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1.
Br J Nurs ; 30(15): 934-935, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34379469

RESUMO

Richard Griffith, Senior Lecturer in Health Law at Swansea University, continues his series on the articles of the European Convention on Human Rights and considers Article 8 in the context of assisted dying.


Assuntos
Direitos Humanos , Suicídio Assistido , Direitos Humanos/legislação & jurisprudência , Humanos , Suicídio Assistido/legislação & jurisprudência , Reino Unido
3.
Med J Aust ; 215(3): 125-129, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34109641

RESUMO

OBJECTIVES: To investigate the perspectives of doctors involved with voluntary assisted dying in Victoria regarding the Voluntary Assisted Dying Act 2017 (Vic) and its operation. DESIGN, SETTING, PARTICIPANTS: Qualitative study; semi-structured interviews with 32 doctors who had participated in the voluntary assisted dying system during its first year of operation (commenced 19 June 2019). Doctors were interviewed during April-July 2020. RESULTS: Three major themes related to problems during the first year of operation of the Act were identified: the statutory prohibition of health professionals initiating discussions with their patients about voluntary assisted dying; the Department of Health and Human Services guidance requirement that all doctor-patient, doctor-pharmacist, and pharmacist-patient interactions be face-to-face; and aspects of implementation, including problems with the voluntary assisted dying online portal, obtaining documentary evidence to establish eligibility, and inadequate resourcing of the Statewide Pharmacy Service. CONCLUSIONS: Doctors reported only limited concerns about the Victorian voluntary assisted dying legislation, but have had some problems with its operation, including implications for the accessibility of voluntary assisted dying to eligible patients. While legislative change may resolve some of these concerns, most can be ameliorated by improving the processes and systems.


Assuntos
Definição da Elegibilidade/legislação & jurisprudência , Pessoal de Saúde/ética , Relações Médico-Paciente/ética , Médicos/psicologia , Suicídio Assistido/legislação & jurisprudência , Adulto , Idoso , Atitude do Pessoal de Saúde , Definição da Elegibilidade/ética , Feminino , Recursos em Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Assistência Farmacêutica/economia , Farmacêuticos/ética , Médicos/estatística & dados numéricos , Pesquisa Qualitativa , Vitória/epidemiologia
4.
Clin Ter ; 172(3): 193-196, 2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33956035

RESUMO

Abstract: Medically assisted suicide is considered among the most contro-versial of the current bioethical debate in our Country. In the Italian legal system, we are lacking specific discipline of this practice, as it is covered by the general legal forms applicable to crimes against life. The Constitutional Court, with Decision No. 242/2019, declared the illegitimacy of Art. 580 of the Criminal Code (instigation to suicide), in the part not excluding the punishment of those who facilitates the execution of the intention to commit suicide, independently and freely formed, by a person kept alive by life support and suffering an irreversible disease, source of physical or psychological suffering that the person deems intolerable, but who is fully capable of making free and conscious decisions. The Constitutional Court found that the current regulatory fra-mework concerning the end of life leaves certain situations constitutio-nally worthy of protection and to be balanced with other constitutionally relevant assets without adequate protection. The Court has identified the conditions that can justify third-party assistance in ending the life of a sick person. The judges envisaged the possibility of including this discipline under Law No. 219/2017, but this hypothesis is not shared by the Italian National Bioethics Committee.


Assuntos
Crime/legislação & jurisprudência , Suicídio Assistido/legislação & jurisprudência , Humanos , Itália , Julgamento
5.
CMAJ Open ; 9(2): E358-E363, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33849985

RESUMO

BACKGROUND: Under the Canadian Criminal Code, medical assistance in dying (MAiD) requires that patients give informed consent and that their ability to consent is assessed by 2 clinicians. In this study, we intended to understand how Canadian clinicians assessed capacity in people requesting MAiD. METHODS: This qualitative study used interviews conducted between August 2019 and February 2020, by phone, video and email, to explore how clinicians assessed capacity in people requesting MAiD, what challenges they had encountered and what tools they used. The participants were recruited from provider mailing listserves of the Canadian Association of MAiD Assessors and Providers and Aide médicale à mourir. Interviews were audio-recorded and transcribed verbatim. The research team met to review transcripts and explore themes as they emerged in an iterative manner. We used abductive reasoning for thematic analysis and coding, and continued to discuss until we reached consensus. RESULTS: The 20 participants worked in 5 of 10 provinces across Canada, represented different specialties and had experience assessing a total of 2410 patients requesting MAiD. The main theme was that, for most assessments, the participants used the conversation about how the patient had come to choose MAiD to get the information they needed. When the participants used formal capacity assessment tools, this was mostly for meticulous documentation, and they rarely asked for psychiatric consults. The participants described how they approached assessing cases of nonverbal patients and other challenging cases, using techniques such as ensuring a quiet environment and adequate hearing aids, and using questions requiring only "yes" or "no" as an answer. INTERPRETATION: The participants were comfortable doing MAiD assessments and used their clinical judgment and experience to assess capacity in ways similar to other clinical practices. The findings of this study suggest that experienced MAiD assessors do not routinely require formal capacity assessments or tools to assess capacity in patients requesting MAiD.


Assuntos
Tomada de Decisão Clínica , Eutanásia Ativa Voluntária , Consentimento Livre e Esclarecido/normas , Competência Mental , Prática Profissional/estatística & dados numéricos , Controle Social Formal/métodos , Suicídio Assistido , Atitude do Pessoal de Saúde , Canadá , Tomada de Decisão Clínica/ética , Tomada de Decisão Clínica/métodos , Códigos de Ética , Eutanásia Ativa Voluntária/ética , Eutanásia Ativa Voluntária/legislação & jurisprudência , Eutanásia Ativa Voluntária/psicologia , Guias como Assunto , Humanos , Enfermeiras e Enfermeiros , Médicos , Padrões de Prática Médica/ética , Padrões de Prática Médica/normas , Pesquisa Qualitativa , Direito a Morrer/ética , Direito a Morrer/legislação & jurisprudência , Suicídio Assistido/ética , Suicídio Assistido/legislação & jurisprudência , Suicídio Assistido/psicologia
6.
10.
BMJ Support Palliat Care ; 11(1): 59-67, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32601150

RESUMO

BACKGROUND: The legalisation of medical assistance in dying in numerous countries over the last 20 years represents a significant shift in practice and scope for many clinicians who have had little-to-no training to prepare them to sensitively respond to patient requests for hastened death. AIMS: Our objective was to review the existing qualitative literature on the experiences of healthcare providers responding to requests for hastened death with the aim of answering the question: how do clinicians make sense of, and respond to patients' expressed wishes for hastened death? METHODS: We performed a systematic review and meta-synthesis of primary qualitative research articles that described the experiences and perspectives of healthcare professionals who have responded to requests for hastened death in jurisdictions where MAiD (Medical Assistance in Dying) was legal or depenalised. A staged coding process was used to identify and analyse core themes. RESULTS: Although the response to requests for hastened death varied case-by-case, clinicians formulated their responses by considering seven distinct domains. These include: policies, professional identity, commitment to patient autonomy, personal values and beliefs, the patient-clinician relationship, the request for hastened death and the clinician's emotional and psychological response. CONCLUSION: Responding to a request for hastened death can be an overwhelming task for clinicians. An approach that takes into consideration the legal, personal, professional and patient perspectives is required to provide a response that encompasses all the complexities associated with such a monumental request.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/psicologia , Suicídio Assistido/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Suicídio Assistido/legislação & jurisprudência
11.
Int J Psychol ; 56(1): 64-74, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32441328

RESUMO

The opportunity for patients to request support to die is legalised in several countries and is associated with the development of a social and political debate that has taken place in recent years. We believe that psychologists can contribute to this debate. Here, we conducted a literature and legislation review with the aim of understanding arguments regarding the roles of the psychologist in hastening death. A systematic review of the peer-review literature in this field was carried out. The legislation of each country with hasten death practices was analysed to understand if psychologists are included in the protocols of hasten death practices. Despite a lack of literature, we found competence assessment, communication, psychological counselling, research and training and public policy to be the possible roles of psychologists in requests to hasten death. Based on the review, an agenda for future research is developed. We highlight the importance of psychology, raising its profile in the study of the various forms of death hastening requests.


Assuntos
Psicologia/normas , Suicídio Assistido/psicologia , Feminino , Humanos , Masculino , Suicídio Assistido/legislação & jurisprudência
12.
BMJ Support Palliat Care ; 11(2): 200-208, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32563993

RESUMO

BACKGROUND: Voluntary assisted dying (VAD) became legal in the Australian state of Victoria on 19 June 2019 and will be legal in Western Australia from 2021. Other Australian states are progressing similar law reform processes. In Australia and internationally, doctors are central to the operation of all legal VAD regimes. It is broadly accepted that doctors, as a profession, are less in favour of VAD law reform than the rest of the community. To date, there has been little analysis of the factors that motivate doctors' support or opposition to legalised VAD in Australia. AIM: To review all studies reporting the attitudes of Australian doctors regarding the legalisation of VAD, including their willingness to participate in it, and to observe and record common themes in existing attitudinal data. DESIGN: Scoping review and thematic analysis of qualitative and quantitative data. DATA SOURCES: CINAHL, Embase, Scopus, PubMed and Informit were searched from inception to June 2019. RESULTS: 26 publications detailing 19 studies were identified. Thematic analysis of quantitative and qualitative findings was performed. Three overarching themes emerged. 'Attitudes towards regulation' encompassed doctors' orientation towards legalisation, the shortcomings of binary categories of support or opposition and doctors' concerns about additional regulation of their professional practices. 'Professional and personal impact of legalisation' described tensions between palliative care and VAD, and the emotional and social impact of being providers of VAD. 'Practical considerations regarding access' considered doctors' concerns about eligibility criteria and their willingness to provide VAD. CONCLUSION: A detailed understanding of medical perspectives about VAD would facilitate the design of legislative models that take better account of doctors' concerns. This may facilitate their greater participation in VAD and help address potential access issues arising from availability of willing doctors.


Assuntos
Eutanásia Ativa Voluntária/legislação & jurisprudência , Eutanásia Ativa Voluntária/psicologia , Cuidados Paliativos/legislação & jurisprudência , Cuidados Paliativos/psicologia , Médicos/psicologia , Suicídio Assistido/legislação & jurisprudência , Suicídio Assistido/psicologia , Adulto , Atitude do Pessoal de Saúde , Austrália , Humanos
13.
BMJ Support Palliat Care ; 11(1): 107-114, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30826737

RESUMO

Medical assistance in dying (MAiD) is a globally polarising topic which often sparks debate surrounding the ethical and moral dilemmas that arise with a life-ending intervention. To gain a better understanding of this intervention, it is important to explore the experience of those most intimately affected by MAiD. Family caregivers of those with a terminal illness are the backbone of the healthcare and support team, often providing a substantial amount of informal care while at the same time coping with their own distress and anticipatory grief. However, we know the least about how MAiD impacts the psychosocial well-being of these same individuals. The aim of this article is to explore the experience of MAiD from the family caregiver perspective, namely their beliefs and opinions about the intervention, how the process of MAiD impacts them, how the intervention shapes their view of their loved one's quality of death, and the psychosocial outcomes after the passing of their loved one. Beyond the literature, challenges within both the clinical and research realms will be discussed and future directions will be offered. While MAiD is currently legal in only a small number of countries, a better understanding of the impact of MAiD will help inform policy and legislation as they are developed in other jurisdictions. Further, this article aims to inform future research and clinical interventions in order to better understand and support those seeking MAiD and their families.


Assuntos
Atitude Frente a Morte , Cuidadores/psicologia , Suicídio Assistido/psicologia , Adaptação Psicológica , Adulto , Idoso , Antecipação Psicológica , Cultura , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Princípios Morais , Pesquisa Qualitativa , Suicídio Assistido/legislação & jurisprudência , Inquéritos e Questionários
15.
CMAJ Open ; 8(4): E825-E831, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33293332

RESUMO

BACKGROUND: Bill C-14, the legislation that legalized medical assistance in dying (MAiD) in Canada in 2016, outlines eligibility criteria and includes both a mandated 10-day reflection period and a requirement that the patient have capacity to consent at the time MAiD is provided. We examined clinical factors associated with shortened reflection periods or loss of capacity before provision of MAiD. METHODS: This retrospective database review involved patients who requested MAiD at a tertiary care hospital in Toronto, Canada, between June 2016 and April 2019. We used logistic regression analyses to examine the association between the combined outcome of unanticipated loss of decisional capacity, shortening of the reflection period or death and the clinical risk factors of interest (age, sex, location of MAiD request [inpatient v. outpatient], score on palliative performance scale [PPS] and diagnosis [cancer v. noncancer]). We generated receiver operating characteristic curves to identify the PPS score (encompassing 5 functional domains: ambulation, activity level, self-care, intake and level of consciousness) that best predicted loss of capacity, shortening of the reflection period or death. RESULTS: In total, 155 patients requested assessment for MAiD, and 136 of these were included in the statistical analyses. For 68 patients, the reflection period was not shortened; the other 68 patients lost capacity, died or required shortening of the reflection period. In contrast to the results for age, sex, location of request and diagnosis, the PPS score was associated with loss of capacity or shortening of the reflection period (odds ratio 4.63, 95% confidence interval 2.87-8.23, per 10-point decrease in PPS score). PPS scores less than or equal to 40% balanced sensitivity, specificity and negative predictive value while emphasizing sensitivity to prevent false negative errors. INTERPRETATION: The PPS score at the time of MAiD request was strongly associated with loss of capacity or shortening of the reflection period, with lower scores incrementally increasing the risk of these outcomes. For patients with a PPS score of 40% or below, close monitoring is warranted, potentially with plans made to allow rapid provision of MAiD should their clinical condition deteriorate.


Assuntos
Tomada de Decisões , Cuidados Paliativos/normas , Suicídio Assistido/estatística & dados numéricos , Assistência Terminal/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Masculino , Competência Mental , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias/epidemiologia , Ontário , Desempenho Físico Funcional , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Suicídio Assistido/legislação & jurisprudência , Taxa de Sobrevida , Centros de Atenção Terciária
17.
Can Rev Sociol ; 57(4): 604-631, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33151637

RESUMO

This article explores debates on medical assistance in dying (MAID) in Canada as they unfolded on Twitter before its adoption in June 2016. The opposition, which came from diverse groups-religious, experts, politicians-led to polarizing debates about the social acceptability of this measure. Our finding shows that the so-called lay citizens refused to leave the discussion to experts and politicians and got involved in the debates around the issue. Our results also show that Twitter was mainly used to share information, hence complementing the role of traditional media. Overall, the platform gave rise to an "ambient political participation," allowing minority or marginalized groups as well as lay citizens to share their knowledge and opinion about MAID. This may have favored a certain form of empowerment.


Assuntos
Assistência Médica/legislação & jurisprudência , Distância Psicológica , Opinião Pública , Mídias Sociais/estatística & dados numéricos , Suicídio Assistido/legislação & jurisprudência , Canadá , Suicídio Assistido/psicologia
18.
J Law Med Ethics ; 48(3): 555-564, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33021186

RESUMO

Agency is the human capacity to freely choose one's thoughts, motivations and actions without undue internal or external influences; it is distinguished from decisional capacity. Four well-known conditions that can deeply affect agency are depression, demoralization, existential distress, and family dysfunction. The study reviews how they may diminish agency in persons whose circumstances may lead them to consider or request euthanasia or assisted suicide. Since agency has been a relatively neglected dimension of autonomous choice at the end of life, it is argued that to respect the autonomy of individuals, it is essential to establish their agency.


Assuntos
Tomada de Decisões , Eutanásia/psicologia , Motivação , Autonomia Pessoal , Suicídio Assistido/psicologia , Desmoralização , Depressão , Eutanásia/ética , Eutanásia/legislação & jurisprudência , Conflito Familiar , Humanos , Angústia Psicológica , Suicídio Assistido/ética , Suicídio Assistido/legislação & jurisprudência
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