"Legal approach of medical assistance at the End of life — Border line between Hospice Palliative care and Physician-Assisted-Suicide —"

2018 ◽  
Vol 28 (2) ◽  
pp. 1-32
Author(s):  
Ju-hee Eom ◽  
Myung-hee Kim
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Assisted Suicide ◽  
Physician Assisted Suicide ◽  
Medical Assistance ◽  
Border Line ◽  
Hospice Palliative Care

To die, to sleep, perchance to dream? A response to DeMichelis, Shaul and Rapoport

2019 ◽  
Vol 45 (12) ◽  
pp. 832-834 ◽  
Author(s):  
Joel L Gamble ◽  
Nathan K Gamble ◽  
Michal Pruski
Keyword(s):  
Palliative Care ◽  
Medical Ethics ◽  
End Of Life ◽  
Assisted Suicide ◽  
Palliative Sedation ◽  
Physician Assisted Suicide ◽  
Medical Assistance ◽  
End Of Life Decisions ◽  
Medical Assistance In Dying ◽  
Life Decisions

In developing their policy on paediatric medical assistance in dying (MAID), DeMichelis, Shaul and Rapoport decide to treat euthanasia and physician-assisted suicide as ethically and practically equivalent to other end-of-life interventions, particularly palliative sedation and withdrawal of care (WOC). We highlight several flaws in the authors’ reasoning. Their argument depends on too cursory a dismissal of intention, which remains fundamental to medical ethics and law. Furthermore, they have not fairly presented the ethical analyses justifying other end-of-life decisions, analyses and decisions that were generally accepted long before MAID was legal or considered ethical. Forgetting or misunderstanding the analyses would naturally lead one to think MAID and other end-of-life decisions are morally equivalent. Yet as we recall these well-developed analyses, it becomes clear that approving of some forms of sedation and WOC does not commit one to MAID. Paediatric patients and their families can rationally and coherently reject MAID while choosing palliative care and WOC. Finally, the authors do not substantiate their claim that MAID is like palliative care in that it alleviates suffering. It is thus unreasonable to use this supposition as a warrant for their proposed policy.

scholarly journals ASPEK ETIKA DAN LEGAL EUTHANASIA

2018 ◽  
Vol 18 (3) ◽  
Author(s):  
Taufik Suryadi ◽  
Kulsum Kulsum
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Assisted Suicide ◽  
Life Support ◽  
Medical Science ◽  
Final Decision ◽  
Physician Assisted Suicide ◽  
Definition Of Death ◽  
Definition Of

Abstrak. Isu-isu tentang akhir kehidupan (end of life) selalu menarik untuk dibicarakan. Penentuan akhir kehidupan ini sering menjadi dilema bagi para dokter karena apabila dokter tidak memahami tentang pengambilan keputusan akhir hidup pasien ia akan menghadapi konsekuensi bioetika dan medikolegal. Terdapat beberapa istilah yang berkaitan dengan isu akhir kehidupan yaitu euthanasia, withholding and withdrawal life support, physician assisted suicide, dan  palliative care. Dengan berkembangnya ilmu kedokteran dan teknologi, definisi kematian menjadi sulit ditentukan karena dengan bantuan alat canggih kedokteran kehidupan ‘dapat diperpanjang’. Dari kenyataan inilah maka timbul pertanyaan serius: “Sampai kapan dokter harus mempertahankan kehidupan?. Apakah semua jenis pengobatan dan perawatan yang dapat  memperpanjang hidup manusia itu harus selalu diberikan?”.Dari permasalahan ini dapat didiskusikan tentang euthanasia ditinjau dari sudut bioetika dan medikolegal. Kata kunci: euthanasia, aspek bioetika, aspek medikolegal  Abstract .The issues of end of life are always interesting to discussed. This final determination of life is often a dilemma for doctors because if the doctor does not understand the final decision of the patient's life he will face the consequences of bioethics and medicolegal. There are several terms related to the issues of end of life that is euthanasia, withholding and withdrawal life support, physician assisted suicide, and palliative care. With the development of medical science and technology, the definition of death becomes difficult to determine because with the help of advanced medical devices 'life can be extended'. It is from this fact that a serious question arises: "How long should doctors maintain life? Are all types of cure and care that can extend the life of a human should always be given? "From this issues can be discussed about euthanasia in terms of bioethics and medicolegal. Keywords: euthanasia, bioethics aspect, medicolegal aspect

Hospice Palliative Care Volunteers’ Attitudes, Opinions, Experiences, and Perceived Needs for Training Around Medical Assistance in Dying (MAiD)

2021 ◽  
pp. 104990912098513
Author(s):  
Stephen Claxton-Oldfield ◽  
Sophie Beaudette
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Family Members ◽  
Mail Survey ◽  
Medical Assistance ◽  
Perceived Needs ◽  
Medical Assistance In Dying ◽  
Volunteer Programs ◽  
Hospice Palliative Care

Medical assistance in dying (MAiD) has been legal in Canada for over 4 years, but little is known about hospice palliative care (HPC) volunteers’ attitudes toward MAiD. To address this issue, 48 volunteers from 2 HPC volunteer programs in Atlantic Canada completed an anonymous mail survey examining their attitudes, opinions, experiences, and perceived needs for training around MAiD. The volunteers’ responses were generally supportive of MAiD as an end-of-life option and approving of some of the proposed changes to the current MAiD legislation (e.g., 85% of the volunteers either strongly agreed or agreed that advance requests for MAiD should be permitted). In terms of volunteers’ experiences, 15% of the volunteers reported that a patient of theirs had tried to initiate a conversation with them about MAiD. Nearly all (96%) of the volunteers indicated that it was not appropriate for them to bring up the topic of MAiD with their patients or patients’ family members/caregivers. Seventy percent of the volunteers reported that if a patient of theirs chose to pursue MAiD that they would be comfortable with being present (if asked) when it was being administered. Nearly two-thirds (64%) of the volunteers were interested in learning more about MAiD. The implications of this study for volunteer policies, specifically, those policies relating to the role of volunteers when it comes to conversations about MAiD with patients and patients’ family members/caregivers (should they arise) are discussed, as is the need for training on the topic of MAiD.

scholarly journals Requests for euthanasia and assisted suicide: A qualitative study of the wordings of requests from patients at the end of life hospitalised in palliative care units.

2019 ◽  
Author(s):  
Florence Mathieu-Nicot ◽  
Aline Chassagne ◽  
Daniele Leboul ◽  
Anne Bousquet ◽  
Aurélie Godard-Marceau ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
End Of Life ◽  
Assisted Suicide ◽  
Third Party ◽  
Physician Assisted Suicide ◽  
Structured Interviews ◽  
Initial Request ◽  
Registration Number ◽  
Palliative Care Units

Abstract Background Whilst euthanasia and assisted suicide are forbidden by French Law, patients at the end of life, hospitalized in Palliative Care Units, sometimes express the Wish to Hasten their Death. Few Studies have analyzed the formulation of these patient requests in interviews and the associated death-related representations. The DESA study analyzed the expression of patients’ requests, focusing on the terms and how patients worded their wishes. The aim is to identify from the “raw wording” of the patients’ requests, the means of expressing them in all its singularity and evolution. Methods This is a qualitative study that took place in 11 French Palliative care Units during on year and included adult patients who had made an explicit request (euthanasia or physician assisted suicide) to a health care provider. Semi-structured interviews were conducted within 48 hours of the initial request (D0), then a week later (D7). Results At DO, the initial request is a request for euthanasia and it calls a third person urgently. This request is related to physical and psychological suffering, trauma and representations of death. At D7, we observe a semantic change; the request is less explicit and requires less intervention by a third party. The quest remains that of a death without suffering. Conclusions These patients express themselves easily on their request and listening is necessary to be able to hear the meaning of the words but also their functions. It is their nuance, variety and evolution that help to understand what the requirements mean. Trial registration number : ClinicalTrials.gov Identifier: NCT02845817

scholarly journals Medical assistance in dying legislation: Hospice palliative care providers’ perspectives

2021 ◽  
pp. 096973302110120
Author(s):  
Soodabeh Joolaee ◽  
Anita Ho ◽  
Kristie Serota ◽  
Matthieu Hubert ◽  
Daniel Z Buchman
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Health Providers ◽  
Care Providers ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Care Plans ◽  
Hospice Palliative Care

Background: After over 4 years since medical assistance in dying legalization in Canada, there is still much uncertainty about how this ruling has affected Canadian society. Objective: To describe the positive aspects of medical assistance in dying legalization from the perspectives of hospice palliative care providers engaging in medical assistance in dying. Design: In this qualitative descriptive study, we conducted an inductive thematic analysis of semi-structured interviews with hospice palliative care providers. Participants and setting: Multi-disciplinary hospice palliative care providers in acute, community, residential, and hospice care in Vancouver and Toronto, Canada, who have engaged in end-of-life care planning with patients who have inquired about and/or requested medical assistance in dying. Ethical considerations: The research proposal was approved by University of British Columbia Research Ethics Board in Vancouver and University Health Network in Toronto. Participants were informed regarding the research goals, signed a written consent, and were assigned pseudonyms. Results: The 48 participants included hospice palliative care physicians (n = 22), nurses (n = 15), social workers (n = 7), and allied health providers (n = 4). The average interview length was 50 min. Positive aspects of medical assistance in dying legalization were identified at (1) the individual level: (a) a new end-of-life option, (b) patients’ last chance to express control over their lives, (c) patient and family comfort and relief, and (d) a unique learning experience for hospice palliative care providers; (2) the team level: (a) supportive collegial relationships, (b) broadened discussions about end-of-life and palliative care, and (c) team debriefs provide opportunities for education and support; and (3) the institutional level: (a) improved processes to facilitate the implementation logistics. Conclusion: While being involved in the medical assistance in dying process is complex and challenging, this study sheds light on the positive aspects of medical assistance in dying legalization from the hospice palliative care provider’s perspectives. Medical Assistance in Dying legalization has resulted in improved end-of-life conversations between hospice palliative care providers, patients, and their families. Improved communication leads to a better understanding of patients’ end-of-life care plans and bridges some of the existing gaps between hospice palliative care and medical assistance in dying.

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 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.

Terminal Sedation: Palliative Care for Intractable Pain, Post Glucksberg and Quill

2003 ◽  
Vol 29 (1) ◽  
pp. 45-76
Author(s):  
Rob McStay
Keyword(s):  
Palliative Care ◽  
Supreme Court ◽  
Assisted Suicide ◽  
Life Support ◽  
Intractable Pain ◽  
Terminal Sedation ◽  
Physician Assisted Suicide ◽  
The Right ◽  
Artificial Life Support ◽  
Unconscious State

In 1997, the U.S. Supreme Court tacitly endorsed terminal sedation as an alternative to physician-assisted suicide, thus intensifying a debate in the legal and medical communities as to the propriety of terminal sedation and setting the stage for a new battleground in the “right to die” controversy. Terminal sedation is the induction of an unconscious state to relieve otherwise intractable distress, and is frequently accompanied by the withdrawal of any life-sustaining intervention, such as hydration and nutrition. This practice is a clinical option of “last resort” when less aggressive palliative care measures have failed. Terminal sedation has also been described as “the compromise in the furor over physician-assisted suicide.”Medical literature suggests that terminal sedation was a palliative care option long before the Supreme Court considered the constitutional implications of physician-assisted suicide. Terminal sedation has been used for three related but distinct purposes: (1) to relieve physical pain; (2) to produce an unconscious state before the withdrawal of artificial life support; and (3) to relieve non-physical suffering.

scholarly journals Trends and Patterns in the Public Awareness of Palliative Care, Euthanasia, and End-of-Life Decisions in 3 Central European Countries Using Big Data Analysis From Google: Retrospective Analysis (Preprint)

2021 ◽  
Author(s):  
Matthias Huemer ◽  
Daniela Jahn-Kuch ◽  
Guenter Hofmann ◽  
Elisabeth Andritsch ◽  
Clemens Farkas ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Assisted Suicide ◽  
Public Awareness ◽  
End Of Life Decisions ◽  
The Public ◽  
Care Services ◽  
Life Decisions ◽  
Advance Health Care Directives

BACKGROUND End-of-life decisions, specifically the provision of euthanasia and assisted suicide services, challenge traditional medical and ethical principles. Austria and Germany have decided to liberalize their laws restricting assisted suicide, thus reigniting the debate about a meaningful framework in which the practice should be embedded. Evidence of the relevance of assisted suicide and euthanasia for the general population in Germany and Austria is limited. OBJECTIVE The aim of this study is to examine whether the public awareness documented by search activities in the most frequently used search engine, Google, on the topics of <i>palliative care, euthanasia</i>, and <i>advance health care directives</i> changed with the implementation of palliative care services and new governmental regulations concerning end-of-life decisions. METHODS We searched for policies, laws, and regulations promulgated or amended in Austria, Germany, and Switzerland between 2004 and 2020 and extracted data on the search volume for each search term topic from Google Trends as a surrogate of public awareness and interest. Annual averages were analyzed using the Joinpoint Regression Program. RESULTS Important policy changes yielded significant changes in search trends for the investigated topics. The enactment of laws regulating advance health care directives coincided with a significant drop in the volume of searches for the topic of euthanasia in all 3 countries (Austria: −24.48%, <i>P</i>=.02; Germany: −14.95%, <i>P</i><.001; Switzerland: −11.75%, <i>P</i>=.049). Interest in palliative care increased with the availability of care services and the implementation of laws and policies to promote palliative care (Austria: 22.69%, <i>P</i>=.01; Germany: 14.39, <i>P</i><.001; Switzerland: 17.59%, <i>P</i><.001). The search trends for advance health care directives showed mixed results. While interest remained steady in Austria within the study period, it increased by 3.66% (<i>P</i><.001) in Switzerland and decreased by 2.85% (<i>P</i><.001) in Germany. CONCLUSIONS Our results demonstrate that legal measures securing patients’ autonomy at the end of life may lower the search activities for topics related to euthanasia and assisted suicide. Palliative care may be a meaningful way to raise awareness of the different options for end-of-life care and to guide patients in their decision-making process regarding the same.

Sign in / Sign up

Export Citation Format

Share Document