Between illness and death: "Euthanasia".

The arguments for and against euthanasia present a complex picture that will need to be discussed and decided in Mexico. This article addresses some relevant aspects such as the legal determination of death, the field of bioethics intervention, terminology related to euthanasia, its classifications, international instruments promoting human rights, as well as reflections on the importance of palliative care and the patient's right to be in a terminal situation to act in accordance with their goals, expectations and beliefs, in the context of their family and social relationships.

Los argumentos a favor y en contra de la eutanasia exponen un panorama complejo, que será necesario discutir y decidir en México. En este artículo se abordan algunos aspectos relevantes, como la determinación legal de la muerte, el campo de intervención de la bioética, la terminología relacionada con la eutanasia, sus clasificaciones, los instrumentos internacionales promotores de los derechos humanos, y reflexiones sobre la importancia de los cuidados paliativos y el derecho que tiene el paciente en situación terminal para actuar conforme a sus objetivos, expectativas y creencias, en el contexto de sus relaciones familiares y sociales.

Causas de morte e razões para eutanásia em gatos na Região Central do Rio Grande do Sul (1964-2013) / Causes of death and reason for euthanasia in cats in the central region of Rio Grande do Sul, Brazil (1964-2013)

Este trabalho tem por objetivo determinar a prevalência das doenças que causam a morte ou levam à eutanásia de gatos da região central do Rio Grande do Sul. Para isto, foram revisados os arquivos do Laboratório de Patologia Veterinária (LPV) da Universidade Federal de Santa Maria (UFSM) entre 1964 a 2013, e foram encontrados um total de 1.247 protocolos de necropsias de gatos. Em 878 protocolos (70,4%) a causa da morte e/ou razão para eutanásia foi estabelecida e em 369 casos (29,6%) não foi possível estabelecer uma causa definitiva. Os diagnósticos encontrados foram avaliados e distribuídos em diferentes categorias. Os grupos responsáveis pelo maior número de causas de morte ou razão para eutanásia em gatos foram os distúrbios causados por agentes físicos (15,6%), seguidos das doenças infecciosas e parasitárias (13,2%) e dos tumores (10,50%). Intoxicações e toxi-infecções (5,3%), doenças degenerativas (4,8%), distúrbios iatrogênicos (3,8%), doenças metabólicas e endocrinológicas (2,7%) foram categorias comuns. Doenças imunomediadas (2,1%), doenças nutricionais (1,6%), eutanásia por conveniência (1,4%) e distúrbios congênitos (1%) foram categorias incomuns. Outros distúrbios perfizeram 8,34% dos casos, As doenças mais importantes também foram avaliadas com relação à idade e os resultados obtidos demonstram que os adultos são mais acometidos pelo distúrbio do trato urinário inferior dos felinos, por traumas e por distúrbios iatrogênicos. Os gatos idosos são mais afetados por tumores e por doenças degenerativas, como a insuficiência renal crônica. Nos filhotes a principal doença que causa a morte ou eutanásia é a peritonite infecciosa feline.(AU)

The objective of this study was to determine the main diseases that cause death or euthanasia in cats in the central region of Rio Grande do Sul, Brazil. The Veterinary Pathology Laboratory (LPV-UFSM) files were reviewed from 1964 to 2013 and a total of 1,247 cat necropsies protocols were found. In 878 (70.40%) protocols the cause of death and/or reason for euthanasia has been established while in 369 (29.59%) cases it was not possible to be determined and these were classified as inconclusive. The final diagnosis were evaluated and classified into different categories. The category which includes the largest number of causes of death or reason for euthanasia in cats are disorders due to physical agents (15.63%), followed by infectious and parasitic diseases (13.15%), tumors (10.50%), other disorders (8.34%), poisoning and toxinfections (5.29%), degenerative diseases (4.81%), iatrogenic disorders (3.76%), metabolic and endocrinological diseases (2.72%), immune-mediated diseases (2.08%), nutritional diseases (1.60), convenience euthanasia (1.44%) and congenital disorders (1.04%). The most important diseases were also evaluated according to age and the results demonstrated that adult cats are most affected by lower urinary tract disease, trauma and iatrogenic disorders. Elderly cats are most affected by tumors and chronic renal failure. However, in young cats, feline infections peritonitis were found to be the most important cause of death or euthanasia.(AU)

Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium.

BACKGROUND: Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress. METHODS: This study is an international qualitative interview study involving interviews with physicians, nurses, and relatives of deceased patients in the UK, The Netherlands and Belgium (the UNBIASED study) about a case of continuous sedation at the end of life they were recently involved in. All interviews were transcribed verbatim and analysed by staying close to the data using open coding. Next, codes were combined into larger themes and categories of codes resulting in a four point scheme that captured all of the data. Finally, our findings were compared with others and explored in relation to theories in ethics and sociology. RESULTS: The participants' responses can be captured as different dimensions of 'closeness', i.e. the degree to which one feels connected or 'close' to a certain decision or event. We distinguished four types of 'closeness', namely emotional, physical, decisional, and causal. Using these four dimensions of 'closeness' it became possible to describe how physicians, nurses, and relatives experience their involvement in cases of continuous sedation until death. More specifically, it shined a light on the everyday moral reasoning employed by care providers and relatives in the context of continuous sedation, and how this affected the emotional impact of being involved in sedation, as well as the perception of their own moral responsibility. CONCLUSION: Findings from this study demonstrate that various factors are reported to influence the degree of closeness to continuous sedation (and thus the extent to which carers feel morally responsible), and that some of these factors help care providers and relatives to distinguish continuous sedation from euthanasia.

The acceptability of ending a patient's life: a France-Portugal-Spain comparison.

The views of French, Portuguese, and Spanish people on end-of-life decisions were compared. Two hundred seventy-seven adults from Barcelona, Oporto, and Toulouse judged the acceptability of life-ending procedures in 42 scenarios composed of all combinations of 3 factors: the patient's age (30 or 80 years), the patient's life expectancy (days, weeks, or months), and the type of procedure (suicide, suicide assisted by the physician, euthanasia by the physician at the request of a suffering patient, euthanasia of a comatose patient at the family's request, euthanasia of a comatose patient as stipulated in the patient's advance directives, euthanasia of a comatose patient without advance directions and without a request from the family, or euthanasia of a suffering patient without a request from the patient). In all 3 countries, the type of procedure had the major effect. The 4 procedures implemented by the patient or at the patient's request were, on average, considered acceptable. The 2 procedures not implemented at the patient's request were considered unacceptable. Euthanasia of a comatose patient at the request of the family was judged mildly acceptable. The attitudes of the people in Toulouse, Oporto, and Barcelona concerning the acceptability of ending a patient's life have now largely converged, although Spanish participants were statistically significantly more accepting than French and Portuguese participants.

The labelling and reporting of euthanasia by Belgian physicians: a study of hypothetical cases.

BACKGROUND: Belgium legalized euthanasia in 2002. Physicians must report each euthanasia case to the Federal Control and Evaluation Committee. This study examines which end-of-life decisions (ELDs) Belgian physicians label 'euthanasia', which ELDs they think should be reported and the physician characteristics associated with correct labelling of euthanasia cases, the awareness that they should be reported and the reporting of them. METHODS: Five hypothetical cases of ELDs: intensified pain alleviation, palliative/terminal sedation, euthanasia with neuromuscular relaxants, euthanasia with morphine and life-ending without patient request were presented in a cross-sectional survey of 914 physicians in Belgium in 2009. RESULTS: About 19% of physicians did not label a euthanasia case with neuromuscular relaxants 'euthanasia', 27% did not know that it should be reported. Most physicians labelled a euthanasia case with morphine 'intensification of pain and symptom treatment' (39%) or 'palliative/terminal sedation' (37%); 21% of physicians labelled this case 'euthanasia'. Cases describing other ELDs were sometimes also labelled 'euthanasia'. Factors associated with a higher likelihood of labelling a euthanasia case correctly were: living in Flanders, being informed about the euthanasia law and having a positive attitude towards societal control over euthanasia. Whether a physician correctly labelled the euthanasia cases strongly determined their reporting knowledge and intentions. CONCLUSION: There is no consensus among physicians about the labelling of euthanasia and other ELDs, and about which cases must be reported. Mislabelling of ELDs could impede societal control over euthanasia. The provision of better information to physicians appears to be necessary.

¿Existe justificación moral para la eutanasia? / ¿Is there a moral justification for euthanasia?

La asimetría existente en la praxis médica conlleva una vulnerabilidad de base por parte del paciente, ya que éste no cuenta con el conocimiento para comprender de manera acabada las consecuencias de dicha praxis. A esto se le debe añadir la expectativa generada por la medicina en las últimas décadas, expectativa que no siempre puede sersatisfecha. La imposibilidad de resolver algunas situaciones particulares de los pacientes, junto con el avance tecnológico, han dado como resultado situaciones conflictivas que han abierto el debate sobre la eutanasia. En este artículo se exploran la especificidad de la praxis médica, los distintos tipos deeutanasia y la visión que los médicos tienen de esta práctica para, finalmente, responder la pregunta sobre la legitimidad moral de la eutanasia y el suicidio asistido.

The asymmetry in medical praxis involves patient vulnerability, since the patient does not have the knowledge needed to understand properly such praxis. We ought to add the expectation generated by medicine in the last decades and these expectations notalways can be satisfied. The impossibility to resolve some patient situation and the technology progress have led to conflict situations giving rise to the euthanasia debate. In this paper we explore the specificity of the medical praxis, different types of euthanasia and medical view on this practice. Finally, we reply the question on euthanasia moral legitimacy and assisted suicide.

Eutanasia: una reflexión desde la mirada Bioética / Euthanasia: reflections from the bioethical perspective

El autor discute el tema de la eutanasia en dos aspectos: su significado conceptual y la dimensión actual de los dilemas morales que envuelven al paciente que solicita morir debido a los sufrimientos insoportables por causa de su enfermedad.Los conceptos de Edgard y Graber Veatch, H. Hairy, M. Hairy son presentados y discutidos. También son presentados los conceptos que califican la eutanasia a través de sus formas voluntaria, involuntaria, no voluntaria y pasiva, el concepto deldoble efecto son discutidas y rebatidas. Son analizados los límites de la autonomía del paciente. El autor disiente de la posición de Engelhardt que es un defensor de la autonomía total sin restricciones como un derecho del enfermo y acepta el pensamientode Pellegrino y Thomasma que proponen que tanto el médico como los pacientes tienen compromisos con los principios morales fundamentales. Este es un argumento poderosa por lo cual no se debe aceptar la eutanasia activa.

Terminalidad de la vida: aspectos médico-legales de la eutanasia / End of life: medical and legal aspects of the euthanasia

El progreso de la ciencia médica y sus efectos sobre el ser humano encuentran en la muerte un límite ético a sus posibilidades. El progreso médico, en ocasiones, se opone a los derechos de los pacientes, apareciendo la eutanasia como uno de sus principales conflictos. La discusión bioética debe resolver el dilema sobre permitir o no la muerte de todo paciente terminal que así lo desee. Algunas legislaciones han permitido la eutanasia, basadas en la autonomía del paciente, cuando aparecen situaciones que no permiten una buena calidad de vida en pacientes que padecen enfermedades terminales. El propósito de este artículo es realizar un análisis acerca de la eutanasia con el objetivo de clarificar los conceptos, sus aspectos bioéticos y realizar un análisis del proyecto de ley que pretende aprobar la eutanasia en Chile, encontrándose en dicho proyecto muchas contradicciones dentro del mismo y en relación con la legislación chilena en general.

The progress of medical science and their effect on the human being find in the death the ethical limits to their possibilities. The medical science, sometimes, opposes to the patients rights, so appear the euthanasia like one of these principals' troubles. The bioethics discussion must to resolve the question about to permit the possibilities of death to all terminals patients who don't want to continue with their lives. Some legislation has permitted the euthanasia based on autonomy of the patients when some situation doesn't permit one well quality of life in patients with terminal illness. The purpose of this paper is to make an analysis about the euthanasia with the object to clarify some concepts, their bioethical aspects and to analyze the Chilean project of law which pretends to regulate the euthanasia, finding many contradictions inside the project and in their relation with the Chilean legislation in general.

[Conversations on the "good death": the bioethical debate on euthanasia]. / Conversações sobre a "boa morte": o debate bioético acerca da eutanásia.

Despite extensive current debate on euthanasia, many open and apparently unsolvable issues persist, awaiting a better conceptual treatment. The area includes "prejudices and fundamentalisms" in relation to the theme, still viewed as taboo by a major share of society, specifically in the case of Brazil, while semantic imprecision in the term and argumentative tensions surround the issue, focusing on the principles of sacredness of life, quality of life, and autonomy and the so-called "slippery slope" argument. The purpose of the current essay is thus to serve as a sphere of inquiry concerning euthanasia, moving from historical antecedents towards a better solution to the problem and the demarcation of necessary future perspectives for enhanced understanding of the issue.

Attitudes toward palliative care, conceptions of euthanasia and opinions about its legalization among French physicians.

We assume that actors of the professionalization process of palliative care make a special effort to demarcate it from euthanasia, and that such an effort has a significant impact on beliefs and attitudes toward euthanasia among the whole medical profession. We investigated concurrently attitudes toward palliative care, conceptions of euthanasia and opinion toward its legalization among a sample of 883 French general practitioners, oncologists and neurologists. We found four contrasted profiles of attitudes toward palliative care, which were closely correlated with being in touch with palliative care providers. Attitudes toward palliative care were closely correlated with beliefs about which medical practices should be labelled euthanasia, and these beliefs were in turn strongly associated with opinions toward euthanasia legalization. Our results suggest that the relationship between palliative care and euthanasia mixes semantic and strategic aspects, beyond cognitive and conative ones.

Euthanasia: a need for reform.

Recent high profile right-to-die cases have served to heighten the confusion surrounding euthanasia, particularly in relation to active and passive euthanasia. It is apparent that the underlying philosophical basis of the active-passive distinction has led to distortions in the law surrounding this issue, which further compounds the confusion. It is time for a more honest approach to assistance in dying. In the long-term, reform is inevitable and may involve reclassifying passive and active euthanasia as life-terminating acts. Nurses need to have an understanding of the ethical and legal basis of euthanasia to acknowledge and define their possible future role in relation to the provision of life-terminating acts.