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Will to live
Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public.
Will to live in the terminally ill.
Hospitals in euthanasia row
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. firstname.lastname@example.org
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
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.
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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".
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