Libre et éclairé : voilà comment devrait être un consentement viable, valable et authentique, tant dans le monde de la santé que dans celui des affaires. Mieux même, et plus conforme à l’actualité, est qu’il soit « libre et informé » : cela met en avant la personne concernée plutôt que le message et sa source lumineuse forcément en surplomb. Telles sont en tout cas les conditions qui lui donnent son label aux plans de la loi et de la déontologie, si ce n’est à celui de l’éthique. Pour autant, liberté et information se situent-elles exactement au même niveau fondateur ? Jouent-elles des rôles symétriques dans le processus qui conduit au oui ?
Comment en sommes-nous arrivés, comme société, à envisager de proposer « la mort donnée » comme un service légal au titre de la liberté et de la dignité des hommes ? Cette « césarienne de la mort » qui consisterait à faire mourir les gens à l’heure dite, sur rendez-vous, de façon médicalisée et réglée (comme on parle de la chirurgie réglée face à la chirurgie d’urgence). Cédant à la tentation de nous rendre maître de la mort en la provoquant par anticipation. Parce qu’à une vision globale de la vie humaine, nous substituons une vision morcelée, réduite à des particules élémentaires, fournie par la numérisation de l’univers.
Après avoir présenté les arguments pour et contre la légalisation de l'euthanasie, l'auteur pointe la nécessité de ne pas imposer son opinion et de respecter les valeurs et les convictions religieuses et morales de chacun. Il mentionne également les nouvelles problématiques qui s'ajoutent à ce débat : l'euthanasie des mineurs, des malades psychiatriques et des personnes démentes.
Policies and practices have been developed to operationalize assisted dying processes in Canada. This project utilized an environmental scan to determine the spectrum of assisted death reporting practices and medical certificate of death (MCD) completion procedures both nationally and internationally. Findings suggest medically assisted dying (MAiD) is represented on the MCD inconsistently nationally and internationally. Related factors include the specifics of local assisted death legislation and variations in death-reporting legislation, variation in terminology surrounding assisted death and designated oversight agency for assisted dying reporting.
The consideration of laypeople’s views of conditions under which euthanasia is justifiable is important for policy decisions. In an online survey of US respondents, we examined how patient’s symptoms influence justifiability of euthanasia. Euthanasia was judged more justifiable for conditions associated with physical suffering and negative impact on other people. The weight given to physical suffering and negative impact on others in evaluation of justifiability of euthanasia also differed based on personal characteristics. The results suggest that public discourse about medical assistance in dying should take into account differences in its perceived justifiability for patients with different conditions.
This study aims to examine perceptions and attitudes toward euthanasia among university students who are pursuing bachelor’s degrees. Although the legalization and application of euthanasia are discussed commonly by health-care professionals and partially by lawyers, the ideas of other segments of society, especially university students, are taken place very rarely. The research was conducted descriptively to determine the ideas of 1,170 students at Kastamonu University from six different departments: arts and sciences, theology, tourism, nursing, school of physical education, and sports with using a questionnaire. Findings demonstrated that 73.2% of the students do not approve euthanasia. Also, it was found that there are significant differences depending on age, gender, department of study, income level, place of living, and the loss of kinsmen. This study serves as a resource for future research to understand the effects of sociodemographic characteristics on the decision of euthanasia.
Research has documented associations among religious affiliation, religious practice, and attitudes toward voluntary euthanasia, yet very few studies have investigated how particular religious beliefs influence these attitudes. I use data from the General Social Survey (GSS; N = 19,967) to evaluate the association between the belief in life after death and attitudes toward voluntary euthanasia. I find that those who believe in life after death are significantly less likely than those who do not believe in life after death or those who doubt the existence of life after death to have positive attitudes toward voluntary euthanasia. These associations hold even after controlling for religious affiliation, religious attendance, views of the Bible, and sociodemographic factors. The findings indicate that to understand individuals’ views about voluntary euthanasia, one must pay attention to individuals’ particular religious beliefs.
Veterinary professionals are recognized as an important source of support for many veterinary clients, particularly during companion animal euthanasia and end-of-life care. While many veterinary professionals recognize the importance of their role, many also report feeling unsure about what methods of support are most effective. Furthermore, few evidence-based guidelines currently exist to inform veterinary professionals on the support of grieving clients. To begin bridging this gap, this study qualitatively explored how veterinary professionals currently report supporting grieving clients before, during, and after companion animal euthanasia. Findings suggest that veterinary participants in this study strive to be meaningful sources of support for grieving clients and employ an array of support practice to do so. However, opportunities exist for veterinary professionals to better explore clients' needs, expectations, and feelings as they relate to companion animal euthanasia, including offering more grief-related resources and access to professional counseling services.
Huit membres du personnel soignant belge échangent leurs point de vue sur la fin de vie, les soins palliatifs et la pratique de l'euthanasie. Ils évoquent leur expérience quotidienne et rendent compte de la complexité de certaines situations.
BACKGROUND: Medical Assistance in Dying, also known as euthanasia or assisted suicide, is expanding internationally. Canada is the first country to permit Nurse Practitioners to provide euthanasia. These developments highlight the need for nurses to reflect upon the moral and ethical issues that euthanasia presents for nursing practice.
PURPOSE: The purpose of this article is to provide a narrative review of the ethical arguments surrounding euthanasia in relationship to nursing practice.
METHODS: Systematic search and narrative review. Nine electronic databases were searched using vocabulary developed from a stage 1 search of Medline and CINAHL. Articles that analysed a focused ethical question related to euthanasia in the context of nursing practice were included. Articles were synthesized to provide an overview of the literature of nursing ethics and euthanasia.
ETHICAL CONSIDERATIONS: This review was conducted as per established scientific guidelines. We have tried to be fair and respectful to the authors discussed.
FINDINGS: Forty-three articles were identified and arranged inductively into four themes: arguments from the nature of nursing; arguments from ethical principles, concepts and theories; arguments for moral consistency; and arguments from the nature of the social good. Key considerations included nursing's moral ontology, the nurse-patient relationship, potential impact on the profession, ethical principles and theories, moral culpability for acts versus omissions, the role of intention and the nature of the society in which euthanasia would be enacted. In many cases, the same assumptions, values, principles and theories were used to argue both for and against euthanasia.
DISCUSSION: The review identified a relative paucity of literature in light of the expansion of euthanasia internationally. However, the literature provided a fulsome range of positions for nurses to consider as they reflect on their own participation in euthanasia. Many of the arguments reviewed were not nursing-specific, but rather are relevant across healthcare disciplines. Arguments explicitly grounded within the nature of nursing and nurse-patient relationships warrant further exploration.
OBJECTIVE: Introduction: The right to life - is natural inherent human right, the fundamental principle of the existence of mankind, recognized by all civilized countries. It is enshrined in numerous international and national legal acts as the most important benefit of a man. However, there are discussions about the use of euthanasia. Therefore, the problem of the legalization of euthanasia requires careful study. The aim: The purpose of this article is to analyze and systematize existing problems of the legalization of euthanasia. The main objective of the article is to study the legal grounds for the introduction of euthanasia in the context of realizing the right to life, to study the content of palliative care, to distinguish the barriers to its development, and to formulate propositions for their elimination.
PATIENTS AND METHODS: Materials and methods: Theoretical (analysis, synthesis, generalization, systematization, etc.) and empirical methods (observation, survey, classification, etc.) were used in the course of the research.
RESULTS: Results: The author has revealed the negative attitude of medical staff to the possibility of using different forms of euthanasia during the study. The reasons for the positive attitude of patients, who were in the thermal stage to the euthanasia, have been determined. It has been established that the correction of most causes leads to a significant reduction in the percentage of positive attitude to euthanasia. The arguments of opponents and supporters of the legalization of euthanasia procedure have been analyzed. On this basis the author has proved the objective absence of legal grounds for the legalization of euthanasia procedure and direct violation of human rights to life.
CONCLUSION: Conclusions: The author has proved the expediency of the development of palliative care as an alternative to euthanasia, has outlined the obstacles to its development, has offered to develop regulatory base for the legal regulation of the provision of palliative care, to establish the National Coordination Council on palliative and hospice care, to form the system of state control over the quality of provision of palliative care and observance of the rights of patients.
BACKGROUND/AIM: Appropriate decision-making in end-of-life (EOL) care is essential for both junior and senior physicians. The aim of this study was to compare the decision-making and attitudes of medical students with those of experienced general practitioners (GP) regarding EOL-care.
MATERIALS AND METHODS: A questionnaire presenting three cancer patient scenarios concerning decisions and ethical aspects of EOL-care was offered to 500 Finnish GPs and 639 graduating medical students in 2015-2016.
RESULTS: Responses were received from 222 (47%) GPs and 402 (63%) students. The GPs withdrew antibiotics (p<0.001) and nasogastric tubes (p=0.007) and withheld resuscitation (p<0.001), blood transfusions (p=0.002) and pleural drainage (p<0.001) more often than did the students. The students considered euthanasia and assisted suicide less reprehensible (p<0.001 in both) than did the GPs.
CONCLUSION: Medical students were more unwilling to withhold and withdraw therapies in EOL-care than were the GPs, but the students considered euthanasia less reprehensible. Medical education should include aspects of decision-making in EOL-care.
BACKGROUND: Palliative care and Advance Care Planning (ACP) are increasingly recommended for an optimal management of late-stage dementia. In Belgium, euthanasia has been decriminalized in 2002 for patients who are "mentally competent" (interpreted as non-demented). It has been suggested that advance directives for euthanasia (ADE) should be made possible for dementia patients.
OBJECTIVE: This study presents the results of an internet survey among Belgian dementia specialists.
METHODS: In 2013, the Belgian Dementia Council (BeDeCo) organized a debate on end of life decisions in dementia. Participants were medical doctors who are specialists in the dementia field. After the debate, an anonymous internet survey was organized. The participation rate was 55%. The sample was representative of the BeDeCo members.
RESULTS: The results showed consensus in favor of palliative care and ACP, although ACP is not systematically addressed in practice. Few patients with dementia have requested euthanasia, but for those who did the participants had agreed to implement it for some patients. A majority of participants (94%) believe that most patients and their families are poorly informed about euthanasia. Although most participants (77%) said they approved the Law on euthanasia, 65% said they were against an extension of the Law to allow ADE for dementia.
CONCLUSION: Palliative care and ACP are clearly accepted by professionals, although a gap between recommendation and practice remain. Euthanasia is a much more debated issue, even if a majority of professionals are, in principle, in favor of the current Law and seem to disapprove with a Law change allowing ADE for dementia. A better education for both health professionals and the lay public will be a key element in the future.
The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide (EAS). This study aimed to explore the content of this pressure as experienced by general practitioners (GP). We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: (1) emotional blackmail, (2) control and direction by others, (3) doubts about fulfilling the criteria, (4) counterpressure by patient's relatives, (5) time pressure around referred patients and (6) organisational pressure. We conclude that the pressure can be attributable to the patient-physician relationship and/or the relationship between the physician and the patient's relative(s), the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account.
The aim of this paper was to study the viewpoints of Sunni Islam and Hinduism on euthanasia to explore whether the Sunni tradition's belief in the hereafter and the Hindu culture's faith in reincarnation have any impact on these two religions' positions on the rejection or justification of euthanasia. Examining these two theologies' approaches demonstrated that Sunni Islam considers euthanasia suicide/homicide in light of the belief in the hereafter, whereas Hinduism can justify euthanasia through Gandhi's interpretation of ahimsa, on the condition that all methods to alleviate the patient's pain and suffering have been exhausted.
The increasing prevalence of euthanasia in Belgium has been linked to changing attitudes. Using National health survey data (N = 9651), we investigated Belgian adults’ intention to ask a physician for euthanasia or continuous deep sedation in the hypothetical scenario of a terminal illness and examined its connection to sociodemographic and health characteristics. Respectively, 38.3 and 25.8% could envisage asking for euthanasia and continuous deep sedation. Those with very bad to fair subjective health and with depression more likely had an intention to ask for euthanasia, which suggests need for attention in the evaluation of requests from specific patient groups.
La fin de vie, et plus particulièrement l'euthanasie et le suicide médicalement assisté font l'objet de débats éthiques qui touchent à la fois les domaines politique, médical et juridique. Les auteures livrent leur réflexion sur l'incertitude médicale face aux demandes de morts anticipées. Après avoir décrit l'aspect législatif français sur ces questions et leur méthodologie de recherche, les auteures analysent les modalités et les motifs des demandes d'euthanasie et de suicide médicalement assisté ainsi que les différentes niveaux d'interprétation de ces demandes (désir de mort / souffrance). pour terminer, elles montrent de quelle manière la demande de hâter sa propre mort engage les patients, leurs proches et les médecins dans une temporalité particulière.
Les nouvelles législations en matière de fin de vie que ce soit en France ou en Belgique placent les soignants en dehors de leurs repères habituels, dans ce que les auteurs nomment une expérience de la transgression. Ces derniers reviennent sur le vécu des équipes dans ce type de situations.