Facing a request for assisted death - views of Finnish physicians, a mixed method study.

BACKGROUND: Assisted death, including euthanasia and physician-assisted suicide (PAS), is under debate worldwide, and these practices are adopted in many Western countries. Physicians' attitudes toward assisted death vary across the globe, but little is known about physicians' actual reactions when facing a request for assisted death. There is a clear gap in evidence on how physicians act and respond to patients' requests for assisted death in countries where these actions are not legal. METHODS: A survey including statements concerning euthanasia and PAS and an open question about their actions when facing a request for assisted death was sent to all Finnish physicians. Quantitative data are presented as numbers and percentages. Statistical significance was tested by using the Pearson chi-square test, when appropriate. The qualitative analysis was performed by using an inductive content analysis approach, where categories emerge from the data. RESULTS: Altogether, 6889 physicians or medical students answered the survey, yielding a response rate of 26%. One-third of participants agreed or partly agreed that they could assist a patient in a suicide. The majority (69%) of the participants fully or partly agreed that euthanasia should only be accepted due to difficult physical symptoms, while 12% fully or partly agreed that life turning into a burden should be an acceptable reason for euthanasia. Of the participants, 16% had faced a request for euthanasia or PAS, and 3033 answers from 2565 respondents were achieved to the open questions concerning their actions regarding the request and ethical aspects of assisted death. In the qualitative analysis, six main categories, including 22 subcategories, were formed regarding the phenomenon of how physicians act when facing this request. The six main categories were as follows: providing an alternative to the request, enabling care and support, ignoring the request, giving a reasoned refusal, complying with the request, and seeing the request as a possibility. CONCLUSIONS: Finnish physicians' actions regarding the requests for assisted death, and attitudes toward euthanasia and PAS vary substantially. Open discussion, education, and recommendations concerning a request for assisted death and ethics around it are also highly needed in countries where euthanasia and PAS are not legal.

Perceived stress, optimism-pessimism, psychological adjustment, and death distress of nurses during the COVID-19 pandemic.

OBJECTIVE: the aim of this study is to investigate the relationship between death distress, psychological adjustment, optimism, pessimism and perceived stress among nurses working during the COVID-19 pandemic. METHOD: this study was designed as cross-sectional/cohort. The population of the study involved 408 nurses from Northern Cyprus, which are registered as full members of the Nurse Council. The sample comprised 214 nurses, who volunteered to participate in the study. The study data was collected using a web-based online survey (Demographic form, the Coronavirus Stress Measure, The Optimism and Pessimism Questionnaire, The Brief Adjustment Scale-6, The Death Distress Scale). RESULTS: the results indicated that perceived stress significantly and negatively predicted optimism (ß = -0.21, p < 0.001) and pessimism (ß = 0.38, p < 0.001). Perceived stress had significant and positive predictive effects on psychological adjustment (ß = 0.31, p < 0.001) and death distress (ß = 0.17, p < 0.01). Further analysis results revealed that pessimism mediates the association of stress with psychological adjustment and death distress; however, optimism only mediates the effect of stress on psychological adjustment among nurses. CONCLUSION: a low level of pessimism is effective in strengthening nurses' psychological adjustment skills againt perceived stress and death distress. Nurses should consider behavioral strategies to help reduce the level of pessimism during periods such as pandemics. BACKGROUND: (1) High levels of perceived stress increased higher score of psychological adjustment. (2) Pessimism mediates the association of stress with adjustment and death distress. (3) Optimism only mediates the effect of stress on psychological adjustment among nurses.

Resisting the (re-)medicalisation of dying and grief in the post-digital age: Natural language processing and qualitative analysis of data from internet support forums.

In the mid-twentieth century, the social movement of death revivalism sought to resist the medicalisation of dying and grief through promotion of the dying person retaining autonomy, and societal openness toward death and bereavement. Despite this advocacy, present-day dying in high income countries is largely institutionalised, with value placed on control over the body and emotions. These phenomena are at odds with the ambitions of death revivalism, and demonstrate the re-medicalisation of dying and grief. Furthermore, contemporary society is continually advancing into the post-digital age, reflected in digital technologies being a tacit part of human existence. Within this framework, this study aims to investigate how people living with life-limiting illness and their loved ones experience, negotiate, and resist medicalisation of dying and grief through online internet forums. We collected posts through web-scraping and utilised Natural Language Processing techniques to select 7048 forum posts from 2003 to 2020, and initially categorise data, before utilising Inductive Thematic Analysis, which generated two major themes. The theme of 'Comfort' describes online forums facilitating psychosocial support which was often used to compensate for systemic deficiencies, especially during the Covid-19 pandemic. Common sources of comfort included animal companions and spirituality, in stark contrast with the medicalised model. The theme of 'Capability' describes online forums acting as solutions for people facing disempowering care systems, including providing information on legal rights and benefits which may not be otherwise easily available, and facilitating collective advocacy. Our findings indicate that community-led online forums can play an effective and sustainable role in democratising care and retaining agency when facing life-limiting illness and grief. Future palliative and bereavement care research must focus on how online forums can be integrated into existing systems, made transparent and accessible, be adequately funded and structured, and be optimised, including compensating for service disruption encountered during future pandemics.

[The subjective experience of contact with the deceased or necrophany: a widespread and little-known phenomenon]. / Le vécu subjectif de contact avec un défunt ou nécrophanie : un phénomène répandu et peu connu.

The subjective experience of contact with the deceased (VSCD), spontaneous and direct, by people most often in mourning, is neither rare nor new. It's even considered a universal and timeless phenomenon. Yet this psychological and sensory manifestation, which can manifest itself through sight, hearing, smell or touch, remains little known to the general public and health professionals alike. This article is an opportunity for many to discover this phenomenon, also known as necrophany.

Factors influencing death attitudes of medical students: a scoping review.

Aim: To summarize factors influencing death attitudes of medical students, help identify intervention targets, and design precision interventions for improving death attitudes of medical students. Methods: Web of Science, PubMed, Embase, OVID, China National Knowledge Infrastructure, and Wanfang databases were searched. Retrieval time was from January 2012 to September 2023. Studies on factors influencing death attitudes of medical students were included. Results: Thirty-five studies were included in the final review. A total of 28 factors influencing death attitudes of medical students were summarized and divided into three categories comprising personal factors, social factors, and psychological factors. More than 15 studies confirmed that gender, religion, and discussing death with families were factors that influenced medical students' death attitudes. Conclusion: Results indicate that there are many types of factors that influence death attitudes of medical students. It is necessary for universities to implement death education based individual characteristics and guide medical students to cultivate generally optimistic death attitudes and appropriate life values.

Understanding posthumous sperm retrieval during war through a terror management theory perspective.

Terror Management Theory (Tmt, solomon et al., 1991) claims that individuals use three anxiety buffer mechanisms to regulate their death awareness - cultural worldviews, self-esteem, and proximity seeking. In this article, we use these three TMT anxiety buffers to explain the phenomenon of posthumous sperm retrieval, requested by spouses or parents, usually of young soldiers who died during their military service. Whereas this phenomenon has been known for some time, it increased dramatically in the initial days following the massacre conducted by the Hamas terrorist organization in Israel on October 7, 2023. We claim that this was an immediate reaction to this terror event, which posed a direct, existential threat to those who were exposed to the massacre and the soldiers who defended the country, but also to the entire Israeli society, as well as for Jews around the globe. We use interpretive phenomenology to qualitatively examine the phenomenon of retrieving sperm from dead young men, analyzing the requests to retrieve sperm posthumously as a sign of the need to provide these young men with symbolic immortality, on both personal and national levels. We integrate this explanation with the military ethos and the tendency of Israeli society to endorse familyist and pronatalist values to expand our understanding of this contemporary phenomenon in Israel.

Mediating effects of attitude on the relationship between knowledge and willingness to organ donation among nursing students.

Background: The current rate of organ donation in China falls significantly below the global average and the actual demand. Nursing students play a crucial role in supporting and promoting social and public welfare activities. This study primary aims to analyze the levels of knowledge, attitudes, willingness toward organ donation, and attitudes toward death among nursing students, and investigate the mediating role of attitude in the relationship between knowledge and willingness. The secondary aims to identify factors that may influence the willingness. Methods: A convenience sample of nursing students completed online-administered questionnaires measuring the level of knowledge, attitudes, and willingness toward organ donation before and after clinical internship. Spearman correlation and mediation analyses were used for data analyses. Results: Before the clinical internship, there were 435 nursing students who had not yet obtained their degrees and were completing their clinical internships. After the internship, this number decreased to 323. The mean score for knowledge before and after the clinical internship (7.17 before and 7.22 after, with no significant difference), the attitude (4.58 before and 4.36 after, with significant difference), the willingness (12.41% before and 8.67% after, with significant difference), the Death Attitude Profile-Revised (DAP-R) score (94.41 before and 92.56 after, with significant difference). The knowledge indirectly affected nursing students' willingness to organ donation through attitude. Knowledge had a direct and positive impact on attitudes (ß = 1.564). Additionally, nursing students' attitudes positively affected their willingness (ß = 0.023). Attitudes played a mediating role in the relationship between knowledge and willingness (ß = 0.035). Additionally, attitude toward death, fear of death, and acceptance of the concept of escape were found to be correlated with their willingness. Conclusion: Organ donation willingness was found to be low among nursing students. Positive attitudes were identified as a mediating factor between knowledge and willingness. Additionally, DAP-R was a related factor. Therefore, it is recommended to focus on improving knowledge and attitude, as well as providing death education to help nursing students establish a positive attitude toward death. These efforts can contribute to the promotion of organ donation.

Factors Associated with Preferred Place of Care and Death in Patients with Parkinson's Disease: A Cross-Sectional Study.

Background: A significant proportion of people with Parkinson's disease (PwPD) die in hospital settings. Although one could presume that most PwPD would favor being cared for and die at home, there is currently no evidence to support this assumption. Objective: We aimed at exploring PwPD's preferences for place of end-of-life care and place of death, along with associated factors. Methods: A cross-sectional study was conducted to investigate PwPD's end-of life wishes regarding their preferred place of care and preferred place of death. Using different approaches within a generalized linear model framework, we additionally explored factors possibly associated with preferences for home care and home death. Results: Although most PwPD wished to be cared for and die at home, about one-third reported feeling indifferent about their place of death. Preferred home care was associated with the preference for home death. Furthermore, a preference for dying at home was more likely among PwPD's with informal care support and spiritual/religious affiliation, but less likely if they preferred institutional care towards the end of life. Conclusions: The variation in responses regarding the preferred place of care and place of death highlights the need to distinguish between the concepts when discussing end-of-life care. However, it is worth noting that the majority of PwPD preferred care and death at home. The factors identified in relation to preferred place of care and death provide an initial understanding of PwPD decision-making, but call for further research to confirm our findings, explore causality and identify additional influencing factors.

The relationship between fear of old age, loneliness and death anxiety in adults.

BACKGROUND: The increase in the number of elderly people in the world, individuals' perspectives on older adults, and false beliefs and ideas about old age negatively affect adults in terms of ageing. This study was conducted to determine the relationship between fear of old age, loneliness and death anxiety in adults. METHOD: This study, which was designed in a correlational cross-sectional descriptive model, was conducted with 1074 adult individuals living in one province in eastern Turkey. Data were collected using Personal Information Form, Fear of Old Age Scale, UCLA Loneliness Scale and Turkish Death Anxiety Scale. Data were analyzed using SPSS 25.0, AMOS 24.0, G*Power 3.1 statistical package programs. RESULTS: In our study, it was determined that the model created in line with the hypotheses was compatible and the model fit indices were within the desired limits as χ2/df = 4.737, root mean square error of approximation = 0.05, comparative fit index = 0.93, goodness-of-fit index = 0.92, adjusted goodness-of-fit index = 0.90, IFI = 0.93. There is a significant relationship between loneliness and death anxiety (P < 0.05). There is a significant relationship between loneliness and fear of old age (P < 0.05). There is a significant relationship between death anxiety and fear of old age (P < 0.05). It was determined that death anxiety has a mediating role in the effect of loneliness on fear of old age (95% confidence interval: 0.112-0.226; P < 0.05). CONCLUSION: As the level of loneliness increases, the level of death anxiety and fear of old age increases. Fear of old age also increases in the mediating role of death anxiety. It is recommended to conduct intervention studies to reduce fear of old age. Longitudinal study on fear of old age is recommended.

Knowledge and attitudes of medical students toward death: a cross-sectional comparative study between an Arab and a Western University.

BACKGROUND: Cultural factors influence attitudes toward death, and gender disparities are evident. Prior studies show that medical students have limited knowledge about death and are uncomfortable with it. Moreover, there is limited research that has examined factors that influence medical students' knowledge and attitudes toward death. OBJECTIVES: The objectives of the study were to compare cultural and gender differences in relation to knowledge and attitudes toward loss and grief and to screen for complicated grief among medical students at the Arabian Gulf University and the University of Toronto. METHODS: A cross-sectional study was disseminated to medical students at both universities in 2022. The variables in the survey included four parts: demographic characteristics of the participants, religious observance, history of encountering loss of a loved one, grief following loss, attitude toward death, and learning about how to deal with grief and death during medical school. The brief grief questionnaire and the death attitude profile-revised scales were used. RESULTS: The study sample consisted of 168 medical students, with 74.1% being female. Complicated grief scores were higher among Arabian Gulf University students (3.87 ± 2.39) than among University of Toronto students (2.00 ± 1.93) and were higher for participants with a higher degree of religious observance in both schools (p < 0.05). Death avoidance (p = 0.003), approach acceptance (p < 0.001), and escape acceptance (p = 0.038) domains were significantly higher among Arabian Gulf University students than among University of Toronto students. Almost three-quarters of University of Toronto students reported not being taught about grief, compared to 54% of Arabian Gulf University students. CONCLUSIONS: Arabian Gulf University medical students scored higher on complicated grief, most likely due to cultural and religious factors. Females at both institutions as well as those who indicated a higher level of religious observance reported higher scores of complicated grief. The study highlights how cultural and religious beliefs influence medical students' attitudes toward death and bereavement. It provides valuable insight into the knowledge and attitudes of medical students toward loss.

Partnering With Parents to Dismantle "Good-Death" Narratives.

This Viewpoint dismantles the notion of a "good death" in pediatrics using quotes from bereaved parents and provides actionable alternatives to improve quality end-of-life care for dying children and their families.

Applying Lessons From Ars Moriendi to Foster Dying Well in Acute Care Settings.

Medical and technological advances have made it possible to keep people alive well beyond what was once possible, leading health care providers to focus on life-sustaining measures rather than questioning the futility of such measures and considering quality of life. In the midst of the struggle to foster dying well in a medicalized environment, acute care nurses may be challenged with shifting the focus to providing optimal end-of-life care because of lack of training, time, and resources. A remedy for the current western societal approach to medicalized dying is to look back in history to a time during the late Middle Ages, when death was an accepted part of medieval life. A literary genre called Ars Moriendi (translated "the art of dying") was written and illustrated to provide instruction on how to die well and how to care for the dying. Nurses can apply lessons from this text to fulfill the ethical obligation to practice with dignity and provide compassionate end-of-life care. These lessons include helping patients and families identify goals of care and accept finitude, encouraging the participation of loved ones at the bedside, and fostering reconciliation at the end of life.

A bioethical perspective on the meanings behind a wish to hasten death: a meta-ethnographic review.

BACKGROUND: The expressions of a "wish to hasten death" or "wish to die" raise ethical concerns and challenges. These expressions are related to ethical principles intertwined within the field of medical ethics, particularly in end-of-life care. Although some reviews were conducted about this topic, none of them provides an in-depth analysis of the meanings behind the "wish to hasten death/die" based specifically on the ethical principles of autonomy, dignity, and vulnerability. The aim of this review is to understand if and how the meanings behind the "wish to hasten death/die" relate to and are interpreted in light of ethical principles in palliative care. METHODS: We conducted a meta-ethnographic review according to the PRISMA guidelines and aligned with Noblit and Hare's framework. Searches were performed in three databases, Web of Science, PubMed, CINAHL, with no time restrictions. Original qualitative studies exploring the meanings given by patients, family caregivers and healthcare professionals in any context of palliative and end-of-life care were included. A narrative synthesis was undertaken. PROSPERO registration CRD42023360330. RESULTS: Out of 893 retrieved articles, 26 were included in the analysis, accounting for the meanings of a total of 2,398 participants. Several factors and meanings associated with the "wish to hasten death" and/or "wish to die" were identified and are mainly of a psychosocial and spiritual nature. The ethical principles of autonomy and dignity were the ones mostly associated with the "wish to hasten death". Ethical principles were essentially inferred from the content of included articles, although not explicitly stated as bioethical principles. CONCLUSIONS: This meta-ethnographic review shows a reduced number of qualitative studies on the "wish to hasten death" and/or "wish to die" explicitly stating ethical principles. This suggests a lack of bioethical reflection and reasoning in the empirical end-of-life literature and a lack of embedded ethics in clinical practice. There is a need for healthcare professionals to address these topics compassionately and ethically, taking into account the unique perspectives of patients and family members. More qualitative studies on the meanings behind a wish to hasten death, their ethical contours, ethical reasoning, and implications for clinical practice are needed.

The state of transience, and its influence on the wish to die of advanced disease patients: insights from a qualitative phenomenological study.

BACKGROUND: The experience of Wish to Die is common in patients living with Advanced Disease. It has been studied worldwide and qualitative studies have contributed to the understanding of the complexity of the phenomenon of the WTD but a deeper understanding on the individual's views is still needed. The objective of this study was to identify common characteristics of the experience of wish to die in advanced disease. METHODS: A phenomenological study was carried out with multicenter participation of patients with advanced disease who had expressed their wish to die to health professionals. Semi-structured interviews were employed to obtain an in-depth perspective of each patient's lived experience. A phenomenological analysis of the data collected was performed to describe and explore the characteristic aspects of the phenomenon under study. RESULTS: Fourteen patients with advanced disease were interviewed. Most of them had cancer. In the analysis of the patients' accounts of their experiences, three common characteristics were identified: a) experiencing a state of transience; b) the attempt to reconnect with oneself; and c) additional disease-related aspects that influence the wish to die. Patients expressed the need for a safe space to address the wish to die and the importance of receiving care that considers both 'being' and 'doing'. CONCLUSIONS: Patients with advanced disease and wish to die experience a state of transience where the patient lives and ephemeral state of existence. Interventions focused on reinforcing the intrinsic value of the individual emerge as essential components of a compassionate accompaniment of those facing the wish to die.

Validation of the Collett-Lester fear of death scale in occupational therapy students: psychometric testing and implications for palliative care education.

BACKGROUND: The fear of death is a common experience among healthcare students and professionals that may impact the quality of care provided to patients, particularly those receiving palliative care. The Collett-Lester Fear of Death Scale is a widely used instrument to assess this fear, although its psychometric properties have not been extensively studied in Occupational Therapy students. The present study aimed to validate the Collett-Lester Fear of Death Scale (CL-FODS) in a sample of Occupational Therapy students and to explore its implications for palliative care education. METHOD: A cross-sectional study was conducted to perform psychometric testing of the CL-FODS in Occupational Therapy undergraduate students. Structural validity, internal consistency, and test-retest reliability were analysed. A total of 195 Occupational Therapy students were included in this study. Additionally, the participants completed a brief survey on their experiences and attitudes towards palliative care. RESULTS: The internal consistency was satisfactory (α = 0.888). The exploratory factor analysis to evaluate the internal structure yielded four factors. The model fit indices were: comparative fit index = 0.89, and root mean square error of approximation = 0.06). The test-retest reliability was satisfactory and demonstrated an intraclass correlation coefficient of 0.939. CONCLUSION: The Spanish version of the CL-FODS showed satisfactory psychometric properties; therefore, assessing fear of death in Occupational Therapy students is helpful. This study highlights the importance of addressing fear of death and palliative care education in Occupational Therapy undergraduates to improve future professional attitudes and, consequently, the quality of patient care at the end of life.