PMC9476241 DOI: 10.1177/21501319221121462] [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] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Assisted suicide and euthanasia are controversial issues today and have been throughout the history of humanity, mainly because there are individuals for and against them. Currently, the legalization of these practices is being discussed in Chile, and the perception of physicians regarding this issue is unknown. Therefore, this study aimed to assess physicians' perception of Chile's euthanasia and assisted suicide. METHODS A nationwide cross-sectional study was carried out in Chile. A questionnaire of physicians' attitudes and opinions on assisted suicide and euthanasia was used. The population was the doctors who work in Chile, and the sample was convenient with a sample calculation of 384 physicians. About 20 variables were considered and included in a form created through the Google forms option, which was distributed through social networks: LinkedIn, Facebook, Twitter, and WhatsApp. To guarantee the anonymity of the participants, the option to request and remember the participant's email was deactivated. A generated database allowed the quantitative analysis of the variables and their expression through frequencies, percentages, and graphs. The European University of the Atlantic's research ethics committee approved this study as stated in the document CE-55 of March 2021. RESULTS A total of 410 physicians were surveyed. 50.7% (n = 208) of the participants identified themselves as men, and 69.8% (n = 286) were Chilean. The city of Santiago was the area of residence of 72.9% (n = 299) of the participants. About 34.6% (n = 142) of participants were general practitioners, and 39.3% (n = 161) of the physicians had more than 20 years of experience. About 68.7% had favorable attitudes toward euthanasia and 54.4% toward assisted suicide; However, although the majority favored legalizing euthanasia and assisted suicide, approximately 48.8% stated that they would not participate in an assisted suicide procedure. CONCLUSIONS There was evidence of support for the implementation and legalization of euthanasia and assisted suicide by physicians in Chile. However, there are still professionals who have not yet decided on a definitive position on these practices.
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Affiliation(s)
| | | | - Iván David Lozada-Martínez
- International Coalition on Surgical Research, Bogotá, Colombia.,Universidad de Cartagena, Cartagena, Colombia
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De Hert M, Thys E, Catthoor K, Van den Broeck K, Matthys F, Vansteelandt K, Detraux J. Media coverage of Belgium's first criminal case concerning euthanasia for psychiatric patients: A content analysis of Flemish newspapers and magazines. Front Psychiatry 2022; 13:1050086. [PMID: 36684025 PMCID: PMC9845880 DOI: 10.3389/fpsyt.2022.1050086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Belgium is one of the few countries worldwide where euthanasia on the grounds of unbearable suffering caused by a psychiatric disorder is legally possible. In April 2010 euthanasia was carried out on a 38-year-old Belgian woman with borderline personality disorder and/or autism. After a complaint by the family, three physicians were referred to the Court of Assizes on the charge of "murder by poisoning". METHODS A content analysis of print and online news coverage of the euthanasia case in a selected sample of Flemish newspapers and magazines, published between December 1, 2019 and March 1, 2020, was conducted to analyze the prominence and framing of the euthanasia case, as well as the portrayal of key figures in this case. A quantitative analysis, as well as an in-depth qualitative analysis (with the aid of NVivo 1.0 software) was performed. RESULTS One thousand two hundred fifteen news articles were identified through database searching. Of these, 789 articles were included after screening for relevance and eligibility. Mean prominence scores were moderate and did not statistically significantly differ between newspapers with a different historical ideological background or form (elite versus popular). The most frequent headline topics featured legal aspects (relating to the Belgian Euthanasia Law or the course of the trial). Headlines and content of most articles (90 and 89%, respectively) did not contain an essential standpoint on the euthanasia case itself or, if they did, were neutral. Historical ideological background, nor form of newspaper (elite versus popular) significantly influenced headline tone or article direction toward the euthanasia case. Despite this, our qualitative analysis showed some subtle differences in selection, statement or tonality of reports between certain newspapers with a different historical ideological background. CONCLUSION Although major Flemish newspapers and magazines generally were neutral in their coverage of the judicial case, major points of contention discussed were: the need for an evaluation and possible amendments to the existing Euthanasia Law, including a revision of the Belgian Control Commission and the system of penalties for physicians, and the absence of any consensus or guidance on how to define psychological suffering.
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Affiliation(s)
- Marc De Hert
- University Psychiatric Center KU Leuven, Leuven, Belgium.,Department of Biomedical Sciences, Research Group Psychiatry, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium.,Antwerp Health Law and Ethics Chair - AHLEC University Antwerpen, Antwerp, Belgium
| | - Erik Thys
- Psycho-Sociaal Centrum, St.-Alexius-Elsene Vzw, Ixelles, Belgium
| | - Kirsten Catthoor
- Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium.,The Collaborative Antwerp Psychiatric Research Institute (CAPRI) and Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.,Flemish Psychiatric Association, Kortenberg, Belgium
| | - Kris Van den Broeck
- The Collaborative Antwerp Psychiatric Research Institute (CAPRI) and Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.,Flemish Psychiatric Association, Kortenberg, Belgium
| | - Frieda Matthys
- Flemish Psychiatric Association, Kortenberg, Belgium.,Department of Psychiatry, University Hospital Brussels, Brussels, Belgium
| | - Kristof Vansteelandt
- Department of Biomedical Sciences, Research Group Psychiatry, KU Leuven, Leuven, Belgium
| | - Johan Detraux
- Department of Biomedical Sciences, Research Group Psychiatry, Public Health Psychiatry, KU Leuven, Leuven, Belgium
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