Practice Of Euthanasia Research Articles

Drugs Used for Euthanasia: A Repeated Population-Based Mortality Follow-Back Study in Flanders, Belgium, 1998–2013

ContextAccording to guideline recommendations, barbiturates and neuromuscular relaxants are the recommended drugs for euthanasia. ObjectivesTo describe changes over time in drugs used to perform euthanasia and differences in case characteristics according to the drugs used. MethodsRepeated population-based mortality follow-back study among physicians attending a large representative sample of deaths in 1998, 2007, and 2013 in Flanders, Belgium. ResultsIn 1998, we identified 25 euthanasia cases (1.2% of all deaths), 142 cases in 2007 (2.0% of all deaths), and 349 cases in 2013 (4.6% of all deaths). Use of recommended drugs to perform euthanasia increased from 11.9% of euthanasia cases in 1998 to 55.3% in 2007 and 66.8% in 2013 (P < 0.001). In 2013, cases with recommended drugs compared with nonrecommended drugs more often involved requests expressed both orally and in writing (86.8%/14.1%; P < 0.001), consultation with colleague physicians (93.8%/69.1%; P < 0.001), and administration in the presence of another physician (98.3%/54.3%; P < 0.001), and were more often self-labeled by physicians as euthanasia (95.5%/0.9%; P < 0.001) and reported to the euthanasia review committee (92.3%/3.8%; P < 0.001). Between 2007 and 2013, physicians consistently labeled cases in which nonrecommended drugs were used as palliative sedation (72.8%/78.4%; P = 0.791) or alleviation of pain and symptoms (13.2%/15.0%; P > 0.999). ConclusionPhysicians in Flanders are increasingly using the recommended drugs for euthanasia. This suggests that guidelines and training regarding the conduct and pharmacological aspects of euthanasia may have had important effects on the practice of euthanasia. However, the declining but persisting use of nonrecommended drugs requires further attention.

The psychological slippery slope from physician-assisted death to active euthanasia: a paragon of fallacious reasoning.

In the debate surrounding the morality and legality of the practices of physician-assisted death and euthanasia, a common logical argument regularly employed against these practices is the "slippery slope argument." One formulation of this argument claims that acceptance of physician-assisted death will eventually lead down a "slippery slope" into acceptance of active euthanasia, including its voluntary, non-voluntary, and/or involuntary forms, through psychological and social processes that warp a society's values and moral perspective of a practice over an extended period of time. This formulation is known as the psychological slippery slope argument. This paper analyzes the psychological slippery slope argument as it is applied to the practice of physician-assisted death, and utilizing recent empirical evidence from various nations around the world that practice physician-assisted death and/or euthanasia, the paper argues that (1) employing the psychological slippery slope argument against physician-assisted death is logically fallacious, (2) this kind of slippery slope is unfounded in practice, and thus (3) the psychological slippery slope argument is insufficient on its own to justify continued legal prohibition of physician-assisted death.

The Practice of Euthanasia and Assisted Suicide Meets the Concept of Legalization

This article explores attempts at legalization of the practice of euthanasia and assisted suicide. Although in many countries there have been high levels of public support for euthanasia and assisted suicide, in most of them, no legislative activity has taken place concerning these practices, and there is a lack of clarity about what is permitted and what is not. I argue that accurate definition of the relevant concepts and a clear delineation of the territory of the debate would help draw a coherent roadmap for legalization. To this end, I analyze five legal approaches to the legalization euthanasia: maintenance of the status quo, legal defenses, de-prioritization, de-criminalization, and legislation. I conclude with a discussion of the moral and legal implications of the foregoing analysis.

'Capacity for Discernment' and Euthanasia on Minors in Belgium.

In 2014, the Belgian Euthanasia Law was amended so as to extend the possibility of obtaining euthanasia to minors who have the capacity for discernment. The amendment led to considerable debate among Belgian legal experts, health care professionals and ethicists, in large part due to concerns about the scope and assessment of the minor's 'capacity for discernment', a concept first introduced in Belgian medical law by the amendment. This article offers a critical legal analysis of the concept of 'capacity for discernment' and its implications for euthanasia practice in Belgium. We do so by focusing on a ruling of the Belgian Constitutional Court of 29 October 2015, where the concept figured prominently in the examination of the constitutionality of the amendment. This approach also allows us to shed light on the interpretation of several core aspects of the original 2002 Euthanasia Law and its 2014 amendment.

Withdrawing life supports therapy in human rights perspective

Indonesia was a country implementing welfare state concept and it meant that State’s intervention to the citizens’ life, from birth to death, was to be a consequence. The enactment of Minister of Health’s Regulation (Permenkes) Number 37 of 2014 on Determination of Death & Utilization of Donor Organs was an example of such interven- tion. In Human Rights perpective, Indonesia was one of the countries having Pro-Life standing point, therefore, euthanasia practice was prohibited because it prioritized the right to life. In line with technological development in the field of medicine, the understanding of human rights and changes within the legislation itself, euthanasia was passively regulated in the legislation. One of the provisions said that for a patient who was in an incurable condition due to his or her illness (terminal state) and medical measures were futile, withdrawing or delay in life support therapy could be taken. However, the term termination of life” was subject to strict requirements and re- strictions. The right of self-determination was one of the requirements that should be fulfilled in the withdrawing life supports therapy procedure.

Euthanasia and small‐population management: development of transparent processes, good governance and a practical application

The issue of euthanasia is one of the more challenging aspects of managing populations of animals in human care. The practice of animal euthanasia is a matter of sensitivity within zoos and the wider community. Decisions are centred on the ethical obligations towards the animals in our care, and the acknowledgement that individual animals matter to our staff, volunteers and visitors. In order to facilitate timely decisions in an objective way to benefit the animal population as a whole, and the need to dedicate resources towards the best possible conservation outcomes, Taronga Conservation Society Australia (Taronga) initiated a process of review in 2009. This review resulted in the development of a Euthanasia Decision Key to assist the process in an inclusive way. Taronga recognizes a responsibility not only to the welfare of the individual but also to the resilience of the animal populations in its care. In some species the resilience of a population is prioritized over the interests, but not welfare, of the individual. Taronga used a combination of considerations underpinned by the life‐history parameters of each species as a guide to formulate decisions when these interests are in potential conflict. Euthanasia is a last resort that is only applied once all other alternatives have been considered. Taronga's approach to welfare and animal care is continually evolving to ensure contemporary practice. This paper describes the decision‐making process that was developed, and the ethical underpinnings inherent within it. The approach and processes continue to evolve to remain contemporary with emerging laws, ethics and societal expectations.

On Dignity and Psychiatry.

On Dignity and Psychiatry.

Australian state of Victoria passes assisted dying bill

Australian state of Victoria passes assisted dying bill

Extending’ euthanasia to those ‘tired of living’ in the Netherlands could jeopardize a well-functioning practice of physicians’ assessment of a patient's request for death

The Dutch Euthanasia Act (EA) took effect in 2002 and regulates the ending of one’s life by a physician at the request of a patient who is suffering unbearably. According to the Dutch Supreme Court, unbearable suffering is a state for which the presence of a medical condition is a strict prerequisite. As a consequence, the Dutch EA has attributed the assessment of unbearable suffering to physicians who evaluate the presence of a medical classifiable disorder. Currently, a debate within the Netherlands questions whether older people, without a medical condition, who value their life as completed, should be granted euthanasia. To concede the autonomy of such a person, the Dutch government intends to create a separate legal framework that regulates this tired of living euthanasia request. This debate is crucial for policy-makers and an international audience because it discusses if a self-directed death of older people, should be implemented in (the current Dutch) euthanasia practice. However, this article argues that the current legal proposal that regulates the tired of living euthanasia request ignores crucial jurisprudence on physicians’ application of the unbearable suffering criterion in practice. Furthermore it points out that this proposal neglects physicians role in guaranteeing a euthanasia practice of due care and that its use of an ethic of absolute autonomy could jeopardize this well-established practice.

National survey of medical choices in caring for terminally ill patients in Italy, a cross-sectional study.

In Italy, euthanasia and assisted suicide remain illegal but have been the subject of constant debate. Such discussions, however, seem to take relatively little account of physicians' views and attitudes. We used an anonymous questionnaire to survey the attitudes and practices concerning euthanasia and the care of terminally ill patients of 5000 Italian physicians from among the approximately 20,000 members of seven of the most important Italian scientific societies. They were asked to complete an anonymous questionnaire consisting of 15 items, which also collected demographic and professional information. The response rate was 23.5%, and 855 questionnaires were returned. The respondents (75% males) had a median age of 51 years and 47% practiced medicine in a hospital or university setting. The survey showed that the attitude of Italian physicians towards caring for terminal patients is generally against the practice of euthanasia insofar as 84% and 87%, respectively, would, on a theoretical basis, be unwilling to prescribe or administer lethal drugs. Only 1.2-2% of the physicians declared that they had resorted at least once to active euthanasia practices consisting of the prescription and/or direct administration of lethal drugs during their professional lives, and 0.5-0.9% during the previous year. The main factor significantly influencing the opinions and behaviors of the physicians was religion. To our knowledge, this is the first Italian survey investigating the opinions and practices on euthanasia of a large sample of physicians from all over the country, belonging to various medical specialties. Our findings confirm the considerable influence of religion on physician's opinions and practice concerning end-of-life care.

Attitude Towards Euthanasia among Students of Arts College-A Comparative Study

This study was undertaken to study the awareness and perception about euthanasia among arts students and to compare the regional differences, if any. This cross-sectional study was conducted at different colleges in Mangalore (representing south) and Srinagar and Jammu (representing north) among 400 arts students. The students responded to self-administered questionnaires that comprised of ten questions. A total of 400 students participated in the study, 200 from South and 200 from North between the age group of 17 to 21 years. The majority of participants (85%) from north and 70% from south were against introducing a law permitting the practice of euthanasia. 78% of participants from north and 46% from south were of the opinion that it should not be allowed. The participants were questioned that if euthanasia is allowed, who according to them should do it, and it was found that majority of the participants from north were of the opinion that euthanasia should be decided by the family whereas participants from south believed that euthanasia should be decided by the doctor. The main concern of respondents in south (52%) regarding euthanasia was that it can be misused in different situations, whereas in north the participants (55%) were against euthanasia based on their religious belief. Majority of students were against the legalization of euthanasia. Further study should be conducted to know the awareness and perception of euthanasia among the general population.

The need to exercise caution in accepting addiction as a reason for performing euthanasia.

The recent practice in Belgium and the Netherlands of accepting addiction as a reason for performing euthanasia raises important issues for the field of addiction and the practice of euthanasia. In this paper we outline some of these issues. We also argue that physicians making decisions about whether to accept requests for euthanasia from people with an allegedly untreatable addiction should consider two issues carefully. They should ensure that: (1) the person has the capacity to give free and informed consent to undergo euthanasia; and (2) their request is the outcome of a deliberative process in which all reasonable treatment options and harm reduction measures have been offered to and considered by the person.

Discricionariedade administrativa e eutanásia animal em unidade de vigilância de zoonoses: um estudo de caso

A discricionariedade do poder público para a prática da eutanásia em animais nas Unidades de Vigilância de Zoonoses (UVZ`s) em prol da saúde pública é tema de muita discussão. Este artigo apresenta um estudo de caso sobre a prática de eutanásia ocorrido em uma Unidade de Vigilância de Zoonose na cidade de Belo Horizonte/MG, visando analisar a discricionariedade pública e o processo da eutanásia bem como as legislações que permeiam as UVZ`s para executar tal processo em cães errantes.

Involvement of palliative care in euthanasia practice in a context of legalized euthanasia: A population-based mortality follow-back study

Background: In the international debate about assisted dying, it is commonly stated that euthanasia is incompatible with palliative care. In Belgium, where euthanasia was legalized in 2002, the Federation for Palliative Care Flanders has endorsed the viewpoint that euthanasia can be embedded in palliative care. Aim: To examine the involvement of palliative care services in euthanasia practice in a context of legalized euthanasia. Design: Population-based mortality follow-back survey. Setting/participants: Physicians attending a random sample of 6871 deaths in Flanders, Belgium, in 2013. Results: People requesting euthanasia were more likely to have received palliative care (70.9%) than other people dying non-suddenly (45.2%) (odds ratio = 2.1 (95% confidence interval, 1.5–2.9)). The most frequently indicated reasons for non-referral to a palliative care service in those requesting euthanasia were that existing care already sufficiently addressed the patient’s palliative and supportive care needs (56.5%) and that the patient did not want to be referred (26.1%). The likelihood of a request being granted did not differ between cases with or without palliative care involvement. Palliative care professionals were involved in the decision-making process and/or performance of euthanasia in 59.8% of all euthanasia deaths; this involvement was higher in hospitals (76.0%) than at home (47.0%) or in nursing homes (49.5%). Conclusion: In Flanders, in a context of legalized euthanasia, euthanasia and palliative care do not seem to be contradictory practices. A substantial proportion of people who make a euthanasia request are seen by palliative care services, and for a majority of these, the request is granted.

On-farm euthanasia practices and attitudes of commercial meat rabbit producers

Appropriate and timely on-farm euthanasia is the responsibility of the producer, working together with their herd veterinarian. Unfortunately, validated methods for euthanasia of commercial meat rabbits are lacking and there...

Should Euthanasia Be Considered Iatrogenic?

As more countries adopt laws and regulations concerning euthanasia, pediatric euthanasia has become an important topic of discussion. Conceptions of what constitutes harm to patients are fluid and highly dependent on a myriad of factors including, but not limited to, health care ethics, family values, and cultural context. Euthanasia could be viewed as iatrogenic insofar as it results in an outcome (death) that some might consider inherently negative. However, this perspective fails to acknowledge that death, the outcome of euthanasia, is not an inadvertent or preventable complication but rather the goal of the medical intervention. Conversely, the refusal to engage in the practice of euthanasia might be conceived as iatrogenic insofar as it might inadvertently prolong patient suffering. This article will explore cultural and social factors informing families', health care professionals', and society's views on pediatric euthanasia in selected countries.

Attitudes toward euthanasia: Contradictory views and ideas of alzheimer patients’ relatives

IntroductionAlzheimer's disease (AD) is one of the pressing social problems as the negative effects of the disease often manifest on patients’ relatives. Relatives of AD patients experience physical and psychological burden during the care.ObjectivesTo clarify what kind of views on euthanasia are more common among relatives of patients with AD.MethodsThe study involved 23 AD patients’ relatives (mean age 60, SD = 2). There were 5 men (22%) and 18 women (78%). All participants were directly involved in caring for their relatives with AD. A 19-item structured questionnaire (E. Nikolaev, 2016) was used for measuring medical, legal, ethical, socio-cultural, spiritual and personal aspects of attitudes to euthanasia.ResultsThe respondents were less likely to see euthanasia as medical issue. They also referred it to kind of ethical and legal problems. Legal aspects were determined by greater consent to its legalization and by awareness of imperfections of legal basis for its immediate implementation. Ethical issues according to which euthanasia practice was related to the development of humanity complemented this vision. These settings were in conflict with socio-cultural perceptions of euthanasia. Respondents were convinced in possibility of various forms of abuse during euthanasia. Supporting the ideas of euthanasia in general, many respondents on a personal level were not ready to apply them to their relatives with AD in practice.ConclusionsAttitudes to euthanasia in AD patients’ relatives was contradictory. It was determined by divergent ideas about euthanasia in field of legal, social, cultural, spiritual and personal issues of this interdisciplinary phenomenon.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Stockperson attitudes toward pig euthanasia.

Euthanasia is a necessary act for any facility keeping live animals. Nevertheless, the crucial role and responsibility of the stockperson in deciding and conducting on-farm euthanasia has been overlooked. Stockperson characteristics and knowledge that lead to appropriate decision-making and the skills to competently perform the procedure remain to be identified. An important component of the stockperson's characteristics that predict behavior is the stockperson's attitudes. This preliminary study investigated the factors that influence stockperson attitudes toward the practice of on-farm euthanasia in the pork industry. A total of 120 stockpeople from 10 Australian pig farms (ranging in size from 50 to 4,754 sows and from 2 to 32 employees) completed a questionnaire based on focus group input to assess their attitudes toward euthanasia and decision processes. Factors identified included stockperson attitudes and attributes (empathy affect, empathy attribution, feeling bad about euthanizing, and negative attitudes to pigs), beliefs about the working environment (perceived time constraints and relying on others), and factors related to decision-making (comfortable with euthanasia, trouble deciding and avoid if possible, confidence, insufficient knowledge, seeking knowledge, and using sources to get advice). Numerous significant correlations were found between these variables. Furthermore, regression analyses showed confidence as the only significant predictor of being comfortable with euthanasia (12.5% of the variance; < 0.001); insufficient knowledge and empathy attribution both as predictors of trouble deciding and avoid if possible (15.1% of the variance; = 0.001 and = 0.032, respectively); and empathy affect, insufficient knowledge, and perceived time constraints as predictors of feeling bad about euthanizing (23.2% of the variance; < 0.001, = 0.006, and = 0.022, respectively). Stockpeople reported seeking more knowledge if they had not euthanized an animal before working with pigs ( = 0.05), and women reported greater difficulty than men in conducting euthanasia ( < 0.01). The findings indicate that euthanasia, which comprises both a decision-making process and the act itself, can adversely affect stockpeople. This preliminary study offers insights for implementation of successful practical and humane pig euthanasia protocols on farm. This will benefit stockperson well-being and animal well-being alike.

Physician-Assisted Suicide and Euthanasia in the ICU: A Dialogue on Core Ethical Issues.

Many patients are admitted to the ICU at or near the end of their lives. Consequently, the increasingly common debate regarding physician-assisted suicide and euthanasia holds implications for the practice of critical care medicine. The objective of this article is to explore core ethical issues related to physician-assisted suicide and euthanasia from the perspective of healthcare professionals and ethicists on both sides of the debate. We identified four issues highlighting the key areas of ethical tension central to evaluating physician-assisted suicide and euthanasia in medical practice: 1) the benefit or harm of death itself, 2) the relationship between physician-assisted suicide and euthanasia and withholding or withdrawing life support, 3) the morality of a physician deliberately causing death, and 4) the management of conscientious objection related to physician-assisted suicide and euthanasia in the critical care setting. We present areas of common ground and important unresolved differences. We reached differing positions on the first three core ethical questions and achieved unanimity on how critical care clinicians should manage conscientious objections related to physician-assisted suicide and euthanasia. The alternative positions presented in this article may serve to promote open and informed dialogue within the critical care community.

Exploring the Grief Experience Among Callers to a Pet Loss Support Hotline

ABSTRACTThe present study explored the grief experience among callers to the Ontario Veterinary College Pet Loss Support Hotline (PLSH). Summary notes (n = 75) of the conversations between callers and PLSH volunteers were qualitatively analyzed using content analysis. Major content categories emerging from the analysis include personal pet narrative; perceived support sources; grief experiences; relationship with pet; memorialization; grief coping strategies; grief triggers; decision to euthanize; and veterinary interaction. Findings support that pet loss grief is a broad, complex construct, which can be complicated by a pet owner’s perceptions that they have minimal social support sources and negative veterinary interactions. Pet owners involved in the current study appeared comfortable sharing personal stories about their pet’s death when asked. In addition, memorialization appeared to be widely used by PLSH callers and may have helped them cope with their loss. Importantly, the interaction with veterinary staff was identified to potentially aggravate or alleviate a pet owner’s grief experience. Implications for mental health counselors and veterinary staff are that asking pet owners to tell their pet’s story and explore their support network may have value following the loss of a pet. Also, effectively communicating about memorialization and grief coping strategies may be beneficial when talking to owners experiencing grief. Finally, there continues to be a need for curricula and continuing professional training courses for veterinarians and mental health counselors to address topics such as the human–animal bond, grief, euthanasia, and memorialization practices.