Withholding life prolonging treatment, and self deception

Sayers, Gwen M; Perera, Suraj

doi:10.1136/jme.28.6.347

Cited by 10 publications

(5 citation statements)

References 8 publications

(6 reference statements)

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“…The medical technologies are not, however, without cost. The cost includes huge medical fees and the long-term suffering of patients caused by the artificial prolongation of life (Kuo, 2002;Sayers & Perera, 2002). Even now, with the Law of Palliative Medicine, a complicated dying process that makes significant demands on the resources of the intensive care ward may represent death's most "modern form" in Taiwan.…”

Section: Resultsmentioning

confidence: 98%

Comparisons of Life Images and End-of-Life Attitudes Between the Elderly in Taiwan and New Zealand

Hsin

Macer²

2006

Journal of Nursing Research

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Rapid advances in medical technology may in the near future make "natural" aging and old age diseases the main causes of human death in affluent societies (apart from accidents). When dealing with end of life issues, medical sociology will need to focus more on life and death in seniors. Understanding the attitudes of older persons toward life and death is important for both performing end-of-life medical care and in developing end-of-life policies. Descriptive bioethical analysis of attitudes in different cultures can aid a fuller understanding of the views inside each culture and the trajectories of conflict situations within each culture. In-depth interviews were conducted with 112 senior citizens in Taiwan and with 25 senior citizens in New Zealand. All interviews were transcribed verbatim; qualitative data analysis was used to examine people's views on life and death. Their images of life and end of life attitudes were compared. Analysis of the key concepts they mentioned revealed distinctive views in life attitudes between these two groups. However, in spite of differences in culture and traditions, most life and end-of-life attitudes among elderly people in the two groups were rather similar. According to these similarities, an interpretation of these values was made within a Confucian and Taoist framework that might be applicable to non-Eastern cultures as well.

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Section: Resultsmentioning

confidence: 98%

Comparisons of Life Images and End-of-Life Attitudes Between the Elderly in Taiwan and New Zealand

Hsin

Macer²

2006

Journal of Nursing Research

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“…In particular, the representative of a ''passive'' type of intervention in the study-disconnection of a life support machinestill involves some action, in contrast to never starting a treatment (such as not inserting an endotracheal tube or not prescribing or administering an antibiotic). Physicians in various countries usually, [46][47][48] though not always, 49 consider withholding life sustaining treatment as different from, and more acceptable than, withdrawing it. Future studies can investigate the impact on acceptability of these gradations between an active and a passive role.…”

Section: Health Professionalsmentioning

confidence: 99%

The acceptability of ending a patient’s life

Guedj

2005

J Med Ethics

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Objectives: To clarify how lay people and health professionals judge the acceptability of ending the life of a terminally ill patient. Design: Participants judged this acceptability in a set of 16 scenarios that combined four factors: the identity of the actor (patient or physician), the patient's statement or not of a desire to have his life ended, the nature of the action as relatively active (injecting a toxin) or passive (disconnecting life support), and the type of suffering (intractable physical pain, complete dependence, or severe psychiatric illness). Participants: 115 lay people and 72 health professionals (22 nurse's aides, 44 nurses, six physicians) in Toulouse, France. Main measurements: Mean acceptability ratings for each scenario for each group. Results: Life ending interventions are more acceptable to lay people than to the health professionals. For both, acceptability is highest for intractable physical suffering; is higher when patients end their own lives than when physicians do so; and, when physicians are the actors, is higher when patients have expressed a desire to die (voluntary euthanasia) than when they have not (involuntary euthanasia). In contrast, when patients perform the action, acceptability for the lay people and nurse's aides does not depend on whether the patient has expressed a desire to die, while for the nurses and physicians unassisted suicide is more acceptable than physician assisted suicide. Conclusions: Lay participants judge the acceptability of life ending actions in largely the same way as do healthcare professionals.

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“…where an interviewer was present but GPs were given or shown scenarios and asked to give quantitative responses) were included. Studies investigating end of life decision making were excluded because of the many ethical, legal and societal issues inherent in these decisions which are unlikely to be present in the everyday clinical decisions made by GPs working in the community [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

Perceived difficulty and appropriateness of decision making by General Practitioners: a systematic review of scenario studies

McCleary

Ramsay

Francis

et al. 2014

BMC Health Serv Res

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BackgroundHealth-care quality in primary care depends largely on the appropriateness of General Practitioners’ (GPs; Primary Care or Family Physicians) decisions, which may be influenced by how difficult they perceive decisions to be. Patient scenarios (clinical or case vignettes) are widely used to investigate GPs’ decision making. This review aimed to identify the extent to which perceived decision difficulty, decision appropriateness, and their relationship have been assessed in scenario studies of GPs’ decision making; identify possible determinants of difficulty and appropriateness; and investigate the relationship between difficulty and appropriateness.MethodsMEDLINE, EMBASE, PsycINFO, the Cochrane Library and Web of Science were searched for scenario studies of GPs’ decision making. One author completed article screening. Ten percent of titles and abstracts were checked by an independent volunteer, resulting in 91% agreement. Data on decision difficulty and appropriateness were extracted by one author and descriptively synthesised. Chi-squared tests were used to explore associations between decision appropriateness, decision type and decision appropriateness assessment method.ResultsOf 152 included studies, 66 assessed decision appropriateness and five assessed perceived difficulty. While no studies assessed the relationship between perceived difficulty and appropriateness, one study objectively varied the difficulty of the scenarios and assessed the relationship between a measure of objective difficulty and appropriateness. Across 38 studies where calculations were possible, 62% of the decisions were appropriate as defined by the appropriateness standard used. Chi-squared tests identified statistically significant associations between decision appropriateness, decision type and decision appropriateness assessment method. Findings suggested a negative relationship between decision difficulty and appropriateness, while interventions may have the potential to reduce perceived difficulty.ConclusionsScenario-based research into GPs’ decisions rarely considers the relationship between perceived decision difficulty and decision appropriateness. The links between these decisional components require further investigation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0621-2) contains supplementary material, which is available to authorized users.

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Withholding life prolonging treatment, and self deception

Cited by 10 publications

References 8 publications

Comparisons of Life Images and End-of-Life Attitudes Between the Elderly in Taiwan and New Zealand

Comparisons of Life Images and End-of-Life Attitudes Between the Elderly in Taiwan and New Zealand

The acceptability of ending a patient’s life

Perceived difficulty and appropriateness of decision making by General Practitioners: a systematic review of scenario studies

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