Responding to Requests for Euthanasia and Physician-Assisted Suicide

Kenny, Nuala

doi:10.1016/b978-141602597-9.10017-1

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…Awareness of such processes is important when responding to patients with a request for EAS [ 70 , 72 , 73 ]. Physician factors in response to the suffering of patients include attitude and quality of provided palliative care [ 18 , 23 , 72 , 74 ]. Palliative interventions to reduce suffering in end-of-life cancer patients include symptom reduction [ 28 ], psycho-oncologic interventions [ 32 , 33 , 36 , 47 , 75 , 76 ], spiritual care [ 77 , 78 ] and palliative sedation [ 79 , 80 ].…”

Section: Discussionmentioning

confidence: 99%

“…EAS most frequently is performed in the estimated last two weeks of life [ 13 ]. Legal responsibility for EAS allotted to the medical profession changes the dynamics of interaction between patients and physicians [ 18 ]. Doctors face difficulties in assessing and responding to suffering and requests for EAS [ 1 , 3 , 19 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Unbearable suffering and requests for euthanasia prospectively studied in end-of-life cancer patients in primary care

Ruijs¹,

Wal²,

Kerkhof

2014

BMC Palliat Care

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BackgroundAn international discussion about whether or not to legally permit euthanasia and (or) physician assisted suicide (EAS) is ongoing. Unbearable suffering in patients may result in a request for EAS. In the Netherlands EAS is legally permitted, and unbearable suffering is one of the central compulsory criteria. The majority of EAS is performed in cancer patients in the primary care practice. In around one in every seven end-of-life cancer patients dying in the primary care setting EAS is performed. The prevalence of unbearable symptoms and overall unbearable suffering in relationship to explicit requests for EAS was studied in a cohort of end-of-life cancer patients in primary care.MethodsA prospective study in primary care cancer patients estimated to die within six months was performed. Every two months suffering was assessed with the State-of-Suffering V (SOS-V). The SOS-V is a comprehensive instrument for quantitative and qualitative assessment of unbearable suffering related to 69 physical, psychological and social symptoms in five domains.ResultsOut of 148 patients who were asked to participate 76 (51%) entered the study. The studied population were 64 patients who were followed up until death; 27% explicitly requested EAS, which was performed in 8% of the patients. The final interview per patient was analyzed; in four patients the SOS-V was missing. Unbearable symptoms were present in 94% of patients with an explicit request for EAS and in 87% of patients without an explicit request. No differences were found in the prevalence of unbearable suffering for physical, psychological, social and existential symptoms, nor for overall unbearable suffering, between patients who did or who did not explicitly request EAS.ConclusionsIn a population of end-of-life cancer patients cared for in primary care no differences in unbearable suffering were found between patients with and without explicit requests for EAS. The study raises the question whether unbearable suffering is the dominant motive to request for EAS. Most patients suffered from unbearable symptoms, indicating that the compulsory criterion of unbearable suffering may be met a priori in most end-of-life cancer patients dying at home, whether they request EAS or not.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unbearable suffering and requests for euthanasia prospectively studied in end-of-life cancer patients in primary care

Ruijs¹,

Wal²,

Kerkhof

2014

BMC Palliat Care

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“…Mechanisms of transference and counter-transference about coping with suffering may be more prominent in primary care as a consequence of strong patient-physician relationships [58-61]. Further dynamics of care alter once a decision is made to proceed in a process towards EPAS [20,62]. …”

Section: Discussionmentioning

confidence: 99%

Symptoms, unbearability and the nature of suffering in terminal cancer patients dying at home: a prospective primary care study

2013

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BackgroundPrimary care physicians provide palliative home care. In cancer patients dying at home in the Netherlands (45% of all cancer patients) euthanasia in about one out of every seven patients indicates unbearable suffering. Symptom prevalence, relationship between intensity of symptoms and unbearable suffering, evolvement of symptoms and unbearability over time and quality of unbearable suffering were studied in end-of-life cancer patients in primary care.Methods44 general practitioners during three years recruited cancer patients estimated to die within six months. Every two months patients quantified intensity as well as unbearability of 69 symptoms with the State-of-Suffering-V (SOS-V). Also overall unbearable suffering was quantified. The five-point rating scale ranged from 1 (not at all) to 5 (hardly can be worse). For symptoms assessed to be unbearable the nature of the suffering was additionally investigated with open-ended questions. The final interviews were analyzed; for longitudinal evolvement also the pre-final interviews were analyzed. Symptom intensity scores 4 and 5 were defined to indicate high intensity. Symptom unbearability scores 4 and 5 were defined to indicate unbearable suffering. Two raters categorized the qualitative descriptions of unbearable suffering.ResultsOut of 148 requested patients 51% participated; 64 patients were followed up until death. The SOS-V was administered at least once in 60 patients (on average 30 days before death) and at least twice in 33 patients. Weakness was the most frequent unbearable symptom (57%). Pain was unbearable in 25%. Pain, loss of control over one’s life and fear of future suffering frequently were unbearable (89-92%) when symptom intensity was high. Loss of control over one’s life, vomiting and not being able to do important things frequently were unbearable (52-80%) when symptom intensity was low. Unbearable weakness significantly increased between pre-final and final interview. Physical suffering, loss of meaning, loss of autonomy, experiencing to be a burden, fear of future suffering and worrying more frequently occurred in patients suffering unbearably overall.ConclusionsWeakness was the most prevalent unbearable symptom in an end-of-life primary care cancer population. Physical suffering, loss of meaning and loss of autonomy more frequently occurred in patients who suffered unbearably overall.

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Moral distress and moral uncertainty in medical assistance in dying: A simultaneous evolutionary concept analysis

Dorman

Bouchal

2020

Nursing Forum

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Responding to Requests for Euthanasia and Physician-Assisted Suicide

Cited by 3 publications

References 14 publications

Unbearable suffering and requests for euthanasia prospectively studied in end-of-life cancer patients in primary care

Unbearable suffering and requests for euthanasia prospectively studied in end-of-life cancer patients in primary care

Symptoms, unbearability and the nature of suffering in terminal cancer patients dying at home: a prospective primary care study

Moral distress and moral uncertainty in medical assistance in dying: A simultaneous evolutionary concept analysis

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