Dilemmas Encountered by Hospice Workers When Patients Wish to Hasten Death

Harvath, Theresa A.; Miller, Lyndsey M.; Smith, Kathryn A.; Clark, Lisa D.; Jackson, Ann; Ganzini, Linda

doi:10.1097/00129191-200607000-00011

Cited by 28 publications

(67 citation statements)

References 21 publications

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“…Harvath et al (2006) reported that several nurses caring for persons with a wish for premature dying felt personally responsible for this wish and tried to dissuade them from the way they had chosen [22]. The present study cannot confirm this result.…”

Section: Discussioncontrasting

confidence: 67%

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Voluntary stopping of eating and drinking (VSED) as an unknown challenge in a long-term care institution: an embedded single case study

2018

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BackgroundChronically ill persons experience conditions of life that can become unbearable, resulting in the wish to end their life prematurely. Relatives confronted with this wish experience ambivalence between loyalty to the person’s desire to die and the fear of losing this person. Caring for a person during the premature dying process can be morally challenging for nurses. One way to end one’s life prematurely is Voluntary Stopping of Eating and Drinking (VSED).MethodsThis embedded single case study explored the experiences of registered nurses (embedded units of analysis: ward manager, nursing manager, nursing expert) and relatives who accompanied a 49-year-old woman suffering from multiple sclerosis during VSED in a Swiss long-term care institution (main unit of analysis). By means of a within-analysis, we performed an in-depth analysis of every embedded unit of analysis and elaborated a central phenomenon for each unit. Afterwards, we searched for common patterns in a cross-analysis of the embedded units of analysis in order to develop a central model.ResultsThe following central concept emerged from cross-analysis of the embedded units of analysis: As a way of ending one’s life prematurely, VSED represents an unfamiliar challenge to nurses and relatives in the field of tension between one’s personal attitude and the agents' concerns, fears and uncertainties. Particularly significant is the personal attitude, influenced on the one hand by oneˊs own experiences, prior knowledge, role and faith, on the other hand by the VSED-performing person's age, disease and deliberate communication of the decision. Depending on the intention of VSED as either suicide or natural dying, an accepting or dismissing attitude evolves on an institutional and personal level.ConclusionsTo deal professionally with VSED in an institution, it is necessary to develop an attitude on the institutional and personal level. Educational measures and quality controls are required to ensure that VSED systematically becomes an option to hasten death. As VSED is a complex phenomenon, it is necessary to include palliative care in practice development early on and comprehensively. There is a high need of further research on this topic. Particularly, qualitative studies and hypothesis-testing approaches are required.

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Section: Discussioncontrasting

confidence: 67%

“…A nurse reported that she had the feeling of having failed if patients decided for assisted suicide, since this expressed that they did not feel comfortable [22]. So far, nurses' attitudes towards VSED have been rarely researched.…”

Section: Introductionmentioning

confidence: 99%

Voluntary stopping of eating and drinking (VSED) as an unknown challenge in a long-term care institution: an embedded single case study

2018

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“…The study revealed a lack of clear and consistent policy for social workers to follow, leaving them unclear about their role, albeit supportive of assisted dying as an option for their patients. The interview study of Harvath et al 42 with 20 hospice nurses and social workers similarly concluded that there are dilemmas around whether assisted dying is antithetical to hospice care and confusion about the legal and professional boundaries in terms of what constitutes assistance. For some of the nurses and social workers interviewed, discussing assisted dying with patients was viewed as an opportunity to discuss fears and concerns about dying and potentially bring more attention to symptom control.…”

Section: ''mentioning

confidence: 99%

The Relationship of Palliative Care With Assisted Dying Where Assisted Dying is Lawful: A Systematic Scoping Review of the Literature

Gerson

Koksvik

Richards

et al. 2020

Journal of Pain and Symptom Management

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Context. A central approach of palliative care has been to provide holistic care for people who are dying, terminally ill, or facing life-limiting illnesses while neither hastening nor postponing death. Assisted dying laws allow eligible individuals to receive medically administered or self-administered medication from a health provider to end their life. The implementation of these laws in a growing number of jurisdictions therefore poses certain challenges for palliative care.Objectives. To analyze the research literature about the relationship of assisted dying with palliative care, in countries where it is lawful.Methods. A five-stage scoping review process was adapted from the Joanna Briggs Institute. Data sources searched through October 2018 were MEDLINE, CINAHL, PsychINFO, SCOPUS, and ProQuest dissertations and theses, with additional material identified through hand searching. Research studies of any design were included, but editorials or opinion articles were excluded.Results. After reviewing 5778 references from searches, 105 were subject to full-text review. About 16 studies were included: from Belgium (n ¼ 4), Canada (n ¼ 1), Switzerland (n ¼ 2), and the U.S. (n ¼ 9). We found that the relationship between assisted dying and palliative care practices in these locations took varied and sometimes combined forms: supportive, neutral, coexisting, not mutually exclusive, integrated, synergistic, cooperative, collaborative, opposed, ambivalent, and conflicted.Conclusion. The studies in this review cast only partial light on challenges faced by palliative care when assisted dying is legal. There is pressing need for more research on the involvement of palliative care in the developing practices of assisted dying, across a growing number of jurisdictions. J Pain Symptom Manage 2020;59:1287e1303. Ó

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“…This might mean assessing underlying meanings behind the request, searching for palliative solutions, or advocating on behalf of the patient to have his or her request taken seriously by the physician. Contextual factors, such as the time available to create therapeutic relationships with patients and the quality of inter-professional collaboration are important influences on whether nurses realize their perceived responsibilities toward patients in endof-life care Denier et al, 2009;Dierckx de Casterle et al, 2010;Dierckx de Casterle, Verpoort, De Bal, & Gastmans, 2006;Harvath et al, 2006;Matzo & Schwarz, 2001;Schwarz, 2003Schwarz, , 2004Volker, 2001Volker, , 2003. Thus, nursing experiences of assisted death are moral experiences, whereby nurses' engagement in assisted death has repercussions for values they deem important (Beagan & Ells, 2009;Hunt & Carnevale, 2011).…”

Section: Discussionmentioning

confidence: 99%

Engaging with patients who desire death: Interpretation, presence, and constraint

Wright¹,

Chirchikova²,

Véronique³

et al. 2017

CONJ

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Dilemmas Encountered by Hospice Workers When Patients Wish to Hasten Death

Cited by 28 publications

References 21 publications

Voluntary stopping of eating and drinking (VSED) as an unknown challenge in a long-term care institution: an embedded single case study

Voluntary stopping of eating and drinking (VSED) as an unknown challenge in a long-term care institution: an embedded single case study

The Relationship of Palliative Care With Assisted Dying Where Assisted Dying is Lawful: A Systematic Scoping Review of the Literature

Engaging with patients who desire death: Interpretation, presence, and constraint

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