Euthanasia: the role of good care

Facing the issue of dependence: some implications from the literature for the hospice and hospice nurses

“…Loss of independence is known to cause distress in people who are dying, so much so that some wish for an earlier death ( Seale & Addington‐Hall 1995), yet maintaining independence is referred to as a major aim of palliative care throughout the literature. This has not, however, been studied to any great extent.…”

“…This is of course one generalized perspective of nursing and incongruent with the findings of Benner (1984) from her study of nurse experts, who stated that key components of their role were to assist patients to integrate the implications of illness into their lives and, where appropriate, to `be with' rather than `do for' a patient. The extent to which patients are helped to come to terms with their dependence is of critical importance in hospices and hospice nursing since assertions that hospice care should reduce distress and the desire for euthanasia have been dramatically challenged by the work of Seale & Addington Hall (1995), who showed that people who received hospice care were more likely to have respondents who felt that it would have been better if they had died earlier. Their conclusions, that good care (hospice care) does not counteract people's fear of dependence and may serve to increase feelings of lost autonomy, must be critically considered by those who provide care for the terminally ill.…”

“…Although perceived and real dependency may be a problem to those with life‐threatening illness and maintaining independence for as long as possible a goal for some patients, the ability for independent activity will inevitably decline. For those individuals who are admitted to a hospice, this may serve simply to remind them of a decline in ability to do things for themselves ( Seale & Addington‐Hall 1995). The hospice and hospice nurses must face this dilemma and examine the whole issue of dependency if, as Seale & Addington Hall (1994) describe, good care is to obviate the desire to die sooner.…”

Discourses of the body in euthanasia: symptomatic, dependent, shameful and temporal

“…Although concerns around the effects of dependence and the shame of the decaying body have been expressed in a few other studies (Seale and Addington‐Hall 1994; 1995; Lawton 1998), explorations of the discourses of the body requesting euthanasia requires much more research and theorising. If end of life care is to be designed to meet the needs of dying people, then understanding the discursive effects of the dying body can assist health professionals to work with dying people and their families to deal with their unspoken and unspeakable bodily needs.…”

Patient desires: A model for assessment of patient preferences for care of severe or terminal illness

“…The desire for hastened death has an unclear correlation to social support~Breitbart et al, Nelson et al, 2002!. The desire to hasten death has shown a correlation to significant depression~Chochinov et al, 1995significant depression~Chochinov et al, , 1999Rosenfeld et al, 1999;Breitbart et al, 2000;Wilson et al, 2000;Akechi et al, 2001;Emanuel et al, 2002;Nelson et al, 2002;Suarez-Almazor et al, 2002! though nurses caring for patients under Oregon's Death with Dignity Act did not feel depression significantly inf luenced patients who requested hastened death~Ganzini et al, 2002a!. As with the desire to limit interventions, stability of patients' desires to hasten death may vary~Chochi-nov et al, 1995!. Desire to hasten death also serves as an expression of autonomy, dignity, or control~Seale & Addington- Hall, 1995;Eisemann & Richter, 1999;Filiberti et al, 2001;Chochinov et al, 2002;SuarezAlmazor et al, 2002!. Patients who requested physician-assisted suicide under Oregon's Death with Dignity Act were those who valued control and autonomy~Filiberti et al, 2001;Wineberg & Werth, 2003!.…”