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1.
Age Ageing ; 52(1)2023 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-36626318

RESUMO

OBJECTIVES: In the Netherlands, a case of euthanasia of an incompetent patient with dementia and an advance euthanasia directive (AED) caused great societal unrest and led to a petition signed by more than 450 physicians. In this paper, we investigate these physicians' reasons and underlying motives for supporting the 'no sneaky euthanasia' petition, with the aim of gaining insight into the dilemmas experienced and to map out topics in need of further guidance. METHODS: Twelve in-depth interviews were conducted with physicians recruited via the webpage 'no sneaky euthanasia'. General topics discussed were: reasons for signing the petition, the possibilities of euthanasia in incompetent patients and views on good end-of-life care. Data were interpreted using thematic content analysis and the framework method. RESULTS: Reasons for supporting the petition are dilemmas concerning 'sneaky euthanasia', the over-simplified societal debate, physicians' personal moral boundaries and the growing pressure on physicians. Analysis revealed three underlying motives: aspects of handling a euthanasia request based on an AED, good end-of-life care and the doctor as a human being. CONCLUSIONS: Although one of the main reasons for participants to support the petition was the opposition to 'sneaky euthanasia', our results show a broader scope of reasons. This includes their experience of growing pressure to comply with AEDs, forcing them to cross personal boundaries. The underlying motives are related to moral dilemmas around patient autonomy emerging in cases of decision-making disabilities in advanced dementia. To avoid uncertainty regarding patients' wishes, physicians express their need for reciprocal communication.


Assuntos
Demência , Eutanásia , Médicos , Humanos , Diretivas Antecipadas , Pesquisa Qualitativa , Países Baixos , Demência/diagnóstico
2.
Hist Philos Life Sci ; 45(1): 2, 2023 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-36648559

RESUMO

Decisions regarding the end-of-life of minor patients are amongst the most difficult areas of decision-making in pediatric health care. In this field of medicine, such decisions inevitably occur early in human life, which makes one aware of the fact that any life-young or old-cannot escape its temporal nature. Belgium and the Netherlands have adopted domestic regulations, which conditionally permit euthanasia and physician-assisted suicide in minors who experience hopeless and unbearable suffering. One of these conditions states that the minor involved must be legally competent and able to express an authentic and lasting wish to die. This contribution is different from other legal texts on end-of-life decisions in modern health care. Foremost, it deals with the role time-bound components play in our views on the permissibility of such decisions with regard to minor patients. While other disciplines provide profound reflections on this issue, from a legal point of view this side has hardly been explored, let alone examined with regard to its relevance for the legal permissibility of end-of-life decisions in pediatrics. Therefore, the manuscript inquires whether there are legal lessons to be learned if we look more closely to temporality-related aspects of these end-of-life decisions, particularly in connection to a minor patient's assumable ability to choose death over an agonizing existence.


Assuntos
Eutanásia , Suicídio Assistido , Humanos , Criança , Países Baixos , Bélgica
3.
J Adv Nurs ; 79(2): 676-685, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36534409

RESUMO

AIM: To explore final year nursing students' attitudes towards euthanasia due to unbearable mental suffering by using the adapted and validated Euthanasia Attitude Scale. DESIGN: Cross-sectional survey. METHODS: Explorative, descriptive cross-sectional study conducted using an e-mail survey between October 2020 and March 2021 by a sample of final-year baccalaureate nursing students (n = 273) from eight of the eleven Flemish university colleges. The actual questionnaire contains 21 questions and was developed based on a consensus reached following independent translations. The psychometric properties of the Euthanasia Attitude Scale were assessed, including reliability and validity. Independent-sample Mann-Whitney U-test was used to investigate relation between demographic and education-related data, and domain and total score of the UMS-EAS-NL. This study received ethical approval from the Ethical Committee of the University Hospital Brussels, Belgium. RESULTS: McDonald's omega was 0.838 for the total Euthanasia Attitude Scale scores, supporting the validity of the questionnaire. A statistically significant difference in 'Naturalistic beliefs' score was found relating to the year of birth. There are clinically important results between those students who have been involved in euthanasia and those who have not. CONCLUSIONS: Most of the final-year nursing students supported the probability of patients' access to euthanasia due to unbearable mental suffering. To monitor adequate care, it is necessary to prepare nursing students adequately for this complex matter. IMPACT: To date, no large-scale study has examined nursing students' attitudes towards euthanasia because of unbearable mental suffering. It is expected that nursing students may be confronted with such a euthanasia request during an internship, or later in their professional career, in countries where euthanasia is legal. Students showed a high acceptability towards UMS-euthanasia. Clinically significant differences were found for students who had ever been involved in euthanasia.


Assuntos
Eutanásia , Estudantes de Enfermagem , Humanos , Estudos Transversais , Reprodutibilidade dos Testes , Atitude do Pessoal de Saúde , Inquéritos e Questionários
4.
Riv Psichiatr ; 57(6): 303-307, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36503945

RESUMO

INTRODUCTION: In recent months, a great uproar has been aroused by the case of a 23-year-old Belgian woman who requested and obtained euthanasia because she was suffering from a mental disorder, in the absence of any somatic pathology. The news raises some questions and stimulates some reflections both on the general theme of euthanasia carried out for the simple presence of a mental disorder, and for the indefiniteness of the clinical information on the case in question, as well as on the ethical and medico-legal questions connected to such indefiniteness. CASE PRESENTATION: The information on the case was derived essentially from the press and from websites, with no specific access to actual clinical documentation and without in-depth knowledge of case details. One wonders what the real clinical diagnosis of the patient was, only hypothetically identifiable in a Post-traumatic Stress Disorder associated with Major or Chronic Depressive Disorder, probably on the basis of a possible Personality Disorder. One wonders if all the necessary therapeutic interventions had been implemented, in a clinical case that did not theoretically have the characteristics of incurability. One wonders why the death request was considered valid, in a subject perhaps suffering from a mental disorder of such severity as to alter the ability to express valid consent to medical treatment. One wonders why the death request was not considered as an indicator of the severity of the disease, rather than simply being considered as a free choice of a subject capable of self-determination. One wonders why the negative opinion of the patient's family members was not considered. CONCLUSIONS: Belgian legislation provides for euthanasia for patients suffering from mental disorders who, like those suffering from somatic disorders, experience a condition of constant, unbearable and incurable suffering. But the case in question raises numerous perplexities both on the clinical and ethical coherence of Belgian legislation and on the ways in which the rules of this legislation have been observed in this specific situation.


Assuntos
Eutanásia , Transtornos Psicóticos , Transtornos de Estresse Pós-Traumáticos , Feminino , Humanos , Adulto Jovem , Adulto , Instituições de Assistência Ambulatorial , Ansiedade
6.
Cuad Bioet ; 33(109): 269-274, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-36493412

RESUMO

Palliative medicine is the medicine that accompanies the person in their process of dying for alleviate their unwanted suffering, is a medicine that offers comfort care to the patient and his family, a medicine that does not prolong life unnecessarily at the expense of suffering, but rather it widens it, it is a medicine that takes care of life. Medical deontology tells us how our good medical practice through the rules contained in the Code of Ethics. In this article I address the practice of palliative medicine taking into account medical deontology, focusing on two issues that generate controversy such as palliative sedation and euthanasia. I consider that the good practice of palliative medicine consists, not in intentionally causing the death of the patient, but neither in unnecessarily prolong his agony, but to alleviate his suffering until death comes.


Assuntos
Eutanásia , Medicina Paliativa , Assistência Terminal , Humanos , Cuidados Paliativos
7.
Eur Psychiatry ; 65(1): e80, 2022 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-36352491

RESUMO

For more than 20 years, euthanasia in Belgium and The Netherlands is allowed for unbearable suffering caused by terminal or non-terminal illnesses, including psychiatric disorders. Although euthanasia numbers have been increasing over the years, the percentage of cases involving people with a primary psychiatric diagnosis has remained stable (between 1 and 2%). For these cases, the Belgian and Dutch Euthanasia Laws operate similar due care criteria: a well-considered, repeated, and voluntary request from a legally competent adult; a medical condition without prospect of improvement; constant and unbearable suffering that cannot be alleviated; consultation of two independent physicians, including a psychiatrist; and a posteriori evaluation and control [1-3].


Assuntos
Eutanásia , Transtornos Mentais , Adulto , Humanos , Bélgica , Direitos Humanos , Países Baixos
8.
Recenti Prog Med ; 113(11): 649-653, 2022 11.
Artigo em Italiano | MEDLINE | ID: mdl-36318168

RESUMO

In the last years the legal weight of the sick person's autonomy has been increasingly promoted, and many countries have today legislations allowing euthanasia and/or assisted suicide within the law. Even though assisted suicide could cause discomfort to the sick person, it has been often preferred, in order to balance the right of doctors to have respected their ethical and deontological principles with that of sick people to put an end to their suffering. In line with the need to keep in balance the deontological rules of medicine and the rights of sick people, it would be appropriate to shift from the current legal framework considering physician assisted suicide as an obligation for the doctor, having the conscientious objection as an exception, to another that does not envisage physician assisted suicide as an obligation of the doctor considering a "conscientious willingness" as an exception.


Assuntos
Eutanásia , Médicos , Suicídio Assistido , Humanos , Princípios Morais
10.
Omega (Westport) ; 86(1): 187-202, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36223518

RESUMO

This cross-sectional survey was carried out among medical internees (n = 92) and nursing students (n = 228) to investigate their attitudes towards euthanasia. The data was collected by administering a Euthanasia Attitude questionnaire. The findings revealed that a majority (61%) of the participants were in support of euthanasia. Yet ethical dilemmas prevail among students about active and passive euthanasia and legalization of euthanasia. Further, age, gender, religion, education and exposure to patients who require euthanasia were significantly differed with euthanasia attitudes (p < 0.05). Therefore, it is strongly recommended that health care students should receive ethics education to prepare them in dealing with euthanasia related issues in their professional practice.


Assuntos
Eutanásia , Estudantes de Medicina , Estudantes de Enfermagem , Atitude , Atitude do Pessoal de Saúde , Estudos Transversais , Humanos , Inquéritos e Questionários
11.
BMC Med Ethics ; 23(1): 101, 2022 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-36217136

RESUMO

BACKGROUND: Huntington's disease (HD) has a poor prognosis. For HD patients in the Netherlands, one way of dealing with their poor prognosis is by drawing up an advance euthanasia directive (AED). Little is known about the perspectives of HD patients on their AED. AIM: To gain insight into patients' views on and attitudes towards their AED, and changes over time. METHODS: A longitudinal qualitative interview study using 1 to 6 semi-structured interviews over a period of maximum three years. Nine HD patients (5 outpatient clinic, 3 day care, 1 assisted living facility) who either had an AED or were thinking about drawing it up participated in this study. RESULTS: We identified two themes that characterize patients' perspectives on their AEDs: (1) general character of the AED; (2) uncertainty around their AED. Ad (1) The conditions that the participants described in their AED were generally not very specific for the person. Mostly they were general notions of unbearable suffering. Familiarity with HD in the family could play a role in drawing up an AED. Ad (2) Participants generally were aware of the tentative character of their AED and could have doubts concerning their own willingness or the willingness of others in the future. Sometimes these doubts were so great, that it prevented them from drawing up an AED. However, patients did not alter their AED during the follow-up period or changed in their view or attitude on their AED. CONCLUSION: HD patients that draw up an AED usually describe general conditions for euthanasia and recognize that these conditions may change as the disease progresses. An AED or the wish to draw one up may be a good conversation starter for conversations about goals and preferences for future care.


Assuntos
Eutanásia , Doença de Huntington , Diretivas Antecipadas , Atitude , Humanos , Pesquisa Qualitativa
12.
Hastings Cent Rep ; 52(5): 24-31, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36226882

RESUMO

In 2016, a Dutch physician complied with the advance euthanasia directive of a patient with severe dementia. In the ensuing lawsuit, the physician was charged principally with termination of life on request, with euthanasia, that is, and alternatively with murder. A district court acquitted her of both charges, a decision later upheld by the Dutch Supreme Court. Euthanasia is still a criminal offense in the Netherlands, but in 2002, a new euthanasia act came into effect allowing a physician to perform euthanasia if she has fulfilled six due-care criteria, the two most important of which are that she must be satisfied that the patient's request is voluntary and well considered and that the patient's suffering is unbearable, with no prospect of improvement. Neither of these two criteria is controversial; particular cases are controversial when it is disputed that these criteria were fulfilled. Other euthanasia cases, however, are controversial because they belong to a category that is contentious for independent reasons. One such disputed category is euthanasia performed on incompetent patients with an advance directive. Since determining whether these criteria are fulfilled in a particular case depends on the particular circumstances, we describe this 2016 case in detail. We then focus on three general philosophical reasons for doubting the validity of advance euthanasia directives for incompetent patients: the someone else problem, the problem of response shift, and the problem of normative authority. These problems have been discussed before, but our primary aim is to show how they are connected. Taken together, we believe that our two lines of argument make a strong moral case for supporting the Dutch Supreme Court's decision.


Assuntos
Demência , Eutanásia , Médicos , Diretivas Antecipadas , Feminino , Humanos , Princípios Morais , Países Baixos
13.
Hastings Cent Rep ; 52(5): 15-23, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36226883

RESUMO

Many people are afraid they will, as they age or fall ill, become burdens to others. Some who fear this say they would be willing to hasten their own deaths-engaging in self-sacrifice through suicide, assisted suicide, or euthanasia-to avoid it. Still, some bioethicists and other critics of medical aid in dying reject the idea that fear of being a burden can be a good reason for self-sacrifice. They argue that dependency is nearly universal, emphasize that caregiving is a valuable pursuit, and raise concerns about the impact of aid-in-dying policies on vulnerable groups. After defining what it is to be a burden, articulating why being a burden is morally significant, and, crucially, distinguishing burdensomeness from what I call "mere dependency," I defend the intuition that self-sacrifice can be justified by the desire to avoid being a burden and by the concern for the well-being of one's caregivers that this choice implies.


Assuntos
Eutanásia , Suicídio Assistido , Cuidadores , Humanos
14.
Theor Med Bioeth ; 43(5-6): 329-354, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36227395

RESUMO

I offer a principled objection to arguments in favour of legalizing non-voluntary euthanasia on the basis of the principle of beneficence. The objection is that the status of death as a benefit to people who cannot formulate a desire to die is more problematic than pain management care. I ground this objection on epistemic and political arguments. Namely, I argue that death is relatively more unknowable, and the benefits it confers more subjectively debatable, than pain management. I am not primarily referring to the claim that it is difficult to make comparisons between live and post-mortem states, but rather to the fact that it is epistemically and metaphysically problematic to impute a "life-worse-than-death" or a state of "suffering-calling-for-death" to people who cannot subjectively wish to die, as though this kind of suffering were a medically observable fact rather than a belief- and value-laden notion. On the contrary, people enduring similar causes of pain may have different experiences of suffering and views on how it affects the worthwhileness of their existence or the desirability of death or of continuing their lives. The projection of a "suffering-calling-for-death" onto infants or people with severe intellectual disabilities may not be indefensible, but it is more controversial than judging that pain management will improve their well-being from the perspective of beneficence. My argument also relies on our society's liberal endeavour to avoid endorsing unverifiable beliefs about life and death or controversial conceptions of the good life. My goal is not to suggest we should not attend the suffering of cognitively disabled people. On the contrary, I only cast doubt on too quick an assumption that ending their lives is the best way of caring for them, when robust palliative treatments are available. Moreover, I express the concern that a lack of attention to distinctions between "pain-calling-for-relief" and "suffering-calling-for-death" may be based on ableist projections and assumptions. I conclude that it is imperative to continue research into the nature of pain and suffering experienced by individuals with mental or cognitive impairments preventing them from expressing autonomous wishes about the kind of treatment that would most benefit them.


Assuntos
Eutanásia , Suicídio Assistido , Humanos , Estresse Psicológico/psicologia , Beneficência , Cuidados Paliativos , Dor , Eutanásia Ativa Voluntária
16.
Nervenarzt ; 93(Suppl 1): 52-61, 2022 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-36197477

RESUMO

The neurologists Sir Ludwig Guttmann and Robert Wartenberg had a number of things in common, e.g., both enjoyed high international recognition for the clinical care they provided to paraplegics and for their contributions to the development of neurological diagnostics. Both were born before 1900. Both were classified as "Jewish" by the National Socialist regime because of their origins. Both had to flee from Germany in the 1930s but nevertheless did not appear to harbor any grudges after 1945; however, both also show differences even more than similarities. Guttmann (1899-1980) stood up for those persecuted, for instance during the November pogroms in 1938. After his late emigration, he soon found a new home in England. His skills in neurosurgery enabled him to convert a military hospital into the world's leading treatment center for spinal cord injuries. He was the founder of the Paralympic Games and received a knighthood from Queen Elizabeth II. In 1971 the German Neurological Society (DGN) awarded him with a late honorary membership during the presidency of the former SS captain Helmut Bauer. In contrast, Robert Wartenberg (1886-1956) found a new neurological home at the University of California in San Francisco and published numerous books, some of which also attracted attention in the German translation. On various occasions, he opposed the remembrance of National Socialist injustice and even justified the "concurrent research" in conjunction with "euthanasia".


Assuntos
Eutanásia , Neurologia , Neurocirurgia , Alemanha , História do Século XX , Humanos , Socialismo Nacional , Neurologistas
17.
Ethiop J Health Sci ; 32(5): 975-984, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36262713

RESUMO

Background: Nurses play an important role in the healthcare team and are closely involved in the daily care of patients. Sometimes, they are involved in the care of terminal patients, who may thus be confronted with difficult end-of-life decisions such as euthanasia. Therefore, it is important to determine the views on euthanasia of nursing students who will work in health care and prepare them for such situations in their professional life. This study aimed to evaluate the effect of euthanasia education on nursing students' opinions. Methods: Pretest-posttest single group semi-experimental method was used in the study. Data were obtained with two surveys carried out both before and after education. Descriptive statistics, Chi-square test, or Fisher's exact tests were used to analyze. Results: Euthanasia education provided students with a different perspective. The results indicated that 56.4% of the students that they knew about euthanasia partially enough before education. After the training, 65.5% of them indicated that they had enough knowledge. Rate of those who are undecided on many questions before education decreased. Conclusions: Education can significantly change nursing students' approach to euthanasia and provides ethical awareness. Euthanasia and related topics should be added to the curriculum. Students should be encouraged to express their opinions and questions about euthanasia. Students should receive ethics education to prepare them to deal with euthanasia-related issues in their professional lives.


Assuntos
Eutanásia , Estudantes de Enfermagem , Humanos , Atitude do Pessoal de Saúde , Currículo , Inquéritos e Questionários
18.
Psicooncología (Pozuelo de Alarcón) ; 19(2): 327-338, 21 oct. 2022.
Artigo em Espanhol | IBECS | ID: ibc-212081

RESUMO

Los países que han optado por regular los Procesos Adelantados de Muerte (PAM) van en aumento en los últimos años. Este tipo de legislaciones implican directamente a los equipos sanitarios. Los psicólogos incluidos en estos equipos están en contacto con estos procesos, por lo que se torna imprescindible dilucidar, mediante la escasa literatura existente, si los PAM presentan variables diferenciales con otros procesos de muerte, que sean necesarias tener en cuenta durante la asistencia psicológica. Esta recopilación de literatura pretende plantear las diferencias que en la actualidad están contrastadas y plantear qué opciones de intervención psicológica están a nuestra disposición para realizar el acompañamiento a estas personas, sus cuidadores y los equipos sanitarios que los asisten. (AU)


The countries that have chosen to regulate advanced death processes (PAM) have been increasing in recent years. This type of legislation directly involves health teams. The psychologists included in these teams are in contact with these processes, so it becomes essential to elucidate, through the scarce existing literature, if the PAM present differential variables with other death processes, that it is necessary to take into account during psychological assistance. This compilation of literature aims to present the differences that are currently contrasted and to propose what psychological intervention options are available to us to carry out the accompaniment of these people, their caregivers and the health teams that assist them. (AU)


Assuntos
Humanos , Eutanásia/psicologia , Suicídio Assistido/psicologia , Suicídio Assistido/legislação & jurisprudência , Eutanásia/legislação & jurisprudência
19.
Rev. esp. med. legal ; 48(4): 166-174, Octubre - Diciembre 2022. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-213685

RESUMO

La regulación de la eutanasia ha sido objeto de debate desde hace años, desde los campos de la medicina, el derecho y la bioética, y por tanto de la medicina legal, en la que estas 3 disciplinas convergen. En los últimos 30 años hemos vivido un proceso de despenalización y regulación en diferentes países del mundo. Actualmente la eutanasia y/o el suicidio asistido están regulados en 7 países: Holanda, Bélgica, Luxemburgo, Canadá, Colombia, Nueva Zelanda y España, así como en 11 estados de EE. UU.: Oregón, Washington, Montana, Vermont, California, Colorado, Hawai, Maine, Nueva Jersey, Nuevo México y el Distrito Federal de Columbia/Washington D.C., y en 2 estados de Australia: Estado de Victoria y Australia Occidental. En este trabajo de revisión realizamos un estudio sobre los aspectos más importantes de la nueva Ley Orgánica de Regulación de la Eutanasia en España comparando con el resto de los países en los que también tienen la regularización de la eutanasia y/o el suicidio asistido. (AU)


The regulation of euthanasia has been the subject of debate for years, from the fields of Medicine, Law and Bioethics, and therefore of Legal Medicine, in which these three disciplines converge. In the last thirty years we have experienced a process of decriminalization and regulation in different countries of the world. Currently euthanasia and/or assisted suicide are regulated in 7 countries: Holland, Belgium, Luxembourg, Canada, Colombia, New Zealand and Spain, as well as in 11 US states: Oregon, Washington, Montana, Vermont, California, Colorado, Hawaii, Maine, New Jersey, New Mexico and the Federal District of Columbia / Washington D.C, and in 2 states of Australia: State of Victoria and Western Australia. In this review work we carry out a study on the most important aspects of the new law of the regulation of euthanasia in Spain compared to the rest of the countries in which they also have the regularization of euthanasia and / or assisted suicide. (AU)


Assuntos
Humanos , Eutanásia/legislação & jurisprudência , Eutanásia Ativa Voluntária/legislação & jurisprudência , Medicina Legal/legislação & jurisprudência , Espanha , Benchmarking/legislação & jurisprudência
20.
Am J Transplant ; 22(12): 2759-2780, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36100362

RESUMO

The procedure combining medical assistance in dying (MAiD) with donations after circulatory determination of death (DCDD) is known as organ donation after euthanasia (ODE). The first international roundtable on ODE was held during the 2021 WONCA family medicine conference as part of a scoping review. It aimed to document practice and related issues to advise patients, professionals, and policymakers, aiding the development of responsible guidelines and helping to navigate the issues. This was achieved through literature searches and national and international stakeholder meetings. Up to 2021, ODE was performed 286 times in Canada, the Netherlands, Spain, and Belgium, including eight cases of ODE from home (ODEH). MAiD was provided 17,217 times (2020) in the eight countries where ODE is permitted. As of 2021, 837 patients (up to 14% of recipients of DCDD donors) had received organs from ODE. ODE raises some important ethical concerns involving patient autonomy, the link between the request for MAiD and the request to donate organs and the increased burden placed on seriously ill MAiD patients.


Assuntos
Eutanásia , Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Humanos , Doadores de Tecidos , Assistência Médica
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