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1.
N Z Med J ; 133(1517): 18-23, 2020 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-32595218

RESUMO

AIM: To consider the possibility of consequences beyond the alleviation of perceived individual suffering, for families left behind, communities and society as a whole should the End of Life Choice Act gain public support in the September 2020 referendum in New Zealand. METHOD: This study used the Yin case study approach to undertake a single semi-structured in-depth interview with a participant who self-identified as having first-hand experience of assisted dying from a relative's perspective (in a country where this is legal). Thematic analysis was used to identify themes and trends from the interview transcript. RESULTS: Three key themes emerged from the interview: the potential for assisted dying becoming an expectation for others to pursue when unwell and possibly facing a life-threatening illness; the notion of stigma being associated with the individual using assisted dying legislation and the family left behind; and that there may be the potential for such legislation to produce a contagion effect. CONCLUSION: The introduction of assisted dying legislation into New Zealand culture provides a potential hotspot for family, community and social discord that may not be easily remedied. Further study in New Zealand is required to investigate whether a contagion effect of assisted dying is possible, and how as a society, we negotiate what could become a conflicted pathway potentially complicated by prejudice, judgement and stigma.


Assuntos
Preconceito/psicologia , Estigma Social , Suicídio Assistido/legislação & jurisprudência , Humanos , Nova Zelândia
2.
Monash Bioeth Rev ; 38(1): 49-67, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32335862

RESUMO

End-of-life decision-making in patients with dementia is a complex topic. Belgium and the Netherlands have been at the forefront of legislative advancement and progressive societal changes concerning the perspectives toward physician-assisted death (PAD). Careful consideration of clinical and social aspects is essential during the end-of-life decision-making process in patients with dementia. Geriatric assent provides the physician, the patient and his family the opportunity to end life with dignity. Unbearable suffering, decisional competence, and awareness of memory deficits are among the clinical considerations that physicians should incorporate during the end-of-life decision-making process. However, as other societies introduce legislature granting the right of PAD, new social determinants should be considered; Mexico City is an example. Current perspectives regarding advance euthanasia directives (AED) and PAD in patients with dementia are evolving. A new perspective that hinges on the role of the family and geriatric assent should help culturally heterogeneous societies in the transition of their public health care policies regarding end-of-life choices.


Assuntos
Diretivas Antecipadas/ética , Tomada de Decisões/ética , Demência , Ética Médica , Eutanásia/ética , Legislação Médica , Suicídio Assistido/ética , Diretivas Antecipadas/legislação & jurisprudência , Idoso , Bélgica , Bioética , Cultura , Eutanásia/legislação & jurisprudência , Família , Humanos , Consentimento Livre e Esclarecido , México , Países Baixos , Pessoalidade , Médicos , Políticas , Mudança Social , Fatores Sociológicos , Suicídio Assistido/legislação & jurisprudência , Assistência Terminal/ética , Assistência Terminal/legislação & jurisprudência
3.
Br J Nurs ; 29(7): 442-443, 2020 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-32279548

RESUMO

In light of recent media coverage, Emeritus Professor Alan Glasper, from the University of Southampton, discusses polices and guidance that relate to euthanasia and assisted suicide.


Assuntos
Eutanásia/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Guias de Prática Clínica como Assunto , Suicídio Assistido/legislação & jurisprudência , Humanos , Medicina Estatal , Reino Unido
4.
PLoS One ; 15(4): e0232109, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32324815

RESUMO

The legality of euthanasia and assisted suicide (AS) and nature of regulations of these practices remain controversial and the subject of lively debate among experts and the general public. Our study investigates attitudes and behaviours towards AS among older adults in Switzerland where the practice of AS has a relatively long history and remains rather unregulated. We aim to explore how individuals' preferences regarding their end of life, as well as individuals' trust in institutions involved in the practice or control of AS are associated with attitudes and behaviours towards AS. We analyse nationally representative data of adults aged 55 and over from wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland (n = 2,145). While large majorities supported current legal arrangements around AS in Switzerland (81.7%) and stated that they could consider AS for themselves under certain circumstances (61.0%), only a minority either was a member of a right-to-die organisation already (4.9%) or stated they were likely to become a member of such an organisation (28.2%). Stated preferences for control over the end of life and for maintaining essential capabilities at the end of life showed a positive association with AS-related attitudes and behaviours, whereas preferences for feeling socially and spiritually connected, as well as for not being a burden displayed a negative association with our outcomes. Higher levels of trust in one's relative were positively associated with both support for the legality of AS and potential use of AS. A positive association was also found between trust in the Swiss legal system and support for the legality of AS. By contrast, trust in religious institutions displayed a negative association with all five AS-related attitudes and behaviours. Similarly, trust in healthcare insurance companies was negatively associated with potential use of AS. Taken together, older adults were generally supportive towards current practices regarding AS. This approval appears to be closely related to individuals' preferences and, at different extends, to trust in social and public institutions with regard to end-of-life issues, which is relatively high in Switzerland.


Assuntos
Suicídio Assistido/psicologia , Confiança/psicologia , Planejamento Antecipado de Cuidados , Idoso , Idoso de 80 Anos ou mais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Percepção Social , Suicídio Assistido/legislação & jurisprudência , Inquéritos e Questionários , Suíça
7.
Georgian Med News ; (298): 175-180, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32141874

RESUMO

The purpose of this article is to analyze the main medical, legal, and ethical issues and challenges of euthanasia in the digital age. The methods that were used in this study are historical, logical, empirical, as well as comparative legal method for comparison of laws and practices of the EU and post-Soviet countries, including Ukraine. This choice determined by the fact that both groups of countries have common features and relations, while the features of their development affect approaches to regulating such sensitive and potentially open to abuse problems as euthanasia. There is no final legal answer as to whether to legalize, decriminalize or prohibit euthanasia in any of its forms. The features and legal terms of active and passive, voluntary and non-voluntary euthanasia and assisted suicide, especially for psychiatric and minor patients were researched, as well as conflicting arguments, which include individual autonomy, right to choose, the opportunity to get rid of suffering, as well as undermining the practice of palliative care, abuse in cases of vulnerable and dependent patients, moral burden on the doctors. The issue of control of the practice of euthanasia is complicated, given the extent to which it is possible to obtain informed consent, establish criteria for suffering and hopelessness, check the persistence, conviction and validity of requests for euthanasia, especially in the digital era. The potential legislation and judicial practice should provide for strict and effective guarantees, respect for the beliefs of each person and the right not to participate in any contentious practices, the balance of human rights and social values.


Assuntos
Eutanásia , Suicídio Assistido , Eutanásia/ética , Eutanásia/legislação & jurisprudência , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Princípios Morais , Cuidados Paliativos , Suicídio Assistido/ética , Suicídio Assistido/legislação & jurisprudência , Ucrânia
11.
Yale J Biol Med ; 92(4): 575-585, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31866773

RESUMO

The goal of this work is to assess the beliefs of US physicians about the national legalization of physician-assisted suicide (PAS). We sent a survey to 1000 randomly chosen physicians from around the US. Our survey indicates that 60% of physicians thought PAS should be legal, and of that 60%, 13% answered "yes" when asked if they would perform the practice if it were legal. Next, 49% of physicians agreed that most patients who seek PAS do so because of pain, and 58% agreed that the current safeguards in place for PAS, in general, are adequate to protect patients. With respect to specific safeguards, 60% disagreed with the statement that physicians who are not psychiatrists are adequately trained to screen for depression in patients seeking PAS, and 60% disagreed with the idea that physicians can predict with certainty whether a patient seeking PAS has 6 months or less to live. Finally, about one-third (30%) of physicians thought that the legalization of PAS would lead to the legalization of euthanasia, and 46% agreed that insurance companies would preferentially cover PAS over possible life-saving treatments if PAS was legalized nationally. Our survey results suggest several conclusions about physicians' beliefs about PAS. The first is that there is a discrepancy between willingness to endorse and willingness to practice PAS. Second, physicians are generally misinformed with regard to why patients seek PAS, and they are uncertain about the adequacy of safeguards. Third, physicians are still wary of the slippery slope with respect to the legalization of PAS nationwide.


Assuntos
Atitude do Pessoal de Saúde , Médicos/psicologia , Suicídio Assistido , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Suicídio Assistido/economia , Suicídio Assistido/ética , Suicídio Assistido/legislação & jurisprudência , Inquéritos e Questionários
12.
Yale J Biol Med ; 92(4): 733-739, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31866788

RESUMO

A culture of dying characterized by end-of-life care provided by strangers in institutional settings and diminished personal control of the dying process has been a catalyst for the increasing prevalence of legalized physician-assisted dying in the United States and medically-assisted dying in Canada. The moral logic of the right to die that supports patient refusals of life-extending medical treatments has been expanded by some scholarly arguments to provide ethical legitimation for hastening patient deaths either through physician-prescribed medications or direct physician administration of a lethal medication. The concept of medical-assisted dying increases the role and power of physicians in ending life and allows patients who are not terminally ill, or who have lost decision-making capacity, or who are suffering from a irremediable medical condition to have access to medical procedures to hasten death. This extended moral logic can be countered by ethical objections regarding the integrity of the patient-physician relationship and last resorts in ending life, professional concerns about medicalization and a diminished identity of medicine as a healing profession, and social responsibilities to provide equal access to basic health care and to hospice care.


Assuntos
Bioética , Responsabilidade Social , Suicídio Assistido/ética , Humanos , Lógica , Princípios Morais , Suicídio Assistido/legislação & jurisprudência , Assistência Terminal
13.
Yale J Biol Med ; 92(4): 747-750, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31866790

RESUMO

The question of a physician's involvement in aid in dying (or "assisted suicide") is being debated across the country. This article adopts no one position because its authors hold contrasting views. It aims instead to articulate the strongest arguments in favor of aid in dying and the strongest arguments opposed. It also addresses relevant terminology and reviews the history of its legalization in the United States.


Assuntos
Médicos , Suicídio Assistido , Depressão/psicologia , Humanos , Autonomia Pessoal , Suicídio Assistido/legislação & jurisprudência , Suicídio Assistido/psicologia
14.
Yale J Biol Med ; 92(4): 781-791, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31866795

RESUMO

Current efforts to legalize medical aid-in-dying in this country follow a half century of remarkable legal developments regarding when, how, and on whose terms to intervene to prevent death and extend life in critically and terminally ill patients. The starting point-which I call the first stage along the path-was the creation in the two decades following World War II of powerful means of keeping very ill, and typically unconscious, patients alive. The second stage began in the late 1960s as physicians (and then others in society) began to grapple with the consequences of maintaining such patients on life-support indefinitely. Over five decades, judicial decisions, followed by implementing statutes and regulations, transformed legal rights and medical practices. Are the current developments-which center on legalizing medical aid-in-dying-a third stage along the same path, or do the striking differences between the issues raised about life-sustaining treatment and euthanasia suggest that they are separate? What lessons might those proceeding along the aid-in-dying path take from the development of the other path, and if the two paths are still distinct today, might they merge in the future?


Assuntos
Cuidados para Prolongar a Vida/legislação & jurisprudência , Políticas , Suicídio Assistido/legislação & jurisprudência , Humanos , Autonomia Pessoal
15.
Nurs Leadersh (Tor Ont) ; 32(3): 1-3, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31714203

RESUMO

Amid the profile of Medical Assistance in Dying (MAID) and a prevailing interest to support living until death, discussions of appropriate care and care settings for dying abound. The when and how of easing the passage from this corporeal being to a state of other being, whatever you believe that to be, has been focal in healthcare discussions in recent years. I remember a time when the notion of "palliative care" was somewhat novel, in later years when a family member was the recipient of excellent end-of-life care, but still many recent instances in which we, "the system" fail to ensure that that final life journey is aligned (as much as possible) with a person's final wishes. Alas, a 2013 survey by the Canadian Institute for Health Information (CIHI) showed that a majority of Canadians preferred to die at home, but few (15%) died outside of a hospital (CIHI 2018).


Assuntos
Suicídio Assistido/legislação & jurisprudência , Assistência Terminal/métodos , Humanos , Suicídio Assistido/tendências , Assistência Terminal/tendências
16.
Int J Law Psychiatry ; 66: 101464, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706386

RESUMO

The Canadian province of Quebec enacted in 2014 a legislation that permitted medical assistance in dying (MAID) under specific conditions and the rest of Canada followed suit in June 2016. In this article, which is the second in a set of case series of requests for MAID in Canadian psychiatry, we present the cases of two patients who made a request for MAID to their treating psychiatrist in an outpatient clinic. While one is advanced in age and suffering from intense physical and psychic pain with little if any psychiatric comorbidity, the other is a young and medically healthy woman who nonetheless suffers from extensive psychiatric comorbidity. This article discusses both cases in light of recent scientific literature and case law that is slowly emerging in Canada, focusing on the concepts of the end of life and its legal definition as well as psychic suffering and its management in those wishing to receive physician-assisted dying. In our conclusion, we stress the need to clarify the definition of treatment resistance, the necessity to determine each physician's role when many are involved, as well as the importance of treating psychic pain holistically, which can sometimes require going beyond standard psychiatric care.


Assuntos
Eutanásia/psicologia , Transtornos Mentais/psicologia , Suicídio Assistido/psicologia , Adulto , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Canadá , Comorbidade , Eutanásia/legislação & jurisprudência , Feminino , Humanos , Psiquiatria , Quebeque , Suicídio Assistido/legislação & jurisprudência , Universidades
17.
Recenti Prog Med ; 110(10): 462-472, 2019 Oct.
Artigo em Italiano | MEDLINE | ID: mdl-31657811

RESUMO

On October 24, 2018 the Italian Constitutional Court held that the absolute ban on assisted suicide provided for by Art. 580 of the Italian criminal code is unconstitutional under certain conditions. On the one hand, this Article «serves the purpose of protecting interests that are worthy of protection by the legal system¼ (p. 6), such as life and the protection of weak and vulnerable people. On the other hand, in specific situations like the one in the DJ Fabo's case, the assistance to die «may seem to the sick person to be the only way out of being kept alive by artificial methods that are no longer desired, and which he or she has the right to refuse¼ (p. 8). In particular the Court has set four conditions under which the absolute prohibition of suicide assistance can turn to be unconstitutional, and namely in those cases in which «assisted persons are (a) affected by an illness that is incurable and (b) causes physical or psychological suffering, which they find absolutely intolerable, and who are (c) kept alive by means of life support treatments, but remain (d) capable of making free and informed decisions¼ (p. 8). In such a situation the absolute ban on suicide assistance obliges the patient to «undergo a slower process, in a scenario that corresponds less well to the patient's vision of a dignified death and which is marked by more pain and suffering for the people close to the patient¼ (p. 9). Being aware of the impact and scope of its remarks and of the values at stake, the Court decided not to immediately declare the unconstitutionality of art. 580 of the criminal code, but rather to postpone the official discussion of the questions of constitutionality to the hearing on September 24, 2019. In a «"collaborative" and "dialogical"¼ perspective, the Court thus called upon the Parliament to regulate a subject which is at the «intersection between values of primary importance, the balancing of which presupposes, in a direct and immediate way, choices that the legislator is, first of all, authorized to make¼ (p. 11). As already known, the Parliament has not passed a law on assisted suicide so far; the Court will therefore decide at the hearing on September 24 how to amend what has already defined as a «unconstitutional regulatory scheme¼ (p. 11). Against this background and considering the reasoning of the Court in December 2018, the Authors of this Document - legal scholars and professionals with long-standing experience in these topics - decided to open an interdisciplinary discussion on the main legal end-of-life issues. Starting from the Order but without limiting the analysis to it, the Working Group met on a monthly basis at the University of Trento and with the support of the Jean Monnet BioTell Project, addressing and studying in depth the large number of tricky issues raised by the Order of the Constitutional Court and linked to a possible Parliament decision. The results of these discussions have been gathered and developed in the Document together with some operational proposals, offering a "constitutionally oriented" and scientific grounded understanding of end-of-life issues. The Working Group thus aimed to contribute to the public debate suggested by the Court, which must be truly informed and plural due to the impact on institutional choices. On September 25, the Constitutional Court ruled the impunity of those who foster the suicide under the conditions expressed in the Court press release reporting the Court's judgment.


Assuntos
Direito a Morrer/legislação & jurisprudência , Suicídio Assistido/legislação & jurisprudência , Constituição e Estatutos , Humanos , Itália
18.
BMC Palliat Care ; 18(1): 75, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31472690

RESUMO

BACKGROUND: Laws allowing assisted suicide and euthanasia have been implemented in many locations around the world but some individuals suffering with terminal illness receiving palliative care services are hastening death or die by suicide without assistance. This systematic review aims to summarise evidence of palliative care professionals' experiences of patients who died by suicide or hastened death in areas where assisted dying is legal and to understand when hastened death is considered to be a suicide. METHODS: AMED, CINAHL Complete, PsycINFO, PubMED, and Academic Search Ultimate were searched for articles from inception through June 2018. Quality assessment used the Hawker framework. RESULTS: A total of 1518 titles were screened resulting in thirty studies meeting eligibility criteria for this review. Published studies about professionals' experiences from areas with legalised assisted dying includes limited information about patients who hasten death outside legal guidelines, die by suicide without assistance, or if the law impacts suicide among palliative care patients. CONCLUSION: There are a range of experiences and emotions professionals' experience with patients who die by euthanasia, assisted suicide, or hasten death without assistance. The included literature suggests improved communication among professionals is needed but does not explicitly identify when a hastened death is deemed a suicide in areas where assisted dying is practiced. More research is needed to help clarify what hastened death means in a palliative care context and identify how and if assisted dying impacts issues of suicide in palliative care settings.


Assuntos
Pessoal de Saúde/psicologia , Cuidados Paliativos/normas , Suicídio Assistido/classificação , Suicídio/classificação , Atitude do Pessoal de Saúde , Pessoal de Saúde/ética , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Suicídio/ética , Suicídio/legislação & jurisprudência , Suicídio Assistido/ética , Suicídio Assistido/legislação & jurisprudência
19.
Nurs Philos ; 20(4): e12281, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31478340

RESUMO

Death and dying are natural phenomena embedded within complex political, cultural and social systems. Nurses often practice at the forefront of this process and have a fundamental role in caring for both patients and those close to them during the process of dying and following death. While nursing has a rich tradition in advancing the palliative and end-of-life care movement, new modes of care for patients with serious and irremediable medical conditions arise when assisted death is legalized in a particular jurisdiction. In early 2015, the Supreme Court of Canada released its landmark decision Carter v. Canada (Attorney General) ('Carter'), which legalized physician-assisted suicide in particular clinical situations. The new law provided the broad national framework for Medical Assistance in Dying (MAiD) in Canada but, once the law was passed, provincial and territorial governments and health professional regulatory bodies each had to undertake a process of developing policies, procedures and processes to guide MAiD-related practice specific to their jurisdiction. In this paper, we begin to examine the political ramifications and professional tensions arising from MAiD for nurses and nursing, focusing specifically upon the impacts for registered nurses. We identify how variations in the provincial and territorial literature and regulatory guidelines across Canada have given rise to role confusion and uncertainty among some registered nurses and how this may potentially impact patient care. We then continue to highlight the need for greater political activism among nurses to foster greater clarity in nursing roles in MAiD and to advocate for improved supports for patients and those close to them.


Assuntos
Papel do Profissional de Enfermagem , Suicídio Assistido/legislação & jurisprudência , Canadá , Humanos , Assistência Terminal
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