Factors that Influence End-Of-Life Decision Making Amongst Attending Physicians

2021 ◽  
pp. 104990912110638
Author(s):  
Suraj Pai ◽  
Tracy Andrews ◽  
Amber Turner ◽  
Aziz Merchant ◽  
Michael Shapiro
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Work Experience ◽  
Assisted Suicide ◽  
Online Survey ◽  
Care Physician ◽  
University Hospital ◽  
Physician Assisted Suicide ◽  
Eol Care ◽  
Attending Physicians

Background: Medical advances prolong life and treat illness but many patients have chronically debilitating conditions that prevent them from making end-of-life (EOL) decisions for themselves. These situations are difficult to navigate for both patient and physician. This study investigates physicians’ feelings and approach toward EOL care, physician-assisted suicide (PAS), and euthanasia. Methods: An anonymous, self-administered online survey was distributed through the New Jersey Medical School servers and American College of Surgeons forums. The survey presented clinical EOL vignettes and subjective questions regarding PAS and euthanasia. Results: We obtained 142 responses from attending physicians. Respondents were typically male (61%), married (85%), identified as Christian (54%), had more than 20 years of experience (55%), and worked at a university hospital (57%). Religious beliefs and years of work experience seemed to be significant contributors in EOL decision making, whereas gender and medical specialty were not significantly influential. Conclusion: Factors such as years of work experience and religious belief may influence medical professionals’ opinions about PAS and euthanasia and their subsequent actions regarding EOL care. In many cases, the boundaries are blurred and require further study before concrete conclusions can be made.

scholarly journals Voluntary Stopping of Eating and Drinking in Swiss Outpatient Care

GeroPsych ◽  
2020 ◽  
pp. 1-9
Author(s):  
Sabrina Stängle ◽  
Wilfried Schnepp ◽  
Daniel Büche ◽  
André Fringer
Keyword(s):  
End Of Life ◽  
Outpatient Care ◽  
Assisted Suicide ◽  
Online Survey ◽  
Response Rate ◽  
Physician Assisted Suicide ◽  
Natural Death

Abstract. Besides physician-assisted suicide, there is another end-of-life practice under discussion: voluntary stopping of eating and drinking (VSED). In this study, we assess the occurrence of VSED in outpatient care and evaluate nurses’ attitudes about it. We recruited 395 nurses (24% response rate) in our online survey. The occurrence of VSED in Switzerland lies at 0.5%. Most nurses (84.6%) were aware of VSED, and 39.5% had experienced it with patients. VSED was mostly (70.3%) regarded as a natural death, and nearly all (95.1%) were willing to care for these patients; however, about one-quarter (26.5%) expressed moral concerns. Our results show that VSED occurs in rare cases, and that nurses are willing to accompany patients during this VSED, but express moral concerns.

Palliative Care/Physician-Assisted Dying: Alternative or Continuing Care?

2006 ◽  
Vol 7 (1) ◽  
pp. 41-44 ◽  
Author(s):  
Marion Malakoff
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advance Directives ◽  
Assisted Suicide ◽  
Life Support ◽  
Care Physician ◽  
Physician Assisted Suicide ◽  
Dying Patients ◽  
Physician Assisted Dying ◽  
Wrongful Death

End-of-life care for dying patients has become an issue of importance to physicians as well as patients. The debate centers around whether the option of physician-assisted suicide cuts off, or diminishes the value of, palliative care. This ongoing attention makes the crafting of advance directives from patients detailing their end-of-life choices essential. Equally important is the appointment of a health care surrogate. The surrogate, when the patient is too ill to make decisions, should be empowered to make them in his stead. No American court has found a clinician liable for wrongful death for granting a request to refuse life support. An entirely separate issue is that of legalized physician-assisted suicide. As of this writing, only Oregon has made this legal (see Gonzales v. Oregon). It is likely that this issue will be pursued slowly through the state courts, making advance directives and surrogacy all the more crucial.

scholarly journals Religious and Spiritual Beliefs of Gynecologic Oncologists May Influence Medical Decision Making

2011 ◽  
Vol 21 (3) ◽  
pp. 573-581 ◽  
Author(s):  
Lois Ramondetta ◽  
Alaina Brown ◽  
Gwyn Richardson ◽  
Diana Urbauer ◽  
Premal H. Thaker ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Assisted Suicide ◽  
Online Survey ◽  
Medical Decision Making ◽  
Medical Community ◽  
Complex Case ◽  
Medical Decision ◽  
Clinical Practices ◽  
Survey Tool

BackgroundReligious (R) and spiritual (S) beliefs often affect patients' health care decisions, particularly with regard to care at the end of life. Furthermore, patients desire more R/S involvement by the medical community; however, physicians typically do not incorporate R/S assessment into medical interviews with patients. The effects of physicians' R/S beliefs on willingness to participate in controversial clinical practices such as medical abortions and physician-assisted suicide has been evaluated, but how a physician's R/S beliefs may affect other medical decision-making is unclear.MethodsUsing SurveyMonkey, an online survey tool, we surveyed 1972 members of the International Gynecologic Oncologists Society and the Society of Gynecologic Oncologists to determine the R/S characteristics of gynecologic oncologists and whether their R/S beliefs affected their clinical practice. Demographics, religiosity, and spirituality data were collected. Physicians were also asked to evaluate 5 complex case scenarios.ResultsTwo hundred seventy-three (14%) physicians responded. Sixty percent "agreed" or "somewhat agreed" that their R/S beliefs were a source of personal comfort. Forty-five percent reported that their R/S beliefs ("sometimes," "frequently," or "always") play a role in the medical options they offered patients, but only 34% "frequently" or "always" take a R/S history from patients. Interestingly, 90% reported that they consider patients' R/S beliefs when discussing end-of-life issues. Responses to case scenarios largely differed by years of experience, although age and R/S beliefs also had influence.ConclusionsOur results suggest that gynecologic oncologists' R/S beliefs may affect patient care but that most physicians fail to take an R/S history from their patients. More work needs to be done to evaluate possible barriers that prevent physicians from taking a spiritual history and engaging in discussions over these matters with patients.

scholarly journals How to Reveal Disguised Paternalism – Version 2.0

2021 ◽  
Author(s):  
Niels Lynøe ◽  
Ingemar Engström ◽  
Niklas Juth
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Assisted Suicide ◽  
Age Groups ◽  
Physician Assisted Suicide ◽  
Medical Specialties ◽  
Soft Paternalism ◽  
Clinical Consequences ◽  
Version 2.0 ◽  
Low Degrees

Abstract Objectives: To further develop an index for detecting disguised paternalism, which might influence physicians’ evaluations of whether or not a patient is decision competent at the end of life. Disguised paternalism can be actualized when physicians transform hard paternalism into soft paternalism by denying the patient’s decision-making competence. Methods: A previously presented index was further developed to make it possible to distinguish between high and low degrees of disguised paternalism using the average index of the whole sample. We recalculated the results from a 2007 study to compare to a 2020 study. Both studies are about physicians’ attitudes towards, and arguments for or against, physician assisted suicide (PAS). Results: The 2020 study showed that geriatricians, palliativists and middle aged physicians (46-60 years) had indices indicating disguised paternalism, in contrast with the results from the 2007 study, which showed that all specialties (apart from GPs, surgeons and older physicians) had indices indicating high degrees of disguised paternalism.Conclusions: The proposed index for identifying disguised paternalism reflects the attitude of a group attitudes towards physician assisted suicide. The indices make it possible to compare the various medical specialties and age groups from the 2007 study with the 2020 study. Because disguised paternalism might have clinical consequences for the rights of competent patients to participate in decision-making, it is important to reveal disguised hard paternalism, which could masquerade as soft paternalism and thereby manifest in practice.

scholarly journals Ethical considerations at the end-of-life care

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.

Does Culture Matter? Young and Middle-Aged Iranian-American Adults’ Perspectives Regarding End-of-Life Care Planning

2021 ◽  
pp. 104990912110368
Author(s):  
Zahra Rahemi ◽  
Veronica Parker
Keyword(s):  
End Of Life ◽  
Online Survey ◽  
English Language ◽  
Treatment Options ◽  
Care Planning ◽  
Middle Aged ◽  
Cross Sectional ◽  
Comfort Care ◽  
Iranian American ◽  
Eol Care

Background: An increase of cultural diversity and treatment options offer opportunities and challenges related to end-of-life (EOL) care for healthcare providers and policymakers. EOL care planning can help reduce confusion and uncertainty when individuals and family members need to make decisions about EOL care options. Objective: The purpose of this study was to investigate preferences, attitudes, and behaviors regarding EOL care planning among young and middle-aged Iranian-American adults. Methods: A cross-sectional national sample of 251 Iranian-American adults completed surveys. Paper and online surveys in English and Persian were offered to potential participants. Results: All the participants completed online survey in English language. In incurable health conditions, 56.8% preferred hospitalization and intensive treatments. From the 40.6% participants who preferred comfort care, most preferred care at home (29.5%) compared to an institution (11.1%). Those who preferred hospitalization at EOL mostly preferred intensive and curative treatments. The mean score of attitudes toward advance decision-making was moderately high (11.48 ± 2.77). Favorable attitudes were positively associated with acculturation (r = .31, p < .001), age (r = .15, p < .05), and number of years living in the U.S. (r = .26, p < .001). Conversely, spirituality and favorable attitudes were negatively associated (r = −.17, p < .05). Conclusion: Immigrant and culturally diverse individuals have experienced different living and healthcare environments. These differences can influence their EOL care planning and decisions. Knowledge of diverse perspectives and cultures is essential to design culturally congruent plans of EOL care.

Requests for euthanasia and physician-assisted suicide and the availability and application of palliative options

2006 ◽  
Vol 4 (4) ◽  
pp. 399-406 ◽  
Author(s):  
MARIJKE C. JANSEN-VAN DER WEIDE, ◽  
BREGJE D. ONWUTEAKA-PHILIPSEN ◽  
GERRIT VAN DER WAL
Keyword(s):  
Decision Making ◽  
Observational Study ◽  
General Practitioners ◽  
Assisted Suicide ◽  
Medical Futility ◽  
Physician Assisted Suicide

Objective: This study investigated the palliative options available when a patient requested euthanasia or physician-assisted suicide (EAS), the extent to which the options were applied, and changes in the patient's wishes.Methods: In an observational study, 3614 general practitioners (GPs) filled in a questionnaire and described their most recent request for EAS (if any) (n = 1,681).Results: Palliative options were still available in 25% of cases. In these cases options were applied in 63%; in 46% of these cases patients withdrew their request. Medication other than antibiotics, which was most frequently mentioned as a palliative option (67%), and applied most frequently (79%), together with radiotherapy, most frequently resulted in patients withdrawing their request.Significance of results: GPs include the availability of palliative options in their decision making when considering EAS. The fact that not all options are applied or, if applied, the patient persists in the request is related to autonomy of the patient, the burden on the patient, and medical futility of the option.

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

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.

Patient autonomy and participation in end-of-life decision-making: An interpretive-systemic focus group study on perspectives of Asian healthcare professionals

2019 ◽  
Vol 18 (4) ◽  
pp. 425-430 ◽  
Author(s):  
Oindrila Dutta ◽  
Priya Lall ◽  
Paul Victor Patinadan ◽  
Josip Car ◽  
Chan Kee Low ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Patient Autonomy ◽  
Healthcare Professionals ◽  
Program Effectiveness ◽  
Self Determination ◽  
Truth Telling ◽  
Focus Group Study ◽  
Eol Care ◽  
Care Decision

AbstractObjectivesAsia's first national advance care planning (ACP) program was established in Singapore in 2011 to enhance patient autonomy and self-determination in end-of-life (EoL) care decision-making. However, no known study has examined the extent to which ACP in Singapore successfully met its aims. The purpose of the current study was to examine the attitudes of local healthcare professionals on patients’ autonomy in decision-making at the EoL since they strongly influence the extent to which patient and family wishes are fulfilled.MethodsGuided by the Interpretive-Systemic Framework and Proctor's conceptual taxonomy of implementation research outcomes, an interview guide was developed. Inquiries focused on healthcare professionals’ attitudes towards ACP, their clinical experiences working with patients and families, and their views on program effectiveness. Sixty-three physicians, nurses, medical social workers, and designated ACP coordinators who were actively engaged in ACP facilitation were recruited from seven major hospitals and specialist centers in Singapore through purposive sampling. Twelve interpretive-systemic focus groups were conducted, recorded, transcribed, and analyzed using a thematic analysis.ResultsThe extent to which patients in Singapore can exert autonomy in EoL care decision-making is influenced by five themes: (i) collusion over truth-telling to patient, (ii) deferment of autonomy by patients, (iii) negotiating patient self-determination, (iv) relational autonomy as the gold standard and (v) barriers to realization of patient choices.Significance of resultsHealthcare practitioners in Asian communities must align themselves with the values and needs of patients and their family and jointly make decisions that are consistent and congruent with the values of patients and their families. Sensitivity towards such cross-cultural practices is key to enhancing ACP awareness, discourse, and acceptability in Asian communities.

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