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PubMed2000

Attitudes of cancer patients, their family members and health professionals toward active euthanasia.

This qualitative study describes the attitudes of four groups of people in cancer care toward active euthanasia. Patients (32) with incurable cancer, their family members (13), nurses (13) and physicians (13) participated in the study which was carried out in two central hospitals and in four health centres in Finland. The data was collected by means of focused interviews which were taped, transcribed and then analysed by content analysis. More than half of the participants said that they could ethically justify active euthanasia. Most of these were family members and nurses. The main reasons for their ethical justification were the terminal illness of the patient, the presence of suffering and pain and the patient's own request. Those who could not justify active euthanasia said that one human being has no right to decide death of another. Potential abuse, uncertainty about the finality of the situation, the possibility of effective alleviation of symptoms and the effects which the practice might have on medical staff were also mentioned by this group. The results of this study support the assumption given in the earlier literature that attitudes toward active euthanasia are most positive where terminally ill cancer patients are concerned.

Adult↗
PubMed1994

Voluntary active euthanasia and physician-assisted suicide in Dutch nursing homes: requests and administration.

OBJECTIVE: To learn how many requests for voluntary active euthanasia and/or physician-assisted suicide (EAS) are made to Dutch nursing home physicians (NHPs) and how often these requests are honored. DESIGN: Retrospective survey. SETTING: The Netherlands. PARTICIPANTS: All Dutch NHPs affiliated with the Dutch Association of Nursing Home Physicians (n = 713). MEASUREMENTS: An anonymous postal questionnaire was sent to all Dutch NHPs affiliated with the Dutch Association of Nursing Home Physicians (n = 713). Respondents were asked how often they had received an explicit request for EAS and whether they had complied with that request. Those who had complied were asked questions about the last occasion on which they had administered either voluntary active euthanasia or physician-assisted suicide. RESULTS: The response rate was 86% (n = 582). Of the respondents, 88% had never administered EAS in nursing homes. The remaining 12% (n = 69) had received 164 requests for voluntary active euthanasia and 53 requests for physician-assisted suicide in the period 1986 through mid-1990. Of these requests, 74 were granted (51 voluntary active euthanasia and 23 physician-assisted suicide). Dutch NHPs together receive an average of 300 requests for EAS a year. They comply with 25 of such requests annually. CONCLUSION: Not many requests for EAS are made in Dutch nursing homes. Of these requests, fewer than 1 in 10 result in the actual administration of EAS. The data presented are relatively constant for the 4.5-year period studied.

Adult↗
PubMed1996

Beliefs of Alberta physicians concerning active euthanasia: analysis of qualitative data collected in the Alberta Euthanasia Survey.

Often the type of information collected in surveys of physicians' opinions about active euthanasia has not revealed their experiences and the rationale(s) they use in arriving at their opinions. This paper presents a qualitative analysis of comments made in a large survey of Alberta physicians' opinions about active euthanasia to identify issues physicians commented upon, and to explore the rationale(s) behind their opinions. This information adds an important qualitative perspective to the current debate about euthanasia and assisted suicide.

Alberta↗
PubMed1995

[Active euthanasia].

The growing interest in the subject of active euthanasia in connection with the debate regarding legalization of such practices in Denmark necessitates taking a definite standpoint. The difference in concept between active and passive euthanasia is stressed, and the Dutch guidelines are reviewed. The article discusses how far the patient's autonomy should go, as it regards the consideration of self-determination as being too narrow a criterion in itself. The discussion on the quality of life is included, and the consequences of the process of expulsion as a sociological concept are considered--the risk of a patient feeling guilty for being alive and therefore feeling compelled to request active euthanasia. The changed function of the physician is underlined, and it is discussed whether active euthansia will cause a breach of confidence between the physician and his patient. In connection with the debate the following tendencies in society are emphasized: lack of clarity, increasing medicalization and utilitarian priorities.

Denmark↗
PubMed1992

[Attitudes towards active euthanasia and its legislation in Spain].

BACKGROUND: The present forms of carrying out public health care have lead to probably more effective medicine but which at the same time has led to greater risks in violating patients' rights and welfare. At present, a series of arguments are been debated for soliciting the legalization of euthanasia as a form of avoiding possible abuses. Thus, the opinions and attitudes concerning legislation for active euthanasia in terminally ill patients were herein investigated. METHODS: An anonymous survey was elaborated in which 1,109 subjects from three sectors of the population participated: a) hospital personnel (doctors n = 346 and nurses n = 346) of the University Hospital San Carlos in Madrid, b) students (n = 261) of the University Complutense of Madrid, and c) retired people (n = 156) in an old age residence in the province of Madrid (Pinto). The sample was made up of a total of 446 males and 657 females with ages of between 20 and 90 years. RESULTS: Most of those surveyed were in agreement in determined circumstances or totally in agreement with legislation for active euthanasia in terminally ill patients (63%). With respect to acceptation to the practice of legislation for active euthanasia 63% were in agreement in determined circumstances or totally in agreement. Significant differences were found (p less than 0.05) in relation to age, sex, marital status, religion and political ideology of the subjects. CONCLUSIONS: Although the results found in this study concerning the opinions and attitudes on legislation for active euthanasia in terminally ill patients coincided when compared with other existing studies with respect to acceptation for legislation, a less favorable tendency to the same was evident.

Adult↗
PubMed1997

[Attitude of cancer patients, their relatives, nurses and doctors to active euthanasia].

In this qualitative study the attitudes of the different groups of people to active euthanasia are described. 32 persons having incurable cancer, 13 relatives, 13 nurses and 13 doctors participated in the study. The study was carried out in two central hospitals and in four local hospitals. The data was collected by theme-interviews. The interviews were taped and transcribed. The interview-texts were analysed by content analysis. More than half of the participants in the study approved of active euthanasia. Among the relatives and the nurses the approval was most common. Also the attitudes of the doctors were more positive that it has been reported in the earlier studies. In the decision making concerning active euthanasia the persons with positive attitude emphasized the meaning of terminal illness, the existence of suffering and pain and the self-determination of the person. The persons with negative attitude said that a human being has no right to decide on the death of an other human being. The misuses, the uncertainty of the finality of the situation and the effective possibilities to the symptom control came out too. The doctors mentioned also the arguments concerning their own profession.

Adult↗
PubMed1985

Euthanasia--again. "Letting die" is not in the patient's best interests: a case for active euthanasia.

Recent discussions in the Journal on the subject of euthanasia have relied on intuitive appeals to distinctions traditionally considered to be morally relevant, such as the distinction between acts and omissions (or killing and letting die), or ordinary and extraordinary means of treatment. These discussions remained inconclusive. However, the question of euthanasia no longer remains inconclusive if one adopts the perspective suggested by the United States President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research and by the World Medical Assembly--that a doctor should act in his or her patient's best interests. From this vantage point, it is argued, there will be instances when active euthanasia is the proper cause of action.

Ethics, Medical↗
PubMed1994

Active euthanasia--time for a decision.

There has been renewed interest in the moral arguments surrounding euthanasia. Some patients are now apprehensive of advanced medical technology which they fear may result in a prolonged and undignified death. In the current situation of scarce resources for health care, both patients and doctors could be coerced into considering active euthanasia if it was legally available. In this paper it is argued that doctors now need to make a clear statement rejecting active euthanasia but affirming that in certain cases passive euthanasia, or letting die, may be morally justifiable.

Decision Making↗
PubMed1997

Palliative options of last resort: a comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide, and voluntary active euthanasia.

Palliative care is generally agreed to be the standard of care for the dying, but there remain some patients for whom intolerable suffering persists. In the face of ethical and legal controversy about the acceptability of physician-assisted suicide and voluntary active euthanasia, voluntarily stopping eating and drinking and terminal sedation have been proposed as ethically superior responses of last resort that do not require changes in professional standards or the law. The clinical and ethical differences and similarities between these 4 practices are critically compared in light of the doctrine of double effect, the active/passive distinction, patient voluntariness, proportionality between risks and benefits, and the physician's potential conflict of duties. Terminal sedation and voluntarily stopping eating and drinking would allow clinicians to remain responsive to a wide range of patient suffering, but they are ethically and clinically more complex and closer to physician-assisted suicide and voluntary active euthanasia than is ordinarily acknowledged. Safeguards are presented for any medical action that may hasten death, including determining that palliative care is ineffective, obtaining informed consent, ensuring diagnostic and prognostic clarity, obtaining an independent second opinion, and implementing reporting and monitoring processes. Explicit public policy about which of these practices are permissible would reassure the many patients who fear a bad death in their future and allow for a predictable response for the few whose suffering becomes intolerable in spite of optimal palliative care.

Beneficence↗
PubMed1994

Oncology nurses' attitudes toward the legalization of voluntary active euthanasia.

Euthanasia is not a new concept. However, there is a growing trend to legalize voluntary active euthanasia. The purpose of this study was to explore oncology nurses' attitudes toward voluntary active euthanasia. The population consisted of 200 registered nurses who were members of the Oncology Nurses' Society and who resided in Illinois, Indiana, Iowa, and Missouri. I developed a questionnaire using a Likert-type scale to measure the attitudes. A one-way analysis of variance was used for data analysis. Relationships among religious beliefs, personal experience, educational preparation, and years of practice as an oncology nurse were investigated. Religious belief was the only variable that was significant in the formation of attitudes toward voluntary active euthanasia.

Analysis of Variance↗