The people speak: social media on euthanasia/assisted dying

What do health care professionals want to know about assisted dying? Setting the research agenda in New Zealand

BACKGROUND

New Zealand recently introduced law permitting terminally ill people to request and receive assisted dying (AD) in specified circumstances. Given the nature and complexity of this new health service, research is vital to determine how AD is operating in practice.

OBJECTIVE

To identify research priorities regarding the implementation and delivery of AD in New Zealand.

METHODS

Using an adapted research prioritisation methodology, the researchers identified 15 potential AD research topics. A mixed-methods survey of health professionals was undertaken where respondents were asked to rate the 15 topics according to the relative importance for research to be conducted on each issue. Respondents could also suggest additional research areas, and were invited to participate in a follow-up interview.

RESULTS

One hundred and nineteen respondents completed the survey. 31% had some experience with AD. The highest rated research topic was the 'effectiveness of safeguards in the Act to protect people'; the lowest rated topic was research into the 'experiences of non-provider (e.g., administrative, cleaning) staff where assisted dying is being provided'. Respondents suggested 49 other research topics. Twenty-six interviews were conducted. Thematic analysis of interview data and open-ended survey questions was undertaken. Six research themes were identified: general factors related to the wider health system; the experiences of health care providers at the bedside; medico-legal issues; the impact of AD; experiences on the day of dying; and the overall effectiveness of the AD system. Key issues for stakeholders included safety of the AD service; ensuring access to AD; achieving equity for 'structurally disadvantaged' groups; and ensuring the well-being of patients, families/whānau, providers and non-providers.

CONCLUSIONS

Based on early experiences of the implementation of the AD service, health professionals provide important insights into what research should be prioritised post-legalisation of AD. These findings can be used to shape the research agenda so that research may inform law, policy and best practice.

'I want to die on my own terms': Dominant interpretative repertoires of 'a good death' in old age in Dutch newspapers

RATIONALE

There is a paucity of empirical studies exploring how death and dying in old age are actually represented and debated within the Dutch society.

OBJECTIVE

This study examines the discourse used in Dutch newspapers on the good death and dignified dying. It analyses how different types of social actions and positions are construed, thereby describing how death and dying in old age are portrayed in newspaper media.

METHODS

173 newspaper articles between 2010 and 2020 were selected from five Dutch national newspapers. Data were thematically coded and scrutinised for discursive patterns in order to identify interpretative repertoires and their functions.

RESULTS

Four interpretative repertoires of good death and dying in old age were identified, all drawing on the assisted dying debate: Choice, Risk, Care, and Complexity. Each repertoire constructs a particular image of death and dying, varying from it being a personal choice; a last resort; a joint journey; to a contingent quest. The different repertoires imply distinct identities and actions. The Choice-repertoire construes older people as active subjects who autonomously determine their own death. The Risk- and Care-repertoires both construe older people primarily as passive and acted upon: either threatened by illness, decline and death; or protected and cared for by others and society. The Complexity-repertoire construes older people's situation as an object of reflection.

DISCUSSION AND CONCLUSION

The strong prevalence of the Choice-repertoire in Dutch newspapers construes good death and dignified dying in old age in a salient way, unrepresentatively highlighting assisted dying as the preferred imagined practice. It is hypothesised that reimaging the Care- and Complexity-repertoires in such a way that they construe older persons in a more active subject role could help depolarise the debate on death and dying in old age.

The views of Aotearoa/New Zealand adults over 60 years regarding the End of Life Choice Act 2019

This study described the views of older New Zealand adults toward assisted dying and specifically the End of Life Choice Act (2019), an Act making assisted dying legal. An anonymous postal and online survey of 636 adults 60 years and older was conducted. The majority of respondents did not support legalization (85.7%), while 8.8% were in favor (5.5% did not specify a view). Weighted binary logistic regression indicated that the odds of support for legalization were lower in those respondents with a religious affiliation (OR = .020, S.E. = 0.60, p = .00), and there were 2.66 times greater odds in those identifying as male (S.E. = 0.34, p = .005). On the other hand, those respondents under 65 years had increased odds of supporting legalization (OR = 1.89, S.E. = .029, p = .045). Results indicate that most participants were concerned about potential abuses and coercive practices if assisted dying became legally available in New Zealand.

The mediated discourse and voice of euthanasia: the Israeli media as a case study

Euthanasia is an important social and quality of life issue. However, it is highly controversial and thus continuously debated especially given its legitimacy and legality differ between countries. Little is known about the role media plays concerning this topic. To fill this gap, this study applies a mixed methods approach to a case study of Israeli media, including a quantitative content analysis of news articles (to measure the discourse of 'civil participation'), a thematic analysis of news articles (to examine the 'voice') and a quantitative content analysis of Facebook comments (to measure 'being heard'). Results indicate that while the media highly enables the media capability of 'voice' (both 'voicing' and 'being heard'), it limits the media capability of 'civil participation' to a narrow array of discourse, hindering the social debate. These results reveal the role the media plays regarding euthanasia, integral to individuals' quality of life through the realisation of their media capabilities, and in relation to the act of euthanasia itself.

Effects of Educative Materials on Doctors' Intention to Initiate Life-Saving Procedures After a Suicide Attempt: Randomised Controlled Trial

Introduction: The topic of euthanasia, assisted dying, and how to deal with death wishes has received strong public and media attention in many countries. Nevertheless, there is currently no research which has analysed if educative materials that favour or disfavour the initiation of life-saving measures after a suicide attempt impact on attitudes to initiate such procedures among physicians. Materials and Methods: A double-blind randomised controlled trial was conducted to test if educative materials that either support life-saving measures or rather recommend against it after a near-fatal suicide attempt has an effect on intentions to initiate such measures (trial registration: DRKS00024953, www.drks.de). N = 192 doctors from the Medical University Vienna (Austria) participated in the study and either read educative materials not recommending (n = 59), or recommending life-saving measures (n = 64), or were not reading educative materials (n = 69, control group). The primary outcome was intentions to initiate life-saving measures in an open case vignette featuring the case of a terminally ill cancer patient. Other variables assessed were demographics, experiences with terminally ill and dying patients, training or qualification in mental health, specialty, position, whether doctors worked in emergency medicine, and attitudes toward assisted dying. A logistic regression analysis was used. Results: There was no immediate effect of educative materials on intentions to initiate life-saving measures, χ2(2) = 0.94, p = 0.63. The adjusted model including all tested predictors was significant [χ2(15) = 37.82, df = 15, p < 0.001]. Attending position, male gender, low age, and more negative attitudes to assisted dying predicted a decision for life-saving measures. Higher agreement with life-saving measures was reported for a case vignette about a patient with schizophrenia than for a case vignette about a patient with Huntington's disease. Discussion: Educative materials either favouring or disfavouring the initiation of life-saving measures after a suicide attempt do not appear to immediately influence related decision-making processes. Related intentions appear mainly influenced by personal opinions on the topic and by the specific patient case. Good-quality in-depth discussions regarding end-of-life decisions and to develop well-founded and non-opinionated guidelines are highly warranted.

Frames and counter-frames giving meaning to palliative care and euthanasia in the Netherlands

Background

Based on the case of palliative care and euthanasia in the Netherlands, this paper presents an analysis of frames and counter-frames used in the ongoing public debate about these two intertwined topics. Each (counter)frame presents a cultural theme that can act as a prism to give meaning to palliative care and/or euthanasia. Each frame comprehends a different problem definition, consequences and policy options. Typical word choices and metaphors are identified that can evoke these frames and the underlying reasoning. The frames do not belong to a specific stakeholder but a pattern can be seen in their use that is related to interests and ideology.

Methods

An inductive framing analysis was conducted of 2,700 text fragments taken from various Dutch newspapers, websites of stakeholders and policy documents in the period 2016–2018. After an extensive process of thematic coding, axial coding, selective coding and peer review seven frames and seven counter-frames about palliative care and euthanasia were constructed. Fifteen experts in the field of palliative and/or end-of-life care commented on the overview during a member check.

Results

Two frames about palliative care were constructed: the Fear of death frame, which stresses the hopeless ‘terminality’ of palliative care and the Heavy burden frame, in which palliative care is too big a responsibility for the relatives of the patient. In addition, two counter-frames were constructed: palliative care as a contributor to Quality of life and Completion. With regard to euthanasia, five frames were identified that lead to a problematising definition: Thou shalt not kill, Slippery slope, Lack of willpower, I am not God, and Medical progress. Five counter-frames offer a non-problematising definition of euthanasia in the debate: Mercy, Prevention, Triumph of reason, Absolute autonomy, and Economic utility thinking.

Conclusions

The debate in the Netherlands on euthanasia and palliative care is characterized by a plurality of angles that goes beyond the bipolar distinction between the pros and cons of euthanasia and palliative care. Only with an overview of all potential frames in mind can an audience truly make informed decisions. The frame matrix is not only useful for policy makers to know all perspectives when joining public debate, but also to health care workers to get into meaningful conversations with their patients and families.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00772-9.

A citizens' jury on euthanasia/assisted dying: Does informed deliberation change people's views?

Euthanasia or assisted dying (EAD) remains a highly contentious issue internationally. Although polls report that a majority New Zealanders support EAD, there are concerns about the framing of the polling questions, and that those responding to the questions do not know enough about the situations described, the options available and the potential implications of EAD policy. One way to address these concerns is through a citizens' jury, which is a method of learning how a group of people view an issue following informed deliberation. This citizens' jury was conducted to learn whether a group of 15 New Zealanders thought the law should be changed to allow some form of EAD and the reasons for their view, having been informed about the issue, heard arguments for and against, and having deliberated together. The jury met for two and a half days. They did not reach a consensus, but become polarized in their positions, with several changing their positions to either strong opposition or strong support. The reasons why people support or oppose EAD were not reducible to particular principles or arguments, but reflected an integrated assessment of a range of considerations, informed by personal priorities and experiences. These results suggest that views on EAD may change in response to informed deliberation that the EAD debate involves a range of value judgments and is not likely to be resolved through deliberation alone. These results may inform international debate on EAD policy.

Body Donation after Medically Assisted Death: An Emerging Consideration for Donor Programs

Around the world, the recent introduction of assisted death laws has meant that undertaking medical assistance in dying (MAID) is now an option for some persons wishing to end their life. Some of these people donate their bodies to medical science, and by doing so have created a new route from which donor programs can now receive bodies. Such donations have also illuminated a myriad of novel ethical questions. This article considers the emotive and controversial topic of MAID in relation to body donation, describing the experiences of McMaster University, Canada, where several MAID body donors have been received by the anatomical donor program. It provides background on the development and implementation of MAID in Canada, and describes the experience of staff and students at McMaster to MAID donations. It also explores the relevance of MAID to body donation programs, and discusses several of the ethical challenges facing body donation programs who may encounter MAID body donors. These include the appropriateness of accepting MAID donors, issues with informed consent, the effect of personal engagement with MAID donors, information sharing around MAID donations, governance issues, and negative historical parallels between MAID and euthanasia. Suggestions on how to manage MAID body donation focus on how issues affecting institutions, faculty, and students may be approached utilizing appropriate transparency and communication, some of which may facilitate student professional development around the topic of MAID. It is also suggested that the development of ethically appropriate guidelines on MAID body donations may positively guide the anatomical community.