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

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.

scholarly journals Public and physicians’ support for euthanasia in people suffering from psychiatric disorders: a cross-sectional survey study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Kirsten Evenblij ◽  
H. Roeline W. Pasman ◽  
Agnes van der Heide ◽  
Johannes J. M. van Delden ◽  
Bregje D. Onwuteaka-Philipsen
Keyword(s):  
Psychiatric Disorders ◽  
General Public ◽  
Assisted Suicide ◽  
Psychiatric Patients ◽  
Good Health ◽  
Survey Study ◽  
Political Debate ◽  
Cross Sectional Survey ◽  
Eligibility Criteria ◽  
Cross Sectional

Abstract Background Although euthanasia and assisted suicide (EAS) in people with psychiatric disorders is relatively rare, the increasing incidence of EAS requests has given rise to public and political debate. This study aimed to explore support of the public and physicians for euthanasia and assisted suicide in people with psychiatric disorders and examine factors associated with acceptance and conceivability of performing EAS in these patients. Methods A survey was distributed amongst a random sample of Dutch 2641 citizens (response 75%) and 3000 physicians (response 52%). Acceptance and conceivability of performing EAS, demographics, health status and professional characteristics were measured. Multivariable logistic regression analyses were performed. Results Of the general public 53% were of the opinion that people with psychiatric disorders should be eligible for EAS, 15% was opposed to this, and 32% remained neutral. Higher educational level, Dutch ethnicity, and higher urbanization level were associated with higher acceptability of EAS whilst a religious life stance and good health were associated with lower acceptability. The percentage of physicians who considered performing EAS in people with psychiatric disorders conceivable ranged between 20% amongst medical specialists and 47% amongst general practitioners. Having received EAS requests from psychiatric patients before was associated with considering performing EAS conceivable. Being female, religious, medical specialist, or psychiatrist were associated with lower conceivability. The majority (> 65%) of the psychiatrists were of the opinion that it is possible to establish whether a psychiatric patient’s suffering is unbearable and without prospect and whether the request is well-considered. Conclusion The general public shows more support than opposition as to whether patients suffering from a psychiatric disorder should be eligible for EAS, even though one third of the respondents remained neutral. Physicians’ support depends on their specialization; 39% of psychiatrists considered performing EAS in psychiatric patients conceivable. The relatively low conceivability is possibly explained by psychiatric patients often not meeting the eligibility criteria.

scholarly journals Attitudes towards physician-assisted suicide and euthanasia in Spanish university students

2019 ◽  
Vol 27 (3) ◽  
pp. 490-499 ◽  
Author(s):  
María Sol Rodríguez-Calvo ◽  
José Luis Soto ◽  
Isabel María Martínez-Silva ◽  
Fernando Vázquez-Portomeñe ◽  
José Ignacio Muñoz-Barús
Keyword(s):  
Medical Students ◽  
University Students ◽  
Undergraduate Students ◽  
Assisted Suicide ◽  
Willingness To Participate ◽  
Physician Assisted Suicide ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Assisted Death ◽  
Academic Degree

Abstract Attitudes toward physician-assisted death among medical students differ between populations. The aim of this study was to explore attitudes towards euthanasia and physician-assisted suicide among Spanish university students. A cross-sectional survey was conducted by asking undergraduate students (Medicine, Nursing and Law) of the University of Santiago de Compostela to complete an anonymous 17-item questionnaire. Most participants exhibited a positive attitude towards physician-assisted suicide (54%) and euthanasia (75%), as well as towards their legalization. Attitudes were consistent with the underlying ethical reasoning, with no differences in terms of age, gender or academic degree. In addition, consistency was found between attitudes and willingness to participate in physician-assisted suicide and euthanasia, should they be legal. The results showed that the attitudes of medical students towards euthanasia and physician-assisted suicide were positive and similar to non-medical students.

scholarly journals Prevalence and characteristics of older adults with a persistent death wish without severe illness: a large cross-sectional survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Iris D. Hartog ◽  
Margot L. Zomers ◽  
Ghislaine J. M. W. van Thiel ◽  
Carlo Leget ◽  
Alfred P. E. Sachs ◽  
...  
Keyword(s):  
Older Adults ◽  
Assisted Suicide ◽  
Oldest Old ◽  
Severe Illness ◽  
Physician Assisted Suicide ◽  
Cross Sectional Survey ◽  
Questionnaire Response ◽  
Cross Sectional ◽  
Death Wishes ◽  
Death Wish

Abstract Background Some older persons develop a persistent death wish without being severely ill, often referred to as “completed life” or “tiredness of life”. In the Netherlands and Belgium, the question whether these persons should have legal options for euthanasia or physician-assisted suicide (EAS) is intensely debated. Our main aim was to investigate the prevalence and characteristics of older adults with a persistent death wish without severe illness, as the lack of this knowledge is a crucial problem in de debate. Methods We conducted a survey among a representative sample of 32,477 Dutch citizens aged 55+, comprising questions about health, existential issues and the nature of the death wish. Descriptive statistics were used to describe the group with a persistent death wish and no severe illness (PDW-NSI) and several subgroups. Results A total of 21,294 respondents completed the questionnaire (response rate 65.6%). We identified 267 respondents (1.25%) as having a persistent death wish and no severe illness (PDW-NSI). PDW-NSI did not only occur among the oldest old. Although qualifying themselves as “not severely ill”, those with PDW-NSI reported considerable health problems. A substantial minority of the PDW-NSI-group reported having had a death wish their whole lives. Within the group PDW-NSI 155 (0.73%) respondents had an active death wish, of which 36 (0.17% of the total response) reported a wish to actually end their lives. Thus, a death wish did not always equal a wish to actually end one’s life. Moreover, the death wishes were often ambiguous. For example, almost half of the PDW-NSI-group (49.1%) indicated finding life worthwhile at this moment. Conclusions The identified characteristics challenge the dominant “completed life” or “tiredness of life” image of healthy persons over the age of 75 who, overseeing their lives, reasonably decide they would prefer to die. The results also show that death wishes without severe illness are often ambiguous and do not necessarily signify a wish to end one’s life. It is of great importance to acknowledge these nuances and variety in the debate and in clinical practice, to be able to adequately recognize the persons involved and tailor to their needs.

Non-physician-assisted suicide in The Netherlands: a cross-sectional survey among the general public

2013 ◽  
Vol 40 (12) ◽  
pp. 842-848 ◽  
Author(s):  
Merel Kristi Schoonman ◽  
Ghislaine José Madeleine Wilhelmien van Thiel ◽  
Johannes Jozef Marten van Delden
Keyword(s):  
The Netherlands ◽  
General Public ◽  
Assisted Suicide ◽  
Physician Assisted Suicide ◽  
Cross Sectional Survey ◽  
Cross Sectional

Chronic disruptive pain in emerging adults with and without chronic health conditions and the moderating role of psychiatric disorders: Evidence from a population-based cross-sectional survey in Canada

2017 ◽  
Vol 17 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Rana A. Qadeer ◽  
Lilly Shanahan ◽  
Mark A. Ferro
Keyword(s):  
Mental Health ◽  
Psychiatric Disorders ◽  
Emerging Adults ◽  
Regression Models ◽  
Daily Functioning ◽  
Moderating Effects ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Drug Disorders

AbstractBackground and aimsThere has been a growth in the proportion of emerging adults vulnerable to pain-related sequelae of chronic health conditions (CHCs). Given the paucity of research during this important developmental period, this study investigated the association between CHCs and chronic disruptive pain among emerging adults and the extent to which psychiatric disorders moderate this association.MethodsData come from the 2012 Canadian Community Health Survey - Mental Health (CCHS-MH). This cross-sectional survey included 5987 participants that were 15-30 years of age and self-reported their CHCs (n = 2460,41%) and the extent to which pain impacted daily functioning using items from the Health Utilities Index Mark 3 (HUI 3). Group comparisons between respondents with CHCs and healthy controls were made using chi-square tests. Odds ratios (OR) and 95% confidence intervals (CI) were computed from ordinal logistic regression models adjusting for sociodemographic covariates. Product-term interactions between CHCs and psychiatric disorders were included in the models to explore moderating effects. All analyses were weighted to maintain representativeness of the study sample to the Canadian population.ResultsThe mean age of participants was 23.5 (SE 0.1) years and 48% were female. Compared to healthy controls, a greater proportion of participants with CHCs reported having chronic pain (20.3% vs. 4.5%, p < 0.001). Among those with chronic pain, respondents with CHCs reported a greater number of activities prevented because of chronic disruptive pain (χ2 = 222.28, p< 0.001). Similarly, in logistic regression models, participants with CHCs had greater odds of reporting chronic disruptive pain (OR = 4.94, 95% CI = 4.08-5.99). Alcohol (β = –0.66; p = 0.025) and drug abuse/dependence disorders (β = –1.24; p = 0.012) were found to moderate the association between CHCs and chronic disruptive pain. Specifically, the probability of chronic disruptive pain was higher for emerging adults without CHCs and with alcohol or drug disorders; however, among participants with CHCs, probability was higher for those without these disorders.ConclusionsThere is a robust association between CHCs and chronic disruptive pain. The moderating effects suggest that alcohol or drug disorders are especially harmful for emerging adults without CHCs and contribute to higher levels of chronic disruptive pain; however, among those with CHCs, alcohol and illicit drugs may be used as a numbing agent to blunt chronic disruptive pain.ImplicationsFindings from this study have implications for the integration and coordination of services to design strategies aimed at managing chronic disruptive pain and preventing pain-related disabilities later in life. Within the health system, healthcare providers should engage in dialogues about mental health and substance use regularly with emerging adults, be proactive in screening for psychiatric disorders, and continue to monitor the impact of pain on daily functioning. Given the age range of emerging adults, there is tremendous opportunity for clinicians to work cooperatively with colleagues in the education system to support emerging adults with and without CHCs. Overall, clinicians, researchers, educators, and those in social services should continue to be mindful of the complex interrelationships between physical and mental health and chronic disruptive pain and work cooperatively to optimize health outcomes and prevent pain-related disabilities among emerging adults.

Side effects following COVID-19 vaccination: A cross-sectional survey with age-related outcomes in Saudi Arabia

2021 ◽  
Vol 11 (3) ◽  
pp. 119-125
Author(s):  
Ahlam Alghamdi ◽  
Alnada Ibrahim ◽  
Mohammed Alraey ◽  
Afrah Alkazemi ◽  
Isra Alghamdi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Side Effects ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Age Related

Euthanasia and assisted suicide for psychiatric disorders

2018 ◽  
pp. 251-290
Author(s):  
Walter Glannon
Keyword(s):  
Psychiatric Disorders ◽  
Assisted Suicide ◽  
Psychiatric Patients ◽  
Patient Experiences ◽  
Treatment Resistant Depression ◽  
Physician Assisted Suicide ◽  
Treatment Resistant ◽  
Reasonable Limit ◽  
Resistant Depression

This chapter discusses reasons for and against euthanasia and physician-assisted suicide for patients with treatment-resistant depression or other psychiatric disorders. Although these actions may seem anathema to the goal of treating psychiatric patients in order to prevent suicide, there may be cases in which it would be permissible to bring about or assist in the death of a person with one of these disorders. The permissibility of these actions depends on four conditions. First, the patient must be competent enough to weigh the reasons for and against euthanasia and assisted suicide. Second, the patient must make an informed and persistent request for it. Third, the suffering the patient experiences from the disorder must be unbearable and interminable. Fourth, the disorder must be resistant to all indicated treatments given to the patient over many years. There must be a reasonable limit to the time a patient could be expected to wait for a possible treatment that might relieve symptoms. Any right to euthanasia or assisted suicide entails at most a permission and not an obligation for a physician to perform these actions.

scholarly journals Age-related factors influence HIV testing within subpopulations: a cross-sectional survey of MSM within the Celtic nations

2019 ◽  
Vol 95 (5) ◽  
pp. 351-357
Author(s):  
Jenny Dalrymple ◽  
Kareena McAloney-Kocaman ◽  
Paul Flowers ◽  
Lisa M McDaid ◽  
Jamie Scott Frankis
Keyword(s):  
Hiv Testing ◽  
Online Survey ◽  
Future Research ◽  
Sociocultural Factors ◽  
Health Improvement ◽  
Cross Sectional Survey ◽  
Related Factors ◽  
Cross Sectional ◽  
Factors Influencing ◽  
Age Related

ObjectivesDespite a recent fall in the incidence of HIV within the UK, men who have sex with men (MSM) continue to be disproportionately affected. As biomedical prevention technologies including pre-exposure prophylaxis are increasingly taken up to reduce transmission, the role of HIV testing has become central to the management of risk. Against a background of lower testing rates among older MSM, this study aimed to identify age-related factors influencing recent (≤12 months) HIV testing.MethodsCross-sectional subpopulation data from an online survey of sexually active MSM in the Celtic nations—Scotland, Wales, Northern Ireland and Ireland (n=2436)—were analysed to compare demographic, behavioural and sociocultural factors influencing HIV testing between MSM aged 16–25 (n=447), 26–45 (n=1092) and ≥46 (n=897).ResultsMultivariate logistic regression demonstrated that for men aged ≥46, not identifying as gay (OR 0.62, CI 0.41 to 0.95), location (Wales) (OR 0.49, CI 0.32 to 0.76) and scoring higher on the personalised Stigma Scale (OR 0.97, CI 0.94 to 1.00) significantly reduced the odds for HIV testing in the preceding year. Men aged 26–45 who did not identify as gay (OR 0.61, CI 0.41 to 0.92) were also significantly less likely to have recently tested for HIV. For men aged 16–25, not having a degree (OR 0.48, CI 0.29 to 0.79), location (Republic of Ireland) (OR 0.55, CI 0.30 to 1.00) and scoring higher on emotional competence (OR 0.57, CI 0.42 to 0.77) were also significantly associated with not having recently tested for HIV.ConclusionKey differences in age-related factors influencing HIV testing suggest health improvement interventions should accommodate the wide diversities among MSM populations across the life course. Future research should seek to identify barriers and enablers to HIV testing among the oldest and youngest MSM, with specific focus on education and stigma.

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