Grief After Euthanasia and Physician-Assisted Suicide

Andriessen, Karl; Krysińska, Karolina; Dransart, Dolores Angela Castelli; Dargis, Luc; Mishara, Brian L.

doi:10.1027/0227-5910/a000630

Cited by 36 publications

(43 citation statements)

References 60 publications

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“…Although there is little evidence of increased risk of adverse grief or altered mental health outcomes in individuals bereaved by assisted death, 34,35,47 some family members may require additional support through the MAID process and during bereavement. Anticipatory guidance is a proactive intervention to prepare patients and family members for anticipated occurrences.…”

Section: Discussionmentioning

confidence: 99%

Care Considerations in a Patient- and Family-Centered Medical Assistance in Dying Program

et al. 2020

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Background: Medical Assistance in Dying (MAID) became legal in Canada in June 2016. As part of a project designed to improve end-of-life care for those requesting MAID, qualitative data from patients, families, and providers were used to assess opportunities to enhance patient-and family-centered care (PFCC) in this program. Methods: Thirty interviews were conducted with patients, families, and healthcare providers. Five patients who requested an assessment for MAID, 11 family members, and 14 healthcare providers were interviewed about their experiences in 2017. Comparative coding and thematic analysis were completed with the support of NVivo12. Results: Emotional PFCC considerations included: exploring and validating the emotional journey, navigating the uncertain, judgmental experiences, and the emotional impact on families and the care team. Physical PFCC considerations included: sensitivity in eligibility assessments, weaving in interdisciplinary care, provision of anticipatory guidance, and death location. Spiritual PFCC considerations included: honoring choice, listening to life stories, supporting spiritual needs, and acknowledging loss. Relational PFCC considerations included: defining the circle of support, supporting the circle, and relational investments. Conclusion: Fundamental to a PFCC MAID program, practitioners must be afforded time to provide holistic care. Program-related suggestions include incorporating interdisciplinary care early, and throughout the illness trajectory, consistency in care providers, appropriate anticipatory guidance, and bereavement supports for family, and dedicate space for MAID provisions. Patients and families must be included in the ongoing development and re-evaluation of MAID programs to ensure continued focus on quality end-of-life care.

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Section: Discussionmentioning

confidence: 99%

Care Considerations in a Patient- and Family-Centered Medical Assistance in Dying Program

et al. 2020

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“…Research on the impact of PAD on the mental health of bereaved relatives showed that they experienced feeling of isolation and fear of social stigma [ 16 – 19 ]. However, if they knew that the passing was an autonomous choice, they could accept the death and showed less symptoms of grief and posttraumatic stress disorder [ 16 – 19 ]. However, research on the impact of PAD on the mental health of bereaved relatives is scarce.…”

Section: Introductionmentioning

confidence: 99%

“I lost so much more than my partner” – Bereaved partners’ grief experiences following suicide or physician-assisted dying in case of a mental disorder

Snijdewind

Keijser

Casteelen³

et al. 2022

BMC Psychiatry

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Background There is a lack of existing research on grief following the intentional death of people suffering from a mental disorder. Our study aims to provide insight into grief experiences and social reactions of bereaved persons who lost their life partners, who were suffering from a mental disorder, to physician-assisted dying (PAD) or suicide. Methods For this mixed-methods research, we conducted a survey and in-depth interviews with 27 persons living in the Netherlands and bereaved by the death of their life partners. The deceased life partners suffered from a mental disorder and had died by physician-assisted dying (n = 12) or suicide (n = 15). Interviews explored grief experiences and social reactions. In the survey we compared self-reported grief reactions of partners bereaved by suicide and PAD using the Grief Experience Questionnaire. Results Compared to suicide, physician-assisted dying was associated with less severe grief experiences of the bereaved partners. Participants reported that others rarely understood the suffering of their deceased partners and sometimes expected them to justify their partners’ death. Following physician-assisted dying, the fact that the partner’s euthanasia request was granted, helped others understand that the deceased person’s mental suffering had been unbearable and irremediable. Whereas, following suicide, the involvement of the bereaved partners was sometimes the focus of judicial inquiry, especially, if the partner had been present during the death. Conclusion When individuals suffering from a mental disorder die by suicide or PAD, their bereaved partners may experience a lack of understanding from others. Although both ways of dying are considered unnatural, their implications for bereaved partners vary considerably. We propose looking beyond the dichotomy of PAD versus suicide when studying grief following the intentional death of people suffering from a mental disorder, and considering other important aspects, such as expectedness of the death, suffering during it, and partners’ presence during the death.

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“…Regarding the outcome, people bereaved by MAiD (but not MAiD-NT) generally had similar or lower scores on measures of disordered grief, mental health, and posttraumatic stress compared with those who died naturally [36]. However, a Swiss study [37] showed that among members or close friends who were present at an assisted suicide, 13% met the criteria for full Post Traumatic Stress Disorder (PTSD), 6.5% for subthreshold PTSD, and 4.9% for complicated grief, indicating a higher prevalence of psychiatric disorders than the general population.…”

Section: Opinions and Attitudes Of Relatives Of Patients With Psychia...mentioning

confidence: 98%

Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders

Grassi

Folesani

Marella

et al. 2022

Curr Psychiatry Rep

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Purpose of Review Over the last 30 years, medical assistance in dying (MAiD) including euthanasia (EU) and physician-assisted death (or suicide, PAS) has become the center of a large debate, particularly when these practices have involved people with psychiatric illness, including resistant depression, schizophrenia, personality, or other severe psychiatric disorders. We performed a review utilizing several databases, and by including the most relevant studies in full journal articles investigating the problem of MAiD in patients with psychiatric disorders but not in physical terminal conditions (non-terminal, MAiD-NT). Recent Findings Literature has shown that a small percentage of people with psychiatric disorders died by MAiD-NT in comparison with patients with somatic diseases in terminal clinical conditions (e.g., cancer, AIDS). However, the problem in the field is complex and not solved yet as confirmed by the fact that only a few countries (e.g., the Netherlands, Belgium, Luxemburg) have legalized MAiD-NT for patients with psychiatric disorders, while most have maintained the practices accessible only to people with somatic disease in a terminal phase. Also, how to make objective the criterion of irremediability of a mental disorder; how to balance suicide prevention with assisted suicide; how to avoid the risk of progressively including in requests for MAiD-NT vulnerable segments of the population, such as minors, elderly, or people with dementia, in a productive-oriented society, are some of the critical points to be discussed. Summary The application of MAiD-NT in people with psychiatric disorders should be further explored to prevent end-of-life rights from contradicting the principles of recovery-oriented care.

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Grief After Euthanasia and Physician-Assisted Suicide

Cited by 36 publications

References 60 publications

Care Considerations in a Patient- and Family-Centered Medical Assistance in Dying Program

Care Considerations in a Patient- and Family-Centered Medical Assistance in Dying Program

“I lost so much more than my partner” – Bereaved partners’ grief experiences following suicide or physician-assisted dying in case of a mental disorder

Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders

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