Euthanasia and organ donation still firmly connected: reply to Bollen et al

2021 ◽  
pp. medethics-2021-107498
Author(s):  
Zeljka Buturovic
Keyword(s):  
Organ Donation ◽  
Assisted Suicide ◽  
Study Groups ◽  
Patients With Cancer ◽  
Future Developments ◽  
Whole Process ◽  
Point Of Interest ◽  
Situational Pressure ◽  
Process Work ◽  
Additional Reason

Bollen et al, replying to my own article, describe, in great detail, administrative and logistical aspects of euthanasia approval and organ donation in the Netherlands. They seem to believe that no useful lessons can be drawn from experiences of related groups such as euthanasia patients (typically patients with cancer) who cannot donate organs; patients who chose assisted suicide as opposed to euthanasia; patients in intensive care units and their relatives and suicidal young people as if we can only learn about organ donation in euthanasia patients by studying this exact group and no other, no matter how closely related and obviously relevant. However, it is not only permissible but also absolutely essential to gather evidence that goes beyond immediate point of interest and carefully study groups that share important features with it. Also, groups eligible for euthanasia are constantly expanding, theoretically, legally and practically, and it would be irresponsible to not foresee what are likely future developments. Finally, myopic focus on the technicalities of the procedure misses psychological reality that drives decisions and behaviours and which rarely mimics administrative timelines. Patients proceeding through euthanasia pipeline already face substantial situational pressure and adding organ donation on top of it can make the whole process work as a commitment device. By allowing euthanasia patients to donate their organs, we are giving them additional reason to end their lives, thus creating an unbreakable connection between the two.

Diagnosis and Management of Genitourinary Rhabdomyosarcoma

2019 ◽  
Author(s):  
Ahmed Abdelhalim ◽  
Zhan Tao (Peter) Wang ◽  
Ali Nael ◽  
Antoine E Khoury
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Risk Stratification ◽  
Collaborative Study ◽  
Tumor Biology ◽  
Study Groups ◽  
Soft Tissue Tumors ◽  
Tumor Surveillance ◽  
Future Developments ◽  
International Collaborative Study

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. Genitourinary RMS accounts for 15 to 25% of all RMSs and is a heterogeneous group of soft tissue tumors that vary in presentation, distribution, and prognosis. This article reviews the pathophysiology and tumor biology of RMS. It will also describe the initial approach to its diagnosis and current tumor surveillance protocols. Furthermore, this article presents the evidence behind a number of different staging and risk stratification systems currently used to guide treatment. Lastly, this article reviews future developments of investigational studies and risk stratification under investigation by a number of large international collaborative study groups. This review contains 17 figures, 7 tables, and 68 references. Keywords:  Rhabdomyosarcoma, genitourinary, staging, diagnosis, paratesticular, bladder, prostate, RMS

Pain Management and Disciplinary Action: How Medical Boards Can Remove Barriers to Effective Treatment

1996 ◽  
Vol 24 (4) ◽  
pp. 338-343 ◽  
Author(s):  
Chris Stern Hyman
Keyword(s):  
Pain Management ◽  
Assisted Suicide ◽  
Pain Treatment ◽  
Chronically Ill ◽  
The Elderly ◽  
Disciplinary Action ◽  
Current Debate ◽  
Physician Assisted Suicide ◽  
Patients With Cancer ◽  
State Medical Boards

The current debate about physician-assisted suicide and the question of whether patients would ask for such help if their pain were adequately controlled place in sharp focus the issue of undertreated pain. Studies have repeatedly documented the scope of the problem. A 1993 study of 897 physicians caring for cancer patients found that 86 percent of the physicians reported that most patients with cancer are undermedicated for their pain. A 1994 study found that noncancer patients receive even less adequate pain treatment than patients with cancer-related pain, and that minority patients, the elderly, and women were more likely than others to receive inadequate pain treatment. Although the problem of undertreatment of pain is multifaceted, I only address how state medical boards contribute to the problem and suggest possible remedies.The literature on palliative care describes the numerous barriers that impede effective pain management and that result in the inadequate prescribing of pain-relieving drugs for terminally and chronically ill patients.

scholarly journals Dependency of Military Capabilities on Technological Development

2015 ◽  
Vol 6 (2) ◽  
pp. 29-58 ◽  
Author(s):  
Vesa Kuikka ◽  
Juha-Pekka Nikkarila ◽  
Marko Suojanen
Keyword(s):  
Building Block ◽  
Technological Development ◽  
Numerical Data ◽  
Quantitative Model ◽  
Levels Of Abstraction ◽  
Technological Forecasting ◽  
Future Developments ◽  
Whole Process ◽  
Subjective Evaluations ◽  
High Level

Abstract Our goal is to get better understanding of different kind of dependencies behind the high-level capability areas. The models are suitable for investigating present state capabilities or future developments of capabilities in the context of technology forecasting. Three levels are necessary for a model describing effects of technologies on military capabilities. These levels are capability areas, systems and technologies. The contribution of this paper is to present one possible model for interdependencies between technologies. Modelling interdependencies between technologies is the last building block in constructing a quantitative model for technological forecasting including necessary levels of abstraction. This study supplements our previous research and as a result we present a model for the whole process of capability modelling. As in our earlier studies, capability is defined as the probability of a successful task or operation or proper functioning of a system. In order to obtain numerical data to demonstrate our model, we conducted a questionnaire to a group of defence technology researchers where interdependencies between seven representative technologies were inquired. Because of a small number of participants in questionnaires and general uncertainties concerning subjective evaluations, only rough conclusions can be made from the numerical results.

Procedural safeguards cannot disentangle MAiD from organ donation decisions

2020 ◽  
pp. medethics-2020-106456
Author(s):  
Zeljka Buturovic
Keyword(s):  
Decision Making ◽  
Organ Donation ◽  
Ethical Issues ◽  
Rare Event ◽  
Organ Donors ◽  
Medical Assistance In Dying ◽  
Patients With Cancer ◽  
Human Decision ◽  
The One

In the past, a vast majority of medical assistance in dying (MAiD) patients were elderly patients with cancer who are not suitable for organ donation, making organ donation from such patients a rare event. However, more expansive criteria for MAiD combined with an increased participation of MAiD patients in organ donation is likely to drastically increase the pool of MAiD patients who can serve as organ donors. Previous discussions of ethical issues arising from these trends have not fully addressed difficulties involved in separating decision to end one’s life from the one to donate one’s organs. However, realities of organ donation logistics and human decision making suggest that this separation can be extraordinary difficult. The need to maximise quality of donated organs complicates dying experience of the donor and is likely in tension with the dying experience the patient envisioned when first considering MAiD. Furthermore, the idea that patients will think about MAiD first, and only when firmly decided to end their life, consider organ donation, runs contrary to organ donation policies in some countries as well as end of life and everyday decision making. This opens the door for organ donation to serve as an incentive in MAiD decisions. Dispensing with the simplistic assumption that organ donation can never be a factor in MAiD decisions is, therefore, essential first step to properly addressing ethical issues at hand.

Discontinuing chronic medications: Perceptions of patients with life-limiting illness.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 97-97
Author(s):  
Jean Kutner ◽  
Christine Ritchie ◽  
Jon Furuno ◽  
Maryjo Prince-Paul ◽  
Jennifer Tjia ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Functional Decline ◽  
Study Groups ◽  
Shared Decision ◽  
Chi Square ◽  
Patients With Cancer ◽  
Chronic Medications ◽  
Potential Benefits ◽  
Cognitively Intact

97 Background: Optimal management of chronic medications is uncertain in life-limiting illness. To inform shared decision making, we assessed patient perceptions in a trial on the safety of discontinuing statins in life-limiting illness. Methods: Eligible adults (life expectancy 1–12 months, on statin for ≥ 3 months for primary/secondary prevention, recent functional decline, no active cardiovascular disease) were randomized to discontinue or continue statins and were followed monthly for up to 1 year. Cognitively intact participants were asked 9 questions regarding discontinuing statins prior to randomization. We used Pearson chi-square to compare responses between study groups and between those with and without cancer. Of 381 participants, 297 (78%) were cognitively intact (138 discontinued, 159 continued statins). Mean age was 72 years (SD 11) and mean number of medications used was 11.5 (SD 5.0); 58% (N = 173) had cancer. Results: There were no statistically significant differences between the study groups in responses to the medication perception questions. Aggregate findings are presented (Table). Patients with cancer were less likely to think that they may be able to stop other medications (28% vs. 42%, p=0.007) and that statin discontinuation means that the doctor is giving up on them (1% vs. 7%, p=0.013). Conclusions: Few participants expressed concerns about discontinuing statins; many perceived potential benefits. Cancer patients may perceive less impact from stopping statins. Clinicians should inquire about patient concerns when engaging in shared decision making about discontinuing chronic medications in the setting of advanced cancer. Clinical trial information: NCT01415934. [Table: see text]

scholarly journals Relations between Desire for Early Death, Depressive Symptoms and Antidepressant Prescribing in Terminally Ill Patients with Cancer

2002 ◽  
Vol 95 (8) ◽  
pp. 386-390 ◽  
Author(s):  
E Tiernan ◽  
P Casey ◽  
C O'Boyle ◽  
G Birkbeck ◽  
M Mangan ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Terminal Illness ◽  
Assisted Suicide ◽  
Terminally Ill ◽  
Depression Scale ◽  
Early Death ◽  
Physician Assisted Suicide ◽  
Patients With Cancer ◽  
Terminally Ill Patients ◽  
Treatment Of Depression

Some patients with advanced cancer express the wish for an early death. This may be associated with depression. We examined the relations between depressive symptoms and desire for early death (natural or by euthanasia or physician-assisted suicide) in 142 terminally ill patients with cancer being cared for by a specialist palliative care team. They completed the Hospital Anxiety and Depression Scale questionnaire and answered four supplementary questions on desire for early death. Only 2 patients expressed a strong wish for death by some form of suicide or euthanasia. 120 denied that they ever wished for early release. The desire for early death correlated with depression scores. Depressive symptoms were common in the whole group but few were on antidepressant therapy. Better recognition and treatment of depression might improve the lives of people with terminal illness and so lessen desire for early death, whether natural or by suicide.

Organ Donation After Assisted Suicide

2014 ◽  
Vol 98 (3) ◽  
pp. 252-253
Author(s):  
Elaine Chen
Keyword(s):  
Organ Donation ◽  
Assisted Suicide

Organ Donation After Assisted Suicide

2014 ◽  
Vol 98 (3) ◽  
pp. 247-251 ◽  
Author(s):  
David M. Shaw
Keyword(s):  
Organ Donation ◽  
Assisted Suicide
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