Euthanasia And Assisted Suicide Research Articles

Data and Trends in Assisted Suicide and Euthanasia, and Some Related Demographic Issues

AbstractAlthough considerable gains in survival have been observed in developed countries, particularly in the last stretch of life, part of these additional years of life are lived in bad health. In this context, a number of actions/inactions that limit or may limit life span are becoming increasingly common. Demography and quantitative sociology are well‐positioned to make a significant contribution to the measurement of the consistency of different end‐of‐life interventions, to the examination of differences over time, space and among different social groups, and to the analysis of the behaviors and attitudes of different stakeholders (the sufferers, their relatives, health care personnel, public opinion). We focus here on euthanasia and assisted suicide (EAS). First, we discuss changes in public opinion on EAS in developed countries. Second, we analyze the diffusion and temporal trends of EAS, with a particular focus on Switzerland, the Netherlands, and Belgium; three countries for which it is also possible to consider the connections between the diffusion of EAS and palliative care. Third, we consider several differential aspects of the spread of EAS (mainly by sex, age, and cause of death).

Euthanasia and assisted suicide: Who are the vulnerable?

One of the common domains in health care in which the concept of vulnerability is used is end-of-life care, including euthanasia and assisted suicide (EAS). Since different uses and implications of the notion have been recognised in the literature on EAS, this paper aims to analyse them and reflect on who is the most vulnerable in the context of EAS. A prior exploratory review of the literature has served as a starting point for the discussion. We concluded that vulnerability is a complex, multi-perspective and multi-layered concept, which implies the vulnerability of different stakeholders involved in EAS practices and vulnerability in different aspects of being human (i.e., physical, mental, moral, social and spiritual). A comprehensive understanding of the notion of vulnerability, which balances as well as complements the concept of autonomy, seems to be an indispensable element of the discourse on EAS.

Euthanasia and assisted suicide (EAS) in psychiatric patients

IntroductionA legal definition for EAS describes this procedure as “intentionally terminating life by someone other than the person concerned, at the latter’s request”. The number of requests for EAS has been progressively increasing in countries where this procedure is allowed, including concerning psychiatric patients (2% of all requests). EAS for reasons of unbearable suffering raises ethical concerns due to lack of criteria for psychiatric patients.ObjectivesTo discuss the avaliable data about EAS and its controversial value in psychiatric patients.MethodsNon-systematic review of literature on current knowledge about EAS, particularly in patients with mental disorder.ResultsIn terms of sociodemographic and clinical characteristics, these patients were mostly women, with at least two psychiatric conditions; the main diagnosis is a (treatment-resistant) mood disorder, with some medical comorbidity. Psychological suffering was the main motivation, in patients with severe symptomatology associated with psychiatric and physical conditions (26% reported both psychological and physical suffering). These patients tend to be empowered and value self-determination. There is to highlight a high percentage of patients still alive after a not granted pEAS request (69%) and a high rate of pEAS requests withdrawals (37%).ConclusionsSuicide prevention remains a priority in terms of public health. Thus, there is a need to ensure that EAS isn`t a way to increase suicide mortality by giving access to lethal methods to suicidal patients. In some cases, EAS request has a paradoxical value to regain control of life and it`s related to the transient nature of unbearable mental suffering.The actual process provides a continued recovery-oriented care in parallel with the EAS evaluation, and a thorough evaluation which requires a multi-expert panel with the envolvement of mental health professionals. Ethical concerns remains about its paradox: unbearable psychological suffering is a target for suicide prevention and also a required criterion for EAS.Disclosure of InterestNone Declared

Older Adults Who Experience Their Lives to Be Completed and No Longer Worth Living: A Systematic Mini-Review Into Used Terminology, Definitions, and Interpretations.

In the Netherlands and in Belgium, a political debate emerged regarding the possibility of euthanasia and assisted suicide (EAS) for older adults who experience their lives as completed and no longer worth living, despite being relatively healthy. This mini-review aimed to (1) present an overview of the terms used to denote this phenomenon as well as their definitions and to (2) explore how the underlying experiences are interpreted by the study authors. A systematic search was performed in Web of Science, MEDLINE, PsycINFO, and CINAHL, yielding 35 articles meeting the selection criteria. We selected empirical, English-language articles published in peer-reviewed journals. Participants had to have a first-person experience of the phenomenon or be assessed for it, or have a third-person experience of the phenomenon. Results show that the terms tiredness of life (ToL) and weariness of life (WoL) were used most frequently, also in the broader literature on suicidal expressions across the life span. Many studies mentioned operational definitions or synonyms rather than theoretical definitions. Moreover, inside the EAS debate, the term ToL was more common, its definition incorporated death wishes, and it was regularly framed existentially. Outside of this debate, the phenomenon was generally considered as a part of suicidal ideation distinct from death wishes, and its experience was often associated with underlying psychopathology. We discuss the need to establish consensus definitions and conclude that only a multidimensional view may be suitable to capture the complex nature of the phenomenon.

"Nothing Hurts Less Than Being Dead": Psychological Pain in Case Descriptions of Psychiatric Euthanasia and Assisted Suicide from the Netherlands: « Rien ne fait moins mal qu'être mort »: La douleur psychologique dans les descriptions de cas d'euthanasie et de suicide assisté psychiatrique aux Pays-Bas.

Euthanasia and assisted suicide (EAS) of individuals with mental disorders is a growing practice in several countries, including the Netherlands. Here, we aimed to identify the most frequent dimensions of and associated factors to psychological pain, which has been associated with suicidality, in individuals undergoing psychiatric EAS. An exploratory retrospective content analysis of the English translation of 66 digital case records of individuals who died by EAS in the Netherlands between 2011 and 2014 was performed. Nine standard psychological pain dimensions (irreversibility, loss of control, emptiness, emotional flooding, freezing, social distancing, narcissistic wounds, confusion, and self-estrangement), illness, and sociodemographic variables were evaluated by 2 independent raters using a premade data abstraction form (Kohen κ > 0.8 in all cases). The mean number of dimensions was 4.64 ± 1.20 (median = 5), out of 9. The most frequent dimensions were irreversibility, loss of control, emptiness, and emotional flooding, in decreasing order. Past treatment refusal and the mention of social connections in case descriptions were related to the higher number of psychological pain dimensions (4.89 ± 1.24 vs. 4.31 ± 1.07, P = 0.03 and 5.05 ± 1.17 vs. 4.43 ± 1.17, P = 0.03, respectively). Emotional flooding was the only dimension specifically associated with specific psychiatric conditions, namely posttraumatic phenomena and personality disorders. Numerous psychological pain dimensions were detected in case descriptions of individuals who underwent EAS before the procedure. Subjective nature of the study precludes definite conclusions but suggest that future studies should explore psychological pain and the role of interventions targeting it in patients requesting EAS.

Autism and Assisted Suicide

Autistic people have died by euthanasia and assisted suicide (EAS) in Belgium and the Netherlands. While these countries’ laws allow EAS for patients suffering from nonterminal psychological disorders when certain “due care” criteria are met, the practice of granting EAS for psychological disorders in general has drawn scrutiny. But there are complex issues specific to autism that have received little attention. The author examines three important questions about the Belgian and Dutch due care criteria as they pertain to autism. First, how might autism affect decision-making capacity for EAS? Second, how might autism affect the voluntariness of EAS requests? Third, is autism a medically futile condition such that there is no reasonable alternative to EAS for alleviating suffering? The author argues that what is known about autism vis-à-vis these due care criteria suggests that autistic people might be a vulnerable group at heightened risk for irremediable harm of premature death from EAS.

Public and physicians\u2019 support for euthanasia in people suffering from psychiatric disorders: a cross-sectional survey study

BackgroundAlthough euthanasia and assisted suicide (EAS) in people with psychiatric disorders is relatively rare, the increasing incidence of EAS requests has given rise to public and political debate. This study aimed to explore support of the public and physicians for euthanasia and assisted suicide in people with psychiatric disorders and examine factors associated with acceptance and conceivability of performing EAS in these patients.MethodsA survey was distributed amongst a random sample of Dutch 2641 citizens (response 75%) and 3000 physicians (response 52%). Acceptance and conceivability of performing EAS, demographics, health status and professional characteristics were measured. Multivariable logistic regression analyses were performed.ResultsOf the general public 53% were of the opinion that people with psychiatric disorders should be eligible for EAS, 15% was opposed to this, and 32% remained neutral. Higher educational level, Dutch ethnicity, and higher urbanization level were associated with higher acceptability of EAS whilst a religious life stance and good health were associated with lower acceptability. The percentage of physicians who considered performing EAS in people with psychiatric disorders conceivable ranged between 20% amongst medical specialists and 47% amongst general practitioners. Having received EAS requests from psychiatric patients before was associated with considering performing EAS conceivable. Being female, religious, medical specialist, or psychiatrist were associated with lower conceivability. The majority (> 65%) of the psychiatrists were of the opinion that it is possible to establish whether a psychiatric patient’s suffering is unbearable and without prospect and whether the request is well-considered.ConclusionThe general public shows more support than opposition as to whether patients suffering from a psychiatric disorder should be eligible for EAS, even though one third of the respondents remained neutral. Physicians’ support depends on their specialization; 39% of psychiatrists considered performing EAS in psychiatric patients conceivable. The relatively low conceivability is possibly explained by psychiatric patients often not meeting the eligibility criteria.

Factors associated with requesting and receiving euthanasia: a nationwide mortality follow-back study with a focus on patients with psychiatric disorders, dementia, or an accumulation of health problems related to old age

BackgroundRecently, euthanasia and assisted suicide (EAS) in patients with psychiatric disorders, dementia, or an accumulation of health problems has taken a prominent place in the public debate. However, limited is known about this practice. The purpose of this study was threefold: to estimate the frequency of requesting and receiving EAS among people with (also) a psychiatric disorder, dementia, or an accumulation of health problems; to explore reasons for physicians to grant or refuse a request; and to describe differences in characteristics, including the presence of psychiatric disorders, dementia, and accumulation of health problems, between patients who did and did not request EAS and between patients whose request was or was not granted.MethodsA nationwide cross-sectional survey study was performed. A stratified sample of death certificates of patients who died between 1 August and 1 December 2015 was drawn from the central death registry of Statistics Netherlands. Questionnaires were sent to the certifying physician (n = 9351, response 78%). Only deceased patients aged ≥ 17 years and who died a non-sudden death were included in the analyses (n = 5361).ResultsThe frequency of euthanasia requests among deceased people who died non-suddenly and with (also) a psychiatric disorder (11.4%), dementia (2.1%), or an accumulation of health problems (8.0%) varied. Factors positively associated with requesting euthanasia were age (< 80 years), ethnicity (Dutch/Western), cause of death (cancer), attending physician (general practitioner), and involvement of a pain specialist or psychiatrist. Cause of death (neurological disorders, another cause) and attending physician (general practitioner) were also positively associated with receiving euthanasia. Psychiatric disorders, dementia, and/or an accumulation of health problems were negatively associated with both requesting and receiving euthanasia.ConclusionsEAS in deceased patients with psychiatric disorders, dementia, and/or an accumulation of health problems is relatively rare. Partly, this can be explained by the belief that the due care criteria cannot be met. Another explanation is that patients with these conditions are less likely to request EAS.

Older People's Discourses About Euthanasia and Assisted Suicide: A Foucauldian Exploration.

This study aims to contribute an alternative understanding of the position of older people in the euthanasia and assisted suicide (EU/AS) debate. Seven interviews were analyzed using Foucauldian discourse analysis, to explore concepts like knowledge, power, subjectification and surveillance. The participants presented a "confused and conflicted" discourse, expressing the view that EU/AS is a family affair, whilst also articulating a strong sense of self-determination. Although a discourse of the medicalization of dying through medical control and surveillance was endorsed, an alternative discourse of "dying outside the medical gaze" emerged. Participants, who were in favor of EU/AS, felt "voiceless," as apparent double standards were applied in the debate, and powerful others, for example, physicians and politicians, seemed reluctant to engage. Within an "aged death" discourse, the anticipated dependency on poor care from (professional) others, made participants consider EU/AS as ways of avoiding this stage of life and the associated loss of dignity. By using Foucauldian discourse analysis, alternative power relationships were revealed which might give a different interpretation to the concept of the "slippery slope." Societal discourses and related behaviors, which devalue the dependent and old, might become internalized by older people, leading them to consider EU/AS as preferable end-of-life options.

Do guidelines on euthanasia and physician-assisted suicide in Dutch hospitals and nursing homes reflect the law? A content analysis

To describe the content of practice guidelines on euthanasia and assisted suicide (EAS) and to compare differences between settings and guidelines developed before or after enactment of the euthanasia law...

Euthanasia requests and cancer types in the Netherlands: Is there a relationship?

Cancer patients have generally requested for euthanasia and assisted suicide (EAS) more frequently than others. However, different terminal cancers are accompanied by different clinical courses. This study seeks to explore the relationship, if any, between EAS requesters and cancer types, as relates to the provision of end-of-life care in the Netherlands. Standardized questionnaires were retrospectively sent to all general practitioners (GPs) in 10 of 23 GP-districts in the Netherlands. Of the 3614 respondents (60%), 1442 could describe a most recent EAS request from a cancer patient. Compared to all home cancer deaths, lung, pancreas, stomach oesophagus, lip-mouth-throat cancers and melanomas occur more frequently in the group of cancer patients who requested for EAS; while prostate, haemo-lymphatic, urinary tract, bladder and uterus cancer occur relatively less frequently. Vomiting, shortness of breath and anxiousness were symptoms positively associated, and old age was negatively associated with cancers in which patients relatively frequently request for EAS. There are differences in the extent to which patients with different cancer types request for EAS. Although shortness of breath, vomiting and anxiousness are associated with cancer types in which patients relatively frequently request for EAS, most symptoms are not associated with this. Possibly a common pathway, including more existential concerns, is important in the last stages of life.

Consultants in cases of intended euthanasia or assisted suicide in The Netherlands.

To investigate how often physicians act as a consultant in the review of intended euthanasia and assisted suicide (EAS), by whom physicians are asked to act as a consultant, and the consultant's reasons for not agreeing with the intended performance of EAS. A retrospective descriptive study. The Netherlands. A stratified random sample of 405 Dutch physicians. Number of times the physician has been a consultant; how often a physician had previously been asked to be a consultant by the same treating physician; why consultants advised against EAS. 42% of interviewed physicians had acted as a consultant for EAS and 11% had been a consultant more than three times. Half the physicians who acted as a consultant more than once were invited to do so by the same attending physician, and 41% of consultants had previously consulted the attending physician. The main reasons consultants advised against EAS were because treatment options were still available, the patient's request was not well-considered or persistent, and the patient's suffering was not unbearable and hopeless. Many physicians have at some time been a consultant in a case of intended EAS, but only very few have been able to gain experience in consultancy. To guarantee high standards of consultation, it may be advisable to appoint and train specific consultants for EAS.

The role of the social network in active euthanasia and physician-assisted suicide

Objective:To obtain insight into the involvement of a patient's social network in the process leading to theadministration of euthanasia and assisted suicide (EAS). Design:Descriptive, retrospective. Method:Data were collected by means of anonymous questionnaires sent to a random sample of 521 generalpractitioners (GPs) in the Province of North Holland and 521 GPs from the rest of the Netherlands and all 713 Dutch nursing home physicians (NHPs). The data were collected over the period 1986 to June 1990 inclusive. Results:GPs and NHPs had discussions most often with the partner of the patient about the patient's request for EAS, thedoctor's intention to administer EAS and the actual administering of EAS. According to both the GPs and the NHPs the social network practically always agreed with the doctor's decision to administer EAS. The persons who were most often present at the patient's bedside when EAS was administered were the patient's partner and children (29%). Often, especially in the cases of GPs, the decision not to report EAS was determined by the desire of relatives and/or the physician not to involve the relatives in a judicial inquiry. ConclusionTo a large extent the social network was involved in the patient's request for EAS, the doctor's intention toadminister EAS and the actual administering of EAS. This seems to be important both for good decision-making with regard to EAS and for helping relatives to come to terms with the loss of a dear one.

Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases

In the Netherlands, physicians are allowed to practice euthanasia pursuant to medico-legal guidelines established by the Dutch Supreme Court. The Court has in effect carved out a defence of medical necessity for physicians who would otherwise be convicted of Penal Code offences that are likewise found in the Canadian Criminal Code. The Dutch euthanasia policy, or EAS (euthanasia and assisted suicide), applies to both consensual lethal injection and assisted-suicide scenarios. The Dutch policy is grounded in the bio-ethical principles of patient autonomy and beneficence. The law stipulates that the request for death must be the voluntary choice of a mentally competent patient whose suffering is unbearable and irremediable. This article discusses the application of these principles in the context of five Dutch EAS cases. The cases illustrate how a commitment to autonomy/beneficence can lead to a broadening of the patient-centred criteria which would justify a physician in taking active steps to end life.