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Abstract: Multiple sources of regulation seek to shape euthanasia practice in Belgium, including legislation and training. This study comprehensively mapped which of these sources govern which domains of euthanasia practice, such health professionals' obligations, or managing patient requests. Scoping review methodology was used to search for scholarly records which discussed Belgian euthanasia regulation. Template analysis was used to generate themes describing the domains of euthanasia practice governed by sources of regulation. Of 1364 records screened, 107 records were included. Multiple sources of regulation govern each domain, which are: the permissible scope of euthanasia; the legal status of a euthanasia death; the euthanasia process; the rights, obligations, and roles of those involved; system workings; and support for health professionals who provide euthanasia. Domains with significant yet fragmented regulation may lead to inconsistent care provision. Policymakers should develop coherent guidance to support health professionals to navigate this regulatory landscape.
Abstract: The aim of this article is to identify how the social dimension and social work are conceived in Basic Law 3/2021 on the regulation of euthanasia and, specifically, in the Guarantee and Evaluation Commission of the Community of Madrid. For this purpose, a qualitative exploratory study was carried out using in-depth semi-structured interviews with expert key informants. The sample was made up of seven specialist professionals with a direct (member) or indirect relationship with the Guarantee and Evaluation Commission. The main results indicate that social work professionals do not have the same recognition as other professionals in the Guarantee and Evaluation Commission. This hinders the biopsychosocial and holistic approach that the healthcare authorities are currently pursuing. Keywords: Euthanasia; medically assisted suicide; social work; Community of Madrid.
Abstract: In 2015, the Belgian Federal Commission for the Control and Evaluation of Euthanasia referred a physician to the public prosecutor’s office because it concluded that the physician might have violated the legal conditions for euthanasia. It was the commission’s first referral since its establishment in 2002. However, in 2019, the Antwerp Court sitting in chambers decided not to pursue the physician in criminal court. News reports suggested that it had ruled that the physician did not perform euthanasia because the patient drank the lethal potion herself, thus classifying the act as physician-assisted suicide. However, the court did not make the reasons for its decision public.In this article, we consider the legal and ethical aspects of physician-assisted suicide and euthanasia. Although we discern clear differences between these end-of-life decisions, we also note important similarities. Countries that legalise voluntary physician-assisted dying may choose to legislate one or both end-of-life decisions. Providing a legal basis for both options can prevent major legal problems, ensuring that those doctors who violate the law are not acquitted.
Abstract: 'Assisted dying' (an umbrella term for euthanasia and/or assisted suicide) is frequently defended as an act of autonomous self-determination in death but, given a choice, between 93.3% and 100% of patients are reluctant to self-administer (median 99.5%). If required to self-administer, fewer patients request assisted death and, of these, a sizable proportion do not self-administer but die of natural causes. This manifest avoidance runs counter to the concept of autonomous self-determination, even on the supposition that suicide could truly be autonomous. The avoidance of self-administration does not show that self-administration, when it occurs, is necessarily autonomous. It suggests, rather, that there are other frames by which assisted dying is being understood. One such is desire for medical control, a desire shared by patients and doctors. Such a frame is not directed towards an exacting autonomy (self-directed action by the patient) but towards a comforting heteronomy (letting the doctor take control).
Abstract: The World Medical Association is opposed to assisted dying on the basis of “its strong commitment to the principles of medical ethics [autonomy, beneficence, non-maleficence, and justice] and that utmost respect has to be maintained for human life”. Assisted dying cannot be introduced without also strengthening palliative care services, including investment, support for additional training needs, and appropriate workforce capacity, not least to allow time for compassionate shared decision making with patients. Some countries have more than 20 years of experience with legalisation for assisted dying, but global data collection is not standardised, and quality research involving safety and the influence of differing social, cultural, and political environments is urgently needed.
Abstract: In early March 2024, Emmanuel Macron announced that he intended to introduce an 'end-of-life' bill which, after receiving a favourable response from the National Ethics Consultative Committee that recognized the possibility of a form of assisted dying and after an Assessment Mission on the Claeys-Leonetti Law (which has, since 2016, bolstered the rights of patients and persons at the end-stage of life), was first submitted to a Citizens' Panel that delivered its conclusions in April 2023, and then made the subject of a report on palliative care in late 2023. This end-of-life bill (the spirit of which was clarified by the President in March) would be introduced in spring 2024, before being submitted to the National Assembly and the Senate. With this in mind, this article by Sergio Perelman and Pierre Pestieau offers a useful overview of the very diverse arrangements and practices in force in the industrialized countries, which, as we know, are all seeing accelerated population-ageing on account of falling birth rates and increased life expectancy. As a preliminary, the authors helpfully underscore the difference between healthcare that is curative in nature and aimed at keeping patients alive and well, and care aimed at improving the 'quality of death'. How and where will we die in the future? The article points up the great disparities that exist between countries, particularly in the areas of palliative care, euthanasia and assisted suicide, as well as the differences over who bears the costs, which are variously divided between welfare systems and families.
Abstract: The level of engagement reflects an unprecedented dialogue within the realm of bioethics.” Since 2016, under the Claeys-Leonetti law, doctors have been allowed to prescribe continuous deep sedation to patients at the end of life and patients with a terminal illness have been able to refuse life-sustaining treatment. Perhaps it would have been appropriate to define a life expectancy of less than 3 months as in therapeutic trials,” he said. [...]the law only concerns patients who request it. “Sometimes, despite the commitment and dedication of our caregivers, life is no longer really life. [...]what we are proposing provides for assistance in dying, governed by strict conditions, precise criteria and a decision falling to the medical team.”
Abstract: End-of-life care has always been prominent in discussions of clinical ethics. Almost 30% of hospital inpatients are in their last year of life. Doctors frequently encounter people with end-of-life care needs and should to be equipped to respond. However, what has been written about it leaves many doctors, other healthcare workers and the public uncertain and confused. What key things should doctors know and understand? The principles are the same as in any area of medicine, but they have to be applied in a different context. Some goals (e.g. long-term survival) can no longer be achieved, but new ones (e.g. new ways to improve quality of life) become available. By clearly understanding the ethics, we can learn how to do good end-of-life care. This article addresses key areas including why ethics matters in end-of-life care, how to apply familiar principles, how we can overcome barriers to respect for autonomy, applying the doctrine of double effect and understanding the application of ethics in the last days of life. It also gives pointers to further detailed reading.
Abstract: The proposed Assisted Dying for Terminally Ill Adults (Scotland) Bill poses a major challenge for decision making in seriously ill patients and for staff wellbeing. Despite attempts in law, neither unbearable suffering nor terminal illness can be defined in practice, but these phrases are extremely relevant for defining eligibility.
Abstract: The debate on assisted suicide is as topical as ever in Germany. Since the German Federal Constitutional Court declared § 217 of the German Criminal Code (Strafgesetzbuch, StGB) to be invalid in February 2020, it is unclear whether and, if so, which legal regulation will be passed. From a terminological perspective, a distinction needs to be made between assisted suicide and euthanasia on demand. One often hears about medically assisted suicide; however, anyone can assist a suicide.
Abstract: Background Health-care professionals are confronted with patients who wish to end their lives through voluntarily stopping eating and drinking (VSED). During VSED, symptoms such as agitation, thirst or psychological distress may arise, thus making close medical accompaniment necessary. Dealing with these symptoms can put a high burden on palliative care teams. Furthermore, divergent perceptions of the ethical classification of VSED may lead to moral distress. The aim of this study was to assess the influence of experience gained over time on the burden of palliative care professionals while accompanying patients during VSED and to assess the perceptions of coping strategies (...).
Abstract: A small proportion of older people in the Netherlands want to end their lives because they feel their lives to be ‘completed’ and no longer worth living. Currently, there is heated debate over whether or not these people should have the right to euthanasia. Drawing on previous research, we conduct a heuristic analysis of views and experiences of three different ‘parties’ involved in this debate, namely, the older people, their relatives and friends and medical professionals. The views of these three groups tend to be divergent and conflicting, posing a difficult dilemma to decision-makers.
Abstract: Euthanasia and assisted suicide (EAS) requests are common in countries where they are legal. Loneliness and social isolation are modifiable risk factors for mental illness and suicidal behaviour and are common in terminal illness. Our objective was to summarise available literature to clarify whether these and related measures of social connectedness might contribute to requests for EAS. We conducted a pre-registered (PROSPERO CRD42019160508) systematic review and narrative synthesis of quantitative literature investigating associations between social connectedness and a) requested/actual EAS, b) attitudes towards EAS, and c) a desire for hastened death (DHD) by searching six databases (PsycINFO, MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar) from inception to November 2022, rating eligible peer-reviewed, empirical studies using the QATSO quality assessment tool (...).
Abstract: Hastened death practices are legal in several countries. Psychologists are increasingly taking a more active role in end-of-life issues, but the role of psychologists in requests to hasten death is not established. This study aims to contribute guidance for psychological practice in the context of requests to hasten death. We conducted a cross-sectional and cross-cultural study with Psychologists from Portugal and Luxembourg who answer closed and open questions to provide views about their role in hastened death. Psychological assessment, psychological support to patient and family, the exploration of patient decision-making and reorientation of patients were viewed as roles for psychologists. However, these roles may differ depending whether the patient has a terminal or non-terminal illness.
Abstract: It seems probable that some form of medically-assisted dying will become legal in England and Wales in the foreseeable future. Assisted dying Bills are at various stages of preparation in surrounding jurisdictions (Scotland, Republic of Ireland, Isle of Man, Jersey), and activists campaign unceasingly for a change in the law in England and Wales. There is generally uncritical supportive media coverage, and individual autonomy is seen as the unassailable trump card: 'my life, my death'.However, devising a law which is 'fit for purpose' is not an easy matter. The challenge is to achieve an appropriate balance between compassion and patient autonomy on the one hand, and respect for human life generally and medical autonomy on the other. More people should benefit from a change in the law than be harmed. In relation to medically-assisted dying, this may not be possible. Protecting the vulnerable is a key issue (...).
Abstract: Ramos et al. paper offers a narrative review of Spanish Organic Law 3/2021, which regulates euthanasia, focusing on its application to individuals with mental disorders. Ramos et al. examine the application of legal prerequisites from an ethical-legal perspective to ascertain the conditions under which psychiatric euthanasia might be considered legitimate and compliant with legal stipulations. Nevertheless, it is apparent that the core ethical inquiries linked to this matter have not been exhaustively investigated. The criteria laid out are, in our assessment, still open to further debate and broader deliberation. Our article emphasizes the need for a comprehensive ethical and legal debate in Spain regarding psychiatric euthanasia (...).
Abstract: Palliative care teams offer holistic care for patients experiencing serious illness and related suffering, nevertheless, there are times when clinicians are asked by patients for help to obtain assisted dying. Patients in a growing number of areas may be eligible to request medically administered or self-administered lethal medications to control the timing of death and palliative care practices, established to neither hasten nor postpone death, may be challenged when caring for patients asking for assisted dying. In this “Controversies in Palliative Care” article, we invite three experts to provide a synopsis of the key studies that inform their thought processes, share practical advice on their clinical approach, and highlight the opportunities for future research (...).
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