Euthanasia and the medical profession: an Australian study

Advances in medical knowledge and technology are enabling more people to live longer in modern societies. This situation has also created dilemmas for medical practitioners in treating severely or chronically ill patients where the harm caused to them by treatment appears to outweigh the benefits. After reviewing some of the major legal and ethical issues confronting medical practitioners in Australia, this paper reports findings of a survey of Australian doctors' attitudes towards euthanasia. The findings show that a significant number of doctors receive requests from either the patients or their families to hasten death through active or passive euthanasia. A large majority of them also regard some form of passive euthanasia as an acceptable medical decision concerning the end of life. Twenty per cent of general practitioners and 17 per cent of specialists surveyed have taken active steps in the past to hasten the death of a patient. This paper explores the circumstances in which doctors are prepared to perform euthanasia and concludes with a discussion of the legal, ethical and professional issues raised by the survey's findings.     

Hispanic Hospice Patients’ Experiences of End-Stage Restlessness

ABSTRACT

End-stage restlessness, or terminal agitation, is experienced by some patients during their final days and is characterized by physical, emotional, or spiritual distress, agitation or anxiety. End-stage restlessness negatively affects the patient’s death experience and can be distressing to the family and care team. Using the 2007 National Home and Hospice Care survey, this study examined factors associated with experiencing end-stage restlessness among non-Hispanic white and Hispanic hospice patients deceased at time of discharge. Results showed that being Hispanic/Latino, experiencing dyspnea, pain, and receiving palliative sedation treatment were risk factors for experiencing end-stage restlessness. The association between pain and restlessness was stronger for Hispanics compared with non-Hispanic whites. The Hispanic population remains underrepresented and little is known about the patient-centered experiences of Hispanic hospice users. Findings indicated that dying Hispanic patients continue to experience pain and other negative symptoms, even when hospice care is in place. Thus, it is important that social workers provide education to interdisciplinary team members about culturally competent practices, and advocate for a patient-centered approach to care.     

Practical reasons and reasonable practice: the case of euthanasia in The Netherlands

Since the early 1970s the issue of euthanasia has been intensely debated in The Netherlands. Through these debates knowledge about medical practices involving the end of life was no longer confined to medical or legal quarters, but became public to a large extent. Following public opinion changes, the legal reaction to euthanasia changed. By prosecuting test cases the public prosecutors allowed the Dutch Supreme Court to formulate specific conditions in which euthanasia would go unpunished. The political debate about changing the criminal law, which still holds that euthanasia is a serious crime, developed at a much slower pace. Several extensive empirical studies were undertaken to gain valid knowledge about the medical practices. This article is concerned with a presentation of the various debates and the changes that took place in the fields of criminal law, politics, and medicine. The main conclusion is the hypothesis that a more open climate for medical practices concerning the end of life allows society to better control these practices.     

The systematic application of ethical codes in the counseling of persons who are considering euthanasia

As health psychology develops, psychologists and counseling professionals are becoming progressively more involved with patients who have chronic terminal illnesses such as AIDS, Alzheimer's disease, and cancer. Consequently, they will be consulted increasingly by patients, caregivers, and lawyers in cases where euthanasia is being considered. There are numerous ethical dilemmas that could arise when counseling persons who are contemplating euthanasia. Professionals must consider carefully issues such as informed consent, bodily autonomy, respect for a person's dignity, patient welfare, as well as responsibility to society. The national psychological, social work, and medical associations of North America have each adopted a code of ethics. These codes may be used by counseling professionals to assist in the resolution of ethical dilemmas that may arise as a result of working with persons considering euthanasia. This paper discusses the relevance of these codes to the counseling of terminally ill patients.     

Emotional Support for Health Care Professionals: A Therapeutic Role for the Hospital Ethics Committee

Hospital ethics committees (HECs) are typically charged with addressing ethical disputes, conflicts, and dilemmas that arise in the course of patient care. HECs are not widely viewed as having a therapeutic role for health care professionals who experience psychological distress or anticipatory grief in the course of discharging professional duties. A case is presented in which an ethics consultation was requested, chiefly, to secure emotional support for health care professionals who had been asked by a patient to discontinue life-sustaining treatments. As the case demonstrates, HECs may be called upon to provide emotional support and reassurance to health care professionals who willingly carry out psychologically difficult actions, even though these actions may be ethically uncontroversial. In providing this service, the HEC may not necessarily engage in its customary activity of deliberating an ethics issue and resolving a conflict but may still provide valuable assistance, as in the case presented.     

论“安乐死”的可行性

“安乐死”一直是备受法学界、医学界、宗教界等关注的世界性问题。对于“安乐死”,有赞成和反对两种截然不同的观点。各国的法律也对“安乐死”采取不同的态度,有的法律上允许“安乐死”,有的在法律上把安乐死当成是故意谋杀罪。本文主要是从法律角度来说明“安乐死”在法律上不应该是一种犯罪,它对社会、个人具有积极的意义,以及“安乐死”的社会基础来分析“安乐死”具有可行性,同时也探索了“安乐死”的立法问题。     

On gender role violations and judgments made about euthanasia: a research note

The impact of perceived gender role violations on the willingness of evaluators to label a deadly act to "end suffering" as euthanasia was explored in two studies. It was predicted that "killing" (even mercy killing) would be perceived as more role contradictory for a female actor than for a male actor. Therefore, it was expected that the deadly actions of a female actor would be judged as less justified (i.e., less likely to be labeled as euthanasia) than the same action committed by a male actor. A total of 486 undergraduates participated in one of two studies. It was found that although perceptions of justification for a deadly act were clearly influenced by whether or not the method of action taken was direct and proactive (commission) vs. indirect and passive (omission), the gender of the actor did not impact differently on the judgments of the participants. Possible explanations and future research directions are discussed.     

Euthanasia and assisted suicide: a survey of registered social workers in British Columbia

This anonymous postal survey explores the attitudes and experiences concerning voluntary euthanasia (VE) and assisted suicide (AS) held by professionally registered members of the British Columbia Association of Social Workers. Social workers determine only a minor moral distinction between VE and AS and a large majority believe both acts should be legal, in certain circumstances (VE 75.9 per cent; AS 78.2 per cent). Approximately 80.0 per cent feel that social workers should be involved in social policy development concerning VE and AS, and, if such acts were to be legal, 70.0 per cent believe social workers should be involved in the decision making process with clients. Over 21.0 per cent of all social workers and nearly 40.0 per cent of social workers with medical employers have been consulted by a patient about VE or AS. Six respondents (1.1 per cent) reported assisting the death of a patient by VE. None had involvement in AS. Further research and education is required to better inform social work practice in this ethical area. Given the unique position of social workers in health care, they should, for the benefit of patients, families, and physicians, actively participate in the discussion concerning end of life decisions.     

Energy Conservation—A Case Study in Campaign Evaluation

This study demonstrates the considerations involved in evaluation research into the effectiveness of campaigns designed to influence social change. It is an examination of the results of applying aspects of the attitude change studies to the subject of environmental issues. A case study was made of the Smallternatives energy conservation campaign which originated in 1976 in Brisbane, at a time of little recognition of an energy 'crisis' for Australia or the need for energy conservation. Results indicated that levels of concern for environmental issues were present throughout the sample; that one group (who requested Smallternatives information) were more concerned about energy and environmental issues than groups who had not requested it; and that the booklet, when issued without request, had little or no effect on desired attitudes towards energy conservation. These results are discussed with respect to the dilemma of attitude-behaviour consistency, and the impact of information input when it is sent to, rather than requested by, the individual.     

性别视角:清代侠义小说的新景观

文体上,清前期的剑侠女性沿袭了唐人小说的叙事手法,蒲松龄用传奇法而以志怪,使这类形象更具可塑性.清末侠女形象渐与烟花粉黛合流.章回小说的侠女分为"英雄儿女类"小说的佳人化侠女与"英雄传奇类"小说中的妖寒女子.她们的社会身份和性别特质,决定了小说的情节模式和婚姻主题.清代小说显示了从剑侠向女性气质和传统的性别角色回归的趋势,明清社会妇德观的改变是人物演化的深层原因.     

Investigation of Children's Custodial Wishes

One of the criteria used by judges of the Family Court in reaching custody decisions is the wishes of the child. A total of 104 children who were subjects of custody disputes were interviewed for the purpose of trying to ascertain their custodial wishes. Most children expressed a wish, and this preference was usually to remain with the parent the child was already living with. Children's wishes as to whether to remain where they were living or to move to live with the other parent, and their preferences as to whether to live with the mother or the father, did not differ according to age or sex.     

A Series of Single Case Design Clinical Evaluations of an Ericksonian Hypnotic Intervention Used with Clinical Anxiety

This article describes three single case design evaluations of an Ericksonian hypnotic intervention used with anxiety problems. The first study, carried out in a community mental health center, involved a 17-year-old female high school student experiencing problems classifiable under DSM-III criteria as "agoraphobia with panic attacks" and "generalized anxiety" and utilized an integration of a withdrawal and an alternating treatments single case design. The second study, also carried out in a community mental health center, involved a 39-year-old woman experiencing difficulties classifiable as "agoraphobia with panic attacks." This study employed an A-B1-B2-B3-B2 single case design. In these two studies the treatment variable was manipulated as if it were "withdrawable." The third study, in which the treatment variable was manipulated as if it were not withdrawable, involved a 76-year-old woman and a 27-year-old man. The woman was experiencing difficulties classifiable under DSM-III criteria as "agoraphobia with panic attacks." The young man experienced difficulties classifiable as "panic disorder" and "generalized anxiety disorder." The third study employed a multiple baseline across subjects and A-B single case designs. The possible causal role played by the Ericksonian hypnotic intervention is discussed in light of the convergence of results and the methodological limitations of each of the clinical studies. Possible characteristics of the treatment variable are also discussed.     

The Role of Family Care and Living Arrangements in Acute Care Discharge Recommendations

This study examined placement recommendations of elderly acute care patients who are identified by hospital discharge planners as vulnerable to institutionalization. The purpose of the research was to determine the role of available family care and living arrangements prior to hospitalization in the placement recommendations made by discharge planners. Results indicated that elderly who lived with family compared to those who lived alone were in poorer mental, physical and functional health but had considerably more available family care and fewer service needs that could not be met in the community. Additionally, available family care was found to be significantly related to nursing home recommendations, even with living arrangements controlled. Analysis of placement recommendations by prior living arrangements indicated that family care may be especially important in mitigating the consequences of deficient activity of daily living skills and mental complications. Implications of this research to the role of family care in placement decisions are discussed.     

Patient Reluctance to Discuss Pain: Understanding Stoicism,Stigma, and Other Contributing Factors

Some patients are hesitant to disclose when they are experiencing pain. However, the reasons for this, such as stoicism and concern about being a bother to others, are poorly understood. If patient pain goes unrecognized during clinical encounters, patients may also be at greater risk for pain-related crises, use of hospice/palliative care on-call services, and in-patient transfers. This is an evidence-informed development of a practice-oriented conceptual model to understand and address patient reluctance to admit pain. We used a review of the available evidence to better understand the various factors that contribute to an unwillingness to disclose one’s pain, create a conceptual model, and identify relevant assessment measures that may be useful to practitioners. Our review identified six primary attitudes and beliefs that contribute to patient reluctance to openly admit pain: (a) stigma; (b) stoicism; (c) cautiousness; (d) fatalism; (e) bother; and (f) denial. Four assessment measures that address elements of barriers to pain-related communication and four measures of nonverbal signs of pain were also identified and reviewed. Based on the model, social workers and other palliative care providers should consistently and vigilantly inquire about how comfortable patients are about discussing their own pain. Implications for practice and research are presented.     

Promoting Coexistence by Means of Conflict Education: The MACBE Model

This article presents a conflict education program designed to restore relationships among adversaries experiencing protracted, seemingly intractable intergroup conflict. It is designed on the basis of a systems model. The underlying assumption is that breaking the escalation cycle and ameliorating the adversaries' relationships requires a comprehensive intervention. Consequently, the curriculum imparts knowledge about conflict dynamics and teaches constructive conflict resolution skills, enhancing the probability of behavior and attitude change. The program is deemed relevant to efforts of improving Arab-Jewish relations in Israel. Implementation of the intervention requires ample resources, cooperation of local communities, and forbearance of program initiators and participants, which rarely exist in tandem. Nonetheless, even partial implementation can contribute to peaceful coexistence of Arabs and Jews.     

The problem of inadequately relieved suffering

A request for euthanasia or assistance in suicide usually derives from severe patient distress and indicates significant suffering. Although the Hippocratic purview of medicine requires that suffering be acknowledged, its causes be identified, and that steps be taken to provide adequate relief, an appreciation of the diversity of factors that may contribute to suffering underscores the need for methodical assessment and familiarity with a range of therapeutic strategies. It may be argued that when other options to effectively relieve suffering are available, euthanasia and assisted suicide fall outside of the purview of Hippocratic medicine. Given the existence of other options, the capacity for human maleficence, and the lack of resources currently allocated to the relief of suffering, this paper presents a number of reservations regarding the legalization of euthanasia and assisted suicide. In addition, it is suggested that the current community focus on the issue of inadequately relieved suffering should be harnessed to work toward the provision of care that would diminish the impression that elective death is necessary to ensure adequate relief.     

Barriers Associated with the Implementation of an Advance Care Planning Program in a Prison Setting

Advance care planning is considered a best practice within health care. However, the extent to which planning occurs within prison settings is unknown. Through the course of implementing an advance care planning (ACP) program for aging and dying offenders at a medical classification center, multiple barriers were identified that need to be addressed systemically to ensure the medical wishes of offenders were known and honored. This article will outline the barriers and the steps that were taken to create systems change to promote and sustain advance care planning.     

Caregiving Youth Knowledge and Perceptions of Parental End-of-Life Wishes in Huntington’s Disease

Knowledge of patient end-of-life (EOL) wishes and discussions are vital for family caregivers, including children and youth who may be in caregiving roles (“young carers” or “caregiving youth”). However, little is known about caregiving youth awareness and perceptions of EOL issues. This study sought to explore caregiving youth knowledge of EOL wishes and their willingness for EOL discussions. Face-to-face interviews with 40 caregiving youth ages 10–20, who have a parent with Huntington’s disease (HD), provided information about their knowledge of the presence of their ill parent’s living will (LW) and durable power of attorney for health care (DPAHC), and willingness to talk with the parent about EOL choices and possibility of death. Less than one-half of the participants were aware of the parent’s LW or DPAHC. Content analysis revealed themes in reasons to want or not want EOL discussion with the parent: respect for the parent’s wishes, caregiving youths’ opinion not valued, and avoidance of EOL issues. Themes also included reasons to not want discussion with the parent about possibility of death: protecting the parent, parent in denial, parent not ready, and realization of the terminal outcome. Findings suggest HD patients and their caregiving youth need support for open EOL discussions, and could benefit from educational programs and support groups around EOL issues.