Assisted suicide Archives - Page 9 of 11 - Protection of Conscience Project Library

Physician-assisted deaths under the euthanasia law in Belgium: A population-based survey

Kenneth Chambaere, Johan Bilsen, Joachim Cohen, Bregje D Onwuteaka-Philipsen, Freddy Mortier, Luc Deliens

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Abstract
Background: Legalization of euthanasia and physician-assisted suicide has been heavily debated in many countries. To help inform this debate, we describe the practices of euthanasia and assisted suicide, and the use of life-ending drugs without an explicit request from the patient, in Flanders, Belgium, where euthanasia is legal.

Methods: We mailed a questionnaire regarding the use of life-ending drugs with or without explicit patient request to physicians who certified a representative sample (n = 6927) of death certificates of patients who died in Flanders between June and November 2007.

Results: The response rate was 58.4%. Overall, 208 deaths involving the use of life-ending drugs were reported: 142 (weighted prevalence 2.0%) were with an explicit patient request (euthanasia or assisted suicide) and 66 (weighted prevalence 1.8%) were without an explicit request. Euthanasia and assisted suicide mostly involved patients less than 80 years of age, those with cancer and those dying at home. Use of life-ending drugs without an explicit request mostly involved patients 80 years of older, those with a disease other than cancer and those in hospital. Of the deaths without an explicit request, the decision was not discussed with the patient in 77.9% of cases. Compared with assisted deaths with the patient’s explicit re quest, those without an explicit request were more likely to have a shorter length of treatment of the terminal illness, to have cure as a goal of treatment in the last week, to have a shorter estimated time by which life was shortened and to involve the administration of opioids.

Interpretation: Physician-assisted deaths with an explicit patient request (euthanasia and assisted suicide) and without an explicit request occurred in different patient groups and under different circumstances. Cases without an explicit request often involved patients whose diseases had unpredictable end-of-life trajectories. Although opioids were used in most of these cases, misconceptions seem to persist about their actual life-shortening effects.

Chambaere K, Bilsen J, Cohen J, Onwuteaka-Philipsen BD, Mortier F, Deliens L. Physician-assisted deaths under the euthanasia law in Belgium: A population-based survey. Can Med Assoc J. 2010 Jun 15;182(9):895-901.

Reporting of euthanasia and physician-assisted suicide in the Netherlands: Descriptive study

Hilde Buiting, Johannes Van Delden, Bregje D Onwuteaka-Philipsen, Judith Rietjens, Mette Rurup, Donald Van Tol, Joseph Gevers,Paul Van Der Maas,Agnes Van Der Heide

Abstract
Background: An important principle underlying the Dutch Euthanasia Act is physicians’ responsibility to alleviate patients’ suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient’s request, the patient’s suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees’ attention. . . .

Conclusion: Dutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they provide is in most cases sufficient to enable adequate review. Review committees’ control seems to focus on (unbearable) suffering and on procedural issues.

Buiting H, Delden JV, Onwuteaka-Philipsen BD, Rietjens J, Rurup M, Tol DV et al. Reporting of euthanasia and physician-assisted suicide in the Netherlands: Descriptive study. BMC Medical Ethics. 2009;10(1).

Physicians’ beliefs about conscience in medicine: a national survey

Ryan E Lawrence, Farr A Curlin

Abstract
PURPOSE: To explore physicians’ beliefs about whether physicians sometimes have a professional obligation to provide medical services even if doing so goes against their conscience, and to examine associations between physicians’ opinions and their religious and ethical commitments.

METHOD: A survey was mailed in 2007 to a stratified random sample of 1,000 U.S. primary care physicians, selected from the American Medical Association Physician Masterfile. . . .

RESULTS: The response rate was 51% (446/879 delivered questionnaires). Forty-two percent and 22% believed they are never and sometimes, respectively, obligated to do what they personally believe is wrong, and 36% agreed with both statements. Physicians who are more religious are more likely to believe that physicians are never obligated to do what they believe is wrong (58% and 31% of those with high and low intrinsic religiosity, respectively; multivariate odds ratio, 2.9; 95% CI, 1.2-7.2). Those with moral objections to any of three controversial practices were more likely to hold that physicians should never do what they believe is wrong.

CONCLUSION: A substantial minority of physicians do not believe there is ever a professional obligation to do something they personally believe is wrong.

Lawrence RE, Curlin FA. Physicians’ beliefs about conscience in medicine: a national survey.. Acad Med. 2009;84(9):1276-1282.

The Attitude of Flemish Palliative Care Physicians to Euthanasia and Assisted Suicide

Bert Broeckaert, Joris Gielen, Trudie Van Iersel, Stef Van Den Branden

Abstract
Surveys carried out among palliative care physicians have shown that most participants do not support euthanasia and assisted suicide. Belgium, however, is one of the few countries in the world in which voluntary euthanasia is allowed by law. The potential influence of this legal dimension thus warranted a study of the attitudes of Belgian palliative care physicians toward euthanasia and assisted suicide. . . .The majority of the physicians favour legalisation on assisted suicide. There is no significant association between the euthanasia clusters and attitudes toward assisted suicide. We conclude that although most Flemish palliative care physicians agree that there may be circumstances in which a euthanasia request is justified, they also strongly believe in the effects of good palliative care and want the ‘palliative filter’ to be included in the law on euthanasia. Religion and worldview are an important factor determining attitudes towards euthanasia.

Broeckaert B, Gielen J, Iersel TV, Branden SVD. The Attitude of Flemish Palliative Care Physicians to Euthanasia and Assisted Suicide. Ethical Perspectives. 2009;16(3):311-335.

Medically Assisted Death: Nancy B. v. Hotel-Dieu de Quebec

Bernard M Dickens

Abstract
In Nancy B. v. Hotel-Dieu de Quebec, the Quebec Superior Court held that a patient was legally entitled to discontinue and decline medical treatment when she found it unacceptable. The author discusses how this case is consistent with several other, decisions, yet distinguishable from certain Canadian decisions which contributed to its outcome. Through an analysis of Criminal Code provisions against homicide and on the duty to preserve life, the doctrine of informed consent, and related jurisprudence, the author argues that the Nancy B. decision narrows the gap between allowing a patient to suffer natural death and medically assisting death. The author also raises issues associated with the notion of medical futility. He concludes that “the Nancy B. case moves the discourse in medical ethics and law towards the feminist “carebased” paradigm and suggests that the carefully- circumscribed judicial response was an appropriate legal answer to the question of how best to care for Nancy B..

Dickens BM. Medically Assisted Death: Nancy B. v. Hotel-Dieu de Quebec. McGill Law Journal. 1993;38(1053-1070.

To Die, to Sleep: US Physicians’ Religious and Other Objections to Physician-Assisted Suicide, Terminal Sedation, and Withdrawal of Life Support

Farr A Curlin, Chinyere Nwodim, Jennifer L Vance, Marshall H Chin, John D Lantos

American Journal of Hospice and Palliative Care

Abstract
This study analyzes data from a national survey to estimate the proportion of physicians who currently object to physician-assisted suicide (PAS), terminal sedation (TS), and withdrawal of artificial life support (WLS), and to examine associations between such objections and physician ethnicity, religious characteristics, and experience caring for dying patients. Overall, 69% of the US physicians object to PAS, 18% to TS, and 5% to WLS. Highly religious physicians are more likely than those with low religiosity to object to both PAS (84% vs 55%, P < .001) and TS (25% vs 12%, P < .001). Objection to PAS or TS is also associated with being of Asian ethnicity, of Hindu religious affiliation, and having more experience caring for dying patients. These findings suggest that, with respect to morally contested interventions at the end of life, the medical care patients receive will vary based on their physicians’ religious characteristics, ethnicity, and experience caring for dying patients.

Curlin FA, Nwodim C, Vance JL, Chin MH, Lantos JD. To Die, to Sleep: US Physicians’ Religious and Other Objections to Physician-Assisted Suicide, Terminal Sedation, and Withdrawal of Life Support. American J Hospice & Pall Care. 2008;25(12):112-120.

The Ever-Expanding Health Care Conscience Clause: The Quest for Immunity in the Struggle Between Professional Duties and Moral Beliefs

Maxine M. Harrington

Extract
Conclusion
Conscience clauses raise many difficult issues in a pluralistic society. Health care providers have special obligations to patients that are not replicated in many other professional endeavors. Duties prescribed
by law and professional codes of conduct expect health care providers to act out of respect for the patient’s welfare and dignity. While no one suggests that health professionals should abandon their religious or moral principles, patients should not suffer harm or potential harm because of a belief they do not share. It is often appropriate to accommodate individuals who wish to exercise their principles in the care of patients, but conscience clauses that promote blanket immunity for refusals to provide health care services resolve the tension between patient needs and provider autonomy in a onesided manner.

When health care providers deviate from standards of care, engage in unprofessional conduct, or unduly burden their colleagues and employers through refusals to perform services, exemptions from malpractice, disciplinary, or employment actions are not appropriate. . .Accordingly, legislators should not tie the hands of disciplinary boards in addressing such conduct.

The clamor for absolute immunity from employment actions for health care workers asserting moral refusals to treat demonstrates a myopic view of the burdens imposed by such objections on patients, employers, and coworkers. . . . Although legislators may choose to heighten the de minimis accommodation standard under Title VII, abrogation of the undue hardship test is not warranted from either a policy or legal prospective.

. . . the overriding purpose of our health care system is to protect the health and safety of patients. The expansion of refusal legislation to create immunity for health care providers who refuse any service for almost any reason is cause for alarm. Conscience clauses fail to achieve a reasonable balance when they confer a special benefit on those whose religious, moral, or ethical beliefs compel them to deny health care while absolving them of the potentially harmful consequences of their choices. . .

Harrington MM. The Ever-Expanding Health Care Conscience Clause: The Quest for Immunity in the Struggle Between Professional Duties and Moral Beliefs. 34 Fla. St. U. L. Rev. 779, 816 n.237 (2007)

Equality, Justice, and Paternalism: Recentreing Debate about Physician-Assisted Suicide

Andrew Sneddon

Abstract
Debate about physician-assisted suicide has typically focused on the values of autonomy and patient well-being. This is understandable, even reasonable, given the importance of these values in bioethics. However, these are not the only moral values there are. The purpose of this paper is to examine physician-assisted suicide on the basis of the values of equality and justice. In particular, I will evaluate two arguments that invoke equality, one in favour of physician-assisted suicide, one against it, and I will eventually argue that a convincing equality-based argument in support of physician-assisted suicide is available. I will conclude by showing how an equality-based perspective transforms some secondary features of debate about this issue.

Sneddon A. Equality, Justice, and Paternalism: Recentreing Debate about Physician-Assisted Suicide. J Applied Phil. 2006 Nov;23(4):387-404.

Foreword: The Role of Religion in Health Law and Policy

William J Winslade, Ronald A Carson

Extract
This symposium issue explores several continuing controversies at the intersection of Law, Ethics, Healthcare, Politics, Health Policy and Religion: abortion, contraception, the status of embryos, stem cell research, IVF, personal and professional autonomy, end- of-life decisions, and religiously based health care systems. The multiple values associated with each of these topics strain and threaten to usurp the effectiveness of our legal system to regulate them.

Winslade WJ, Carson RA. Foreword: The Role of Religion in Health Law and Policy. Houston Journal of Health Law & Policy. 2006 Sep;6(2):245-248.

Emotional and Psychological Effects of Physician-Assisted Suicide and Euthanasia On Participating Physicians

Kenneth R Stevens

Extract
Conclusion
Physician participation in assisted suicide or euthanasia can have a profound harmful effect on the involved physicians. Doctors must take responsibility for causing the patient’s death. There is a huge burden on conscience, tangled emotions and a large psychological toll on the participating physicians. Many physicians describe feelings of isolation. Published evidence indicates that some patients and others are pressuring and intimidating doctors to assist in suicides. Some doctors feel they have no choice but to be involved in assisted suicides. Oregon physicians are decreasingly present at the time of the assisted suicide. There is also great potential for physicians to be affected by countertransference issues in dealing with end-of-Iife care, and assisted suicide and euthanasia..

Stevens KR. Emotional and Psychological Effects of Physician-Assisted Suicide and Euthanasia On Participating Physicians. The Linacre Quarterly. 2006;73(3).