Euthanasia Or Assisted Suicide Research Articles

Stigma and public attitudes toward euthanasia or assisted suicide for psychiatric conditions: results from a general population survey in Germany.

With growing numbers of countries legalizing euthanasia or assisted suicide (EAS), there is a debate as to whether EAS should also be available to people with severe, treatment-resistant mental illness. Excluding mental illness as a legitimate reason to receive EAS has been framed as discriminating against people with mental illness. We examine whether approval or opposition to psychiatric EAS are related to stigma toward people with mental illness. We asked a representative sample of the general population in Germany (N = 1515) whether they would approve of EAS for someone with severe, treatment-resistant mental illness. Stigma was assessed with the Value-Based Stigma Inventory (VASI), addressing rejection of people with mental illness in relation to different personal values. A total of 19% of the German population approved of psychiatric EAS. Higher stigma scores were associated with greater approval of EAS (Spearman rank correlation coefficient, 0.28; P < 0.001). This association held true when controlling for sociodemographic variables. It was strongest for stigma related to perceived threats to one's security, reputation and meritocratic values. Our results highlight that, although opposing psychiatric EAS is sometimes framed as discriminatory, approval of psychiatric EAS might also carry hidden, stigmatising motives. To avoid any unintended negative consequences for people with severe, treatment-resistant mental illness, any legislation on psychiatric EAS needs to be crafted with particular caution.

ASSESSMENT OF DECISIONAL COMPETENCE IN DEMENTIA– A QUALITATIVE STUDY OF 60 EUTHANASIA CASES

Abstract The Netherlands allows euthanasia or assisted suicide (EAS) for people with dementia. The number of dementia EAS cases gradually increases every year, up to 288 cases in 2022. This practice remains controversial, as dementia is not directly lethal and may impair decisional competence. The Dutch euthanasia review committees (RTE) refer to Appelbaum and Grisso’s criteria for the assessment of decisional competence, but how these criteria are applied in clinical practice remains unknown. This study examined qualitatively which factors, and how, influence the judgment of decisional competence for EAS requests of people with dementia. Thematic analysis of 60 dementia EAS case summaries published online by the RTE between 2012 and 2021. Twenty patients had an advance directive and were decisionally compromised at time of EAS. Forty patients were decisionally competent at time of EAS, of which twenty also had an advance directive (purposive sampling). Two researchers independently coded all text related to decisional competence. A theoretical framework was developed. The four cognitive criteria of Appelbaum and Grisso were dimensional and cut-off points were influenced by six supporting factors that also directly impacted on competence assessment, i.e., level of communication, psychiatric comorbidity, personality, presence of an advance directive, consistency of the request, and the patient-physician relationship. The number of involved physicians and executed investigations were two contextual factors. The multidimensionality and subjectivity of decisional competence assessment may pose ethical and legal challenges. Continuous quality improvement processes may be needed in daily care, including possibilities for reflection.

Requests for euthanasia or assisted suicide of people without (severe) illness

BackgroundSome people request euthanasia or assisted suicide (EAS) even though they are not (severely) ill. In the Netherlands the presence of sufficient medical ground for the suffering is a strict prerequisite for EAS. The desirability of this ‘medical ground’-boundary is currently questioned. Legislation has been proposed to facilitate EAS for older persons with “completed life” or “tiredness of life” in the absence of (severe) illness. ObjectivesTo describe the characteristics and motivations of persons whose requests for EAS in the absence of (severe) illness did not result in EAS and the decision-making process of medical professionals in these types of requests. MethodsAnalysis of 237 applicant records of the Dutch Euthanasia Expertise Center. We studied both the perspectives of applicants and medical professionals. FindingsThe majority of the applicants were women (73%) aged 75 years and older (79%). Applicants most often indicated physical suffering as element of suffering and reason for the request. Medical professionals indicated in 40% of the cases no or insufficient medical ground for the suffering. ConclusionsPhysical suffering plays an important role in requests for EAS even for persons who are not (severely) ill. From the presence of physical suffering it does not necessarily follow that for medical professionals there is sufficient medical ground to comply with the ‘medical ground’-boundary.

Ways of Debating Assisted Suicide and Euthanasia: Implications for Psychiatry

Euthanasia or assisted suicide (EAS) is permitted in a handful of jurisdictions. But its scope (ranging from being restricted to the end of life to no restrictions save those of autonomy) and its legal basis (ranging from a necessary prerogative of physicians to a human right) vary greatly. The debate over psychiatric EAS (pEAS) needs to be understood within this complex context. This essay addresses one specific aspect: can pEAS be grounded on a basic human right? The author argues against pEAS as grounded on a basic human right by showing that such a view has several implications we ought not accept.

Euthanasia: Should psychiatric patients be systematically excluded?

An increase of the number of psychiatric patients requesting euthanasia or assisted suicide (EAS) has been reported in countries practicing EAS. The debate raised by EAS invites psychiatrists to think about their role in this societal issue. If euthanasia for patients with unbearable somatic suffering is the subject of fierce ethical debate, the debate is even fiercer in cases of unbearable psychiatric suffering. In this manuscript, we discuss 3 main points concerning EAS for psychiatric patients. First, we question the notion of irreversibility of the condition and the related medical futility. Second, we focus on the capacity to make informed decisions in such situations. Third, we ask whether psychiatric EAS should be considered as a copycat of traditional suicide or an additional therapeutic alternative. Psychiatrists should produce practice guidelines to be involved in the EAS debate and develop research programs.

Considerations on requests for euthanasia or assisted suicide; a qualitative study with Dutch general practitioners.

In the Netherlands, euthanasia or assisted suicide (EAS) is neither a right of the patient nor a duty of the physician. Beside the legal requirements, physicians can weigh their own considerations when they decide on a request for EAS. We aim at a better understanding of the considerations that play a role when physicians decide on a request for EAS. This was a qualitative study. We analysed 33 interviews held with general practitioners (GPs) from various regions in the Netherlands. The considerations found can be divided in three main types. (i) Perceived legal criteria, (ii) individual interpretations of the legal criteria and (iii) considerations unrelated to the legal criteria. Considerations of this 3rd type have not been mentioned so far in the literature and the debate on EAS. Examples are: the family should agree to EAS, the patient's attitude must reflect resignation, or conflicts must be resolved. Our study feeds the ethical discussion on the tension that can arise between a physician's own views on death and dying, and the views and preferences of his patients. When considerations like 'no unresolved conflicts' or 'enough resignation' influence the decision to grant a request for EAS this poses questions from an ethical and professional point of view. We hypothesise that these considerations reflect GPs' views on what 'good dying' entails and we advocate further research on this topic.

The Controversial Issue of Euthanasia in Patients With Psychiatric Illness.

This commentary discusses a study published in JAMA Psychiatry that investigated the characteristics of patients receiving euthanasia or assisted suicide for psychiatric conditions and how the practice is regulated in the Netherlands. JAMA Psychiatry Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014 Scott Y. H. Kim, MD, PhD; Raymond G. De Vries, PhD; John R. Peteet, MD Importance Euthanasia or assisted suicide (EAS) of psychiatric patients is increasing in some jurisdictions such as Belgium and the Netherlands. However, little is known about the practice, and it remains controversial. Objectives To describe the characteristics of patients receiving EAS for psychiatric conditions and how the practice is regulated in the Netherlands. Design, Setting, and Participants This investigation reviewed psychiatric EAS case summaries made available online by the Dutch regional euthanasia review committees as of June 1, 2015. Two senior psychiatrists used directed content analysis to review and code the reports. In total, 66 cases from 2011 to 2014 were reviewed. Main Outcomes and Measures Clinical and social characteristics of patients, physician review process of the patients’ requests, and the euthanasia review committees’ assessments of the physicians’ actions. Results Of the 66 cases reviewed, 70% (n = 46) were women. In total, 32% (n = 21) were 70 years or older, 44% (n = 29) were 50 to 70 years old, and 24% (n = 16) were 30 to 50 years old. Most had chronic, severe conditions, with histories of attempted suicides and psychiatric hospitalizations. Most had personality disorders and were described as socially isolated or lonely. Depressive disorders were the primary psychiatric issue in 55% (n = 36) of cases. Other conditions represented were psychotic, posttraumatic stress or anxiety, somatoform, neurocognitive, and eating disorders, as well as prolonged grief and autism. Comorbidities with functional impairments were common. Forty-one percent (n = 27) of physicians performing EAS were psychiatrists. Twenty-seven percent (n = 18) of patients received the procedure from physicians new to them, 14 of whom were physicians from the End-of-Life Clinic, a mobile euthanasia clinic. Consultation with other physicians was extensive, but 11% (n = 7) of cases had no independent psychiatric input, and 24% (n = 16) of cases involved disagreement among consultants. The euthanasia review committees found that one case failed to meet legal due care criteria. Conclusions and Relevance Persons receiving EAS for psychiatric disorders in the Netherlands are mostly women and of diverse ages, with complex and chronic psychiatric, medical, and psychosocial histories. The granting of their EAS requests appears to involve considerable physician judgment, usually involving multiple physicians who do not always agree (sometimes without independent psychiatric input), but the euthanasia review committees generally defer to the judgments of the physicians performing the EAS. JAMA Psychiatry. 2016;73(4):362-368. doi:10.1001/jamapsychiatry.2015.2887 Language: en

Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014.

Euthanasia or assisted suicide (EAS) of psychiatric patients is increasing in some jurisdictions such as Belgium and the Netherlands. However, little is known about the practice, and it remains controversial. To describe the characteristics of patients receiving EAS for psychiatric conditions and how the practice is regulated in the Netherlands. This investigation reviewed psychiatric EAS case summaries made available online by the Dutch regional euthanasia review committees as of June 1, 2015. Two senior psychiatrists used directed content analysis to review and code the reports. In total, 66 cases from 2011 to 2014 were reviewed. Clinical and social characteristics of patients, physician review process of the patients' requests, and the euthanasia review committees' assessments of the physicians' actions. Of the 66 cases reviewed, 70% (n = 46) were women. In total, 32% (n = 21) were 70 years or older, 44% (n = 29) were 50 to 70 years old, and 24% (n = 16) were 30 to 50 years old. Most had chronic, severe conditions, with histories of attempted suicides and psychiatric hospitalizations. Most had personality disorders and were described as socially isolated or lonely. Depressive disorders were the primary psychiatric issue in 55% (n = 36) of cases. Other conditions represented were psychotic, posttraumatic stress or anxiety, somatoform, neurocognitive, and eating disorders, as well as prolonged grief and autism. Comorbidities with functional impairments were common. Forty-one percent (n = 27) of physicians performing EAS were psychiatrists. Twenty-seven percent (n = 18) of patients received the procedure from physicians new to them, 14 of whom were physicians from the End-of-Life Clinic, a mobile euthanasia clinic. Consultation with other physicians was extensive, but 11% (n = 7) of cases had no independent psychiatric input, and 24% (n = 16) of cases involved disagreement among consultants. The euthanasia review committees found that one case failed to meet legal due care criteria. Persons receiving EAS for psychiatric disorders in the Netherlands are mostly women and of diverse ages, with complex and chronic psychiatric, medical, and psychosocial histories. The granting of their EAS requests appears to involve considerable physician judgment, usually involving multiple physicians who do not always agree (sometimes without independent psychiatric input), but the euthanasia review committees generally defer to the judgments of the physicians performing the EAS.

Consultation and discussion with other physicians in cases of requests for euthanasia and assisted suicide refused by family physicians.

In the Netherlands, in 1995 approximately 9700 people explicitly requested euthanasia or assisted suicide (EAS), and EAS was performed approximately 3600 times (2.7% of all deaths). The most important reasons for not performing EAS when requested by a patient were that the patient died before EAS was performed, or that the physician refused the request.

Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa isolation from pharyngeal swab cultures among the Japanese elderly at admission to a geriatric hospital

Objective : The purpose of this study was to describe: (a) the prevalence and content of policies on euthanasia or assisted suicide (EAS) in three different types of nursing homes; (b) specific content items of written guidelines for EAS; and (c) the prevalence of guidelines on withholding or withdrawing treatment from severely demented patients and patients in a persistent vegetative state in the nursing homes. Design : Descriptive, cross-sectional. Methods : We have used a postal survey among directors of patient care of all ( n = 304) Dutch somatic nursing homes (meant for physically handicapped patients), psychogeriatric nursing homes (meant for patients suffering from dementia) and combined nursing homes. Data were collected from October 1994 through January 1995. Results : Results indicate that psychogeriatric nursing homes less often had a written EAS policy than somatic and combined nursing homes (62, 68 and 80% respectively). The most frequently reported aspects in the EAS guidelines, by the nursing homes with guidelines based on a policy that EAS was accepted under certain conditions; were consultation of another physician (97%), referral to another physician if the attending physician had in-principle objections (82%), and the involvement of the nurse in the decision-making procedure (82%). Of the nursing homes, 9% reported having specific written procedures concerning withholding or withdrawing treatment from severely demented patients. Conclusion : Guidelines in the nursing homes on euthanasia and assisted suicide might be improved. Especially with regard to withholding or withdrawing treatment from incompetent patients, more guidelines should be developed.

Dutch nursing home policies and guidelines on physician-assisted death and decisions to forego treatment

Objective: The purpose of this study was to describe: (a) the prevalence and content of policies on euthanasia or assisted suicide (EAS) in three different types of nursing homes; (b) specific content items of written guidelines for EAS; and (c) the prevalence of guidelines on withholding or withdrawing treatment from severely demented patients and patients in a persistent vegetative state in the nursing homes. Design: Descriptive, cross-sectional. Methods: We have used a postal survey among directors of patient care of all ( n = 304) Dutch somatic nursing homes (meant for physically handicapped patients), psychogeriatric nursing homes (meant for patients suffering from dementia) and combined nursing homes. Data were collected from October 1994 through January 1995. Results: Results indicate that psychogeriatric nursing homes less often had a written EAS policy than somatic and combined nursing homes (62, 68 and 80% respectively). The most frequently reported aspects in the EAS guidelines, by the nursing homes with guidelines based on a policy that EAS was accepted under certain conditions; were consultation of another physician (97%), referral to another physician if the attending physician had in-principle objections (82%), and the involvement of the nurse in the decision-making procedure (82%). Of the nursing homes, 9% reported having specific written procedures concerning withholding or withdrawing treatment from severely demented patients. Conclusion: Guidelines in the nursing homes on euthanasia and assisted suicide might be improved. Especially with regard to withholding or withdrawing treatment from incompetent patients, more guidelines should be developed.

Guidelines on euthanasia and pain alleviation: compliance and opinions of physicians

The objectives of this study are to describe: (a) the presence of; and (b) compliance with guidelines in cases of euthanasia and intensifying the alleviation of pain and symptoms; (c) the opinions of physicians about written guidelines; and (d) the relationship between meeting the requirements for prudent practice and presence of, and compliance with guidelines for euthanasia or assisted suicide (EAS). In 1990 and 1995 interviews were held with 405 physicians (general practitioners, nursing home physicians and clinical specialists). The response rate for the 2 years was 91 and 89%, respectively. The percentage of physicians who reported the existence of EAS guidelines increased from 50% in 1990 to 59% in 1995, and the compliance with these guidelines increased from 51 to 75%, respectively. Of the physicians, 17% stated that there were written guidelines for intensifying the alleviation of pain and symptoms. With regard to meeting the requirements for prudent practice, we found mostly no differences between cases of euthanasia in which EAS guidelines were present, and cases in which there were no guidelines. However, when guidelines did exist and were actually used, it seems there was a better adherence to consultation and notification, although numbers were small. The increase since 1990 in agreement with the statement that an institution should formulate a policy with regard to euthanasia, may reflect the growing awareness of the specific role of the management, and not only the physician, in this matter.