Euthanasia and physician-assisted suicide: attitudes and
experiences of oncology patients, oncologists, and the public.COMPASSIONATE HEALTHCARE NETWORK
C H N
Will to live
Will to live in the terminally
ill.
Euthanasia and physician-assisted suicide: attitudes and
experiences of oncology patients, oncologists, and the public.
Emanuel EJ, Fairclough DL, Daniels ER, Clarridge BR. Lancet. 1996 Jun
29;347(9018):1805-10.
Division of Cancer Epidemiology and Control, Dana-Farber Cancer Institute,
Boston, Massachusetts 02115, USA.
BACKGROUND: Euthanasia and physician-assisted suicide are pressing public
issues. We aimed to collect empirical data on these controversial interventions,
particularly on the attitudes and experiences of oncology patients. METHODS: We
interviewed, by telephone with vignette-style questions, 155 oncology patients,
355 oncologists, and 193 members of the public to assess their attitudes and
experiences in relation to euthanasia and physician-assisted suicide. FINDINGS:
About two thirds of oncology patients and the public found euthanasia and
physician-assisted suicide acceptable for patients with unremitting pain.
Oncology patients and the public found euthanasia and physician-assisted suicide
least acceptable in vignettes involving "burden on the family" and
"life viewed as meaningless". In no vignette--even for patients with
unremitting pain--did a majority of oncologists find euthanasia or
physician-assisted suicide ethically acceptable. Patients actually experiencing
pain were more likely to find euthanasia or physician-assisted suicide
unacceptable. More than a quarter of oncology patients had seriously thought
about euthanasia or physician-assisted suicide and nearly 12 percent had
seriously discussed these interventions with physicians or others. Patients with
depression and psychological distress were significantly more likely to have
seriously discussed euthanasia, hoarded drugs, or read Final Exit. More than
half of oncologists had received requests for euthanasia or physician-assisted
suicide. Nearly one in seven oncologists had carried out euthanasia or
physician-assisted suicide. INTERPRETATION: Euthanasia and physician-assisted
suicide are important issues in the care of terminally ill patients and while
oncology patients experiencing pain are unlikely to desire these interventions
patients with depression are more likely to request assistance in committing
suicide. Patients who request such an intervention should be evaluated and,
where appropriate, treated for depression before euthanasia can be discussed
seriously.
PMID: 8667927 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=8667927&dopt=Abstract
Will to live
in the terminally ill.
Chochinov HM, Tataryn D, Clinch JJ, Dudgeon
D.
Department of Psychiatry, University of Manitoba, Winnipeg,
Canada. chochin@cc.umanitoba.ca
BACKGROUND: Complex biomedical and
psychosocial considerations figure prominently in the debate about euthanasia
and assisted suicide. No study to date, however, has examined the extent to
which a dying patient's will to live fluctuates as death approaches. METHODS:
This study examined patients with cancer in palliative care. Will to live was
measured twice daily throughout the hospital stay on a self-report 100 mm visual
analogue scale. This scale was incorporated into the Edmonton symptom assessment
system, a series of visual analogue scales measuring pain, nausea, shortness of
breath, appetite, drowsiness, depression, sense of well-being, anxiety, and
activity. Maximum and median fluctuations in will-to-live ratings, separated by
12 h, 24 h, 7 days, and 30 days, were calculated for each patient. FINDINGS: Of
585 patients admitted to palliative care during the study period (November,
1993, to May, 1995), 168 (29%; aged 31-89 years) met criteria of cognitive and
physical fitness and agreed to take part. The pattern of median changes in
will-to-live score suggested that will to live was stable (median changes <10
mm on 100 mm scale for all time intervals). By contrast, the average maximum
changes in will-to-live score were substantial (12 h 33.1 mm, 24 h 35.8 mm, 7
days 48.8 mm, 30 days 68.0 mm). In a series of stepwise regression models
carried out at 12 h, 24 h, and 1-4 weeks after admission, the four main
predictor variables of will to live were depression, anxiety, shortness of
breath, and sense of well-being, with the prominence of these variables changing
over time. INTERPRETATION: Among dying patients, will to live shows substantial
fluctuation, with the explanation for these changes shifting as death
approaches.
PMID: 10485723 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=10485723&dopt=Abstract
Hospitals
in euthanasia row
By Lech Mintowt-czyz, Evening Standard
13 December
2004
Four London hospitals are allowing elderly patients to request that
they be allowed to die, it emerged today. 
Look here too!
Doctors are allowed to mark down any request by patients that they
be allowed to die if they become critically ill. Hospital managers have told
them they can follow any such instruction should the circumstances arise.
A spokesman for the Hammersmith Hospitals Trust, which has launched the
initiative, said doctors did not ask patients for their views and only marked
their notes should they make a specific demand.
Patients at each of the
trust's four hospitals - Hammersmith, Charing Cross, Ravenscourt Park and Queen
Charlotte's and Chelsea - are understood to be affected.
The spokesman
denied the policy amounted to allowing patients to make a "living will" but
reports in today's Daily Mail drew savage criticism from pro-life campaign
groups.
Phyllis Bowman of Right to Life said: "You tick the box and you
are ticking your life away. Elderly people are very easy to coerce, especially
when they are on their own, confused and sick in a hospital bed."
Julia
Quenzler, of the SOSNHS campaign group, added: "If ever the elderly and
vulnerable needed confirmation that they are considered expendable, this is it."
Lib-Dem health spokesman Paul Burstow said: "If this is what Hammersmith are
doing they need to rethink.
"At no point should it be acceptable for the
purpose of a doctor to be to hasten someone's death.
"There are far too
many assumptions made about a person's ability to recover and enjoy life on the
basis of their birth date."
The controversy comes as MPs prepare for a
row over the issue of "living wills" during tomorrow's debate on the
Government's Mental Capacity Bill.
More than 100 MPs from both sides of
the House are said to oppose the Bill, which critics call a charter for
euthanasia.
The Bill proposes to give legal backing to living wills in
which individuals specify how they would be treated should they become
incapacitated and unable to communicate.
As "treatment" includes
provision of nutrition and water by tube, this could involve allowing death by
starvation or dehydration.
Over the weekend medical expert Baroness
Warnock fuelled controversy by declaring she did not want to be a "burden" on
her family.
The 80-year-old peer said: "In other contexts sacrificing
oneself for one's family would be considered good. I don't see what is so
horrible about not wanting to be an increasing nuisance." Age Concern branded
her stance "outrageous".
Source: http://www.thisislondon.co.uk/news/articles/15284596?source=Evening%20Standard
Return to
This page was
added April 15, 2007, since that date you are visitor
to this page.