Practice Of Euthanasia Research Articles

The Dutch practice of euthanasia and assisted suicide in patients suffering from psychiatric disorders: a qualitative case review study.

Euthanasia or assisted suicide (EAS) in patients suffering from a psychiatric disorder (PD) is a controversial topic worldwide. In the Netherlands, this practice is regulated by law. All cases of EAS have to be reported and are assessed by the Regional Euthanasia Review Committees (RTEs), who publish a selection of all cases on their website. To provide insight into the Dutch practice of EAS in patients suffering from a psychiatric disorder. We performed a retrospective case review study in which all published cases of EAS in patients suffering from a PD between 2017 and 2022 were analyzed. Not applicable. Characteristics of patients who died by EAS because of suffering from a PD, characteristics of the reporting physician and consultant(s) and the RTEs assessment of published cases. Of the 72 cases studied, the majority of patients were female (n=48, 67%), suffered from 3 or more conditions (n=38, 53%) and died by euthanasia instead of assistance in suicide (n=56, 78%). In 63% of cases (n=45), the life termination was performed by a physician from the Euthanasia Expertise center (EE). The RTEs' judgement that the case did not meet the due care criteria (n=11) was in all cases related to issues regarding the (advice of the) independent physician or psychiatric expert. This qualitative study shows that the RTEs attach great importance to a careful evaluation procedure of physicians handling EAS requests and to the physician demonstrating ability to reflect on his views, especially when the independent consultant evaluates the case different than the physician. Training for physicians and more transparency in the assessment of EAS requests in patients with a PD may lower the threshold for physicians to handle requests of these patients themselves. Not applicable.

Acceptance of euthanasia by students of selected study disciplines at universities in Lublin, Poland

BackgroundIn the context of discussions between supporters and opponents of euthanasia, and legal regulations regarding this type of practices, the attitude of young people with respect to this phenomenon is a very interesting issue. According to Polish law, euthanasia is prohibited. The aim of this study was to determine the degree of acceptance of euthanasia among students from Polish universities across three different fields of study: psychology, medicine, and economic-technical disciplines, and to identify the factors associated with the acceptance of this phenomenon.MethodsThe study included 627 persons studying in Lublin, Poland: medicine (280), psychology (170), and economic-technical studies (177). The study was conducted as a survey using questionnaire containing items concerning students’ attitudes towards euthanasia. The analysis of the collected data was conducted using the SPSS software (version 29) with the following methods: Chi2, Student’s t-test, Phi test, Cramer’s V test, Kolmogorov-Smirnov test, one-way ANOVA with Dunnett’s post hoc test, linear regression analysis, and categorical regression analysis using optimal scaling (CATREG).ResultsNearly half of the students participating in the study (45.9%) rated the practice of euthanasia as decidedly negative. The highest number of strongly negative evaluations was found among psychology students, and the least among students of economic-technical disciplines. The level of acceptance of euthanasia is significantly associated with religious involvement and studying psychology. Being religious and being a psychology student both contribute to lower acceptance of euthanasia and a lower willingness to consent to euthanasia. Consent to euthanasia is more commonly declared by individuals with experience of living with elderly people.ConclusionsAlthough nearly half of the respondents expressed a negative attitude towards euthanasia, considering the secularization process among Polish youth, it can be assumed that the level of acceptance of euthanasia in this social group will increase. The lower level of acceptance of euthanasia among psychology and medical students compared to students of economic-technical disciplines suggests that the curricula of these studies present alternative solutions to the problems of terminally ill patients other than euthanasia.

Pastoral Therapy on Euthanasia: Christian Humanism and Ubuntu Embracing Openness

The debate over practices of physician-assisted suicide, euthanasia and other end-of-life questions is still ongoing in many countries around the world. At least, as of 2024, only 15 countries had varyingly legalised it under very specific, regulated conditions, while many more still view it as an extremely complex issue that, amongst other things, conflicts with their deeply held religious beliefs. Premised on their belief in the image of God as the source of human life, most monotheistic religions, but Christians in particular believe in the preservation of human life to its natural end. However, the unquestionable reality of this traditionally-held Christian belief does not preclude the rare reality where terminally ill Christians themselves, upon suffering excruciating pain, begin either to desire some form of a hastened death overtly or covertly. Under such conditions, however, pastoral therapists in particular lack the aptitude to openly initiate practical dialogues with patients, be it in the spirit of Ubuntu or to concretise the Christian position. That being said, the purpose of this article is to prepare Christian pastoral therapists in particular and the counselling profession in general to openly handle cases where agonising human suffering leads to suicidal thoughts or actions. In order to achieve this, the paper, through the use of literature reviews and desktop studies, draws on literature encompassing specific biblical instances in which not only physical suffering, but also mental suffering somehow led to suicidal events. The African concept of Ubuntu is then integrated into Christian humanism to promote pastoral therapeutic dialogue which may enrich Christian self-knowledge about the sacredness of human life, despite the urge of suicide or euthanasia. As per Christian humanism framework, Christian self-knowledge is inspired by the excruciating suffering of Jesus Christ on the cross. All things considered, pastoral therapy is endowed with the ability to present the image of God in human suffering while rejecting the urge for euthanasia or suicide.

The prospects of using AI in euthanasia and physician-assisted suicide: a legal exploration

AbstractThe Netherlands was the first country to legalize euthanasia and physician-assisted suicide. This paper offers a first legal perspective on the prospects of using AI in the Dutch practice of euthanasia and physician-assisted suicide. It responds to the Regional Euthanasia Review Committees’ interest in exploring technological solutions to improve current procedures. The specific characteristics of AI – the capability to process enormous amounts of data in a short amount of time and generate new insights in individual cases – may for example alleviate the increased workload of review committees due to the continuous increase of euthanasia cases. The paper considers three broad categories for the use of AI in the Dutch euthanasia practice: (1) the physician’s assessment of euthanasia requests, (2) the actual execution of euthanasia, and (3) the retrospective reviews of cases by the Regional Euthanasia Review Committees. Exploring the legal considerations around each avenue, both in the EU AI Act and the Dutch legal framework, this paper aims to facilitate the societal discussion on the role of technology in such deeply human decisions. This debate is equally relevant to other countries that legalized euthanasia (e.g. Belgium and Canada) or physician-assisted suicide (e.g. Switzerland and numerous states in the US).

The do’s and don’ts of bovine euthanasia

The goal of humane euthanasia is to produce a “good death” by inducing a rapid, ideally instantaneous, loss of conscious­ness followed quickly by respiratory and cardiac arrest. Bovine euthanasia often presents significant challenges due to the size and nature of the animal, limited options for euthanasia methods, facility limitations and operator experience among many others. In particular, euthanasia under field conditions may present unique challenges. Developing a plan, or standard operating procedure, can reduce the risk of adverse events and help ensure both the welfare of the animal being euthanized and the personnel performing the task. However, the varied circumstances under which bovine euthanasia may be needed can require adaptability and flexibility. Veterinarians and other individuals performing euthanasia should be familiar with standard euthanasia practices and be comfortable with a variety of euthanasia methods to allow adaptability to ensure the welfare of animals requiring euthanasia under a variety of circumstances. The purpose of this paper is to provide practical tips on the do’s and don’ts of humane bovine euthanasia under a variety of circumstances.

Editorial: Boundaries of life: attitudinal, value and political implications on euthanasia, abortion, reproduction and medical practices

Editorial: Boundaries of life: attitudinal, value and political implications on euthanasia, abortion, reproduction and medical practices

Psychological Factors Influencing Attitudes towards Euthanasia, Assisted Suicide and Palliative Care among Medical Students and Doctors in Training.

Background: This study aimed to analyse the attitudes of medical students, Polish and classical philology students and trainee doctors towards the legalisation and practice of euthanasia and assisted suicide, to explore their beliefs about palliative care and to identify the cognitive, behavioural and emotional factors influencing these attitudes. Methods: An anonymous 22-question survey was sent by email to 670 participants, who comprised students of medicine, students of Polish and classical philology and trainee physicians. Results: Out of the 670 people invited to the survey, 313 (46.72%) responded; 215 (68.69%) and 112 (35.80%) participants supported the legalisation of euthanasia and assisted suicide, respectively. No differences were found between the respondent groups studied. The respondents' attitudes were influenced by religion, place of residence and professed values in the doctor-patient relationship. Among the medical students and trainee doctors surveyed, the declared willingness to perform euthanasia was lower, with 90 (43.7%) people, than the support for its legalisation, with 135 (65.5%) people. Significantly higher support for palliative care was expressed by fifth- and sixth-year medical students and trainee doctors, with 88 respondents (89.89%), less support was expressed by first- and fourth-year medical students, with 74 respondents (68.5%), and the lowest support was observed among Polish and classical philology students, with 63 respondents (58.9%). Conclusions: The legalisation of euthanasia and assisted suicide was supported by more than two-thirds and one-third of all the respondents, respectively, with the majority of medical students and trainee doctors surveyed expressing uncertainty or lack of readiness towards their practice. More than 70% of all the respondents showed a positive opinion towards palliative care, with the lowest support being among Polish and classical philology students.

Physicians’ views on the role of relatives in euthanasia and physician-assisted suicide decision-making: a mixed-methods study among physicians in the Netherlands

BackgroundRelatives have no formal position in the practice of euthanasia and physician-assisted suicide (EAS) according to Dutch legislation. However, research shows that physicians often involve relatives in EAS decision-making. It remains unclear why physicians do (not) want to involve relatives. Therefore, we examined how many physicians in the Netherlands involve relatives in EAS decision-making and explored reasons for (not) involving relatives and what involvement entails.MethodsIn a mixed-methods study, 746 physicians (33% response rate) completed a questionnaire, and 20 were interviewed. The questionnaire included two statements on relatives’ involvement in EAS decision-making. Descriptive statistics were used, and multivariable logistic regression analyses to explore characteristics associated with involving relatives. In subsequent interviews, we explored physicians’ views on involving relatives in EAS decision-making. Interviews were thematically analysed.ResultsThe majority of physicians want to know relatives’ opinions about an EAS request (80%); a smaller group also takes these opinions into account in EAS decision-making (35%). Physicians who had ever received an explicit EAS request were more likely to want to know opinions and clinical specialists and elderly care physicians were more likely to take these opinions into account. In interviews, physicians mentioned several reasons for involving relatives: e.g. to give relatives space and help them in their acceptance, to tailor support, to be able to perform EAS in harmony, and to mediate in case of conflicting views. Furthermore, physicians explained that relatives’ opinions can influence the decision-making process but cannot be a decisive factor. If relatives oppose the EAS request, physicians find the process more difficult and try to mediate between patients and relatives by investigating relatives’ objections and providing appropriate information. Reasons for not taking relatives’ opinions into account include not wanting to undermine patient autonomy and protecting relatives from a potential burdensome decision.ConclusionsAlthough physicians know that relatives have no formal role, involving relatives in EAS decision-making is common practice in the Netherlands. Physicians consider this important as relatives need to continue with their lives and may need bereavement support. Additionally, physicians want to perform EAS in harmony with everyone involved. However, relatives’ opinions are not decisive.

Euthanasia and assisted suicide in people with mental disorders: a case report

IntroductionUntil 2020, only Belgium, Luxembourg, Switzerland, and the Netherlands legalized euthanasia and assisted suicide in Europe. Spain joined this list in March 2021 with the Euthanasia Regulation Law. However, the practice of euthanasia and assisted suicide in individuals with severe mental disorders is complex due to potential cognitive and decision-making challenges. Psychiatrists play a vital role in evaluating such requests.Objectiveshe case of a patient with recurrent depressive disorder requesting euthanasia is presented, followed by a theoretical review of the subject.MethodsA case is presented with a bibliographic review.Results An 89-year-old man with a history of one prior brief psychiatric hospitalization for depression three years ago was admitted after attempting suicide with an overdose of medication. He reports depressive symptoms of several years of evolution. Medical tests came back normal, but he had a urinary catheter due to voiding issues. He was initially on a medication regimen of amitriptyline, clomethiazole, and fluvoxamine. Despite his depressive state, he maintained his cognitive and decision-making abilities. Medication adjustments were made, including discontinuing amitriptyline and switching fluvoxamine to amitriptyline. His depressive symptoms worsened after three days, leading to the addition of trazodone to his treatment. He also developed urinary symptoms and was diagnosed with a urinary tract infection and metastatic prostate cancer during urological evaluation. Emotionally, he became more apathetic, anergic, and anhedonic, frequently expressing a desire for euthanasia, even with medication changes. Hyponatremia led to the discontinuation of duloxetine and the introduction of venlafaxine. To address anxiety and sleep problems, clomethiazole was replaced with mirtazapine. Upon learning of his cancer diagnosis, his mood deteriorated further, along with increased anxiety and continued mentions of euthanasia. Lorazepam was introduced, and he was informed of his right to request euthanasia after discussing therapeutic options with urology. Following this consultation, the patient became calmer, stopped expressing thoughts of death, and began making short-term plans, including the possibility of receiving palliative care at home upon discharge.Conclusions Euthanasia and assisted suicide in severe mental disorders are complex due to ethical and medical challenges. Patients must understand their condition, prognosis, and have decision-making capacity. Assessing their suffering is crucial. Coexisting mental and organic issues complicate the request’s origin. In SMD, determining irreversibility is tricky, as these are often chronic, non-terminal conditions. Exhausting treatment options is essential before considering euthanasia, despite patient treatment refusal. Limited research underscores the need for more studies.Disclosure of InterestNone Declared

Euthanasia - A Novel Intricacy for Psychiatry’s Purview?

IntroductionNumerous countries, notably within Europe, have sanctioned the practice of euthanasia. Extant legal frameworks meticulously define the extent, essence, and application of euthanasia, encompassing divergent characterizations, explications of entitlements, procedural modalities, and provisions for access. Nonetheless, the precise function of psychiatrists within these legislative contours remains conspicuously nebulous.ObjectivesThe present inquiry undertakes a comprehensive evaluative review of the euthanasia phenomenon vis-à-vis the intricate tapestry of European legislative paradigms, with an emphasis on elucidating the multifaceted involvement of psychiatry within this evolving landscape.MethodsA nuanced narrative review is undertaken, encapsulating the contemporary state-of-affairs, fundamental conceptual architectures, the tenets of the Spanish Organic Law 03/2021, and the pharmaceutic armamentarium deployed in the orchestration of euthanasic practices. Additionally, the methodological blueprint employed within a prominent tertiary healthcare institution situated in Madrid is meticulously expounded.ResultsTo date, euthanasia has garnered legal imprimatur across diverse jurisdictions including, but not limited to, the Netherlands, Belgium, Colombia, Canada, Spain, and New Zealand. The ambit of assisted death and its application to the domain of mental infirmities is meticulously deconstructed. Within the overarching realm of foundational concepts, a rigorous delineation is rendered between euthanasia, medical succor in the throes of mortality, assisted self-termination, facilitated demise, provision of mortal release, judicious calibration of therapeutic enterprise, and the contours of palliative sedation. Distinction between the principal executor and the advisory consultant is rendered salient. The rubric of conscientious objection emerges as an inviolable entitlement of healthcare practitioners enmeshed in the provisionary matrix.The enduring incumbency of the psychiatrist as a pivotal appraiser of cognitive and volitional faculties holds firm. The conspicuous influence of psychopathological constellations upon the contours of euthanasia eligibility precipitates cogent deliberation.ConclusionsAs the frontiers of euthanasia expand to encompass an augmented array of legal jurisdictions, this study underscores the increasingly intricate role inhabited by psychiatrists in the matrix of evaluative assessments. The proclivity of mental maladies to exert a substantial gravitational pull upon determinations of eligibility for euthanasia accentuates the exigency for refined explication of roles and responsibilities within this evolving sphere, a clarion call resonant not only within the precincts of psychiatry but reverberating across the broader firmament of medical praxis.Disclosure of InterestNone Declared

The changing (and multifaceted) role of the principle of self-determination in the Dutch euthanasia practice

The changing (and multifaceted) role of the principle of self-determination in the Dutch euthanasia practice

How Do Individuals View Euthanasia In Different Cultural Backgrounds Based on Different Ideas of Moral Psychology

To this day, euthanasia remains a topic of lively discussion. The debate over whether it should be practiced or not never stops. This paper presents basic information about euthanasia and analyzes different people's views on euthanasia in the context of religious beliefs and philosophical ideas based on moral psychology. People who grow up in different cultures will have different views on euthanasia. This paper argues that Catholicism, Christianity, and traditional Confucianism are associated with the central idea of deontology (absolute regularity) and tend to reject euthanasia. In contrast, Taoism is associated with the central idea of utilitarianism (the pursuit of the greatest happiness of mankind) and tends to accept the practice of euthanasia. Various ideas have their reasons for rejecting or accepting the practice of euthanasia, each of which thoroughly explains their respective claims. Each idea also has its staunch followers. But regardless of the view one supports, one should be cautious regarding issues related to their own life.

Quelle connaissance et quelle perception ont les professionnels de santé d’un Centre de lutte contre le cancer à propos des pratiques palliatives encadrées par la loi Claeys-Leonetti : étude PAL PRAT

Introduction: The issue of end-of-life care is the subject of a sensitive debate in French society, particularly regarding the possibility for certain patients to have access to medical assistance in dying. The aim of this study was to assess the knowledge and opinion of healthcare providers on the care practices for patients at the end of life, as well as to highlight any specificities in their discourse.Method: A survey of healthcare providers' opinions, composed of closed and open questions, that were analyzed using a lexicometric approach, was distributed in a cancer center.Results: The results of the study reveal a good knowledge of the different procedures. Professionals considered that advance directives should be systematically collected; a majority of them differentiated euthanasia from deep continuous sedation and perceived the latter as a means of relieving patients' suffering without inducing death. The different procedures related to the active assistance in dying were known by a majority of professionals and the survey did not identify a dominant trend concerning the will to practice euthanasia if the legal framework allowed it. Half of the participants considered their training insufficient, indicating the need to fill this gap.Discussion: This survey underlines the importance of training and support for the professionals caring for patients in palliative situation and their relatives in France.

Enhancing euthanasia protocols in practice: a compassionate approach for companion animals

This article focuses on the complex aspects of veterinary euthanasia and aims to highlight the emotional, ethical and logistical challenges of euthanasia in veterinary practice. It advocates for compassionate and consistent euthanasia protocols to improve experiences for pets, owners and veterinary teams, and stresses the importance of understanding and respecting the diverse views within veterinary teams regarding euthanasia. This article also details the considerations in selecting and administering euthanasia protocols for a stress‐free and painless procedure and addresses the need for aftercare and support for both pet owners and veterinary teams after euthanasia, including external grief support resources.

Current Status of the Zebrafish Euthanasia and Humane Endpoint in the Republic of Korea and Guideline Suggestion from Nationwide Expert Elicitation: A Model for Other Countries.

Since its introduction as a model organism in the 1980s, the use of zebrafish (Danio rerio) in research has expanded worldwide. Despite its now widespread use in research, guidelines to safeguard the ethical treatment of zebrafish, particularly with regard to euthanasia and humane endpoint practices, remain inadequate. One well-recognized example is the use of excess tricaine methanesulfonate (MS-222) as a means to euthanize zebrafish, regardless of life stage. In this study, through nationwide expert elicitation, we provide a detailed account of zebrafish research practices within the Republic of Korea and the challenges of implementing appropriate methods for euthanasia as a humane endpoint, with many opting for hypothermic shock. We report a local expert consensus for establishing national guidelines to improve zebrafish welfare and good research practice. Suggestions and recommendations for national guidelines were offered. Taken together, our findings raise awareness broadly among zebrafish research practitioners in the field, offer an accurate account of the welfare and treatment of zebrafish in research within the Republic of Korea, and advocate for the development and implementation of national guidelines. As such, our study is useful as a model to adopt the expert elicitation approach to investigate, quantify, and address welfare concerns in zebrafish research, and to establish best practice guidelines.

Unconstitutionality of criminalizing physicians for the practice of euthanasia

Unconstitutionality of criminalizing physicians for the practice of euthanasia

What Domains of Belgian Euthanasia Practice are Governed and by Which Sources of Regulation: A Scoping Review.

Multiple sources of regulation seek to shape euthanasia practice in Belgium, including legislation and training. This study comprehensively mapped which of these sources govern which domains of euthanasia practice, such health professionals' obligations, or managing patient requests. Scoping review methodology was used to search for scholarly records which discussed Belgian euthanasia regulation. Template analysis was used to generate themes describing the domains of euthanasia practice governed by sources of regulation. Of 1364 records screened, 107 records were included. Multiple sources of regulation govern each domain, which are: the permissible scope of euthanasia; the legal status of a euthanasia death; the euthanasia process; the rights, obligations, and roles of those involved; system workings; and support for health professionals who provide euthanasia. Domains with significant yet fragmented regulation may lead to inconsistent care provision. Policymakers should develop coherent guidance to support health professionals to navigate this regulatory landscape.

Survey of euthanasia methods used in neotropical chiropterans in São Paulo State, Brazil

Zoonotic Surveillance Divisions (ZSDs) rescue and euthanize bats in contact with humans. The euthanasia procedure should be conducted safely for the animal and caretaker and minimal stress for the animal is important. The objectives of this study were: i. evaluate the methods of euthanasia used by ZSDs in the State of São Paulo; ii. compare the methods with national and international guidelines for animal euthanasia practices; iii. assess the methodologies considering taxonomy and eating habits of the main bat species, and iv. propose standardization of euthanasia procedures. Sixty-five ZSDs locations received an online questionnaire or were contacted by telephone and 33 ZSDs (50.8%) responded and are distributed in 11 mesoregions in the state to remain anonymous. The euthanasia methods were divided into chemical (injectable or inhalation), physical, or mixed methods. Bat specimens (n = 550) were identified and classified to evaluate the main genera found in the state. The location of the ZSD, species, eating habits, and the method of euthanasia used were analyzed. The specimens by bat families were Molossidae (n = 340), Phyllostomidae (n = 171), and Vespertilionidae (n = 39). Chemical methods were used in 25 ZSDs (75.75%), physical in 5 (15.15%), and mixed in 3 (9.09%). There is no uniformity or standardization in bat euthanasia methods used by ZSDs, although most are based on acceptable chemical methods. It was proposed an algorithm to assist the veterinarian in choosing the method of euthanasia for bats that will allow standardizing euthanasia procedures for this species, considering physiological differences, and respecting technical, bioethical, and animal welfare guidelines.

Medically Assisted Death and the Ends of Medicine.

This paper aims to refute a common line of argument that it is immoral for physicians to engage in medical assistance in death (MAiD), i.e., the practices of euthanasia and physician-assisted suicide. The argument in question is based on the notion that participating in MAiD is contrary to the professional-role obligations of physicians, due to MAiD's putative inconsistency with the ends of medicine. The paper describes several major flaws from which that argument suffers.

Attitudes of health professionals regarding euthanasia

Euthanasia or good death is a medical procedure that causes the death of a patient with chronic and incurable diseases. In Ecuador, despite having high rates of chronic and terminal diseases, Euthanasia is not legal; This is because the Constitution of the Republic guarantees the right to a dignified life. The objective of this research was to determine the attitudes towards euthanasia on the part of health professionals. We worked under a quantitative approach and descriptive research, where the questionnaire for evaluating attitudes towards euthanasia (CAE) was applied to 110 teachers from the Medicine, Nursing, Nutrition, Clinical Psychology, Laboratory and Physiotherapy Careers of the Faculty of Life Sciences. Health of the Technical University of Ambato. The results reflected that the majority of teachers accept the practice of euthanasia, the Nursing, Medicine and Clinical Laboratory careers have an incidence greater than 60%. 68.18% of teachers are not influenced by ethical, moral and religious aspects, and the use of palliative care. 50.91% of teachers feel motivated to apply euthanasia in order to reduce pain, physical deterioration and suffering. 53.64% support euthanasia due to family issues that affect the economy and well-being. Finally, through Spearman's Rho coefficient, it was determined that there is a direct relationship between the professional study career and the acceptance of euthanasia.