Assuntos
Carcinoma de Células em Anel de Sinete , Tumores do Estroma Gonadal e dos Cordões Sexuais , Neoplasias Testiculares , Humanos , Masculino , Carcinoma de Células em Anel de Sinete/diagnóstico , Carcinoma de Células em Anel de Sinete/patologia , Tumores do Estroma Gonadal e dos Cordões Sexuais/patologia , Neoplasias Testiculares/patologiaRESUMO
Background & objectives: Identifying the impacts of COVID-19 on patients' and practitioners' access to legal assisted dying and euthanasia (AD&E) services is vital to informing service continuity in an ongoing pandemic.Methods: An anonymous online survey collected qualitative and quantitative data from health practitioners and agencies providing legal AD&E services (n = 89), complemented by semi-structured interviews with 18 survey respondents who volunteered.Results: Following governments' responses to the dynamic pandemic context, rates of AD&E inquiries and requests fluctuated across and within jurisdictions, based on a complex interaction of factors affecting patient access to AD&E agencies and assessors as services were disrupted. Service flexibility and nimbleness became key elements in continuing service availability and included calculated 'rule-breaking' considered justifiable to adhere to established bioethics. Making innovative adjustments to usual practice led to reviewing the effectiveness of AD&E services and laws, resulting in providers now improving services and lobbying for legislative change.
RESUMO
Planning for programme sustainability is a key contributor to health and development, especially in low-income and middle-income countries. A consensus evidence-based operational framework would facilitate policy and research advances in understanding, measuring, and improving programme sustainability. We did a systematic review of both conceptual frameworks and empirical studies about health-programme sustainability. On the basis of the review, we propose that sustainable health programmes are regarded as complex systems that encompass programmes, health problems targeted by programmes, and programmes' drivers or key stakeholders, all of which interact dynamically within any given context. We show the usefulness of this approach with case studies drawn from the authors' experience.