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PubMed1977

Potential interest of the elderly in active euthanasia.

As part of a larger study, elderly applicants to institutions and elderly residents of the community were questioned on their potential interest in active euthanasia. Of these, 19 percent and 23 percent respectively said they would want a lethal injection. A further ten and nine percent respectively said they would want a lethal pill, if ever hopelessly ill. Most elderly community residents who would prefer to carry on as best as they could nevertheless thought that alternatives should be available to those wanting them.

Aged↗
PubMed1996

Voluntary active euthanasia and doctor-assisted suicide: knowledge and attitudes of Dutch medical students.

The objective of the study was to gain insight into the knowledge of and attitudes towards voluntary active euthanasia and doctor-assisted suicide (EEDAS) of Dutch medical students, and to determine whether knowledge and attitudes change after a 1-day informative conference about EDAS. Data were collected by means of two self-administered questionnaires. Questionnaire 1 had to be completed before the start of the conference and questionnaire 2 after the conference. In both questionnaires, students were asked by means of two open-ended questions to define euthanasia and doctor-assisted suicide. They were also asked to indicate which of eight statements met with the requirements for prudent practice. Finally, the students were asked to what extent they agreed or disagreed with each of seven statements about attitudes towards EDAS. To determine if a selection occurred among students who returned both questionnaires, their background characteristics, and knowledge and attitudes towards EDAS were compared with those who returned only the first questionnaire. Forty-seven students returned only the first questionnaire, while both questionnaires were returned by 137 students. No differences were found between students who returned both questionnaires and those who returned only the first questionnaire with regard to age, religion, knowledge of and attitudes towards EDAS. Students' knowledge of the definitions of EDAS and the requirements for prudent practice improved significantly. Students' reactions to the statements on attitudes towards EDAS showed that a large majority had a fairly positive attitude towards EDAS. There was no significant difference before and after the conference. Male students and students with a religion were more opposed to EDAS than female students and students without a religion. The fact that the students' knowledge of EDAS improved after a 1-day conference does not imply sufficient understanding of the issue. Because EDAS is allowed only under strict conditions in the Netherlands, medical students require special training. Only then will they be equipped to deal with requests for EDAS during their future careers.

Adolescent↗
PubMedDate not supplied

A concept analysis of voluntary active euthanasia.

TOPIC: Euthanasia has a wide range of classifications. Confusion exists in the application of specific concepts to various studies. PURPOSE: To analyze the concept of voluntary active euthanasia using Walker and Avant's concept analysis method. SOURCES OF INFORMATION: A comprehensive literature review from various published literature and bibliographies. CONCLUSIONS: Clinical, ethical, and policy differences and similarities of euthanasia need to be debated openly, both within the medical profession and publicly. Awareness of the classifications about euthanasia may help nurses dealing with "end of life issues" properly.

Attitude to Death↗
PubMed1994

Voluntary active euthanasia and physician-assisted suicide in Dutch nursing homes: are the requirements for prudent practice properly met?

OBJECTIVE: To acquire data about and an understanding of the way in which Dutch nursing home physicians (NHPs) who administer voluntary active euthanasia and/or physician-assisted suicide (EAS) cope with the requirements for prudent practice. These requirements include: the patient must experience his or her suffering as unbearable and hopeless; the wish to die must be well considered and persistent; the request must be voluntary; the NHP must consult at least one other physician; the physician is not allowed to issue a certificate testifying to natural death and is obliged to keep records. DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS: See preceding paper. RESULTS: Sixty-nine NHPs (12%) indicated that they had administered EAS on at least one occasion. The state of the patient was described by the NHP as utterly hopeless in 88% of cases and as utterly unbearable in 64% of the cases. The period of time between the first discussion of the subject and the actual administration varied from less than a day to more than a year. The most frequently given reasons for the request were unbearable suffering (53%) and hopeless suffering (49%). The majority of the NHPs (85%) indicated that it was the patient who first broached the subject of EAS. Eighty-five percent of the NHPs also requested a consultation with another physician. In the majority of cases this second opinion was given by another NHP (63%); over 50% of these NHPs worked in the same nursing home. Ninety-one percent of the physicians consulted were convinced that the request was well considered, and 93% found that there was no alternative treatment available. The nurses involved were consulted informally: 94% were questioned about the request for EAS and 93% about the physician's intention to comply. Seventy-five percent of the respondents said they had made some sort of written notes regarding the last time they had administered EAS. The number of certificates testifying to death by natural causes fell after 1988. In 41% of the cases all requirements were met. CONCLUSION: The results of this study indicate that Dutch NHPs observe all the requirements for EAS in 41% of cases. In the remaining cases, shortcomings were found: NHPs allowed too little time between the first discussion and the actual administration; they did not always keep written records; or they signed a death certificate testifying that the patient had died a natural death.

Adult↗
PubMed1990

The terminal quality of life and passive or active euthanasia.

The problems presented by the different categories of dying people are briefly discussed from the point of view of terminal quality of life. Euthanasia is used in its broader meaning, including both passive and active aspects. Passive euthanasia (PE) is exercised by withholding advanced or basic life support measures, the commonest form being do not resuscitate orders (DNR). Some data on its application are presented. Active euthanasia (AE), which has been proposed and being applied to a limited extent lately, is criticized as leading the physician and the Society onto risky ground. A position is being taken against it. Decision making, examples of guidelines, legal, philosophical and spiritual considerations are discussed. Wisdom and loving care should be exercised by the physician to assist people in their terminal phases and to alleviate their suffering. That there is not a single answer to the problem is discussed.

Humans↗
PubMed1993

An international perspective of active euthanasia: attitudes of nurses in seven countries.

This exploratory study examines the ethical justification that cancer care and dementia care nurses gave for active voluntary euthanasia. A convenient sample of 319 nurses working in seven countries was interviewed using a structured interview guide. The great majority of the nurses could not ethically justify active voluntary euthanasia. Even if the law changed, only 96 of the total sample viewed active voluntary euthanasia as ethical. For those nurses who could ethically justify active voluntary euthanasia, the majority did so because of the patients' suffering.

Adult↗
PubMed1996

Four newly established legal requisites for active euthanasia in Japan.

On March 28, 1995 at the Yokohama District Court in Japan, four legal requisites for active euthanasia were newly established by the chief judge, when he rendered the judgment on the murder case of a physician, Tokunaga. The case has been reported by the news media as a so-called euthanasia. In order to make the legal distinction between murder and euthanasia for this case, the 1962 six legal requisites for euthanasia established 33 years ago at the Nagoya High Court in Japan were revised into the four new legal requisites. The judgment was influenced by the current international situation and Japanese sentiment concerning euthanasia.

Decision Making↗
PubMed1997

The role of the nurse in active euthanasia and physician-assisted suicide.

The researchers wanted to obtain insight into the cooperation between physicians and nurses with regard to active euthanasia and physician-assisted suicide (EAS). In study I a stratified random sample of 203 clinical specialists, 152 general practitioners (GPs) and 50 nursing home physicians (NHPs) participated. In study II a random sample of 521 GPs was drawn from the province of North Holland and a random sample of 521 GPs was drawn from the rest of the Netherlands. For study III all NHPs were approached. Data were collected by means of an interview in study I. In studies II and III an anonymous, postal questionnaire was used. Approximately half of the GPs did not consult with nurses about a patient's request for EAS, the intention to administer EAS, and the actual administration. In 5% of cases, the NHPs and the specialists did not consult with nurses concerning these aspects. The GPs and NHPs indicated in 4% and 3% of the cases, respectively, that nurses administered the lethal drug(s) to the patients; the corresponding figure for the specialists was 21%. Almost all GPs and NHPs and about three-quarters of the specialists thought that nurses should never be allowed to administer EAS.

Cooperative Behavior↗
PubMed2006

A case for justified non-voluntary active euthanasia: exploring the ethics of the Groningen Protocol.

One of the most recent controversies to arise in the field of bioethics concerns the ethics for the Groningen Protocol: the guidelines proposed by the Groningen Academic Hospital in The Netherlands, which would permit doctors to actively euthanise terminally ill infants who are suffering. The Groningen Protocol has been met with an intense amount of criticism, some even calling it a relapse into a Hitleresque style of eugenics, where people with disabilities are killed solely because of their handicaps. The purpose of this paper is threefold. First, the paper will attempt to disabuse readers of this erroneous understanding of the Groningen Protocol by showing how such a policy does not aim at making quality-of-life judgements, given that it restricts euthanasia to suffering and terminally ill infants. Second, the paper illustrates that what the Groningen Protocol proposes to do is both ethical and also the most humane alternative for these suffering and dying infants. Lastly, responses are given to some of the worries expressed by ethicists on the practice of any type of non-voluntary active euthanasia.

Attitude to Health↗
PubMed1996

[The controversy about so-called "active euthanasia"].

In the past few years, the discussion about the right to kill severely ill patients for humanitarian reasons--once called euthanasia and after World War II in the German speaking countries as euphemism called 'aktive Sterbehilfe' (active help to die)--has become more intensive. Actually, only the Netherlands do officially practice euthanasia. But the variant that consists in putting a pharmaceutical at the patient's disposal in order to kill himself is very well known in other countries, e.g. in Switzerland, where the pressure on the legislator to also legalize euthanasia grows. Taking into account medico-ethical reasons, historical experiences, alarming euthanasia ideas in bioethics and social philosophy, the danger due to the impossibility to control the development in this field, and the insidious extension of euthanasia indications, the author rejects firmly the idea of legalized euthanasia. These problems are related to those that occur in fixing the moment of death of potential organ donors. A lack of organs in transplantation medicine should not lead physicians to explant organs from donors in a dying condition. For physicians who take care of potential organ donors and who have to look after their interests towards transplantation teams, it is often too difficult to cope with this task. Local ethical commissions should support them.

Brain Death↗
PubMed1998

[Still a no when it comes to active euthanasia].

While there has been a growing acceptance among the general public in Norway that euthanasia and physician assisted suicide should be made legal, the Norwegian Medical Association still strongly opposes such acts. A recent survey at the University Hospital in Trondheim confirms that Norwegian physicians in general have a very restrictive attitude towards euthanasia. Among 483 physicians (response rate 72.8%), only 17.6% were in favour of physicians actively contributing to shortening the life of a patient. However, 36% of the surgeons and gynecologists had a more liberal view, although only 16.5% would personally assist in such acts. None of 69 oncologists, pediatricians, neurologists or neurosurgeons were willing to perform euthanasia. Should euthanasia be established as a legal right, a considerable number of physicians would probably insist on having the right to abstain.

Attitude of Health Personnel↗
PubMed1998

[Active euthanasia or better palliative therapy?].

The Dutch Supreme Court ruled that in exceptional instances, physician-assisted suicide might be justifiable for patients with unbearable mental suffering but no physical illness. A recent report shows that explicit requests for physician-assisted suicide are not uncommon in psychiatric practice in the Netherlands. Some of those requests were granted and their medical background was described. Psychiatric consultation for medical patients who request physician-assisted suicide is relatively rare. Therefore is seems to be necessary to establish better palliative care for the terminally ill. When psychiatrists help their patients to commit suicide there is a danger of abuse and "slippery slope".

English Abstract↗
PubMed1996

The role of the social network in active euthanasia and physician-assisted suicide.

OBJECTIVE: To obtain insight into the involvement of a patient's social network in the process leading to the administration of euthanasia and assisted suicide (EAS). DESIGN: Descriptive, retrospective. METHOD: Data were collected by means of anonymous questionnaires sent to a random sample of 521 general practitioners (GPs) in the Province of North Holland and 521 GPs from the rest of the Netherlands and all 713 Dutch nursing home physicians (NHPs). The data were collected over the period 1986 to June 1990 inclusive. RESULTS: GPs and NHPs had discussions most often with the partner of the patient about the patient's request for EAS, the doctor's intention to administer EAS and the actual administering of EAS. According to both the GPs and the NHPs the social network practically always agreed with the doctor's decision to administer EAS. The persons who were most often present at the patient's bedside when EAS was administered were the patient's partner and children (29%). Often, especially in the cases of GPs, the decision not to report EAS was determined by the desire of relatives and/or the physician not to involve the relatives in a judicial inquiry. CONCLUSION: To a large extent the social network was involved in the patient's request for EAS, the doctor's intention to administer EAS and the actual administering of EAS. This seems to be important both for good decision-making with regard to EAS and for helping relatives to come to terms with the loss of a dear one.

Communication↗