Physician commitment in end of life care—perspectives from New Zealand and the Netherlands

2004 ◽  
Vol 59 (4) ◽  
pp. 775-785 ◽  
Author(s):  
K Mitchell
2006 ◽  
Vol 62 (6) ◽  
pp. 1552-1563 ◽  
Author(s):  
Mette L. Rurup ◽  
Bregje D. Onwuteaka-Philipsen ◽  
Agnes van der Heide ◽  
Gerrit van der Wal ◽  
Dorly J.H. Deeg

1997 ◽  
Vol 6 (2) ◽  
pp. 189-204 ◽  
Author(s):  
Timothy E. Quill ◽  
Gerrit Kimsma

Voluntary active euthanasia (VAE) and physician-assisted suicide (PAS) remain technically illegal in the Netherlands, but the practices are openly tolerated provided that physicians adhere to carefully constructed guidelines. Harsh criticism of the Dutch practice by authors in the United States and Great Britain has made achieving a balanced understanding of its clinical, moral, and policy implications very difficult. Similar practice patterns probably exist in the United States, but they are conducted in secret because of a more uncertain legal and ethical climate. In this manuscript, we plan to compare end-of-life care in the United States and the Netherlands with regard to underlying values, justifications, and practices. We will explore the risks and benefits of each system for a real patient who was faced with a common end-of-life clinical dilemma, and close with challenges for public policies in both countries.


2015 ◽  
Vol 65 (640) ◽  
pp. e724-e730 ◽  
Author(s):  
Yolanda WH Penders ◽  
Lieve Van den Block ◽  
Gé A Donker ◽  
Luc Deliens ◽  
Bregje Onwuteaka-Philipsen

2021 ◽  
Author(s):  
Lis Heath ◽  
Richard Egan ◽  
Ella Iosua ◽  
Robert Walker ◽  
Jean Ross ◽  
...  

Abstract Background: In New Zealand, 34% of deaths occur in the hospital setting where junior doctors are at the frontline of patient care. The death rate in New Zealand is expected to double by 2068 due to the aging population, but many studies report that graduates feel unprepared to care for people near the end of life and find this to be one of the most stressful parts of their work. International guidelines recommend that palliative and end of life care should be a mandatory component of undergraduate medical education, yet teaching varies widely and remains optional in many countries. Little is known about how medical students in New Zealand learn about this important area of clinical practice. The purpose of this study was to investigate the organisation, structure and provision of formal teaching, assessment and clinical learning opportunities in palliative and end of life care for undergraduate medical students in New Zealand.Methods: Quantitative descriptive, cross-sectional survey of module conveners in New Zealand medical schools.Results: Palliative and end of life care is included in undergraduate teaching in all medical schools. However, there are gaps in content, minimal formal assessment and limited contact with specialist palliative care services. Lack of teaching staff and pressure on curriculum time are the main barriers to further curriculum development.Conclusions: This article reports the findings of the first national survey of formal teaching, assessment and clinical learning opportunities in palliative and end of life care in undergraduate medical education in New Zealand. There has been significant progress towards integrating this content into the curriculum, although further development is needed to address barriers and maximise learning opportunities to ensure graduates are as well prepared as possible.


2021 ◽  
Author(s):  
◽  
Raewyn Anita Davidson

<p>Advance directives are just one aspect of advance care planning. According to the New Zealand Nurses Organisation, advance directives are becoming increasingly common in New Zealand. Nurses are well positioned to take on an increasing role in advance directives, particularly in view of the expected burgeoning older population to which New Zealand is no exception. The literature suggests there is a role for primary health nurses in advance directives but no literature to date is available on this role in the New Zealand context. The aim of this research was to determine primary health nurses' role in advance directives. A qualitative case study research approach was used to explore the knowledge, attitudes, experiences, and involvement of primary health nurses in advance directives. Semi-structured interviews were conducted with 13 senior primary health nurses from one New Zealand province. Two propositions informed the analysis: 1) primary health nurses currently do not have a role in advance directives; and 2) primary health nurses believe that advance directives can promote effective-end-of-life care. Watson's Theory of Human Caring was used as the theoretical framework to guide the study. Three themes were identified from the analysis: encountering challenges, facilitating patient voice, and valuing the person. The findings revealed that primary health nurses had little or no significant experience or involvement in advance directives. Participants described knowledge inconsistencies about advance directives, in particular to related legalities. Nevertheless, participants had positive attitudes towards advance directives and believed there was a role for primary health nurses in early advance directive conversations. They emphasised the importance of teamwork and envisaged their role as one of support to both the patient and doctor. Caring praxis underpinned the nurses' positive attitudes towards advance directives. These caring behaviours sustained the core values of patient autonomy and patient advocacy considered fundamental to sensitive advance directive conversations. Many challenges were identified in terms of the nurse's role in advanced directives. These included cultural considerations for Māori in order to respect The Treaty of Waitangi principles and attending to the cultural needs of the individual Pacific Island groupings. Other challenges included unclear guidelines, unclear role delineation, ethical dilemmas and fragmented or complex communication issues across the primary/secondary health sector. Results of this study may inform nurses of the need to establish nurse–patient relationships built upon trust and positive regard in order to support patients in advanced directive discussions. Implications for nurse educators include incorporating education directed at empowering nurses to participate in ethical decision making to enhance patients' end-of-life care. Given the importance of the multi-disciplinary responsibility in establishing advance directives, there is a need for further research regarding how health professionals could function together in the role of advance directive communication to best meet patients' needs.</p>


2018 ◽  
Vol 46 (5) ◽  
pp. 488-497 ◽  
Author(s):  
Y. Y. Lee ◽  
K. Ranse ◽  
W. Silvester ◽  
A. Mehta ◽  
F. M. P. Van Haren

The incidence of organ donation after circulatory death (DCD) in Australia and New Zealand (ANZ) has steadily increased in recent years. Intensive care doctors are vital to the implementation of DCD and healthcare professionals’ attitudes to DCD can influence their participation. In order to determine ANZ intensive care doctors’ attitudes to DCD, to explore if demographic characteristics influence attitude to DCD and to assess if attitude to DCD can predict palliative prescription rationale at the end of life of DCD donors, a cross-sectional online survey was distributed to ANZ intensive care doctors and responses collected between 29 April and 10 June 2016. Exploratory factor analysis was used to define various attributes of attitude to DCD. Results were subjected to comparative statistical analyses to examine the relation between demographic data and attitude to DCD. Multiple regression models were used to examine if attitude to DCD could predict intensive care doctors’ palliative prescription rationales at the end of life of DCD donors. One hundred and sixty-one intensive care doctors responded to the survey with 69.4% having worked in intensive care for ten years or more. Respondents responded positively to the support of and perceived importance of DCD in helping those who would benefit from the donations (constructive attributes) (mean composite factor score = 3.84, standard deviation [SD] 0.83), they positively perceived that conducive and facilitative orchestration of DCD helps families cope (mean composite factor score = 3.94, SD 0.72) and that they would manage a DCD donor similar to any patient at the end of their life (mean score = 3.94, SD 0.72). Respondents responded negatively to having concerns that the circulatory death of potential DCD donors does not occur within the specified time frame (mean score = 2.28, SD 1.02). There was an association between organ donation professional education courses, familiarity with national guidelines and positive attitudes to certain attributes of attitude to DCD. Regression models demonstrated the attitude to DCD may predict intensive care doctors’ palliative medication prescription rationales at the end of life of the DCD donor. Intensive care doctors in ANZ adopt a morally neutral attitude to DCD where they recognise the importance of organ donation, and support and conduct DCD as a part of good end-of-life care.


Sign in / Sign up

Export Citation Format

Share Document