How do general practitioners assess the criteria for due care for euthanasia in concrete cases?

Wolf, Johanna E. Hanssen-de; Pasman, H. Roeline W.; Onwuteaka‐Philipsen, Bregje D.

doi:10.1016/j.healthpol.2007.12.009

Cited by 14 publications

(12 citation statements)

References 8 publications

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“…In qualitative interviews with and observations of physicians, it is described how physicians test their impression regarding the voluntariness of the request and the unbearableness of the symptoms in repeated discussions with family members [ 35 , 38 ]. Likewise, Hanssen’s quantitative study showed that GPs had conversations with the patient in 95% of cases and with family members in 71% of cases to come to a judgment about unbearable suffering [ 63 ].…”

Section: Resultsmentioning

confidence: 99%

The involvement of family in the Dutch practice of euthanasia and physician assisted suicide: a systematic mixed studies review

2019

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Background Family members do not have an official position in the practice of euthanasia and physician assisted suicide (EAS) in the Netherlands according to statutory regulations and related guidelines. However, recent empirical findings on the influence of family members on EAS decision-making raise practical and ethical questions. Therefore, the aim of this review is to explore how family members are involved in the Dutch practice of EAS according to empirical research, and to map out themes that could serve as a starting point for further empirical and ethical inquiry. Methods A systematic mixed studies review was performed. The databases Pubmed, Embase, PsycInfo, and Emcare were searched to identify empirical studies describing any aspect of the involvement of family members before, during and after EAS in the Netherlands from 1980 till 2018. Thematic analysis was chosen as method to synthesize the quantitative and qualitative studies. Results Sixty-six studies were identified. Only 14 studies had family members themselves as study participants. Four themes emerged from the thematic analysis. 1) Family-related reasons (not) to request EAS. 2) Roles and responsibilities of family members during EAS decision-making and performance. 3) Families’ experiences and grief after EAS. 4) Family and ‘the good euthanasia death’ according to Dutch physicians. Conclusion Family members seem to be active participants in EAS decision-making, which goes hand in hand with ambivalent feelings and experiences. Considerations about family members and the social context appear to be very important for patients and physicians when they request or grant a request for EAS. Although further empirical research is needed to assess the depth and generalizability of the results, this review provides a new perspective on EAS decision-making and challenges the Dutch ethical-legal framework of EAS. Euthanasia decision-making is typically framed in the patient-physician dyad, while a patient-physician-family triad seems more appropriate to describe what happens in clinical practice. This perspective raises questions about the interpretation of autonomy, the origins of suffering underlying requests for EAS, and the responsibilities of physicians during EAS decision-making.

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Section: Resultsmentioning

confidence: 99%

The involvement of family in the Dutch practice of euthanasia and physician assisted suicide: a systematic mixed studies review

2019

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“…The larger survey not only aimed to examine psychiatrists’ attitudes, but also their concrete experiences and whether they can see themselves taking part in euthanasia procedures based on psychiatric conditions in the future. The instrument was developed on the basis of five existing questionnaires [ 15 , 16 , 21 – 23 ], and adjusted to the context of current psychiatric clinical practice in Flanders.…”

Section: Methodsmentioning

confidence: 99%

Belgian psychiatrists’ attitudes towards, and readiness to engage in, euthanasia assessment procedures with adults with psychiatric conditions: a survey

et al. 2020

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Background: Although the Belgian assessment pathway for legal euthanasia requires the engagement of at least one psychiatrist, little is known about psychiatrists' attitudes towards euthanasia for adults with psychiatric conditions (APC). This study aims to gauge psychiatrists' attitudes towards and readiness to engage in euthanasia assessment and/or performance procedures in APC. Methods: This cross-sectional survey study was performed between November 2018 and April 2019. The survey was sent to a sample of 499 eligible psychiatrists affiliated to the Flemish Association for Psychiatry, a professional association that aims to unite and represent all psychiatrists working in Flanders, the Dutch-speaking, northern part of Belgium. The Association's members comprise an estimated 80-90% of all psychiatrists active in Flanders. Only psychiatrists working with APC (83% of the association's total membership) were included. Factorial Anova and Chi Square tests were performed to examine if and to what extent psychiatrists' backgrounds were associated with, respectively, their attitudes and their readiness to play a role in euthanasia procedures concerning APC. Results: One hundred eighty-four psychiatrists completed the questionnaire (response rate 40.2%); 74.5% agree that euthanasia should remain permissible for APC. However, 68.9% question some of the approaches taken by other physicians during the euthanasia assessment and only half consider euthanasia assessment procedures compatible with the psychiatric care relationship. Where active engagement is concerned, an informal referral (68%) or preliminary advisory role (43.8%) is preferred to a formal role as a legally required advising physician (30.3%), let alone as performing physician (< 10%). Conclusion: Although three quarters agree with maintaining the legal option of euthanasia for APC, their readiness to take a formal role in euthanasia procedures appears to be limited. More insight is required into the barriers preventing engagement and what psychiatrists need, be it education or clarification of the legal requirements, to ensure that patients can have their euthanasia requests assessed adequately.

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“…For this study, the survey questions on the psychiatrist's concrete engagement in euthanasia cases based on psychiatric conditions were taken from a larger survey instrument, which is posted in the Open Science Framework repository (see Appendices A and B in OSF) accompanying this paper (in Dutch) and the Supplemental Materials in OSF (in French and English). The instrument was developed on the basis of five existing questionnaires [9][10][11][12][13], and adjusted to the context of current psychiatric clinical practice in Belgium. This larger survey was tested for cognitive validation purposes (i.e.…”

Section: Survey Instrumentmentioning

confidence: 99%

The engagement of psychiatrists in the assessment of euthanasia requests from psychiatric patients in Belgium: a survey study

et al. 2020

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Background: Since its legalisation in 2002, the number of times euthanasia has been carried out in response to requests from adults with psychiatric conditions (APC) has continued to increase. However, little is known about why and how psychiatrists become engaged in the assessment of such euthanasia requests. Methods: A cross-sectional survey study was conducted between November 2018 and April 2019 of 499 psychiatrists affiliated with the Flemish Psychiatry Association. Chi square/Fisher's exact tests were performed to examine if, and to what extent, psychiatrists' backgrounds relate to their concrete experiences. The answers to the open question regarding motives for (non-) engagement were thematically coded. Results: Two hundred one psychiatrists participated, a response rate of 40%. During their careers, 80% of those responding have been confronted with at least one euthanasia request from an APC patient and 73% have become involved in the assessment procedure. Their engagement was limited to the roles of: referring physician (in 44% of the psychiatrists), attending physician (30%), legally required 'advising physician' (22%), and physician participating in the actual administration of the lethal drugs (5%). Within the most recent 12 months of practice, 61% of the respondents have been actively engaged in a euthanasia assessment procedure and 9% have refused at least once to be actively engaged due to their own conscientious objections and/or the complexity of the assessment. The main motive for psychiatrists to engage in euthanasia is the patient's fundamental right in Belgian law to ask for euthanasia and the psychiatrist's duty to respect that. The perception that they were sufficiently competent to engage in a euthanasia procedure was greater in psychiatrists who have already had concrete experience in the procedure.

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How do general practitioners assess the criteria for due care for euthanasia in concrete cases?

Cited by 14 publications

References 8 publications

The involvement of family in the Dutch practice of euthanasia and physician assisted suicide: a systematic mixed studies review

The involvement of family in the Dutch practice of euthanasia and physician assisted suicide: a systematic mixed studies review

Belgian psychiatrists’ attitudes towards, and readiness to engage in, euthanasia assessment procedures with adults with psychiatric conditions: a survey

The engagement of psychiatrists in the assessment of euthanasia requests from psychiatric patients in Belgium: a survey study

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