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Physician assisted dying

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https://www.readbyqxmd.com/read/29284475/existential-decision-making-in-a-fatal-progressive-disease-how-much-do-legal-and-medical-frameworks-matter
#1
Christian Weber, Barbara Fijalkowska, Katarzyna Ciecwierska, Anna Lindblad, Gisela Badura-Lotter, Peter M Andersen, Magdalena Kuźma-Kozakiewicz, Albert C Ludolph, Dorothée Lulé, Tomasz Pasierski, Niels Lynöe
BACKGROUND: Healthcare legislation in European countries is similar in many respects. Most importantly, the framework of informed consent determines that physicians have the duty to provide detailed information about available therapeutic options and that patients have the right to refuse measures that contradict their personal values. However, when it comes to end-of-life decision-making a number of differences exist in the more specific regulations of individual countries. These differences and how they might nevertheless impact patient's choices will be addressed in the current debate...
December 28, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/29282122/advice-and-care-for-patients-who-die-by-voluntarily-stopping-eating-and-drinking-is-not-assisted-suicide
#2
Andrew McGee, Franklin G Miller
BACKGROUND: A competent patient has the right to refuse foods and fluids even if the patient will die. The exercise of this right, known as voluntarily stopping eating and drinking (VSED), is sometimes proposed as an alternative to physician assisted suicide. However, there is ethical and legal uncertainty about physician involvement in VSED. Are physicians advising of this option, or making patients comfortable while they undertake VSED, assisting suicide? This paper attempts to resolve this ethical and legal uncertainty...
December 27, 2017: BMC Medicine
https://www.readbyqxmd.com/read/29240045/pier-diego-siccardi-1880-1917-and-the-clinica-del-lavoro-in-the-trench-warfare
#3
Michele Augusto Riva, Michela Caramella, Massimo Turato, Giancarlo Cesana
BACKGROUND: The year 2017 marks the centenary of the death of the Italian scientist Pier Diego Siccardi (1880-1917), one of Luigi Devoto's assistants at the "Clinica del Lavoro" in Milan. OBJECTIVES: To commemorate Siccardi and to describe the activities of the physicians of the "Clinica del Lavoro" during World War I. METHODS: A comprehensive analysis was conducted on scientific papers written by Pier Diego Siccardi and by other physicians belonging to the Clinica del Lavoro, in the period 1915-1918...
December 14, 2017: La Medicina del Lavoro
https://www.readbyqxmd.com/read/29236658/how-using-generative-learning-strategies-improved-medical-student-self-competency-in-end-of-life-care
#4
Sandra Marquez Hall, Janet Lieto, Roy Martin
During a mandatory fourth-year core geriatric medicine rotation at our medical school, we discovered that our medical students were struggling with end-of-life (EOL) issues both personally and professionally. We implemented curriculum changes to assist them in developing emotional awareness about death and dying, and to help develop their ability to respond personally and professionally to patients and their families during EOL experiences.In our new curriculum, a seasoned ethicist at our university conducts 2 educational sessions addressing EOL issues...
2017: Permanente Journal
https://www.readbyqxmd.com/read/29230475/improving-decisions-about-transport-to-the-emergency-department-for-assisted-living-residents-who-fall
#5
Jefferson G Williams, Michael W Bachman, Michael D Lyons, Benjamin B Currie, Lawrence H Brown, A Wooten Jones, Jose G Cabanas, Alan K Kronhaus, J Brent Myers
Background: Residents of assisted living facilities who fall may not be seriously ill or injured, but policies often require immediate transport to an emergency department regardless of the patient's condition. Objective: To determine whether unnecessary transport can be avoided. Design: Prospective cohort study. Setting: One large county with a single system of emergency medical services. Participants: Convenience sample of residents in 22 assisted living facilities served by 1 group of primary care physicians...
December 12, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29214967/fear-of-life-fear-of-death-and-fear-of-causing-death-how-legislative-changes-on-assisted-dying-are-doomed-to-fail
#6
Matti Häyry
Fear of life, fear of death, and fear of causing death form a combination that prevents reasoned changes in laws concerning end-of-life situations. This is shown systematically in this article using the methods of conceptual analysis. Prevalent fears are explicated and interpreted to see how their meanings differ depending on the chosen normative stance. When the meanings have been clarified, the impact of the fears on the motivations and justifications of potential legislative reforms are assessed. Two main normative stances are evoked...
January 2018: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
https://www.readbyqxmd.com/read/29212490/attitudes-towards-assisted-suicide-and-euthanasia-among-care-dependent-older-adults-50-in-austria-the-role-of-socio-demographics-religiosity-physical-illness-psychological-distress-and-social-isolation
#7
Erwin Stolz, Hannes Mayerl, Peter Gasser-Steiner, Wolfgang Freidl
BACKGROUND: Care-dependency constitutes an important issue with regard to the approval of end-of-life decisions, yet attitudes towards assisted suicide and euthanasia are understudied among care-dependent older adults. We assessed attitudes towards assisted suicide and euthanasia and tested empirical correlates, including socio-demographics, religiosity, physical illness, psychological distress and social isolation. METHODS: A nationwide cross-sectional survey among older care allowance recipients (50+) in private households in Austria was conducted in 2016...
December 7, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/29209424/severe-copd-and-the-transition-to-a-palliative-approach
#8
Amanda Landers, Rachel Wiseman, Suzanne Pitama, Lutz Beckert
Patients with severe chronic obstructive pulmonary disease (COPD) have a chaotic trajectory towards death. Research has focused on identifying a "transition point" that would allow identification of those patients who may benefit from a palliative approach to their care, or referral to a specialist palliative care service. This article aims to outline difficulties in identifying this transition point, summarise current literature on this topic and suggests a model based on clinical milestones. Educational aims: To outline the difficulties associated with identifying patients with severe COPD who are at risk of dying...
December 2017: Breathe
https://www.readbyqxmd.com/read/29133281/should-medical-assistance-in-dying-be-extended-to-incompetent-patients-with-dementia-research-protocol-of-a-survey-among-four-groups-of-stakeholders-from-quebec-canada
#9
Gina Bravo, Claudie Rodrigue, Vincent Thériault, Marcel Arcand, Jocelyn Downie, Marie-France Dubois, Sharon Kaasalainen, Cees M Hertogh, Sophie Pautex, Lieve Van den Block
BACKGROUND: Alzheimer's disease and related disorders affect a growing number of people worldwide. Quality of life is generally good in the early stages of these diseases. However, many individuals fear living through the advanced stages. Such fears are triggering requests for medical assistance in dying (MAiD) by patients with dementia. Legislation was recently passed in Canada and the province of Quebec allowing MAiD at the explicit request of a patient who meets a set of eligibility criteria, including competence...
November 13, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/29078769/this-moral-coil-a-cross-sectional-survey-of-canadian-medical-student-attitudes-toward-medical-assistance-in-dying
#10
Eli Xavier Bator, Bethany Philpott, Andrew Paul Costa
BACKGROUND: In February, 2015, the Supreme Court of Canada struck down the ban on medical assistance in dying (MAiD). In June, 2016, the federal government passed Bill C-14, permitting MAiD. Current medical students will be the first physician cohort to enter a system permissive of MAiD, and may help to ensure equitable access to care. This study assessed medical student views on MAiD, factors influencing these views, and opportunities for medical education. METHODS: An exploratory cross-sectional survey was developed and distributed to medical students across all years of a three-year Canadian undergraduate medical program...
October 27, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/29066037/end-of-life-care-preferences-in-patients-with-severe-and-persistent-mental-illness-and-chronic-medical-conditions-a-comparative-cross-sectional-study
#11
Dominique Elie, Amanda Marino, Susana G Torres-Platas, Saeid Noohi, Trent Semeniuk, Marilyn Segal, Karl J Looper, Soham Rej
OBJECTIVES: Physicians rarely engage severe and persistent mental illness (SPMI) patients in end-of-life care discussion despite an increased risk of debilitating medical illnesses and mortality. Access to quality palliative care and medical assistance in dying (MAID) has become a priority in Canada and many jurisdictions. In this study, we compared SPMI and chronic medically ill (CMI) patients' end-of-life care preferences and comfort level with end-of-life care discussion, and identified potential predictors of interest in MAID...
January 2018: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/29052518/voluntary-stopping-of-eating-and-drinking-is-medical-support-ethically-justified
#12
Ralf J Jox, Isra Black, Gian Domenico Borasio, Johanna Anneser
BACKGROUND: Physician-assisted dying has been the subject of extensive discussion and legislative activity both in Europe and North America. In this context, dying by voluntary stopping of eating and drinking (VSED) is often proposed, and practiced, as an alternative method of self-determined dying, with medical support for VSED being regarded as ethically and legally justified. ARGUMENT: In our opinion, this view is flawed. First, we argue that VSED falls within the concept of suicide, albeit with certain unique features (non-invasiveness, initial reversibility, resemblance to the natural dying process)...
October 20, 2017: BMC Medicine
https://www.readbyqxmd.com/read/29050837/forensic-patients-in-the-emergency-department-who-are-they-and-how-should-we-care-for-them
#13
Celia J Filmalter, T Heyns, R Ferreira
BACKGROUND: Patients who suffer violent, crime related injuries are likely to seek medical assistance in emergency departments. Forensic patients may not disclose the cause of their injuries leading to the impairment of evidence. We explored healthcare providers' perceptions of forensic patients and how they should be cared for. METHOD: The perceptions of physicians and nurses regarding the profiles and care of forensic patients were explored in three urban emergency departments...
October 16, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/29033297/no-easy-way-out-a-case-of-physician-assisted-dying-in-the-emergency-department
#14
David H Wang
Currently, 1 out of 6 Americans lives within a jurisdiction in which physician-assisted dying is legally authorized. In most cases, patients ingest lethal physician-assisted dying medications at home without involvement of emergency medical services (EMS) or the emergency department (ED). However, occasionally the dying process is interrupted as a result of incomplete ingestion or vomiting of medications, confusion about timing of dying trajectory, familial emotional distress, and other variables. A case is presented here of a patient who arrived by ambulance to an urban ED after ingesting physician-assisted dying medication...
October 12, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28983787/morally-relevant-similarities-and-differences-between-assisted-dying-practices-in-paradigm-and-non-paradigm-circumstances-could-they-inform-regulatory-decisions
#15
Jeffrey Kirby
There has been contentious debate over the years about whether there are morally relevant similarities and differences between the three practices of continuous deep sedation until death, physician-assisted suicide, and voluntary euthanasia. Surprisingly little academic attention has been paid to a comparison of the uses of these practices in the two types of circumstances in which they are typically performed. A comparative domains of ethics analysis methodological approach is used in the paper to compare 1) the use of the three practices in paradigm circumstances, and 2) the use of the practices in paradigm circumstances to their use in non-paradigm circumstances...
October 5, 2017: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/28975242/ethics-and-the-legalization-of-physician-assisted-suicide-an-american-college-of-physicians-position-paper
#16
Lois Snyder Sulmasy, Paul S Mueller
Calls to legalize physician-assisted suicide have increased and public interest in the subject has grown in recent years despite ethical prohibitions. Many people have concerns about how they will die and the emphasis by medicine and society on intervention and cure has sometimes come at the expense of good end-of-life care. Some have advocated strongly, on the basis of autonomy, that physician-assisted suicide should be a legal option at the end of life. As a proponent of patient-centered care, the American College of Physicians (ACP) is attentive to all voices, including those who speak of the desire to control when and how life will end...
October 17, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28958073/five-year-results-of-patients-supported-by-heartmate-ii-outcomes-and-adverse-events
#17
Jasmin S Hanke, Sebastian V Rojas, Claudius Mahr, Anja-Franziska Schmidt, Amelie Zoch, Günes Dogan, Christina Feldmann, Ezin Deniz, Ullrich Molitoris, Christoph Bara, Martin Strüber, Axel Haverich, Jan D Schmitto
OBJECTIVES: Improved outcomes over the past decade have increased confidence of physicians and patients in extended duration of left ventricular assist device (LVAD) support. This single-centre cohort study reports 5-year outcomes with the HeartMate II (HMII) LVAD. METHODS: We describe a cohort of 89 patients who received a HMII LVAD between February 2004 and December 2010. The causes of death and adverse events were assessed by examination of medical records. A total of 202...
September 2, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28940342/physician-assisted-death-and-severe-treatment-resistant-depression
#18
Bonnie Steinbock
Should people suffering from untreatable psychiatric conditions be eligible for physician-assisted death? This is possible in Belgium and the Netherlands, where PAD for psychiatric conditions is permitted, though rare, so long as the criteria of due care are met. Those opposed to all instances of PAD point to Belgium and the Netherlands as a dark warning that once PAD is legalized, restricting it will prove impossible because safeguards, such as the requirement that a patient be terminally ill, will inevitably be eroded or discarded...
September 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28915075/responding-to-patient-requests-for-hastened-death-physician-aid-in-dying-and-the-clinical-oncologist
#19
Rebecca A Spence, Charles D Blanke, Thomas J Keating, Lynne P Taylor
Physician aid in dying (PAD) or assisted suicide is becoming legal in more US jurisdictions. Meanwhile, the needs of terminally ill patients with cancer are receiving greater attention, including the integration of palliative care into oncology practice. This article highlights a case vignette of a patient with advanced cancer who requests PAD from her oncologist, as a backdrop to help the practicing oncologist examine his or her moral stance regarding participation in aid in dying. The article concludes by offering a framework within which the practicing oncologist can receive and process a patient's request for PAD...
October 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28837009/public-and-professional-insights-on-end-of-life-care-results-of-the-2016-health-care-in-canada-survey
#20
Terrence Montague, Joanna Nemis-White, John Aylen, Sara Ahmed, Sharon Baxter, Lesli Martin, Owen Adams, Amédé Gogovor
A new dimension has been added to Canadian Medicare ߝ exemption from prosecution for physicians, nurse practitioners and assistants providing medical assistance in dying for competent and informed adult patients with a grievous and irremediable medical condition causing intolerable physical or psychological suffering, irreversible decline in capabilities and reasonably foreseeable natural death. To define stakeholders' perceptions on all contemporary end-of-life care options, we analyzed data from the 2016 Health Care in Canada Survey comprising representative samples of the adult public (n = 1,500), physicians (n = 102), nurses (n = 102), pharmacists (n = 100), administrators (n = 100) and allied health professionals (n = 100)...
2017: Healthcare Quarterly
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