Development and dissemination of institutional practice guidelines on medical end-of-life decisions in Dutch health care institutions

Hesselink, B.A.M.; Pasman, H. Roeline W.; Wal, Gerrit van der; Maas, P.J. van der; Heide, Agnes van der; Onwuteaka‐Philipsen, Bregje D.

doi:10.1016/j.healthpol.2009.09.016

Cited by 4 publications

(12 citation statements)

References 15 publications

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“…Twenty-six of 35 articles addressed regulatory issues. 9–34 Major challenges discussed were issues of defining and evaluating criteria toward eligibility for MAiD. 9–16 , 18 , 20–23 , 28–31 There was consensus that existing eligibility criteria were often vague or ambiguous, subject to interpretation by practitioners.…”

Section: Resultsmentioning

confidence: 99%

“…16,44 Health services, particularly those serving patients at end-of-life, must readily adopt practice guidelines and streamline responses to the growing number of MAiD requests. 13,14,17 While the challenges appear daunting, certain areas warrant heightened attention to alleviate policy ambiguities. First is determining comprehensive, specific and clear criteria for eligibility.…”

Section: Discussionmentioning

confidence: 99%

“…15,29,32,33 Seven articles examined the use of guidelines and/or frameworks to support decision-making. 13,17,21,26,[32][33][34] Werth et al argued that guidelines were necessary to aid psychological evaluations of mental condition(s) and capacity to consent 32 -a necessary criterion in some jurisdictions. All seven articles agreed that institutional and professional guidelines to support MAiD practices are necessary, but often underdeveloped or poorly integrated into existing health services.…”

Section: Regulatory Challengesmentioning

confidence: 99%

“…All seven articles agreed that institutional and professional guidelines to support MAiD practices are necessary, but often underdeveloped or poorly integrated into existing health services. 13,17,21,26,[32][33][34] While many institutions appear to have practice guidelines, these were not always systematically disseminated to all stakeholders. 17 Six papers discussed concerns about physician adherence to MAiD policy.…”

Section: Regulatory Challengesmentioning

confidence: 99%

“…13,17,21,26,[32][33][34] While many institutions appear to have practice guidelines, these were not always systematically disseminated to all stakeholders. 17 Six papers discussed concerns about physician adherence to MAiD policy. 12,[23][24][25]28,34 Three authors highlighted that the mandatory notification procedure for MAiD was often not completed or completed with significant variation.…”

Section: Regulatory Challengesmentioning

confidence: 99%

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Medical assistance in dying: implications for health systems from a scoping review of the literature

Fujioka

Mirza

Klinger

et al. 2019

J Health Serv Res Policy

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Objective Medical assistance in dying (MAiD) is the medical provision of substances to end a patient’s life at their voluntary request. While legal in several countries, the implementation of MAiD is met with ethical, legislative and clinical challenges, which are often overshadowed by moral discourse. Our aim was to conduct a scoping review to explore key barriers for the integration of MAiD into existing health systems. Methods We searched electronic databases (CINAHL, Embase, MEDLINE, and PsycINFO) and grey literature sources from 1990 to 2017. Studies discussing barriers and/or challenges to implementing MAiD from a health system’s perspective were included. Full-text papers were screened against inclusion/exclusion criteria for article selection. A thematic content analysis was conducted to summarize data into themes to highlight key implementation barriers. Results The final review included 35 articles (see online Appendix 1). Six categories of implementation challenges emerged: regulatory (n = 26), legal (n = 15), social (n = 9), logistical (n = 9), financial (n = 3) and compatibility with palliative care (n = 3). Within four of the six identified implementation barriers (regulatory, legal, social and logistical) were subthemes, which described barriers related to legalizing MAiD in more detail. Conclusion Despite multiple challenges related to its implementation, MAiD remains a requested end-of-life option, requiring careful examination to ensure adequate integration into existing health services. Comprehensive models of care incorporating multidisciplinary teams and regulatory oversight alongside improved clinician education may be effective to streamline MAiD services.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Regulatory Challengesmentioning

confidence: 99%

Section: Regulatory Challengesmentioning

confidence: 99%

Section: Regulatory Challengesmentioning

confidence: 99%

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Medical assistance in dying: implications for health systems from a scoping review of the literature

Fujioka

Mirza

Klinger

et al. 2019

J Health Serv Res Policy

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Regulating voluntary assisted dying practice: A policy analysis from Victoria, Australia

Willmott

White

2021

Health Policy

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Do guidelines on euthanasia and physician-assisted suicide in Dutch hospitals and nursing homes reflect the law? A content analysis

et al. 2011

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To describe the content of practice guidelines on euthanasia and assisted suicide (EAS) and to compare differences between settings and guidelines developed before or after enactment of the euthanasia law in 2002 by means of a content analysis. Most guidelines stated that the attending physician is responsible for the decision to grant or refuse an EAS request. Due care criteria were described in the majority of guidelines, but aspects relevant for assessing these criteria were not always described. Half of the guidelines described the role of the nurse in the performance of euthanasia. Compared with hospital guidelines, nursing home guidelines were more often stricter than the law in excluding patients with dementia (30% vs 4%) and incompetent patients (25% vs 4%). As from 2002, the guidelines were less strict in categorically excluding patients groups (32% vs 64%) and in particular incompetent patients (10% vs 29%). Healthcare institutions should accurately state the boundaries of the law, also when they prefer to set stricter boundaries for their own institution. Only then can guidelines provide adequate support for physicians and nurses in the difficult EAS decision-making process.

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Development and dissemination of institutional practice guidelines on medical end-of-life decisions in Dutch health care institutions

Cited by 4 publications

References 15 publications

Medical assistance in dying: implications for health systems from a scoping review of the literature

Medical assistance in dying: implications for health systems from a scoping review of the literature

Regulating voluntary assisted dying practice: A policy analysis from Victoria, Australia

Do guidelines on euthanasia and physician-assisted suicide in Dutch hospitals and nursing homes reflect the law? A content analysis

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