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1.
BMC Palliat Care ; 21(1): 2, 2022 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-34980093

RESUMEN

BACKGROUND: There is a lack of research to guide the implementation of voluntary assisted dying legislation within a hospice setting. Furthermore, there is limited published information related to the expectations of the community and staff to assist decision making regarding voluntary assisted dying in a community hospice. The aim of this study was to explore the expectations of staff, volunteers and members of the community as how a rural Australian community hospice could respond in relation to imminent enactment of Voluntary Assisted Dying legislation. METHODS: A total of 63 Hospice staff and volunteers and community members participated in 11 workshops. This qualitative study used the interpretive description method to analyse the workshop transcripts. RESULTS: While there was not a consensus view on community expectation, there was agreement among the participants for respect for a patient's individuality and choices. Furthermore, care offered in hospice needs to remain non-judgemental and patient focused regardless of whether voluntary assisted dying policy was implemented or not. Both opportunities and risks associated with implementation were identified by the participants. CONCLUSION: There was common ground around the respect for the dying person and the ideal of a "safe place" despite opposing views on what this may mean in practice. There is a need for clarity in organisational responses around policy, risk management, education, and staff support.


Asunto(s)
Cuidados Paliativos al Final de la Vida , Hospitales para Enfermos Terminales , Suicidio Asistido , Australia , Humanos , Población Rural
2.
Artículo en Alemán | MEDLINE | ID: mdl-34919151

RESUMEN

In 2020, the Federal Constitutional Court declared the ban on assisted suicide unconstitutional and invalid. The court derived a right to self-determined dying from the general right of personality. This right also includes the freedom to take one's own life and to seek help from third parties for this purpose and to make use of help if it is offered. In the meantime, there are several proposals for regulations and draft laws that pursue different concepts of a possible future regulation of assisted suicide. However, from the perspective of criminal law, the search for a new regulation should always be preceded by the question of the necessity of a new regulation. A new regulation must not be limited to certain groups of persons, such as persons with incurable, terminal illnesses, because otherwise the suicide motive would be assessed. This brings with it the particular challenge of finding a regulation that covers the different problem and need situations without assessing the suicide motive and also takes into account that the autonomy of the individual can be endangered in different ways.The article takes its starting point in the right to suicide, sheds light on different concepts, and discusses their advantages and disadvantages without explicitly highlighting individual legislative proposals. This is intended to enrich the further debate with individual aspects. At the same time, it advocates legislative restraint.


Asunto(s)
Eutanasia , Suicidio Asistido , Libertad , Alemania , Humanos , Derecho a Morir
3.
BMC Health Serv Res ; 21(1): 1195, 2021 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-34736463

RESUMEN

BACKGROUND: Even as healthcare providers and systems were settling into the processes required for Medical Assistance in Dying (MAID) under Bill C-14, new legislation was introduced (Bill C-7) that extended assisted death to persons whose natural death is not reasonably foreseeable. The purpose of this paper is to describe the experiences of nurses and nurse practitioners with the implementation and ongoing development of this transition. METHODS: This qualitative longitudinal descriptive study gathered data through semi-structured telephone interviews with nurses from across Canada; cross sectional data from 2020 to 2021 is reported here. The study received ethical approval and all participants provided written consent. FINDINGS: Participants included nurses (n = 34) and nurse practitioners (n = 16) with significant experience with MAID. Participants described how MAID had transitioned from a new, secretive, and anxiety-producing procedure to one that was increasingly visible and normalized, although this normalization did not necessarily mitigate the emotional impact. MAID was becoming more accessible, and participants were learning to trust the process. However, the work was becoming increasingly complex, labour intensive, and often poorly remunerated. Although many participants described a degree of integration between MAID and palliative care services, there remained ongoing tensions around equitable access to both. Participants described an evolving gestalt of determining persons' eligibility for MAID that required a high degree of clinical judgement. Deeming someone ineligible was intensely stressful for all involved and so participants had learned to be resourceful in avoiding this possibility. The required 10-day waiting period was difficult emotionally, particularly if persons worried about losing capacity to give final consent. The implementation of C-7 was perceived to be particularly challenging due to the nature of the population that would seek MAID and the resultant complexity of trying to address the origins of their suffering within a resource-strapped system. CONCLUSIONS: Significant social and system calibration must occur to accommodate assisted death as an end-of-life option. The transition to offering MAID for those whose natural death is not reasonably foreseeable will require intensive navigation of a sometimes siloed and inaccessible system. High quality MAID care should be both relational and dialogical and those who provide such care require expert communication skills and knowledge of the healthcare system.


Asunto(s)
Suicidio Asistido , Cuidado Terminal , Estudios Transversales , Humanos , Asistencia Médica , Investigación Cualitativa
4.
BMC Palliat Care ; 20(1): 174, 2021 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-34758799

RESUMEN

BACKGROUND: Intolerable suffering is a common eligibility requirement for persons requesting assisted death, and although suffering has received philosophic attention for millennia, only recently has it been the focus of empirical inquiry. Robust theoretical knowledge about suffering is critically important as modern healthcare provides persons with different options at end-of-life to relieve suffering. The purpose of this paper is to present findings specific to the understanding and application of suffering in the context of MAID from nurses' perspectives. METHODS: A longitudinal qualitative descriptive study using semi-structured telephone interviews. Inductive analysis was used to construct a thematic account. The study received ethical approval and all participants provided written consent. RESULTS: Fifty nurses and nurse practitioners from across Canada were interviewed. Participants described the suffering of dying and provided insights into the difficulties of treating existential suffering and the iatrogenic suffering patients experienced from long contact with the healthcare system. They shared perceptions of the suffering that leads to a request for MAID that included the unknown of dying, a desire for predictability, and the loss of dignity. Eliciting the suffering story was an essential part of nursing practice. Knowledge of the story allowed participants to find the balance between believing that suffering is whatever the persons says it is, while making sure that the MAID procedure was for the right person, for the right reason, at the right time. Participants perceived that the MAID process itself caused suffering that resulted from the complexity of decision-making, the chances of being deemed ineligible, and the heighted work of the tasks of dying. CONCLUSIONS: Healthcare providers involved in MAID must be critically reflective about the suffering histories they bring to the clinical encounter, particularly iatrogenic suffering. Further, eliciting the suffering stories of persons requesting MAID requires a high degree of skill; those involved in the assessment process must have the time and competency to do this important role well. The nature of suffering that patients and family encounter as they enter the contemplation, assessment, and provision of MAID requires further research to understand it better and develop best practices.


Asunto(s)
Suicidio Asistido , Canadá , Personal de Salud , Humanos , Asistencia Médica , Investigación Cualitativa
8.
BMJ ; 375: n2496, 2021 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-34654718
9.
BMJ ; 375: n2494, 2021 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-34654725
10.
Intern Med J ; 51(10): 1713-1716, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34664368

RESUMEN

Depressive symptoms, including those as part of a major depressive disorder, are common at the end of life. A number of psychiatrists consider that a diagnosis of major depression precludes the capacity to make a decision to request voluntary assisted dying (VAD), although this is not a unanimous view. This paper uses a case of a patient in which two different psychiatric opinions were formed regarding her capacity to make the decision to request VAD. The difference of view can be related to whether major depression was diagnosed and the association made between depression and the capacity to request VAD. The view that an absence of major depression is required in order to establish the capacity to request VAD is potentially at odds with the legal definition and not necessarily in keeping with the patient's experience at the end of life.


Asunto(s)
Trastorno Depresivo Mayor , Suicidio Asistido , Trastorno Depresivo Mayor/diagnóstico , Femenino , Humanos
12.
BMJ ; 375: n2515, 2021 10 19.
Artículo en Inglés | MEDLINE | ID: mdl-34666987
14.
BMJ ; 375: n2518, 2021 10 19.
Artículo en Inglés | MEDLINE | ID: mdl-34667032
15.
BMJ ; 375: n2513, 2021 10 20.
Artículo en Inglés | MEDLINE | ID: mdl-34670759
17.
BMJ ; 375: n2498, 2021 10 18.
Artículo en Inglés | MEDLINE | ID: mdl-34663586
18.
BMJ ; 375: n2492, 2021 10 14.
Artículo en Inglés | MEDLINE | ID: mdl-34649860
19.
BMJ ; 375: n2486, 2021 10 14.
Artículo en Inglés | MEDLINE | ID: mdl-34649865
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