Psychosocial determinants of nurses' intention to practise euthanasia in palliative care.

BACKGROUND: Most studies on euthanasia fail to explain the intentions of health professionals when faced with performing euthanasia and are atheoretical. RESEARCH OBJECTIVE: The purpose of this study was to identify the psychosocial determinants of nurses' intention to practise euthanasia in palliative care if it were legalised. RESEARCH DESIGN: A cross-sectional study using a validated anonymous questionnaire based on an extended version of the Theory of Planned Behaviour. PARTICIPANTS AND RESEARCH CONTEXT: A random sample of 445 nurses from the province of Quebec, Canada, was selected for participation in the study. ETHICAL CONSIDERATIONS: The study was reviewed and approved by the Ethics Committee of the Centre hospitalier universitaire de Québec. FINDINGS: The response rate was 44.2% and the mean score for intention was 4.61 ± 1.90 (range: 1-7). The determinants of intention were the subjective (odds ratio = 3.08; 95% confidence interval: 1.50-6.35) and moral (odds ratio = 2.95; 95% confidence interval: 1.58-5.49) norms. Specific beliefs which could discriminate nurses according to their level of intention were identified. DISCUSSION: Overall, nurses have a slightly positive intention to practise euthanasia. Their family approval seems particularly important and also the approval of their medical colleagues. Nurses' moral norm was related to beneficence, an ethical principle. CONCLUSION: To our knowledge, this is the first study to identify nurses' motivations to practise euthanasia in palliative care using a validated psychosocial theory. It also has the distinction of identifying the ethical principles underlying nurses' moral norm and intention.

Psychosocial determinants of physicians' intention to practice euthanasia in palliative care.

BACKGROUND: Euthanasia remains controversial in Canada and an issue of debate among physicians. Most studies have explored the opinion of health professionals regarding its legalization, but have not investigated their intentions when faced with performing euthanasia. These studies are also considered atheoretical. The purposes of the present study were to fill this gap in the literature by identifying the psychosocial determinants of physicians' intention to practice euthanasia in palliative care and verifying whether respecting the patient's autonomy is important for physicians. METHODS: A validated anonymous questionnaire based on an extended version of the Theory of Planned Behavior was mailed to a random sample of 445 physicians from the province of Quebec, Canada. RESULTS: The response rate was 38.3% and the mean score for intention was 3.94 ± 2.17 (range: 1 to 7). The determinants of intention among physicians were: knowing patients' wishes (OR = 10.77; 95%CI: 1.33-86.88), perceived behavioral control-physicians' evaluation of their ability to adopt a given behavior-(OR = 4.35; 95%CI: 1.44-13.15), moral norm-the appropriateness of adopting a given behavior according to one's personal and moral values-(OR = 3.22; 95%CI: 1.29-8.00) and cognitive attitude-factual consequences of the adoption of a given behavior-(OR = 3.16; 95%CI: 1.20-8.35). This model correctly classified 98.8% of physicians. Specific beliefs that might discriminate physicians according to their level of intention were also identified. For instance, physicians' moral norm was related to the ethical principle of beneficence. CONCLUSIONS: Overall, physicians have weak intentions to practice euthanasia in palliative care. Nevertheless, respecting patients' final wishes concerning euthanasia seems to be of particular importance to them and greatly affects their motivation to perform euthanasia.

The use of palliative sedation: A comparison of attitudes of French-speaking physicians from Quebec and Switzerland.

OBJECTIVE: Previous literature has suggested that laws and regulations may impact the use of palliative sedation. Our present study compares the attitudes of French-speaking physicians practicing in the Quebec and Swiss environments, where different laws are in place regarding physician-assisted suicide. METHOD: Data were drawn from two prior studies, one by Blondeau and colleagues and another by Beauverd and coworkers, employing the same two-by-two experimental design with length of prognosis and type of suffering as independent variables. Both the effect of these variables and the effect of their interaction on Swiss and Quebec physicians' attitudes toward sedation were compared. The written comments of respondents were submitted to a qualitative content analysis and summarized in a comparative perspective. RESULTS: The analysis of variance showed that only the type of suffering had an effect on physicians' attitudes toward sedation. The results of the Wilcoxon test indicated that the attitudes of physicians from Quebec and Switzerland tended to be different for two vignettes: long-term prognosis with existential suffering (p = 0.0577) and short-term prognosis with physical suffering (p = 0.0914). In both cases, the Swiss physicians were less prone to palliative sedation. SIGNIFICANCE OF RESULTS: The attitudes of physicians from Quebec and Switzerland toward palliative sedation, particularly regarding prognosis and type of suffering, seem similar. However, the results suggest that physicians from Quebec could be slightly more open to palliative sedation, even though most were not in favor of this practice as an answer to end-of-life existential suffering.

The integration of a person-centered approach in palliative care.

OBJECTIVE: The philosophy underlying palliative care places the respect of patients and their autonomy at the heart of clinical practice. A study was conducted at a palliative care facility to document changes that occurred after the integration of a person-centered approach focusing on human freedom (which is linked to autonomy): the humanbecoming school of thought. It aimed to describe changes observed in the beliefs and practices of healthcare providers, the concept and respect of autonomy by healthcare providers, care and respect of autonomy experienced by patients' relatives, and consideration of patients' wishes through their documentation. METHOD: The method adopted consisted of a pre-project - process - post-project descriptive qualitative design and was inspired by teaching-learning and mentoring models. Data were collected from 51 healthcare providers and 10 relatives through semistructured interviews and from the medical records of 30 patients during the pre- and post-project phases. They were analyzed and compared at the end of the study. The process phase consisted of offering training sessions and mentoring, encouraging the involvement of healthcare providers, and cocreating integration and care tools. RESULTS: While the analysis exposed some discrepancies with the language of the approach and differences between nurses and other healthcare providers, it revealed, above all, similarities in the changes observed between the different sources of data. The focus moved from being task-centered to being person-centered; the affirmation of the priority of respecting patients' choices, desires, and needs; a presence shifting from being available to true listening; the affirmation of following the ever-changing rhythm of the patient; and a notion of respect of autonomy now including the other. SIGNIFICANCE OF RESULTS: In line with the philosophy of palliative care, the project demonstrated that the integration of the humanbecoming approach can result in changes that contribute to the development of a more person-centered practice.

Attitudes of Quebec doctors toward sedation at the end of life: an exploratory study.

OBJECTIVE: The induction of sedation at the end of life is a much debated practice and not very documented. The goal of this study was to explore the practice from both a clinical and ethical point of view. METHODS: Data were collected through semistructured interviews with 19 Quebec physicians working in palliative care. RESULTS: Doctors' first priority was their patients, not patients' families. Clinically, the therapeutic aim of sedation was strictly to relieve suffering on the part of the patient. Ethically, getting the patient's consent was imperative. The family's consent was only required in cases of incapacity. Generally, sedation and euthanasia were seen as two distinct practices. SIGNIFICANCE OF THE RESEARCH: There are still very few guidelines regarding end-of-life sedation in Québec, and its normative framework is more implicit than explicit. It should be noted that most of the respondents regarded sedation and euthanasia as two distinct practices.

La différence: condition of exclusion or of reconnaissance?

From the Middle Ages onto the 19th century, following the trend set in leper hospitals, madness was to be hidden, secluded in dark places, far away from the mainstream of society. The emergence of the mad person, perceived as inevitably different, allows to make the boundaries between reason and folly, between human and inhuman, irrelevant. If leper hospitals have almost emptied out, if there are much fewer confinement facilities, the values and images related to the leper or the mad person, as well as the sense of exclusion, continue to persist. The purpose of this paper is to show clearly that this matter of exclusion is a serious legacy that could very well apply nowadays to other figures that, each in their own way, symbolize menace or mockery. It applies notably to the aged and the dying who both appear as the opposite of modern society and its values of efficiency, productivity and profitability. The multiplication of places where old people are left to die, and the elderly who are crowded in old folks homes, stand as proof of their exclusion from society. Nevertheless, youth and old age coexist, as well as life and death. If care of others is the trait of a humane civilization, must it be understood that barbarism consists in ignoring its own humanity as well as that of others? In view of such practices of exclusion, policy statements based on recognition of human dignity, where ethical obligation rests on recognition of others and humanism, are rather paradoxical. Is this a paradox or a deadlock; a condition of exclusion or of reconnaissance?

Factors predictive of signed consent for posthumous organ donation.

CONTEXT: The shortage of organs for transplantation has led public health authorities to invest significant efforts in the promotion of organ donation. OBJECTIVE: To identify factors predictive of signed consent for posthumous organ donation by using the theory of planned behavior. PARTICIPANTS AND DESIGN: A random sample of 602 adults completed a questionnaire at baseline, and behavior was self-reported 15 months later. RESULTS: Logistic regression indicated that intention, perceived behavioral control, moral norm, and past behavior were factors predictive of consent for posthumous organ donation. Participants' perceived behavioral control, past behavior, and moral norm were also predictive of intention to sign, but attitude and perceived barriers were 2 additional determinants. Finally, anticipated regret and knowledge of persons who had made an organ donation were 2 moderators of the intention-behavior relationship. CONCLUSION: Overall, the results showed that intention is an important determinant of signing the organ donor's consent sticker and also highlighted that moral consideration and perceived difficulties could be 2 potential avenues for designing interventions.

The dying person: an existential being until the end of life.

This article explores the experience of death from the perspective of existential philosophy, for the purpose of finding ways to humanize end-of-life nursing care. A person in his or her final days is seen by the caregiver as a being seeking the continual creation of his human becoming, from the experience of sickness to death. From the moment the torment of suffering begins, a person needs a presence of humanistic professionalism that embraces the values of the nursing profession.

Physicians' and pharmacists' attitudes toward the use of sedation at the end of life: influence of prognosis and type of suffering.

End-of-life sedation remains a controversial and ill-defined clinical practice; its applications vary considerably. With this in mind, a study was conducted using a 2 x 2 experimental design. The variables experimented with were prognosis (short- or long-term) and type of suffering (physical or existential). The goal was to study the influence of the two independent variables on attitude toward sedation. Four clinical vignettes were completed by 124 clinicians, doctors, and pharmacists working in different palliative care environments in the Province of Quebec. The results indicate that the type of suffering influences a subject's attitude to end-of-life sedation. Thus, when a patient was suffering physically, the respondents were significantly in favour of sedation, whereas they were not in favour of this practice if the suffering was existential. Lastly, it is clear that health professionals are uncomfortable when confronted with their patients' existential suffering. This is an issue worth exploring in future studies.

The nature of care in light of Emmanuel Levinas.

The discipline of nursing is still struggling with the differences that need to be clearly defined between the notions of care and nursing care. To be able to clarify this distinction, agreement must first be reached on the meaning of care itself. The present article proposes a conception of care in light of the philosophy of Emmanuel Levinas (1906-1995). This philosopher's thought throws considerable light on the ontology of care, thanks especially to his focus on the deeper implications of human encounter. A profound sense of responsibility towards the other enables Levinas to bring out such dimensions of the concept of care as the relation involved, the feeling of affection, and the interventions. We examine here what these entail regarding nursing care.