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The Euthanasia Law in Belgium and the Netherlands
Abstract
Recently, a law on euthanasia has been adopted in both the Netherlands and Belgium. In both countries euthanasia has been legalised under strict conditions and after confirmation with a notification procedure. Although both laws are similar, the Belgian law is more extensive on the requirements of prudent practice. On the other hand, in the Dutch society the norm setting on euthanasia has been more widely developed through jurisprudence. Nevertheless, we expect that the medical implementation of the new law and the notification procedure in Belgium will be more difficult than in the Netherlands. In order to promote, safeguard and guarantee the quality of the euthanasia practice, the present euthanasia notification procedure in the Netherlands is supplemented with feedback to the physicians. The strictly anonymous procedure in the Belgian notification procedure prevents this possibility. Therefore, Belgian physicians will not be aided by the notification procedure to improve their knowledge and skills in euthanasia. In Belgium, it is still uncertain whether and how this law will be supported by the medical profession and by the medical schools.
... In the Netherlands, euthanasia is defined as the termination of life by a doctor at the request of a patient (de Haan, 2002;Deliens & Van Der Wal, 2003). The prevalence of euthanasia is increasing in the Netherlands from 2.8% in 2010 to 4.5% in 2015 and in the Dutch spoken part of Belgium from 1.9% to 4.6% between 2007 and 2013 (Chambaere, Vander Stichele, & Mortier, 2015;Dierickx, Deliens, Cohen, & Chambaere 2016;Onwuteaka-Philipsen 2017;Steck, Egger, Maessen, Reisch, & Zwahlen, 2013;Van Der Heide, Van Delden, & Onwuteaka-Philipsen, 2017). ...
... Euthanasia is a criminal offense unless six criteria are met. These criteria, also called the "requirements of due care," are specified in the Dutch Euthanasia Act (Textbox 1) (Deliens & Van Der Wal, 2003; Wet toetsing levensbe€ eindiging op verzoek en hulp bij zelfdoding, 2014). ...
... When the initial thoughts or questions develop over time to an actual request for euthanasia, implying that the patient wants to have his or her life ended by euthanasia in the short term, the request is discussed within the multi-disciplinary team. The rules set by Dutch law are strictly followed (Deliens & Van Der Wal, 2003; Wet toetsing levensbe€ eindiging op verzoek en hulp bij zelfdoding, 2014). ...
In this retrospective study, determinants of unbearable suffering in hospice patients who died due to euthanasia were analyzed. The four dimensions of suffering (physical, psychological, social, and existential) were used as a framework. 28 patients (5% of all admitted patients in nine years) were included. Most patients indicated 3–5 determinants, predominantly a combination of physical (96% of patients) and existential determinants (89%). Fatigue, anorexia, and dry mouth were the most prevalent and severe symptoms. Psychological (21%) and social determinants (4%) were much less often described. The results of this study may be used to assess determinants playing a role in euthanasia requests.
... Euthanasia, defined as the intentional ending of a patient's life through the administration of life-ending drugs by a physician at the explicit patient's request (1)(2)(3), is only permitted by law in a small number of countries or regions worldwide. Moreover, the legal framework in these places mainly applies to terminally physically ill patients (4). ...
... On the 27th of April 2010, euthanasia was carried out on a 38-year-old woman in the presence of her family. 3 The procedure was approved by three physicians (two general practitioners and one psychiatrist), as the Belgian Euthanasia Law demands (15, 16). After the euthanasia had been carried out, the case was reviewed by the FCECE, which decided that the due care criteria had been met and unanimously approved the case. ...
Background
Belgium is one of the few countries worldwide where euthanasia on the grounds of unbearable suffering caused by a psychiatric disorder is legally possible. In April 2010 euthanasia was carried out on a 38-year-old Belgian woman with borderline personality disorder and/or autism. After a complaint by the family, three physicians were referred to the Court of Assizes on the charge of “murder by poisoning”.
Methods
A content analysis of print and online news coverage of the euthanasia case in a selected sample of Flemish newspapers and magazines, published between December 1, 2019 and March 1, 2020, was conducted to analyze the prominence and framing of the euthanasia case, as well as the portrayal of key figures in this case. A quantitative analysis, as well as an in-depth qualitative analysis (with the aid of NVivo 1.0 software) was performed.
Results
One thousand two hundred fifteen news articles were identified through database searching. Of these, 789 articles were included after screening for relevance and eligibility. Mean prominence scores were moderate and did not statistically significantly differ between newspapers with a different historical ideological background or form (elite versus popular). The most frequent headline topics featured legal aspects (relating to the Belgian Euthanasia Law or the course of the trial). Headlines and content of most articles (90 and 89%, respectively) did not contain an essential standpoint on the euthanasia case itself or, if they did, were neutral. Historical ideological background, nor form of newspaper (elite versus popular) significantly influenced headline tone or article direction toward the euthanasia case. Despite this, our qualitative analysis showed some subtle differences in selection, statement or tonality of reports between certain newspapers with a different historical ideological background.
Conclusion
Although major Flemish newspapers and magazines generally were neutral in their coverage of the judicial case, major points of contention discussed were: the need for an evaluation and possible amendments to the existing Euthanasia Law, including a revision of the Belgian Control Commission and the system of penalties for physicians, and the absence of any consensus or guidance on how to define psychological suffering.
... In various European countries, the question whether the possibility of terminating the life of suffering and terminally ill patients in medical practice should be legalised, has been publicly debated. In 2002, both the Netherlands and Belgium legalised (active voluntary) euthanasia (Deliens & van der Wal, 2003: 1240. In Switzerland, (physician) assisted suicide (PAS) is not prosecuted when it is done without 'self-interest' (Bosshard, Fischer & Bar, 2002: 527). ...
... Two elements have been particularly important in this change, in the social and political debate and in the procedural rule-making. First, the evidence that euthanasia occurs in many European countries (as well as outside Europe) has increased concern about the necessity to better understand how euthanasia is performed and how to ensure safe practice (Deliens & van der Wal, 2003: 1240. The growing support of the general public for a 'right to die' legislation has been an important influence for the euthanasia debate (Benson, 1999(Benson, : 2658. ...
The moral and ethical justifiability of euthanasia has been a highly contentious issue. It is a complex concept that has been highly discussed by scholars all around the world for decades. Debates concerning euthanasia have become more frequent during the past two decades. The fact that polls show strong public support has been used in legislative debates to justify that euthanasia should be legalised. However, critics have questioned the validity of these polls. Nonetheless, the general perceptions about life are shifting from a 'quantity of life' to a 'quality of life approach', and from a paternalist approach to that of the patient's autonomy. A 'good death' is now being connected to choice and control over the time, manner and place of death. All these developments have shaped discussion regarding rights of the terminally ill to refuse or discontinue life-sustaining efforts or to even ask for actively ending their life.
... However, until otherwise established, the one who determines the handling of the dying patient, as re ected in the legislation, is still the doctor. Thus, in the Netherlands [17][18][19][20][21][22], Belgium [19,21,23], Luxembourg [24,25], Quebec [24,25], and the United States [31,33], countries where physician-assisted suicide is permitted, only a physician can terminate the life of a patient and he is obligated to consult an additional physician before any action is taken. In these countries and in Switzerland [17,24], prescribing a medication used to terminate life can be done only by a physician. ...
... However, until otherwise established, the one who determines the handling of the dying patient, as re ected in the legislation, is still the doctor. Thus, in the Netherlands [17][18][19][20][21][22], Belgium [19,21,23], Luxembourg [24,25], Quebec [24,25], and the United States [31,33], countries where physician-assisted suicide is permitted, only a physician can terminate the life of a patient and he is obligated to consult an additional physician before any action is taken. In these countries and in Switzerland [17,24], prescribing a medication used to terminate life can be done only by a physician. ...
Background: Coping with end-of-life issues is a major challenge for governments and health systems. Despite progress in legislation, many barriers exist to its full implementation. This study is aimed at identifying these end-of-life barriers in relation to Israel.
Methods: Qualitative in-depth interviews using professionals and decision makers in the health-care and related systems (n=37) were carried out, along with two focus groups based on brainstorming techniques consisting of nurses (n=10) and social workers (n=10). Data was managed and analyzed using Naralyzer software.
Results: Qualitative analysis showed identification of six primary barriers: 1) law, procedures, and forms; 2) clinical aspects; 3) human aspects; 4) knowledge and skills of medical teams; 5) communication; and 6) resource allocation. These were further divided into 44 sub area barriers.
Conclusions: This study highlights the role of the family doctor in end-of-life by training physicians in decision-making workshops and increasing their knowledge in the field of palliative medicine. Effectively channeling resources, knowledge, and support for medical teams, by accounting for the structure and response of the units for home treatment will improve patient's access to information on and support for end-of-life laws, as well as reduce legislative barriers in other countries that face the same issues.
... However, until otherwise established, the one who determines the handling of the dying patient, as re ected in the legislation, is still the doctor. Thus, in the Netherlands [17][18][19][20][21][22], Belgium [19,21,23], Luxembourg [24,25], Quebec [24,25], and the United States [31,33], countries where physician-assisted suicide is permitted, only a physician can terminate the life of a patient and he is obligated to consult an additional physician before any action is taken. In these countries and in Switzerland [17,24], prescribing a medication used to terminate life can be done only by a physician. ...
... However, until otherwise established, the one who determines the handling of the dying patient, as re ected in the legislation, is still the doctor. Thus, in the Netherlands [17][18][19][20][21][22], Belgium [19,21,23], Luxembourg [24,25], Quebec [24,25], and the United States [31,33], countries where physician-assisted suicide is permitted, only a physician can terminate the life of a patient and he is obligated to consult an additional physician before any action is taken. In these countries and in Switzerland [17,24], prescribing a medication used to terminate life can be done only by a physician. ...
Background Coping with end-of-life issues is a major challenge for governments and health systems. Despite progress in legislation, many barriers exist to its full implementation. This study is aimed at identifying these end-of-life barriers in relation to Israel.
Methods Qualitative in-depth interviews using professionals and decision makers in the health-care and related systems (n=37) were carried out, along with two focus groups based on brainstorming techniques consisting of nurses (n=10) and social workers (n=10). Data was managed and analyzed using Naralyzer software.
Results Qualitative analysis showed identification of six primary barriers: 1) law, procedures, and forms; 2) clinical aspects; 3) human aspects; 4) knowledge and skills of medical teams; 5) communication; and 6) resource allocation. These were further divided into 44 sub area barriers.
Conclusions This study highlights the role of the family doctor in end-of-life by training physicians in decision-making workshops and increasing their knowledge in the field of palliative medicine. Effectively channeling resources, knowledge, and support for medical teams, by accounting for the structure and response of the units for home treatment will improve patient's access to information on and support for end-of-life laws, as well as reduce legislative barriers in other countries that face the same issues.
... The Netherlands was the first country to adopt a law on euthanasia in April 2002 after about 30 years of experience with the practice and regulated tolerance between 1990 and 2002 (Deliens and van der Wal, 2003). The law also includes physician-assisted suicide. ...
... The law also includes physician-assisted suicide. The Belgian law, adopted by parliament in May 2002, was strongly based on the Dutch law (Deliens and van der Wal, 2003). Although it does not mention physician-assisted suicide the practice is considered to be a form of euthanasia by the euthanasia review committee (Belgian Federal Control and Evaluation Committee on Euthanasia, 2014). ...
Advances in medicine have greatly improved the methods available to treat seriously ill patients and prolong life. However, it is increasingly recognized that prolonging life might not always be an appropriate goal of medicine and that other goals have to guide medical decision making at the end of life, such as improving the quality of life of patients and their families. If such decisions potentially shorten life, they may be termed end-of-life decisions. The medical end-of-life decisions most often discussed are euthanasia and physician-assisted suicide, which are the focus of this article. We first provide the societal and cultural background surrounding these practices, as well as conceptual clarification, distinguishing them from other end-of-life decisions that may potentially hasten death. The article then addresses the three major functions of a public health approach to euthanasia and physician-assisted suicide: (1) assessment and monitoring of the practices, (2) assurance that the practices adhere to (legal) due care criteria, and (3) mapping and evaluating policy developments.
... An increasing number of countries legally permit the performance of euthanasia and assisted suicide (EAS) for psychiatric illnesses judged to be untreatable. [1][2][3][4] There is however a lack of knowledge regarding the clinical and social demographics of patients requesting EAS. 5 6 This study provides the first large-scale analysis of the social, demographic and psychiatric profile of 1122 patients who made a potentially eligible request for EAS to the Expertise Centrum for Euthanasia (EE). The EE is an independent professional healthcare organisation based in the Hague in the Netherlands. ...
Background
Euthanasia and assisted suicide (EAS) for patients with psychiatric disorders occupies a prominent place in the public debate, but little is known about the psychiatric patients requesting and receiving EAS.
Objective
To compare the social demographic and psychiatric profile of the patients who make a request for EAS and those who receive it.
Method
We carried out a review of records from 1122 patients with psychiatric disorders who have filed a potentially eligible request for EAS at Expertise Centrum for Euthanasia (EE) in the period 2012–2018.
Findings
The majority of the patients requesting EAS were single females, living independently with a comorbid diagnosis of depression with a history of undergoing psychiatric treatment for more than 10 years. From the small number of patients who went on to receive EAS in our sample, the majority were also single women, with a diagnosis of depressive disorder. A small subgroup of patients whose diagnoses included somatic disorders, anxiety disorders, obsessive-compulsive disorders and neurocognitive disorders were over-represented in the group of patients receiving EAS compared with the applicant group.
Conclusion
The average demographic and psychiatric profile of patients requesting and receiving EAS were found to be broadly similar. The majority of patients requesting EAS had received a comorbid diagnosis, making this a difficult-to-treat patient group. Only a small number of patients requesting had their requests granted. Patients from different diagnostic groups showed patterns in why their requests were not granted.
Clinical implications
Many of the patients who withdrew their requests for EAS benefited from being able to discuss dying with end of life experts at EE. Health professionals can make a difference to a vulnerable group of patients, if they are trained to discuss end of life.
... Dr. Marc Moens, president of the Belgian Association of Doctors' Unions (BVAS), even said that "doctors know that this law is simply flawed and find it totally unacceptable that individuals who are not terminally ill will also be eligible for euthanasia" (Nys, 2002). The Dutch law was the subject of an extensive public debate that had begun in the 1970s, whereas the Belgian euthanasia law was the result of a debate that lasted only three years, both in Parliament and within the Bioethics Advisory Committee (Deliens, 2003). Some go so far as to argue that "the 2002 Act on Euthanasia was a hasty and flawed piece of legislation which served to justify a preexistent practice" (Saad, 2017). ...
The global pandemic situation created by COVID-19 leaves many questions open in areas as diverse as politics, economics, society and ethics. The scarcity of health resources and the use that has been made of these by some governments raises the question of whether the distribution of health resources has been equitable, or whether the allocation of health resources depended on criteria such as age. The present work investigates whether those countries or geographical areas where euthanasia is legalized, decriminalized or socially accepted, have followed selective policies limiting access to healthcare by the elderly, thus undermining what is understood as quality of life.
... Cases are reported. The doctor must fulfil the requirements of due care and consult at least one other doctor on the case; the patient must make their request voluntarily and be suffering from unbearable physical or psychological pain [9,49]. ...
In this report the Palliative Care (PC) industry is analysed in the context of increasing acceptance of Euthanasia and/or Assisted Suicide (EAS). Currently, EAS is only legalised in a few countries and US states, but that number is increasing. Patients have the option between continued palliative care or a swift death via EAS which represents a risk that PC providers will have their services substituted by EAS options. This report assess the nature and severity of that substitution threat.
Chapter 1 in a short introduction providing more context. Chapter 2 provides a detailed overview of the PC industry, including how to classify it, its history and current status, and a short analysis of the Porter's factors. Chapter 3 discusses EAS, detailing nomenclature, ethical concerns, legality, and the current practice in four countries -- The Netherlands, Belgium, Switzerland, and USA. Significant differences are observed between the four countries. EAS can be considered a 'proto-industry', it is in its earliest stages of development, its existence depends entirely on its legal status, and business models are only just beginning to form (mostly in Switzerland). Belgium is unique in that EAS has already been integrated within the PC industry. Providers of both PC and EAS might be considered the first players in an emerging 'end-of-life' industry.
Chapter 4 provides the analysis of the substitution threat. The nature of the substitution is laid out, noting that use of EAS does not exclude the use of PC before the fact - there is some evidence that they compliment one another. However, once EAS is committed, PC revenues are lost as the patient stops receiving PC for the remaining weeks that they would have otherwise lived. A model is developed to quantify the loss to the PC industry. Lost profits are estimated for the US PC industry to be currently only $0.8m, but potentially up to 6% of PC revenues are at stake if EAS becomes comparably as common as the Netherlands, but the calculations are fraught with uncertainty. Thus the model is more intended for use within PC providers who can use it to predict their individual losses using their private financial data.
Chapter 4 continues by recommending how the PC industry should respond to the threat in order to minimise losses. First a technique for estimating the likelihood of (continued) EAS legalisation is presented based on the cultural acceptance of EAS and the quality of existing PC. If legalisation is found to be likely, PC providers should move to integrate EAS within their services similar to the Flanders region of Belgium. This way the losses due to EAS can be mitigated by new gains from the EAS procedures. However, if EAS legalisation is found to be unlikely, no response is needed.
... M edical assistance in dying (MAiD) was decrimin alized by the Supreme Court of Canada in Feb ruary 2015, 1 and Canada's federal legislation on MAiD (Bill C14) was passed on June 17, 2016. 2 Since the legislation was passed, through to the end of 2019, a total of 13 946 Canadians have accessed MAiD. 3 Canada joined a growing number of international jurisdictions affording individuals the right to an assisted death, including regions in Europe, the United States, Latin America and Australia. [4][5][6][7][8][9] In Canada, the eligibility requirements for MAiD stipulate that the patient be at least 18 years of age, make a voluntary request, possess capacity to provide consent for MAiD and have a grievous and irremediable medical condition. The lat ter is defined as an illness, disease or disability resulting in an advanced state of irreversible decline wherein the patient is experiencing intolerable physical or psychological suffering and natural death has become reasonably foreseeable. ...
Background:
Bill C-14, the legislation that legalized medical assistance in dying (MAiD) in Canada in 2016, outlines eligibility criteria and includes both a mandated 10-day reflection period and a requirement that the patient have capacity to consent at the time MAiD is provided. We examined clinical factors associated with shortened reflection periods or loss of capacity before provision of MAiD.
Methods:
This retrospective database review involved patients who requested MAiD at a tertiary care hospital in Toronto, Canada, between June 2016 and April 2019. We used logistic regression analyses to examine the association between the combined outcome of unanticipated loss of decisional capacity, shortening of the reflection period or death and the clinical risk factors of interest (age, sex, location of MAiD request [inpatient v. outpatient], score on palliative performance scale [PPS] and diagnosis [cancer v. noncancer]). We generated receiver operating characteristic curves to identify the PPS score (encompassing 5 functional domains: ambulation, activity level, self-care, intake and level of consciousness) that best predicted loss of capacity, shortening of the reflection period or death.
Results:
In total, 155 patients requested assessment for MAiD, and 136 of these were included in the statistical analyses. For 68 patients, the reflection period was not shortened; the other 68 patients lost capacity, died or required shortening of the reflection period. In contrast to the results for age, sex, location of request and diagnosis, the PPS score was associated with loss of capacity or shortening of the reflection period (odds ratio 4.63, 95% confidence interval 2.87-8.23, per 10-point decrease in PPS score). PPS scores less than or equal to 40% balanced sensitivity, specificity and negative predictive value while emphasizing sensitivity to prevent false negative errors.
Interpretation:
The PPS score at the time of MAiD request was strongly associated with loss of capacity or shortening of the reflection period, with lower scores incrementally increasing the risk of these outcomes. For patients with a PPS score of 40% or below, close monitoring is warranted, potentially with plans made to allow rapid provision of MAiD should their clinical condition deteriorate.
... Current debate concerns seeing old-age vulnerability and the accumulation of comorbidities as the result of compounded medical and non-medical problems as unbearable and incurable suffering as defined under the Euthanasia Act [4,5]. In this specific context, the phrase 'the patient is in a medically futile condition of constant and unbearable physical or mental suffering that cannot be alleviated, resulting from a serious and incurable disorder caused by illness or accident' causes divergence in interpretation leading to discussion and a feeling of ambiguity for physicians, healthcare providers and the public. ...
In 2002, the Belgian Act on euthanasia came into effect, regulating the intentional ending of life by a physician at the patient's explicit request. Subsequently, the number of reported euthanasia deaths increased every year. Specifically, the proportion of euthanasia deaths in older persons has risen significantly in the last few years. Since the conception of the Euthanasia Act, Belgian physicians have been confronted with challenges concerning euthanasia requests in older persons with polypathology, tiredness of life or dementia. By exploring these issues, this commentary highlights the importance of a meticulous and team-based assessment of the (i) seriousness of the underlying condition, (ii) voluntariness of the request and (iii) decisional capacity of the older person requesting euthanasia.
... Another major difference in policies between Belgium and the Netherlands is that Belgium does not authorize the right to physician-assisted suicide and allows only physicians to perform euthanasia (Belgium (Euthanasia), 2003). Furthermore, in Belgium the attending physician given a request for MAiD by a patient is required to consult with a second physician regarding the decision to carry out the request (Deliens, van der Wal, Marshall, Fernandez-llimos, & Faus, 2003). ...
Individuals suffering intolerably from a medical condition are legally able to request medical assistance in dying (MAiD) under certain circumstances. MAiD can either entail a physician or nurse practitioner prescribing fatal drugs for the patient to self-administer (physician-assisted suicide) or a physician directly administering lethal drugs (euthanasia). Whereas laws regulating MAiD have been in effect in different areas of the world since 1942, Canada only recently decriminalized MAiD in 2016. Individuals under the age of 18 years are not permitted to receive MAiD in Canada. Because legislation exists in other countries that permit MAiD, the current review aims to (a) review legislation and data pertaining to MAiD in Canada and other countries with particular attention on legislation for minors; (b) address important ethical considerations for extending MAiD services to minors in Canada; and (c) provide recommendations for amendments to current MAiD legislation in Canada based on the findings. Combining data from other countries with ethical implications for offering all options to relieve suffering, it is recommended that Canada extend MAiD legislation to mature minors with the inclusion of psychologists in the assessment of decision-making capacity and informed consent.
... The difficulty with this interpretation is that logically it seems like a basic right of all persons, not to be limited to patients with terminal illness. Indeed, in the Netherlands one sees that logic playing out, as some non-terminal patients have received euthanasia by convincing a physician that a non-medical problem has made their lives not worth living; likewise, the statute adopted in 2002 in Belgium includes special consultation for patients who are not terminally ill [19]. ...
Current efforts to legalize medical aid-in-dying in this country follow a half century of remarkable legal developments regarding when, how, and on whose terms to intervene to prevent death and extend life in critically and terminally ill patients. The starting point-which I call the first stage along the path-was the creation in the two decades following World War II of powerful means of keeping very ill, and typically unconscious, patients alive. The second stage began in the late 1960s as physicians (and then others in society) began to grapple with the consequences of maintaining such patients on life-support indefinitely. Over five decades, judicial decisions, followed by implementing statutes and regulations, transformed legal rights and medical practices. Are the current developments-which center on legalizing medical aid-in-dying-a third stage along the same path, or do the striking differences between the issues raised about life-sustaining treatment and euthanasia suggest that they are separate? What lessons might those proceeding along the aid-in-dying path take from the development of the other path, and if the two paths are still distinct today, might they merge in the future?
... Involuntary or nonvoluntary euthanasia is when euthanasia is undertaken without explicit patient request or consent. 5 In PAS, a physician provides access or means by which a competent person can choose to self-administer a lethal dose of medication (typically barbiturates) with the intention of ending their life. PAS achieves the same outcome as euthanasia with a clear distinction in the method by which that outcome is achieved. ...
Objectives
This study aimed to investigate Australian pharmacists’ views about their role in physician-assisted suicide (PAS), their ethical and legal concerns and overall thoughts about PAS in pharmacy.
Design
Semistructured interviews of pharmacists incorporating a previously validated vignette and thematic analysis.
Setting
Australia (face to face or phone call).
Participants
40 Australian Health Practitioner Regulation Agency registered pharmacists, majority women (65%) with varied experiences in community, hospital, industry, academia, government and other fields.
Results
Emergent themes from the interviews were: legal and logistical framework , ethical framework , training and guidance and healthcare budget . More than half the participants supported the role of pharmacists in the supply of medicines for PAS, while less than half were either against or unsure of the legislation of PAS in Australia. Shared concerns included transparency of prescribing practices and identification of authorised physicians involved in PAS, which were consistent with existing literature. Religious faith, emotion and professional autonomy were key indicators for the implementation of conscientious objection to the supply of medicines in PAS. Re-evaluation of current guidelines, pharmacist training and government reimbursement was also of significance from participants’ perspectives.
Conclusion
This study revealed current concerns of practising pharmacists in Australia, including previously undocumented perspectives on the pharmacoeconomic impact of and barriers relating to PAS. The need for training of all healthcare professionals involved, the provision of clear guidelines, including regulation around storage, administration and disposal of medicines dispensed for PAS and the updating of current therapeutic guidelines around end-of-life care were all issues delineated by this study. These findings highlighted the need for current and future policies to account for all stakeholders involved in PAS, not solely prescribers.
... Euthanasia is usually defined as an act undertaken only under the supervision of a doctor who deliberately ends the life of a person at his or her request 5 . Therefore, the doctor prescribes a lethal substance. ...
Raksts veltīts eitanāzijas pieļaujamības aspektu izpētei, ievērojot Kazahstānas tiesību tradīcijas un pasaules valstu pieredzi. Aiz līdzjūtības izdarīta asistēšana nedziedināmi slima cilvēka pašnāvībai novērš slimības radītas bezjēdzīgas ciešanas. Vienlaikus pastāv daudzas ētiska, tiesiska un medicīniska rakstura problēmas. Juridiski šis jautājums ir daudzšķautņains, jo tiesību normu piemērošanai nepieciešami objektīvi kritēriji, bet eitanāzijas gadījumā nākas operēt ar daudziem subjektīvi vērtējamiem kritērijiem. Pakļaujot citu cilvēku nāvei, vienmēr pastāv ļaunprātīgas rīcības risks. Nobeigumā secināts, ka daudzas valstis neatbalsta eitanāzijas legalizēšanu, uzskatot, ka vairāk jāattīsta paliatīvā aprūpe, kā arī par šiem jautājumiem jāizglīto mediķi un sabiedrība.
... 2<4 Physician-assisted suicide, also known as physician-assisted death (PAD), refers to the voluntary self-administration of medications prescribed by a physician with the specific purpose to cause death. 2 Voluntary euthanasia differs from PAS and PAD in that the physician administers the lethal medication on the direction of the individual making the request to end life. Although PAS (ie, the voluntary self-administration of lethal medication prescribed by a physician with the specific purpose to cause death) has been legal in the Canadian province of Quebec since 2014, 5 Canadian MAiD law expanded on Quebec's Bill 52 by broadening the eligibility criteria, extending the practice to include the rest of Canada, and developing a role for NPs in both prescribing and administering medications to cause death. 1 Under the Canadian criminal code, VE and PAS became collectively known as MAiD. ...
In June 2016, Bill C-14 or Medical Assistance in Dying legislation became law in Canada. With this law came changes to nurses' (ie, nurse practitioner, registered nurse, registered practical nurse) scopes of practice, roles, and responsibilities. While federal law, regulatory, and organizational policies are developed to inform nurses about the practice of medical assistance in dying, there is little evidence examining how nurses' roles and responsibilities are enacted in practice. Therefore, a scoping review was conducted to synthesize the evidence on nurses' roles and responsibilities in relation to medical assistance in dying and to identify gaps in the literature. A secondary aim was to identify organizational supports for nurses to effectively and ethically engage in medical assistance in dying. Using a recognized and rigorous scoping review methodology, the findings from 24 research studies were synthesized in this article. The analysis highlights the importance of effective health care professional engagement with the individual in the decision-making process and of the need to educate, support, and include nurses in providing medical assistance in dying. Overall, the current research on medical assistance in dying is limited in Canada, and more attention is needed on the role of the nurse.
... In 2002, Belgium legislated euthanasia for adults and emancipated minors (Deliens and van der Wal 2003;Griffiths, Weyers, and Adams 2008;Vermeersch 2002; see also Patients Rights Council 2018). The legislation explicated the terms for physicians to end the lives of "the adult or emancipated minor patient" who is in a medically hopeless condition of "constant and unbearable physical or mental suffering that cannot be alleviated, resulting from a serious and incurable condition caused by illness or accident (Constitutional Court 2015). ...
In 2014, Belgium became the first country in the world to legislate euthanasia for children. The decision evoked questions and criticisms in Belgium and in the world at large: should children have the right to ask to die? Are children able to make reasoned and independent choices on such an important matter? Does maturity matter? Are children as autonomous as adults? Is it a logical move to grant terminally ill children who are in intolerable pain this right? What happens if there is a conflict of wishes between the child and parents? This article argues that these questions should be addressed while legislators are fully aware of the relevant medical data regarding child development. The article weighs arguments for and against euthanasia for children, dis cussing patients' autonomy, competence, age and maturity, pressure and abuse, and palliative care. It is suggested that the option of pediatric palliative care should be exhausted before proceeding to euthanasia, and that psychological counselling be made available to both children and guardians. It is further argued that the law should explicate the age of children, and that it should insist on consensus between children and parents.
... This is now possible in Belgium and the Netherlands, where PAD for psychiatric conditions is permitted, though rare, so long as the criteria of due care are met. 1 These criteria require that the physician be convinced that the request of the patient is voluntary and well considered, the patient is suffering unbearably without prospect of improvement, the patient is informed about his situation and prospects, and there are no reasonable alternatives to relieve suffering. Two further conditions are required: an independent physician must be consulted, and the method used must be performed with due medical care and attention. ...
Recently, a few countries have expanded physician-assisted death to individuals with severe, treatment-resistant depression. This article examines the reasons often given against helping those with psychiatric illness to die, and concludes that they do not show that it would always be unjustified. At the same time, the potential danger in expanding the criteria for physician-assisted death is very great, warranting due caution. It remains to be shown that the need for physician-assisted death in this situation outweighs the risks.
... An increasing number of people are confronted with a relative who is dying from a chronic life-limiting disease such as cancer, dementia or cardiovascular disease [1]. These deaths are often, and increasingly, preceded by potentially life-shortening medical endof-life decisions (ELDs) [2][3][4][5][6][7][8][9], including non-treatment decisions (withholding or withdrawing medical treatment) and increasing drug administration to relieve pain and other symptoms, or less common procedures such as physician-assisted suicide and euthanasia (defined as 'the act, undertaken by a third party, which intentionally ends the life of a person at his or her request' [10]). How health care providers deal with the views and concerns of relatives of the person who is dying during the decision-making process is an important determinant of high-quality end-of-life care [11], and informing them about the consequences of a decision, thereby preparing them for the person's death, is the least that can be expected from physicians when such a decision is being made. ...
Objective:
Deaths from chronic illness are often preceded by a potentially life-shortening end-of-life decision (ELD). Involving family in these ELDs may have psychosocial benefits for them and the dying person. This study aims to examine how often ELDs are discussed with relatives of the dying person and which characteristics determine their involvement in those ELDs.
Methods:
A questionnaire survey was conducted in 2013 among physicians attending a large, stratified and representative sample of deaths (n = 6188) in Flanders.
Results:
In 72.3% of ELDs preceding death, family of the dying person were involved. Discussion of an ELD with family members was more likely when the decision was also discussed with the dying person, the ELD was made with the explicit intention to shorten life, specialized palliative care was provided or death occurred in an ICU.
Conclusions:
Involving family in end-of-life decision making appears to be related to the type of formal care services involved, communication with the dying person and the motives behind the decision.
Practice implications:
Our findings suggest a need to further expand a palliative care approach with a focus on both the dying person and their family within and across a variety of health care services.
... I n 2002, Belgium legalized euthanasia, defined as the intentional ending of life by a physician at the patient's explicit request. 1,2 For a patient to be eligible for euthanasia, certain formal criteria for due care must be met. 1 These include a voluntary, well-considered, repeated and written request, expressed by a person with full mental capacity who is fully informed about his or her medical condition and the remaining therapeutic possibilities. 1 The person must be in a state of constant and unbearable physical or mental suffering that cannot be alleviated. Due care criteria for the procedure include an a priori consultation with a second independent physician, consultation with a third physician in cases where death is not expected in the foreseeable future and a posteriori reporting of the case for evaluation purposes. ...
Background:
In 2002, the Belgian Act on Euthanasia came into effect, regulating the intentional ending of life by a physician at the patient's explicit request. We undertook this study to describe trends in officially reported euthanasia cases in Belgium with regard to patients' sociodemographic and clinical profiles, as well as decision-making and performance characteristics.
Methods:
We used the database of all euthanasia cases reported to the Federal Control and Evaluation Committee on Euthanasia in Belgium between Jan. 1, 2003, and Dec. 31, 2013 (n = 8752). The committee collected these data with a standardized registration form. We analyzed trends in patient, decision-making and performance characteristics using a χ2 technique. We also compared and analyzed trends for cases reported in Dutch and in French.
Results:
The number of reported euthanasia cases increased every year, from 235 (0.2% of all deaths) in 2003 to 1807 (1.7% of all deaths) in 2013. The rate of euthanasia increased significantly among those aged 80 years or older, those who died in a nursing home, those with a disease other than cancer and those not expected to die in the near future (p < 0.001 for all increases). Reported cases in 2013 most often concerned those with cancer (68.7%) and those under 80 years (65.0%). Palliative care teams were increasingly often consulted about euthanasia requests, beyond the legal requirements to do so (p < 0.001). Among cases reported in Dutch, the proportion in which the person was expected to die in the foreseeable future decreased from 93.9% in 2003 to 84.1% in 2013, and palliative care teams were increasingly consulted about the euthanasia request (from 34.0% in 2003 to 42.6% in 2013). These trends were not significant for cases reported in French.
Interpretation:
Since legalization of euthanasia in Belgium, the number of reported cases has increased each year. Most of those receiving euthanasia were younger than 80 years and were dying of cancer. Given the increases observed among non-terminally ill and older patients, this analysis shows the importance of detailed monitoring of developments in euthanasia practice.
... 8,9 Consistent with laws in the Netherlands and Belgium, "euthanasia" is usually limited to voluntary cases-those in which the patient is mentally competent and explicitly requests euthanasia. 7,10 Involuntary euthanasia occurs when the patient is mentally competent but did not request euthanasia. Nonvoluntary euthanasia refers to cases when the patient is not mentally competent and could not request euthanasia. ...
Importance:
The increasing legalization of euthanasia and physician-assisted suicide worldwide makes it important to understand related attitudes and practices.
Objective:
To review the legal status of euthanasia and physician-assisted suicide and the available data on attitudes and practices.
Evidence review:
Polling data and published surveys of the public and physicians, official state and country databases, interview studies with physicians, and death certificate studies (the Netherlands and Belgium) were reviewed for the period 1947 to 2016.
Findings:
Currently, euthanasia or physician-assisted suicide can be legally practiced in the Netherlands, Belgium, Luxembourg, Colombia, and Canada (Quebec since 2014, nationally as of June 2016). Physician-assisted suicide, excluding euthanasia, is legal in 5 US states (Oregon, Washington, Montana, Vermont, and California) and Switzerland. Public support for euthanasia and physician-assisted suicide in the United States has plateaued since the 1990s (range, 47%-69%). In Western Europe, an increasing and strong public support for euthanasia and physician-assisted suicide has been reported; in Central and Eastern Europe, support is decreasing. In the United States, less than 20% of physicians report having received requests for euthanasia or physician-assisted suicide, and 5% or less have complied. In Oregon and Washington state, less than 1% of licensed physicians write prescriptions for physician-assisted suicide per year. In the Netherlands and Belgium, about half or more of physicians reported ever having received a request; 60% of Dutch physicians have ever granted such requests. Between 0.3% to 4.6% of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal. The frequency of these deaths increased after legalization. More than 70% of cases involved patients with cancer. Typical patients are older, white, and well-educated. Pain is mostly not reported as the primary motivation. A large portion of patients receiving physician-assisted suicide in Oregon and Washington reported being enrolled in hospice or palliative care, as did patients in Belgium. In no jurisdiction was there evidence that vulnerable patients have been receiving euthanasia or physician-assisted suicide at rates higher than those in the general population.
Conclusions and relevance:
Euthanasia and physician-assisted suicide are increasingly being legalized, remain relatively rare, and primarily involve patients with cancer. Existing data do not indicate widespread abuse of these practices.
... Additionally, physician-assisted suicide, ie, lethal drugs provided by a physician but administered by the patient, has been legally accepted in the Netherlands, Luxemburg, Switzerland, and the states of Oregon, Montana, and Washington in the United States. [21][22][23] Only in the Netherlands is the law on euthanasia or physician-assisted suicide applicable to minors; they can legitimately request assistance in dying from the age of 12 years with parental consent and from the age of 16 years when parents are informed. For neonates, the Groningen Protocol was developed to facilitate reporting of cases for legal control and to enhance quality of decision making. ...
Objectives: To estimate the prevalence of end-of-life decisions and to describe their characteristics and the preceding decision-making process in minors in Belgium.
Design: Population-based postmortem anonymous physician survey.
Setting: Flanders, Belgium.
Participants: All physicians signing the death certificates of all patients (N=250) aged 1 to 17 years who died between June 2007 and November 2008 in Flanders, Belgium.
Outcome Measures: Prevalence and characteristics of end-of-life decisions and the preceding decisionmaking process.
Results: For 165 of the 250 deaths, a physician questionnaire was returned (70.5%). In 36.4%, death was
preceded by an end-of-life decision. Drugs were administered to alleviate pain and symptoms with a possible life-shortening effect in 18.2% of all deaths, nontreatment decisions were made in 10.3%, and lethal drugs without the patient’s explicit request were used in 7.9%. No cases of euthanasia, ie, the use of drugs with the explicit intention to hasten death at the patient’s explicit request, were reported. Poor clinical prospects (84.6%) and low quality of life expectations (61.5%) were important reasons for the physicians to engage in end-of-life decisions. Parents were involved in decision making in 85.2% of these decisions, patients in 15.4%.
Conclusions: Medical end-of-life decisions are frequent in minors in Flanders, Belgium. Whereas parents
were involved in most end-of-life decisions, the patients themselves were involved much less frequently, even when the ending of their lives was intended. At the time of decision making, patients were often comatose or the physicians deemed them incompetent or too young to be involved.
... In Belgium, contrary to the Netherlands, the adoption of the euthanasia law was not preceded by a long preparation period with an explicit tolerance policy in the courts of law, intense intra-and interdisciplinary debate, and the development of professional guidelines. 6 Practical experience with the technical and communicative aspects of euthanasia was limited, both among specialists and GPs. 7 To cope with a flood of individual questions from physicians regarding practical aspects of euthanasia, an organisation for palliative and terminal care set up a counselling service (LEIFartsen), which includes bedside consultation and a telephone service. ...
... Weighing the continuation of life against death they see more advantages in departing life than in maintaining it. In the Netherlands [31][32][33][34] and Belgium [35][36][37][38] most of the people who approach physicians with requests for physician-assisted suicide (PAS) and euthanasia are cancer patients. Cancer is a painful disease that inflicts significant suffering [39][40][41][42]. ...
The article presents the Argument from Autonomy and the Respect for Others Argument as pleas for physician-assisted suicide (PAS). The Kantian argument in support of respecting people always as ends rather than means is emphasized together with the principles of concern and care. The author explains who the patients who wish to die are. The importance of comprehensive palliative care is accentuated and objection to euthanasia is expressed, insisting on checks and balances when we wish to come to the patient’s aid. The plea is confined to physician-assisted suicide, where it is the patient who is in control and performs the final act. The plea for PAS is promoted especially for cancer patients, at the end stage of the disease, who express a repeated wish to die with the help of a doctor. Detailed guidelines for physician-assisted suicide are presented, arguing that we need to insist on them as human lives are at stake. Caution is a must to prevent potential abuse.
... Euthanasia or assisted suicide have been legalized in a small number of countries and states worldwide, and, only in few European states. Currently, Switzerland, Belgium, Luxembourg, and the Netherlands are the only European nations whose laws allow euthanasia [3][4][5][6]. ...
Background
Interventions such as advance care planning (ACP), technology, or access to euthanasia may increase the sense of control over the end of life. In people with advanced dementia, the loss of cognitive and physical function limits the ability to control care. To date, little is known about the acceptability of these interventions from the perspective of persons with dementia and others involved. This study will examine the cross-cultural acceptability, and factors associated with acceptability, of four end-of-life interventions in dementia which contain an element of striving for control. Also, we report on the development and pilot testing of animation video vignettes that explain the interventions in a standardized manner.
Methods
Cross-sectional mixed-methods vignette study. We assess acceptability of two ACP approaches, technology use at the end of life and euthanasia in persons with dementia, their family caregivers and physicians in six countries (Netherlands, Japan, Israel, USA, Germany, Switzerland). We aim to include 80 participants per country, 50 physicians, 15 persons with dementia, and 15 family caregivers. After viewing each animation video, participants are interviewed about acceptability of the intervention. We will examine differences in acceptability between group and country and explore other potentially associated factors including variables indicating life view, personality, view on dementia and demographics. In the pilot study, participants commented on the understandability and clarity of the vignettes and instruments. Based on their feedback, the scripts of the animation videos were clarified, simplified and adapted to being less slanted in a specific direction.
Discussion
In the pilot study, the persons with dementia, their family caregivers and other older adults found the adapted animation videos and instruments understandable, acceptable, feasible, and not burdensome. The CONT-END acceptability study will provide insight into cross-cultural acceptability of interventions in dementia care from the perspective of important stakeholders. This can help to better align interventions with preferences. The study will also result in a more fundamental understanding as to how and when having control at the end of life in dementia is perceived as beneficial or perhaps harmful.
Trial registration
The CONT-END acceptability study was originally registered at the Netherlands Trial Register (NL7985) at 31 August, 2019, and can be found on the International Clinical Trials Registry Platform.
An increasing number of jurisdictions have legalized medical assistance in dying (MAID) with significant variation in the procedures and eligibility criteria used. In the United States, MAID is available for persons with terminal illnesses but is frequently sought by persons with neurologic conditions. Persons with conditions that cause cognitive impairment, such as Alzheimer dementia, are often ineligible for MAID, as their illness is not considered terminal in its early stages, whereas in later stages, they may have impaired decision-making capacity.
De procedure die euthanasie met donatie na circulatoire vaststelling van de dood (DCDD) combineert staat bekend als "orgaandonatie na euthanasie"(ODE). De eerste internationale Roundtable over ODE werd gehouden tijdens het internationale, huisartsengeneeskundige WONCA-congres in 2021 als onderdeel van een scoping review. Het doel was de praktijk en problemen van ODE te inventariseren om patiënten, professionals en beleidsmakers te adviseren, de ontwikkeling van verantwoorde richtlijnen te bevorderen en hulp te bieden bij voorliggende vraagstukken. Dit werd uiteindelijk door middel van literatuuronderzoek, en nationale en internationale stakeholder-bijeenkomsten bereikt. Tot 2021 werd 286 keer ODE uitgevoerd in Canada, Nederland, Spanje en België, waaronder acht maal ODE gestart vanuit huis (ODEH). Euthanasie werd 17.217 keer uitgevoerd (2020) in de acht landen waar ODE mogelijk is. Tot en met 2021, hebben 837 patiënten (tot 14% van de ontvangers van DCDD-donoren), organen afkomstig van ODE ontvangen. ODE herbergt enkele belangrijke ethische aandachtspunten met betrekking tot de autonomie van de patiënt. Het gaat hierbij met name om potentiele druk tussen het verzoek om euthanasie en organen te doneren en de verhoogde belasting voor de ernstig zieke euthanasie patiënten die bij ODE aanwezig is. | 1
La procédure combinant l'aide médicale à mourir (AMM) et les dons d'organes après
constatation du décès circulatoire (DCDC) est connue sous le nom de don d'organes
après euthanasie (DOE). La première table ronde internationale sur le don d'organes
après euthanasie s'est tenue lors de la conférence de médecine familiale de la
WONCA en 2021, dans le cadre d'une étude de la portée. Elle avait pour but de
documenter les pratiques et les questions connexes afin de conseiller les patients, les
professionnels et les décideurs, de faciliter l'élaboration de lignes directrices
responsables et de permettre une meilleure gestion des problèmes existants. À cet
effet, des recherches documentaires ont été effectuées et des réunions nationales et
internationales de parties prenantes ont été organisées. Jusqu'en 2021, le DOE avait
été réalisé 286 fois au Canada, aux Pays-Bas, en Espagne et en Belgique, dont huit
cas à domicile (DOED). L’AMM a été prodiguée 17 217 fois (2020) dans les huit pays
où le DOE est autorisé. Jusqu’en 2021, 837 patients (jusqu'à 14 % des receveurs de
donneurs de DCDC) avaient reçu des organes par DOE. Le DOE soulève
d'importantes préoccupations éthiques concernant l'autonomie des patients, le lien
entre la demande d'AMM et la demande de don d'organes ainsi que le fardeau accru
imposé aux patients gravement malades ayant bénéficié de l'AMM.
REVISIÓN INTEGRAL Práctica y desafíos para la donación de órganos tras la asistencia médica en la muerte: Una revisión del alcance que incluye los resultados de la primera mesa redonda internacional en 2021
El procedimiento que combina la asistencia médica a la muerte (MAiD,por sus siglas en inglés) con las donaciones tras la determinación de lamuerte cardíaca (DCDD, por sus siglas en inglés) se conoce comodonación de órganos tras la eutanasia (ODE, por sus siglas en inglés). Laprimera mesa redonda internacional sobre la ODE se celebró durantela conferencia de medicina familiar de la WONCA de 2021 como partede una revisión del alcance. Su objetivo es documentar la prácticaylas cuestiones relacionadas a fin de asesorar a los pacientes los profesionales y losresponsables políticos, contribuyendo a la elaboración de directrices responsables yayudando a abordar los problemas. Para ello, se realizaron búsquedas bibliográficas Yse celebraron reuniones nacionales e internacionales con las partes interesadas.Hasta 2021, la ODE se realizó 286 veces en Canadá, los Países Bajos, España yBélgica, incluidos ocho casos de ODE desde el hogar (ODEH, por sus siglas eninglés). La MAiD fue suministrada 17.217 veces (2020) en los ocho países en los queestá permitida la ODE. Hasta 2021, 837 pacientes (hasta el 14% de los receptores dedonantes de DCDD) habían recibido órganos provenientes de una ODE. La ODEplantea algunas cuestiones éticas importantes relacionadas con la autonomía delpaciente, la relación entre la solicitud de la MAiD y la solicitud de donación deórganos y el consiguiente aumento de la carga que soportan los pacientesgravemente enfermos que reciben la MAiD
The procedure combining medical assistance in dying (MAiD) with donation after circulatory determination of death (DCDD) is known as organ donation after euthanasia (ODE). The first international roundtable on ODE was held during the 2021 WONCA family medicine conference as part of a scoping review. Its aim was to document practice and related issues so as to advise patients, professionals and policymakers, aiding development of responsible guidelines and helping to navigate the issues. This was achieved through literature searches and national and international stakeholder meetings. Up to 2021, ODE was performed 286 times in Canada, the Netherlands, Spain and Belgium, including eight cases of ODE from home (ODEH). MAiD was provided 17,217 times (2020) in the eight countries where ODE is permitted. As of 2021, 837 patients (up to 14% of recipients of DCDD donors) had received organs from ODE. ODE raises some important ethical concerns involving patient autonomy, the link between the request for MAID and the request to donate organs and the increased burden placed on seriously ill MAiD patients.
En France, près de la moitié des décès (48 % en 2010) a été précédée d’une décision médicale ayant pu hâter la mort du patient. Mais des médicaments ont été donnés pour mettre délibérément fin à la vie dans seulement moins de 1 % des cas. Les décisions prises s’appuient dans leur grande majorité sur les dispositions de la loi Leonetti qui permet sous certaines conditions de limiter ou d’arrêter un traitement, ou d’administrer des médicaments afin de soulager les souffrances du patient, qui peuvent avoir pour effet d’avancer la survenue de la mort. Toutefois, les prescriptions légales encadrant ces décisions ne sont pas encore totalement connues ou respectées : les décisions de fin de vie ne sont pas toujours discutées avec les patients et les équipes soignantes ; la rédaction par les patients de directives anticipées, proposée par la loi Leonetti pour que les soignants prennent en compte leurs souhaits, reste en pratique très rare.
Objectives
To explore the legal understanding and attitudes of nurses and physicians in both acute and chronic geriatric care (Flanders, Belgium) regarding euthanasia in the context of tiredness of life in older people.
Method
Healthcare providers employed in acute care (59 geriatricians and 75 nurses of acute geriatric wards), as well as chronic care (135 general practitioners (GPs) and 76 nurses employed in nursing homes and home care services) were sent a survey with four case vignettes. For each case vignette, respondents were asked the following questions: (1) ‘Does this case fit the due-care criteria of the euthanasia law?’, (2) ‘Do you consider this person to be tired of life?’, (3) ‘Can you comprehend this person’s euthanasia request?’.
Results
In cases of severe and life-limiting physical suffering, where the patient meets the legal criteria for euthanasia in Belgium, only 50% of physicians and nurses are aware of this legal basis. In case of tiredness of life without underlying pathology, nurses showed more comprehension for the euthanasia request compared to physicians (43.0% vs. 10.8%, p < 0.001). Physicians tend to assess the legal base of an euthanasia-request depending on the severity of physical morbidity, whereas nurses show a greater comprehension towards euthanasia-requests even in absence of severe illness. Geriatricians are more reserved regarding performing euthanasia themselves as compared to GPs, regardless of underlying pathology or reason for the euthanasia-request (p < 0.001).
Conclusion
The legal understanding and attitude of Flemish physicians and nurses towards tiredness of life and euthanasia in older patients differed to a great extent. This study showed (1) a lack of awareness of the legal basis for euthanasia in the context of ToL among all HCPs, (2) differences in the extent of comprehension between nurses and physicians and (3) differences in willingness to actually perform euthanasia between geriatricians and GPs. So even with the formulation of strict due-care criteria there is still room for interpretation. This creates a gray area and a discussion point between healthcare providers.
Pembrolizumab-induced thyroiditis
(http://www.mednet.gr/archives/2020-3/pdf/431.pdf)
Introducción. La eutanasia fue despenalizada en Colombia mediante la Sentencia C-239/97 y reglamentada por la Resolución 1216 de 2015 del Ministerio de Salud y Protección Social. Se investigó en algunos medios de circulación nacional la posición a favor, neutra y en contra sobre la eutanasia y su carga argumentativa entre los años 1997 y 2015.
Objetivos. Determinar la posición de algunos medios de comunicación frente a la eutanasia durante 1997-2015 y analizar su contenido argumentativo.
Materiales y métodos. Tras una búsqueda en las versiones virtual e impresa de los periódicos El Tiempo y El Espectador y la Revista Semana, se realizó una clasificación y análisis de contenido de los artículos sobre la eutanasia con apoyo del programa ATLAS.ti, versión 8.
Resultados. De 257 artículos recuperados, 190 incluyeron el término eutanasia en relación con el final de la vida y la salud. El 45% fueron neutros y de carácter informativo y el 78.9% no mencionó los cuidados paliativos. La carga argumentativa a favor recayó sobre contenidos de dignidad, sufrimiento y regulación.
Conclusiones. Los artículos presentaron posiciones opuestas con errores de contenido y superficialidad en el tratamiento del concepto. La postura prevalente fue neutra seguida de la posición a favor. Se evidencia escasa participación de la comunidad médica y casi ninguna mención de los cuidados paliativos.
Background
In June 2016, the Government of Canada passed Bill C-14 decriminalizing medically assisted death. Increasing numbers of Canadians are accessing medical assistance in dying (MAiD) each year, but there is limited information about this population.
Objective
To describe the characteristic outcomes of MAiD requests in a cohort of patients at an academic tertiary care center in Toronto, Ontario, Canada.
Methods
A retrospective chart review of patients making a formal request for a MAiD eligibility assessment from July 16 to September 18. Data extracted included demographics, diagnosis, psychosocial characteristics, information relating to the MAiD request, and clinical outcome.
Results
We received 107 formal requests for MAiD assessment. Ninety-seven patients were found eligible, of whom 80 received MAiD. Cancer was the primary diagnosis for 78% and median age was 74 years. The majority of patients (64%) cited “functional decline or inability to participate in meaningful activities” as the main factor motivating their request for MAiD. Half of patients who received MAiD (46%) described their request as consistent with a long-standing, philosophical view predating their illness. The 10-day reflection period was reduced for 39% of provisions due to impending loss of capacity. Our cohort was very similar demographically to those described both nationally and internationally.
Conclusion
Patients seeking MAiD at our institution were similar to those described in other jurisdictions where assisted dying is legal and represent a group for whom autonomy and independence is critical. We noted a very high rate of risk of loss of capacity, suggesting a need for both earlier assessments and regular monitoring.
Euthanasia is subject of intense debate in many countries where life expectancy is high and degenerative diseases are the leading causes of death. In Belgium, euthanasia can be practiced under strict, legally defined conditions since 2002. Concerns about developments in euthanasia practice in Belgium persist, particularly abroad. Additionally, empirical evidence on the euthanasia practice in countries where it is legal is needed to inform current euthanasia debates. For this dissertation, a secondary analysis of the official databases of all euthanasia cases reported to the Federal Control and Evaluation Committee for Euthanasia was performed. Also, data from a population-based survey among physicians attending a representative sample of death certificates in Flanders were analyzed. This dissertation provides insight into the Belgian euthanasia practice by studying trends in euthanasia practice and by providing empirical evidence on particular issues that have been subject of (international) debate, i.e. involvement of palliative care in euthanasia practice, euthanasia for people with psychiatric disorders or dementia, and registration of euthanasia on death certificates. This dissertation underlines the importance of detailed monitoring of euthanasia practice. To meet this, it is to be recommended that monitoring by the Federal Control and Evaluation Committee for Euthanasia is supplemented by thorough empirical research into euthanasia and other medical end-of-life practices.
Teaching involves a variety of ethical issues, which the authors of this paper try to highlight. In respect to the fact that each area of teaching has some specific ethical problems to consider, the authors go one step further to give an overview of characteristic ethical aspects regarding teaching activity. It is shown that the academic community acts on ethical codes that are based on law and different regulations, but often ethical questions raised from the teaching activity cannot find their answer in laws and regulations. For this reason authors consider it necessary to provide a platform through which the compliance to the law and the ethical or moral aspirations can integrate.
Should people suffering from untreatable psychiatric conditions be eligible for physician-assisted death? This is possible in Belgium and the Netherlands, where PAD for psychiatric conditions is permitted, though rare, so long as the criteria of due care are met. Those opposed to all instances of PAD point to Belgium and the Netherlands as a dark warning that once PAD is legalized, restricting it will prove impossible because safeguards, such as the requirement that a patient be terminally ill, will inevitably be eroded or discarded. However, some supporters respond that limiting PAD to those suffering from terminal illness, or physical illnesses generally, is arbitrary and illogical. In addition, precisely because such patients are not terminally ill, their suffering may last for years, even the rest of their lives. Finally, severe depression may not be treatable. If PAD is justifiable under some conditions—as I shall assume in this article—then why wouldn't it be justifiable for these patients? Why shouldn't psychiatrists who have nothing else to offer their suffering patients be able to help them to die, if that is what they want?
En France, nous manquons de données objectives sur l’incidence des demandes d’euthanasie en contexte de soins palliatifs. Le but de cette étude est de recueillir, classifier et comptabiliser les expressions du souhait de mourir à partir des dossiers informatisés des patients hospitalisés en unités de soins palliatifs en 2010–2011.
In France, almost half of deaths (48% in 2010) are preceded by a medical decision that may hasten death. But only in 1% of cases are drugs administered to deliberately end life. The large majority of decisions taken are based on the provisions of the Leonetti Act, which enables physicians, under specific circumstances, to withhold or withdraw treatment or to administer drugs in order to alleviate pain or symptoms that may have the effect of hastening death. However, the legal provisions governing these decisions are still not always fully known or complied with: end-of-life decisions are not always discussed with the patients and medical teams, and very few patients draw up advance directives, as recommended in the Leonetti Act, to express their wishes to the physicians responsible for their care.
Due to globalizing trend of homogenisation of culture, changes in the health care delivery system and market economics infringing on the practice of medicine, there has been a gradual shift in the attitude of the medical community as well as the lay public towards greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As the subject has gained worldwide prominence, we want to review this topic from Islamic perspective due to its significance in medical ethics and clinical practice.
This chapter addresses some justifications that are frequently raised to exclude minors from making serious and difficult decisions pertaining to their medical care, and, in particular, for requesting euthanasia. The argument from incompetence is considered in detail in the chapter, since it is the most powerful argument utilized to exclude minors, and conversely, to include minors when the argument of incompetence is countered. In current legislation regarding euthanasia in both Belgium and the Netherlands, the request of the (adult) patient is a necessary requirement. The chapter recognises that the seriously ill child or young person particularly needs assistance and support, as both illness and young age tend to relate to an increased dependency and vulnerability. In this respect, it advocates for an approach that reconciles self-determination and protection. In each case, an assessment of the individual's decision-making capacities and the validity of his or her request should be made. Keywords: Belgium; euthanasia; medical care; minors; Netherlands; self-determination
Introduction: Euthanasia is emerging as a grave issue in medical and biomedical fields. The fate of Euthanasia however, swings like a pendulum with terms like 'merciful intervention' at one pole to 'endangering human rights' on the other. The ongoing debate has lead to many surveys with significant results showing the upward increase in acceptance of either performing or securing intentional actions resulting in termination of life. This study is carried out to know about the perception regarding Euthanasia. Objectives: The aim is to perceive understanding towards Euthanasia in medical students and its usage in their future practices. Study design: Qualitative descriptive study design. Place and Duration of Study: This study was the Department of Community Medicine, SMC, Karachi from April 2011 to September 2011. Materials and Methods: Sample size is 400 collected from Dow University of Health sciences. Karachi and sampling design is simple random. Evaluation tool is structured questionnaire based on 3 case studies with the consideration of ethical issues. Results: In the data analysis 48.25% endorsed the act of euthanasia in certain cases while 40.25% strongly disagreed with it. Remaining 11.5% supported the cause only when the patient is willing. 13% individuals opted for actively easing the suffering of a patient in Case-1 while 11% agreed to prescribe a lethal drug/dosage in Case-3 of voluntary euthanasia. A staggering 40% ordered removal of life saving equipment in Case-2 of a vegetative patient as passive euthanasia. The leading cause for supporting euthanasia was increased availability of equipment and resources at a 48% while 62% of the discord was due to belief in life/death being a matter for the Lord only. When faced with a choice, 39% found ethnic discrimination more abusive of a doctor's oath than 23% of those who choose Euthanasia. Conclusion: To conclude, significant numbers of medical students support Euthanasia especially passive euthanasia. Religious beliefs are of serious concerns while gender also plays a small part in the decision making.
In Memory of Ed Pellegrino
Euthanasia in Belgium is not limited to terminally ill patients. It may be applied to patients with chronic degenerative diseases.
Currently, people in Belgium wish to make it possible to euthanize incompetent patients who suffer from dementia. This article
explains the Belgian law and then explores arguments for and against euthanasia of patients with dementia. It probes the dementia
paradox by elucidating Dworkin’s distinction between critical and experiential interests, arguing that at the end-of-life
this distinction is not clearcut. It argues against euthanasia for patients with dementia, for respecting patients’ humanity
and for providing them with more care, compassion, and good doctoring.
Empirical data about end-of-life decision-making practices are scarce. We aimed to investigate frequency and characteristics of end-of-life decision-making practices in six European countries: Belgium, Denmark, Italy, the Netherlands, Sweden, and Switzerland.
In all participating countries, deaths reported to death registries were stratified for cause (apart from in Switzerland), and samples were drawn from every stratum. Reporting doctors received a mailed questionnaire about the medical decision-making that had preceded the death of the patient. The data-collection procedure precluded identification of any of the doctors or patients. All deaths arose between June, 2001, and February, 2002. We weighted data to correct for stratification and to make results representative for all deaths: results were presented as weighted percentages.
The questionnaire response rate was 75% for the Netherlands, 67% for Switzerland, 62% for Denmark, 61% for Sweden, 59% for Belgium, and 44% for Italy. Total number of deaths studied was 20480. Death happened suddenly and unexpectedly in about a third of cases in all countries. The proportion of deaths that were preceded by any end-of-life decision ranged between 23% (Italy) and 51% (Switzerland). Administration of drugs with the explicit intention of hastening death varied between countries: about 1% or less in Denmark, Italy, Sweden, and Switzerland, 1.82% in Belgium, and 3.40% in the Netherlands. Large variations were recorded in the extent to which decisions were discussed with patients, relatives, and other caregivers.
Medical end-of-life decisions frequently precede dying in all participating countries. Patients and relatives are generally involved in decision-making in countries in which the frequency of making these decisions is high.
Review procedures of termination of life on request and assisted suicide and amendment to the Penal Code and the Burial and Cremation Act. Senate, session
- Anon
Euthanasia: the process of legal change in the Netherlands—the making of the “requirements of careful practice”
- Weyers
Actes parlementaires du Sénat de Belgique
- Anon Euthanasia Law