Developments in the practice of physician-assisted dying: perceptions of physicians who had experience with complex cases

Snijdewind, Marianne C.; Tol, Donald G. van; Onwuteaka-Philipsen, Bregje D.; Willems, Dick L.

doi:10.1136/medethics-2016-103405

Cited by 50 publications

(32 citation statements)

References 9 publications

(5 reference statements)

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“…It also has been reported previously that both male and female physicians were at higher risk of suicide than gender‐matched others, and, as in nursing, female physicians were at higher relative risk than male physicians (Schernhammer & Colditz, ). More recently, though, an English study demonstrated that the risk for suicide was only higher in female physicians and nurses and not males (Snijdewind et al, ). In a possibly related finding, we did find in the open‐ended comments that the challenge of balancing home life and parenting with career demands resulted in symptomatic stress.…”

Section: Discussionmentioning

confidence: 99%

Sustainability and Outcomes of a Suicide Prevention Program for Nurses

Davidson

Accardi

Sanchez

et al. 2020

Worldviews Ev Based Nurs

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Background We now know that nurses are at greater risk for suicide than others in the general population. It is known that job stressors are prevalent in nurses who die by suicide. Yet, little is known about targeted suicide prevention for nurses. The first nurse‐centric Healer Education Assessment and Referral (HEAR) suicide prevention program was piloted for 6 months in 2016. The HEAR program was effective in identifying at‐risk nurses. Aim The purpose of this paper is to report the 3‐year sustainability and outcomes of this nurse suicide prevention program. Methods Descriptive statistics are provided of program outcomes over the course of 3 years. Results Over the 3 years, 527 nurses have taken advantage of the screening portion of the program. Of these, 254 (48%) were Tier 1 high risk, and 270 (51.2%) were Tier 2 moderate risk. A startling 48 (9%) had expressed thoughts of taking their own life, 51 (9.7%) had a previous suicide attempt, whereas only 79 (15%) were receiving counseling or therapy. One hundred seventy‐six nurses received support from therapists electronically, over the phone, or in person; 98 nurses accepted referral for treatment. The number of group emotional debriefs rose from eight in 2016 to 15 in 2017 to 38 in fiscal year 2019. Many of the debriefs are now requested (vs. offered), demonstrating the development of a culture open to reaching out for mental health treatment. Linking Evidence to Action The initial success of this pilot program has been sustained. A nurse suicide prevention program of education, assessment, and referral is feasible, well‐received, proactively identifies nurses with reported suicidality and facilitates referral for care. The HEAR program has provided service to physicians and residents for 10 years and now supports effectiveness in nurses. The HEAR program is portable and ready for replication at other institutions.

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Section: Discussionmentioning

confidence: 99%

Sustainability and Outcomes of a Suicide Prevention Program for Nurses

Davidson

Accardi

Sanchez

et al. 2020

Worldviews Ev Based Nurs

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“…Regarding professional autonomy, there is a consensus that no clinician is morally obligated to participate in hastened-death. 65,74 This generally accepted ethical principle is not without its challenges. Ideally, patients seeking hastened-death would do so within the confines of a wellestablished relationship with their physician founded on mutual trust.…”

Section: Autonomy Trust and Controlmentioning

confidence: 99%

“…21,63 The evolution of hastened-death practices in Europe, where nonvoluntary euthanasia is reportedly practiced and terminal illness is not a requirement, provides a basis for those concerns. 5,7,12,73,74,99 In the Netherlands, there are reported cases where regulations were circumvented. 32 Euthanasia for psychological suffering is legal in Belgium and the Netherlands.…”

Section: Fairness Justice and Vulnerabilitymentioning

confidence: 99%

Physician-Hastened-Death in Patients with Progressive Neurodegenerative or Neuromuscular Disorders

Russell

2018

Semin Neurol

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Physician-hastened-death remains a controversial topic for patients and those who care for them. It is a particularly relevant topic for neurologists who currently, or will in the future, reside in jurisdictions where physician-hastened-death is legal. In this article, I attempt to provide a comprehensive and contemporary discussion of hastened-death issues in a measured and respectful fashion. My goal is to provide clinicians with the information necessary to mold their own judgment and conscience in preparation for a time in which one or more of their patients request their participation in physician-hastened-death.

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“…A broadening of the practice of euthanasia to new categories of patients may be a beneficial development, but one can be concerned with overshoot risks of instrumentalisation of physicians 36. However, integral PC nowhere implies that euthanasia is always right for every patient.…”

Section: Summary and Concluding Remarksmentioning

confidence: 99%

Euthanasia embedded in palliative care. Responses to essentialistic criticisms of the Belgian model of integral end-of-life care

Bernheim

Raus

2017

J Med Ethics

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The Belgian model of 'integral' end-of-life care consists of universal access to palliative care (PC) and legally regulated euthanasia. As a first worldwide, the Flemish PC organisation has embedded euthanasia in its practice. However, some critics have declared the Belgian-model concepts of 'integral PC' and 'palliative futility' to fundamentally contradict the essence of PC. This article analyses the various essentialistic arguments for the incompatibility of euthanasia and PC. The empirical evidence from the euthanasia-permissive Benelux countries shows that since legalisation, carefulness (of decision making) at the end of life has improved and there have been no significant adverse 'slippery slope' effects. It is problematic that some critics disregard the empirical evidence as epistemologically irrelevant in a normative ethical debate. Next, rejecting euthanasia because its prevention was a founding principle of PC ignores historical developments. Further, critics' ethical positions depart from the PC tenet of patient centeredness by prioritising caregivers' values over patients' values. Also, many critics' canonical adherence to the WHO definition of PC, which has as the ethical criterion is objectionable. A rejection of the Belgian model on doctrinal grounds also has nefarious practical consequences such as the marginalisation of PC in euthanasia-permissive countries, the continuation of clandestine practices and problematic palliative sedation until death. In conclusion, major flaws of essentialistic arguments against the Belgian model include the disregard of empirical evidence, appeals to canonical and questionable definitions, prioritisation of caregiver perspectives over those of patients and rejection of a plurality of respectable views on decision making at the end of life.

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Developments in the practice of physician-assisted dying: perceptions of physicians who had experience with complex cases

Abstract: The perceived developments could make physicians less willing to consider a request for EAS. Our results also raise questions about the role of physicians and of EAS in society.

Cited by 50 publications

References 9 publications

Sustainability and Outcomes of a Suicide Prevention Program for Nurses

Sustainability and Outcomes of a Suicide Prevention Program for Nurses

Physician-Hastened-Death in Patients with Progressive Neurodegenerative or Neuromuscular Disorders

Euthanasia embedded in palliative care. Responses to essentialistic criticisms of the Belgian model of integral end-of-life care

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