Correction:Comparison of attitudes towards five end-of-life care interventions (active pain control, withdrawal of futile life-sustaining treatment, passive euthanasia, active euthanasia and physician-assisted suicide): a multicentred cross-sectional survey of Korean patients with cancer, their family caregivers, physicians and the general Korean population

ObjectivesThis study determined attitudes of four groups—Korean patients with cancer, their family caregivers, physicians and the general Korean population—towards five critical end-of-life (EOL) interventions—active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide.Design and settingWe enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a ‘good death’ with critical interventions at EoL care.ResultsAll participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling ‘life was meaningful’ (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing ‘freedom from pain’ negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, ‘not being a burden to the family’ was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89).ConclusionGroups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.

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Ethical considerations at the end-of-life care

SAGE Open Medicine ◽

10.1177/20503121211000918 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110009

Author(s):

Melahat Akdeniz ◽

Bülent Yardımcı ◽

Ethem Kavukcu

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Assisted Suicide ◽

Healthcare Professionals ◽

Ethical Decision Making ◽

Biomedical Ethics ◽

Artificial Nutrition ◽

Life Care ◽

Ethical Challenges ◽

Physician Assisted Suicide

The goal of end-of-life care for dying patients is to prevent or relieve suffering as much as possible while respecting the patients’ desires. However, physicians face many ethical challenges in end-of-life care. Since the decisions to be made may concern patients’ family members and society as well as the patients, it is important to protect the rights, dignity, and vigor of all parties involved in the clinical ethical decision-making process. Understanding the principles underlying biomedical ethics is important for physicians to solve the problems they face in end-of-life care. The main situations that create ethical difficulties for healthcare professionals are the decisions regarding resuscitation, mechanical ventilation, artificial nutrition and hydration, terminal sedation, withholding and withdrawing treatments, euthanasia, and physician-assisted suicide. Five ethical principles guide healthcare professionals in the management of these situations.

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Preferences for Advance Directives in Korea

Nursing Research and Practice ◽

10.1155/2012/873892 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 12

Author(s):

So-Sun Kim ◽

Won-Hee Lee ◽

JooYoung Cheon ◽

Jung-Eun Lee ◽

KiSun Yeo ◽

...

Keyword(s):

End Of Life ◽

Advance Directives ◽

End Of Life Care ◽

Healthcare Providers ◽

Tube Feeding ◽

Life Care ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Korean People ◽

End Stage

Background. The goal of advance directives is to help patients retain their dignity and autonomy by making their own decisions regarding end-stage medical treatment. The purpose of this study was to examine preferences of advance directives among general population in Korea.Method. A descriptive cross-sectional survey was performed from October 2007 to June 2008 in Seoul, Korea. A total of 336 city-dwelling adults self-administered the questionnaire and returned it via mail. Data analyses were conducted using SPSS 17.0.Results. Subjects reported the need for healthcare providers' detailed explanations and recommendations regarding end-of-life care. When there is no hope of recovery and death is imminent, most subjects did not want to receive cardiopulmonary resuscitation nor an IV or tube feeding. However, most of the subjects wanted pain management care.Conclusions. The present study showed that many Korean people have an interest in advance directives. The results show that the autonomy and dignity of patient have increased in importance. To provide better end-of-life care, there is a need to educate patients on the definition and intent of an advance directive. Additional proactive communication between patients and their caregivers should be educated to healthcare providers.

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Is Presence Always Complicity? An Analysis of Presence, Its Moral Objects, and Scandal in Proximity to Physician-Assisted Suicide and Euthanasia

Theological Studies ◽

10.1177/00405639211032707 ◽

2021 ◽

Vol 82 (3) ◽

pp. 487-508

Author(s):

Daniel Fleming

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Assisted Suicide ◽

Moral Action ◽

Theological Ethics ◽

Life Care ◽

Physician Assisted Suicide ◽

Recent Letter ◽

Action Intention ◽

Catholic Theological

Catholic chaplains and clinicians who exercise their vocations in contexts wherein physician-assisted suicide and euthanasia (PAS-E) are legal may need to confront the difficult question of whether or not their presence in proximity to these acts and the processes that govern them is consistent with Catholic ethics. Debate on this question to date has focused on complicit presence and scandal. Drawing on Catholic theological ethics and the vision for end-of-life care espoused in the Congregation for the Doctrine of the Faith’s recent letter, Samaritanus Bonus, I argue that some forms of presence in proximity to PAS-E are ethically justifiable. Core to this argument are the three elements of moral action: intention, object, and circumstance, alongside efforts to mitigate the risk of scandal informed by the teaching of Aquinas.

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Complexities in consultations in case of euthanasia or physician-assisted suicide: a survey among SCEN physicians

BMC Family Practice ◽

10.1186/s12875-019-1063-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Tessa D. Bergman ◽

H. Roeline W. Pasman ◽

Bregje D. Onwuteaka-Philipsen

Keyword(s):

Psychiatric Disorders ◽

Assisted Suicide ◽

Public Debate ◽

Main Diagnosis ◽

Physician Assisted Suicide ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Age Related ◽

Attending Physician ◽

Complex Cases

Abstract Background In the Netherlands, euthanasia or physician-assisted suicide (EAS) is allowed if due care criteria are met. One criterion is consultation of a second independent physician, often SCEN physicians. The public debate about EAS focuses on patients with psychiatric disorders, dementia, and tired of living, as complex cases. What complexities SCEN physicians perceive during consultation is unknown. This study aims to assess the frequency of EAS consultations that are perceived difficult by SCEN physicians, to explore what complexities are perceived by SCEN physicians during consultation, and to assess what characteristics are associated with difficult consultations. Methods Data from 2015 to 2017 from an annual cross-sectional survey among SCEN physicians was used. In 2015, the survey focused on the most difficult consultation that year and in 2016/2017 on the most recent consultation. Frequencies of coded answers to an open-ended question were done to explore what complexities SCEN physicians perceived during their most difficult consultation. Univariable and multivariable logistic regression analyses were used to assess what characteristics were associated with difficult consultations. Results 21.6% of cases consulted by SCEN physicians is perceived difficult. Complexities that SCEN physicians perceive were mainly in contact with patients (79.7%) and in the assessment of due care criteria (41.0%). Characteristics that were associated with a higher likelihood of a consultation being difficult are the attending physician being less certain to perform the EAS, patients staying in the hospital, main diagnosis heart failure/CVA, and accumulation of age-related health problems/psychiatry/dementia, and the presence of a psychiatric disorder, or psychosocial or existential problems besides the main diagnosis. Characteristics that were associated with a lower likelihood of a consultation being difficult are high patient’s age and physical suffering as reason to request EAS. Conclusion Complexities perceived by SCEN physicians in EAS consultations are not limited to the ‘complex’ cases present in the current public debate about EAS, e.g. patients with psychiatric disorders, dementia, and tired of living. Attention for these complexities in intervision could indicate if there is a need among SCEN physicians to enhance knowledge and skills in training and to receive specific support in intervision on these complexities.

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End-of-Life Care in the Netherlands and the United States: A Comparison of Values, Justifications, and Practices

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180100007805 ◽

1997 ◽

Vol 6 (2) ◽

pp. 189-204 ◽

Cited By ~ 10

Author(s):

Timothy E. Quill ◽

Gerrit Kimsma

Keyword(s):

United States ◽

The Netherlands ◽

End Of Life ◽

End Of Life Care ◽

Assisted Suicide ◽

Ethical Climate ◽

The United States ◽

Policy Implications ◽

Life Care ◽

Physician Assisted Suicide

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.

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When parents face the death of their child: a nationwide cross-sectional survey of parental perspectives on their child’s end-of life care

BMC Palliative Care ◽

10.1186/s12904-016-0098-3 ◽

2016 ◽

Vol 15 (1) ◽

Cited By ~ 23

Author(s):

Karin Zimmermann ◽

◽

Eva Bergstraesser ◽

Sandra Engberg ◽

Anne-Sylvie Ramelet ◽

...

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Parental Perspectives

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Are registered nurses ready to take care at the end-of-life: crossectional survey

10.21203/rs.3.rs-27365/v1 ◽

2020 ◽

Author(s):

Aurelija Blazeviciene ◽

Lina Laurs ◽

Jamesetta A Newland

Keyword(s):

Registered Nurses ◽

End Of Life ◽

End Of Life Care ◽

Spiritual Needs ◽

Life Care ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Healthcare Settings ◽

Correlational Design ◽

Inadequate Knowledge

Abstract Background: End-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason it is very important to assess all the obstacles to end-of-life care and to provide safe and quality services to patients. The main purpose of this study was to examine attitudes faced by registered nurses in providing end-of-life care and to explore obstacles and supportive behaviors for nurses. Methods: A descriptive, correlational design was applied in this study. Cross‐sectional survey of 1320 registered nurses within 7 hospitals in Lithuania. Results: Registered nurses working in the three different profiles emphasized safe and effective care andthe importance of meeting the patient's spiritual needs at the end of life. The main obstacles assigned by nurses caring for patients at the end of life were angry family membersthe inadequate understanding of nursing care by the patient's relatives; family members' inadequate knowledge about the situation and lack of time to talk to patients about their wishes, lack of nursing knowledge to deal with the bereaved patient's family, lack of evaluation of nurses' opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. Conclusions: Spiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related obstacles remain one of the main obstacles to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.

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Attitudes of registered nurses about the end – of – life care in multi-profile hospitals: a cross sectional survey

10.21203/rs.3.rs-27365/v2 ◽

2020 ◽

Author(s):

Aurelija Blazeviciene ◽

Lina Laurs ◽

Jamesetta A Newland

Keyword(s):

Registered Nurses ◽

End Of Life ◽

Family Involvement ◽

Nursing Care ◽

End Of Life Care ◽

Spiritual Needs ◽

Life Care ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Healthcare Settings

Abstract Background: End-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason why it is very important to assess all barriers to end-of-life care and to provide safe and quality services to patients. This study was aimed at describing nurses' attitudes in providing end-of-life care and exploring barriers and facilitating behaviors of nurses in multi-profile hospitals in Eastern Europe.Methods: A descriptive, correlational design was applied in this study, using a cross-sectional survey of 1,320 registered nurses within 7 hospitals in Lithuania. Results: Registered nurses working in the three different profiles emphasized safe and effective care and the importance of meeting the patient's spiritual needs at the end of life. The main barriers assigned by nurses caring for patients at the end of life were angry family members, inadequate understanding of nursing care by the patient's relatives; lack of time to talk to patients, lack of nursing knowledge to deal with the bereaved patient's family, lack of evaluation of nurses' opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. The main facilitating behaviors to improve nursing care were end-of-life training, volunteering, and family involvement.Conclusions: Spiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related barriers remain one of the main barriers to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.

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End-of-life Care Preferences among Cancer Patients in Southern Thailand: A University Hospital-based Cross-Sectional Survey

10.21203/rs.3.rs-152141/v1 ◽

2021 ◽

Author(s):

Jarurin Pitanupong ◽

Sahawit Janmanee

Keyword(s):

Quality Of Life ◽

End Of Life ◽

Cancer Patients ◽

End Of Life Care ◽

University Hospital ◽

Life Care ◽

Cross Sectional Survey ◽

Cross Sectional ◽

At Home

Abstract Background: End-of-life care preferences may be highly individual, heterogenic, and variable according to culture and belief. This study aimed to explore preferences and factors associated with end-of-life care among Thai cancer patients with the goal of helping optimize their quality of life.Methods: A cross-sectional study surveyed cancer outpatients at Songklanagarind Hospital from August to November 2020. The questionnaires inquired about: 1) personal and demographic information, 2) experiences with end-of-life care received by relatives, and 3) end-of-life care preferences. To determine end-of life preferences, the data were analyzed using descriptive statistics. The data concerning patient demographics and end-of-life care preferences were compared using Fisher’s exact test. Results: The majority of the 96 cancer outpatients were female (65.6%), and the overall mean age was 55.8 ±11.6 years. More than half of them had an experience of observing someone die (68.8%), and they were predominantly satisfied with the care received by their relatives in passing away at home surrounded by family (47.0%) and being conscious until the time of death (68.2%). Most participants preferred receiving the full truth regarding their illness (99.0%), being free of uncomfortable symptoms (96.9%), having their loved ones around (93.8%), being mentally aware at the last hour (93.8%), and having the sense of being meaningful in life (92.7%). Their 3 most important end-of-life care wishes were receiving the full truth regarding their illness, disclosing the full truth regarding their illness to family members, and passing away at home. Conclusion: In order to optimize the quality of life of terminal patients, end-of-life care should ensure they receive the full truth regarding their illness, experience no distress symptoms, remain mentally aware at the last hour of life, feel meaningful in life, and pass away comfortably with loved ones around.

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