ethique_AMM_fin_vie

Assisted dying, moral distress, and conscientious objection.

Sat, 13 Apr 2024 04:00:00 +0000

Lancet; 04/13/2024
(AN 176539872); ISSN: 01406736
CINAHL Complete

James Rachels and the morality of euthanasia.

Mon, 01 Apr 2024 04:00:00 +0000

Theoretical Medicine & Bioethics; 04/01/2024
(AN 176221337); ISSN: 13867415
CINAHL Complete

Ethical Guidance for Patients with Delirium at End of Life.

Mon, 01 Apr 2024 04:00:00 +0000

Medical Ethics Advisor; 04/01/2024
(AN 176407983); ISSN: 08860653
CINAHL Complete

Nurses' perceptions of how their professional autonomy influences the moral dimension of end-of-life care to nursing home residents- a qualitative study

Fri, 29 Mar 2024 00:00:00 +0000

BMC Nurs. 2024 Mar 28;23(1):216. doi: 10.1186/s12912-024-01865-5.

ABSTRACT

BACKGROUND: Over the years, caring has been explained in various ways, thus presenting various meanings to different people. Caring is central to nursing discipline and care ethics have always had an important place in nursing ethics discussions. In the literature, Joan Tronto's theory of ethics of care is mostly discussed at the personal level, but there are still a few studies that address its influence on caring within the nursing context, especially during the provision of end-of-life care. This study aims to explore nurses' perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

METHODS: This study has a qualitative descriptive design. Data were collected by conducting five individual interviews and one focus group during a seven-month period between April 2022 and September 2022. Nine nurses employed at four Norwegian nursing homes were the participants in this study. Data were analysed by employing a qualitative deductive content analysis method.

RESULTS: The content analysis generated five categories that were labelled similar to Tronto's five phases of the care process: (i) caring about, (ii) caring for, (iii) care giving, (iv) care receiving and (v) caring with. The findings revealed that nurses' autonomy more or less influences the decision-making care process at all five phases, demonstrating that the Tronto's theory contributes to greater reflectiveness around what may constitute 'good' end-of-life care.

CONCLUSIONS: Tronto's care ethics is useful for understanding end-of-life care practice in nursing homes. Tronto's care ethics provides a framework for an in-depth analysis of the asymmetric relationships that may or may not exist between nurses and nursing home residents and their next-of-kin. This can help nurses see and understand the moral dimension of end-of-life care provided to nursing home residents during their final days. Moreover, it helps handle moral responsibility around end-of-life care issues, providing a more complex picture of what 'good' end-of-life care should be.

PMID:38549064 | PMC:PMC10976790 | DOI:10.1186/s12912-024-01865-5

Nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care to nursing home residents– a qualitative study.

Thu, 28 Mar 2024 04:00:00 +0000

BMC Nursing; 03/28/2024
Background: Over the years, caring has been explained in various ways, thus presenting various meanings to different people. Caring is central to nursing discipline and care ethics have always had an important place in nursing ethics discussions. In the literature, Joan Tronto’s theory of ethics of care is mostly discussed at the personal level, but there are still a few studies that address its influence on caring within the nursing context, especially during the provision of end-of-life care. This study aims to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents. Methods: This study has a qualitative descriptive design. Data were collected by conducting five individual interviews and one focus group during a seven-month period between April 2022 and September 2022. Nine nurses employed at four Norwegian nursing homes were the participants in this study. Data were analysed by employing a qualitative deductive content analysis method. Results: The content analysis generated five categories that were labelled similar to Tronto’s five phases of the care process: (i) caring about, (ii) caring for, (iii) care giving, (iv) care receiving and (v) caring with. The findings revealed that nurses’ autonomy more or less influences the decision-making care process at all five phases, demonstrating that the Tronto’s theory contributes to greater reflectiveness around what may constitute ‘good’ end-of-life care. Conclusions: Tronto’s care ethics is useful for understanding end-of-life care practice in nursing homes. Tronto’s care ethics provides a framework for an in-depth analysis of the asymmetric relationships that may or may not exist between nurses and nursing home residents and their next-of-kin. This can help nurses see and understand the moral dimension of end-of-life care provided to nursing home residents during their final days. Moreover, it helps handle moral responsibility around end-of-life care issues, providing a more complex picture of what ‘good’ end-of-life care should be.
(AN 176376857); ISSN: 14726955
CINAHL Complete

Ethical dilemmas for palliative care nurses: systematic review

Wed, 27 Mar 2024 00:00:00 +0000

BMJ Support Palliat Care. 2024 Mar 27:spcare-2023-004742. doi: 10.1136/spcare-2023-004742. Online ahead of print.

ABSTRACT

BACKGROUND: Nurses play a unique and critical role in palliative care, and it is noteworthy that nurses often encounter ethical dilemmas in this field.

OBJECTIVE: This review aims to conduct a summarised synthesis of the latest research on the ethical considerations nurses faced in palliative care.

METHODS: We conducted a rigorous systematic review of relevant existing studies published in high-quality English peer-reviewed journals from January 2017 to July 2023. We identified a total of 4492 articles (1029 in Web of Science, 1570 in PubMed and 1893 in Science Direct). Out of these, only 13 studies met the inclusion criteria.

RESULTS: Following the thematic analysis, the ethical considerations reported in these 13 studies were grouped into three main themes and four subthemes: ethical issues in communication (ethical issues in communication with patients, ethical issues in communication with families), ethical issues in decision-making (autonomy, dignity) and moral distress in palliative care.

CONCLUSION: This study elaborated on the ethical challenges faced by nurses in their communication with patients and families as well as decision-making and analysed the causes and effects of ethical distress, hoping to give a hand to ethical issues for nurses' work in palliative care.

PMID:38538036 | DOI:10.1136/spcare-2023-004742

Perspective: legal, ethical, and medical perspectives of the landscape of assisted suicide in Austria

Tue, 26 Mar 2024 00:00:00 +0000

Wien Klin Wochenschr. 2024 Mar 26. doi: 10.1007/s00508-024-02344-2. Online ahead of print.

NO ABSTRACT

PMID:38530423 | DOI:10.1007/s00508-024-02344-2

Case report: Organ donation after euthanasia for psychiatric suffering: some of the practical and ethical lessons Martijn taught us

Wed, 20 Mar 2024 00:00:00 +0000

Front Psychiatry. 2024 Mar 5;15:1234741. doi: 10.3389/fpsyt.2024.1234741. eCollection 2024.

ABSTRACT

Euthanasia in psychiatric patients presents unique challenges, especially when combined with organ donation. In this article, the hurdles psychiatric patients might encounter after expressing their wish for organ donation after euthanasia, are discussed and illustrated by the case of Martijn, a 45-year-old psychiatric patient who altruistically donated his organs after euthanasia. Hospital and physician-related factors, including caution in determination of mental capacity, consideration of conflicting interests, and healthcare staff stress are discussed as impediments to organ donation after euthanasia (ODE) in psychiatric patients. The primary objective of this article is to raise awareness among psychiatrists regarding the fact that although the combination of euthanasia and organ donation is an uncommonly performed procedure, it is frequently requested by psychiatric patients. In conclusion, the article advocates for a nuanced approach, respecting patients' altruistic wishes while at the same time addressing challenges associated with ODE in psychiatric suffering. Where possible, and within the current medical, ethical and legal boundaries, the importance of facilitating organ donation without unnecessarily prolonging the suffering of competent psychiatric patients seeking euthanasia is emphasized. The topic calls, for example, for further qualitative research to understand the stakeholders' perspectives to determine the perceived possibilities on the one hand and boundaries on the other.

PMID:38505793 | PMC:PMC10948434 | DOI:10.3389/fpsyt.2024.1234741

Can an effective end-of-life intervention for advanced dementia be viewed as moral?

Mon, 18 Mar 2024 00:00:00 +0000

Alzheimers Dement (Amst). 2024 Mar 15;16(1):e12528. doi: 10.1002/dad2.12528. eCollection 2024 Jan-Mar.

ABSTRACT

Many people dread prolonged dying with suffering in the terminal illness, advanced dementia. To successfully facilitate a timely dying, advance directives must be effective and acceptable. This article considers whether authorities, including treating physicians, can accept as moral, the effective intervention that ceases caregivers' assistance with oral feeding and hydrating. The article presents eight criticisms and "alternate views" regarding ceasing assisted feeding/hydrating. It draws on perspectives from clinical medicine, law, ethics, and religion. The conflict is between (A) people's core beliefs that reflect cultural norms and religious teachings regarding what is moral versus (B) patients' autonomous right of self-determination and claim right to avoid suffering. The article presents each side as strongly as possible. Accepting the intervention as moral could allow patients a peaceful and timely dying from patients' underlying disease. Confidence in future success can deter patients and their surrogates from considering a hastened dying in earlier stages of dementia.

PMID:38496720 | PMC:PMC10941521 | DOI:10.1002/dad2.12528

Responses to Open Peer Commentaries about "Timely dying in dementia: use patients' judgments and broaden the concept of suffering" and "Can an effective end-of-life intervention for advanced dementia be viewed as moral?"

Mon, 18 Mar 2024 00:00:00 +0000

Alzheimers Dement (Amst). 2024 Mar 15;16(1):e12529. doi: 10.1002/dad2.12529. eCollection 2024 Jan-Mar.

NO ABSTRACT

PMID:38496719 | PMC:PMC10941494 | DOI:10.1002/dad2.12529

Commentary: Can an effective end-of-life intervention for advanced dementia be viewed as moral?

Mon, 18 Mar 2024 00:00:00 +0000

Alzheimers Dement (Amst). 2024 Mar 15;16(1):e12531. doi: 10.1002/dad2.12531. eCollection 2024 Jan-Mar.

ABSTRACT

We comment on Dr. Terman's considerations on the moral justification of ceasing assisted feeding and hydration for people with advanced dementia. The core idea of his paper is that an advance directive can solve future dilemmas regarding assisted feeding. We submit that this static instrument is unfit for the complex and dynamic nature of assessing how to deal with refusals to eat, in particular for people with dementia. It overvalues the past in relation to the present situation and leaves no room for the possibility of changing wishes. Moreover, the perspectives of professional caregivers and families are not addressed because the focus is entirely on individual autonomy in early dementia. Multiple perspectives should be considered in interpreting directives and the actual situation in light of the patient's view of life in order to realistically account for what is morally justifiable in care in advanced dementia.

PMID:38496715 | PMC:PMC10941533 | DOI:10.1002/dad2.12531

What nurses must understand about the ethics of assisted dying

Sat, 16 Mar 2024 00:00:00 +0000

Nurs Open. 2024 Mar;11(3):e2129. doi: 10.1002/nop2.2129.

NO ABSTRACT

PMID:38491839 | PMC:PMC10943369 | DOI:10.1002/nop2.2129

The ISCCM/IAPC Position Statement: Ending the Sisyphean Struggle to Practice Ethical End-of-life Care in India

Wed, 13 Mar 2024 00:00:00 +0000

Indian J Crit Care Med. 2024 Mar;28(3):189-190. doi: 10.5005/jp-journals-10071-24660.

ABSTRACT

Rajagopalan RE, Kapadia F. The ISCCM/IAPC Position Statement: Ending the Sisyphean Struggle to Practice Ethical End-of-life Care in India. Indian J Crit Care Med 2024;28(3):189-190.

PMID:38476993 | PMC:PMC10926041 | DOI:10.5005/jp-journals-10071-24660

James Rachels and the morality of euthanasia

Wed, 13 Mar 2024 00:00:00 +0000

Theor Med Bioeth. 2024 Apr;45(2):69-97. doi: 10.1007/s11017-024-09658-2. Epub 2024 Mar 12.

ABSTRACT

My fundamental thesis is that Rachels dismisses the traditional Western account of the morality of killing without offering a viable replacement. In this regard, I will argue that the substitute account he offers is deficient in at least eight regards: (1) he fails to justify the foundational principle of utilitarianism, (2) he exposes preference utilitarianism to the same criticisms he lodges against classical utilitarianism, (3) he neglects to explain how precisely one performs the maximization procedure which preference utilitarianism requires, (4) his account of the sanctity of life is subject to the very criticism he levels against the traditional position, (5) he cannot justify the exceptions he makes to his interpretation of the sanctity of life, (6) his account could easily be used to justify murder, (7) his embrace of autonomy as an ethical principle undermines his preference utilitarianism, and (8) he cannot maintain the moral identification of acts of killing and letting die.

PMID:38472568 | DOI:10.1007/s11017-024-09658-2

Communication and bioethics at the end of life: real cases, real dilemmas

Thu, 07 Mar 2024 08:28:36 +0000

Author Names: Stone A.M.

Database Source: Embase Daily Updates

Journal Title: Health communication

Article Title: Communication and bioethics at the end of life: real cases, real dilemmas

Year: 2018

Issue:

Volume:

Abstract:

The ISCCM/IAPC Position Statement: Ending the Sisyphean Struggle to Practice Ethical End-of-life Care in India.

Fri, 01 Mar 2024 05:00:00 +0000

Indian Journal of Critical Care Medicine; 03/01/2024
(AN 175916703); ISSN: 09725229
CINAHL Complete

What nurses must understand about the ethics of assisted dying.

Fri, 01 Mar 2024 05:00:00 +0000

Nursing Open; 03/01/2024
(AN 176335603); ISSN: 20541058
CINAHL Complete

Psychometrics assessment of ethical decision-making around end-of-life care scale for adolescents in the final stage of life

Tue, 06 Feb 2024 00:00:00 +0000

Front Pediatr. 2024 Jan 22;11:1266929. doi: 10.3389/fped.2023.1266929. eCollection 2023.

ABSTRACT

INTRODUCTION: Healthcare professionals have a critical role in ethical decision-making around end-of-life care. Properly evaluating the ethical decision-making of health care professionals in end-of-life care requires reliable, tailored, and comprehensive assessments. The current study aimed to translate and assess psychometrically a Persian version of the ethical decision making in end-of-life care scale for Iranian adolescents in the final stages of life.

METHODS: The present study investigates the methodology and multicenter research. 310 healthcare professionals who treat/care for adolescents at the end of life were selected from 7 cities in Iran. The original version of the end-of-life care decision-making scale was translated into Persian using the forward-backward translation method, and its psychometric properties were evaluated using COSMIN criteria.

RESULTS: Exploratory factor analysis revealed that the factor loadings of the items ranged from 0.68 to 0.89, all of which were statistically significant. Furthermore, three factors had eigenvalues greater than 1, accounting for 81.64% of the total variance. Confirmatory factor analysis indicated a proper goodness of fit in the hypothesized factor structure. The internal consistency reliability of the tool was assessed in terms of its homogeneity, yielding a Cronbach's alpha coefficient of 0.93.

CONCLUSION: The Persian version of the End-of-Life Care Decision-Making Scale demonstrates satisfactory validity and reliability among healthcare professionals working with adolescents in the final stages of life. Therefore, nursing managers can utilize this tool to measure and evaluate ethical decision-making in end-of-life care for adolescents in the final stages of life and identify the most appropriate strategies, including educational interventions, to improve ethical decision-making in end-of-life care if necessary.

PMID:38318315 | PMC:PMC10839055 | DOI:10.3389/fped.2023.1266929

The Extent to Which the Wish to Donate One's Organs After Death Contributes to Life-Extension Arguments in Favour of Voluntary Active Euthanasia in the Terminally Ill: An Ethical Analysis

Tue, 06 Feb 2024 00:00:00 +0000

New Bioeth. 2024 Feb 5:1-29. doi: 10.1080/20502877.2024.2308346. Online ahead of print.

ABSTRACT

In terminally ill individuals who would otherwise end their own lives, active voluntary euthanasia (AVE) can be seen as life-extending rather than life-shortening. Accordingly, AVE supports key pro-euthanasia arguments (appeals to autonomy and beneficence) and meets certain sanctity of life objections. This paper examines the extent to which a terminally ill individual's wish to donate organs after death contributes to those life-extension arguments. It finds that, in a terminally ill individual who wishes to avoid experiencing life he considers to be not worth living, and who also wishes to donate organs after death, AVE maximizes the likelihood that such donations will occur. The paper finds that the wish to donate organs strengthens the appeals to autonomy and beneficence, and fortifies the meeting of certain sanctity of life objections, achieved by life-extension arguments, and also generates appeals to justice that form novel life-extension arguments in favour of AVE in this context.

PMID:38317570 | DOI:10.1080/20502877.2024.2308346

A Pilot Efficacy Trial to Educate Muslim Americans about the Islamic Bioethical Perspectives in End-of-Life Healthcare.

Thu, 01 Feb 2024 05:00:00 +0000

Journal of Immigrant & Minority Health; 02/01/2024
In the US, end-of-life health care (EOLHC) is often intensive and invasive, and at times may involve care that is inconsistent with patient values. US Muslims may not receive appropriate religious support, experience uncertainty around end-of-life decision-making, and under-utilize palliative and hospice care. As technological advancements and treatment options rise in EOLHC, Muslim American patients and their families need to understand more about the treatment options that are consistent with their beliefs. The objective of this study was to determine the efficacy of a pilot mosque-based educational workshop focused on increasing Muslim Americans' religious bioethics knowledge about end-of-life healthcare. Intervention sites were four mosques with racially and ethnically diverse members, two in the Chicago metropolitan area and two in the Washington, D.C. area. Eligible participants were self-reported Muslims, aged 18 years or older, who were proficient in English. The intervention included a pre and post-test survey and a workshop focused on the Islamic bioethical perspectives on EOLHC. Knowledge was measured with six true-false questions. Baseline and post-intervention scores were analyzed by McNemar's test and bivariate correlation. Overall, the analysis showed a significant improvement in post-intervention participant knowledge. There was increased knowledge of Islamic bioethical views on the moral status of seeking healthcare, brain death controversies, and religious perspectives on withholding or withdrawing life support near the end of life. Our pilot intervention successfully increased participant knowledge and underscores the need to improve the Muslim community's knowledge about the bioethical dimensions of EOLHC.
(AN 174638905); ISSN: 15571912
CINAHL Complete

A Different Slippery Slope...Pullman D. Slowing the Slide Down the Slippery Slope of Medical Assistance in Dying: Mutual Learnings for Canada and the US. American Journal of Bioethics. 2023;23(11):64-72.

Thu, 01 Feb 2024 05:00:00 +0000

American Journal of Bioethics; 02/01/2024
(AN 175195389); ISSN: 15265161
CINAHL Complete

Organ donation following medical assistance in dying, Part I: a scoping review of legal and ethical aspects.

Thu, 01 Feb 2024 05:00:00 +0000

JBI Evidence Synthesis; 02/01/2024
Objective: The objective of this review was to collate and summarize the current literature on what is known about organ donation following medical assistance in dying (MAiD). Additionally, for this first part of a 2-part scoping review, the focus is on legal and ethical considerations regarding organ donation following MAiD. Introduction: Organ donation following MAiD is a relatively new procedure that has sparked much debate and discussion. A comprehensive investigation into the legal and ethical aspects related to organ donation following MAiD is needed to inform the development of safe and ethical practices. Inclusion criteria: In this review, we included documents that investigated legal and/or ethical issues related to individuals who underwent organ donation following MAiD in any setting (eg, hospital or home) worldwide. We considered quantitative and qualitative studies, text and opinion papers, gray literature, and unpublished material provided by stakeholders. Methods: This scoping review followed JBI methodology. Published studies were retrieved from databases, including MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), Web of Science Core Collection, and Academic Search Complete (EBSCOhost). Gray and unpublished literature included reports from organ donation organizations in Canada, The Netherlands, and Belgium. Two independent reviewers screened all reports (both by title and abstract and by full text) against the inclusion criteria, extracted data, and completed a content analysis. Disagreements between the 2 reviewers were resolved through discussions among the reviewers and the lead reviewer. Results: We included 121 documents for parts I and II of our scoping review, 89 of which are included in part I. The majority of the 89 documents were discussion papers published in English and in Canada from 2019 to 2021. In the content analysis, we identified 4 major categories regarding ethical and legal aspects of organ donation following MAiD: i) legal definitions, legislation, and guidelines; ii) ethics, dilemmas, and consensus; iii) consent and objection; and iv) public perceptions. We identified the main legislation regulating the practices of organ donation following MAiD in countries where both procedures are permitted, the many ethical debates surrounding this topic (eg, eligibility criteria for organ donation and MAiD, disclosure of donors' and recipients' information, directed organ donation, death determination in organ donation following MAiD, ethical safeguards for organ donation following MAiD), as well as the public perceptions of this process. Conclusions: Organ donation following MAiD has raised many legal and ethical concerns regarding establishing safeguards to protect patients and families. Despite the ongoing debates around the risks and benefits of this combined procedure, when patients who request MAiD want to donate their organs, this option can help fulfill their last wishes and diminish their suffering, which should be the main reasons to offer organ donation following MAiD.
(AN 175460392); ISSN: 26898381
CINAHL Complete

Caregivers' Perspectives on Ethical Challenges and Patient Safety in Tele-Palliative Care.

Thu, 01 Feb 2024 05:00:00 +0000

Journal of Hospice & Palliative Nursing; 02/01/2024
Tele-palliative care enables people with a life-limiting illness to consult with palliative care staff without having to leave their homes but requires commitment from all stakeholders, particularly on ethical challenges and patient safety issues. When using telecommunications and virtual technology, ethical challenges and patient safety aspects must be taken into account. The aim was to describe formal and informal caregivers' opportunities in tele-palliative care and the associated ethical and safety challenges using a Whittemore and Knafl integrative review method. Ethical and patient safety perspectives were extracted from studies reporting on tele-palliative care interventions. Content on ethically considerable information on the intervention was coded, categorized, and summarized into a matrix developed in advance from literature on socio-technical arrangements and eHealth applications. Nine studies from experimental and nonexperimental research were included. Four studies reported exclusively on the perspective of formal caregivers, 3 studies addressed the perspective of patients and informal caregivers, and 2 studies covered the perspectives of both. Studies of tele-palliative care interventions implicate effects on patient-caregiver relationships but also show that technology is not seen as a replacement of holistic palliative care. However, the authors do not address other relevant ethical issues (eg, sustainability) or consider aspects of patient safety. There is a need for further research to assess privacy, data security, and patient safety in tele-palliative care from the perspective of caregivers as telehealth becomes increasingly important.
(AN 175424840); ISSN: 15222179
CINAHL Complete

Moral Injury Among Transplant Providers: Evaluating the Effects of Training in End-of-Life Counseling

Thu, 01 Feb 2024 00:00:00 +0000

Kans J Med. 2023 Dec 31;16:324-327. doi: 10.17161/kjm.vol16.21171. eCollection 2023.

ABSTRACT

INTRODUCTION: Ethical issues are pervasive in healthcare, but few specialties rival the moral complexity of transplant medicine. Transplant providers must regularly inform patients that they are no longer eligible to receive a potentially life-saving operation and the stress of these conversations poses a high risk of moral injury. Training in end-of-life counseling (EOLC) has proven to significantly reduce provider stress and burnout. The purpose of this study was to determine whether training in EOLC reduces levels of moral injury among transplant providers.

METHODS: This was a mixed methods study. We interviewed 10 patient participants and administered a survey to staff in the solid organ transplant department at the University of Kansas Health System. Respondents indicated whether they had received training in EOLC and completed the standardized Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP). A two-sample, one-sided t-test compared levels of moral injury between trained and untrained staff. Subsequently, we conducted semi-structured interviews with transplant providers, then performed inductive coding followed by thematic network analysis.

RESULTS: Thirty-seven percent (14/38) of respondents reported a moral injury score at or above the threshold for psychosocial dysfunction associated with moral injury. Analysis revealed no difference in moral injury scores between the trained and untrained groups (p = 0.362, power (1-β) = 0.842). Thematic network analysis demonstrated high-level themes of "challenges", "training", and "stress relief".

CONCLUSIONS: Our study demonstrated a concerning prevalence of moral injury among transplant staff and suggested that EOLC training did not significantly mitigate the threat of moral injury.

PMID:38298384 | PMC:PMC10829853 | DOI:10.17161/kjm.vol16.21171

The debate rages on: physician-assisted suicide in an ethical light

Tue, 30 Jan 2024 00:00:00 +0000

Br J Anaesth. 2024 Jan 29:S0007-0912(24)00003-5. doi: 10.1016/j.bja.2024.01.002. Online ahead of print.

ABSTRACT

The British Medical Association and some Royal Colleges have recently changed their stance on physician-assisted suicide from 'opposed' to forms of 'neutral'. The Royal College of Anaesthetists will poll members soon on whether to follow suit. Elsewhere neutrality amongst professional bodies has preceded legalisation of physician-assisted suicide. We examine the arguments relevant to the anaesthesia community and its potential impact in the UK.

PMID:38290905 | DOI:10.1016/j.bja.2024.01.002

Public Attitudes Toward Ethics and Practices in End-of-Life Decision-Making for Neonates.

Thu, 25 Jan 2024 05:00:00 +0000

JAMA Network Open; 01/25/2024
This cross-sectional study examines the societal perspective on euthanasia and withdrawal of life-prolonging treatment for sick and extremely preterm newborns in Germany. Key Points: Question: Does the German public know about national recommendations for euthanasia and withdrawal of life-prolonging treatment for neonates, and what personal attitudes exist in German society regarding ethical issues and proxy decisions for newborns with severe life-limiting conditions? Findings: In this cross-sectional study of 2116 participants, only 17% of participants reported knowing the recommendations regarding euthanasia and withdrawal of life-prolonging treatment for neonates. Associations between sociodemographic factors and views on ethical issues concerning neonatal end-of-life decisions were low in magnitude. Meaning: Findings of this study suggest that clinicians need to exert additional efforts to explain the legal and ethical framework of end-of-life decisions when counseling parents of periviable infants and that the large variability in attitudes warrants a highly individualized approach. Importance: Attitudes toward end-of-life decision-making in neonatology have been studied in physicians and other health care professionals and are mostly shaped by their clinical education and work experiences. In contrast, attitudes among the general public have not yet been investigated. Objective: To assess (1) attitudes in the general public toward euthanasia and withdrawal of life-prolonging treatment in neonates with severe life-limiting conditions, (2) knowledge of current German recommendations, and (3) values in the German society regarding ethical issues and proxy decisions at the beginning of life. Design, Setting, and Participants: This cross-sectional study was performed in Germany and used an exploratory design to analyze responses to an interview conducted by an independent, established commissioned polling institute in March and April 2022. Participants were 16 years or older, with German language fluency and comprehension and living in Germany. Main Outcomes and Measures: Knowledge about recommendations for euthanasia and withdrawal of life-prolonging treatment as well as personal attitudes toward (1) euthanasia and withdrawal of life-prolonging treatment and (2) surrogate end-of-life decision-making for newborn infants were assessed. Results: The study included 2116 participants (1077 females [50.9%]; mean [SD] age 52.1 [18.7] years). Of the participants, 16.8% (311 of 1851) reported knowing the German recommendations for euthanasia and withdrawal of life-prolonging treatment for neonates. Euthanasia and withdrawal of life-prolonging treatment were supported by 64.7% (1369 of 2116) and 77.9% (1649 of 2116) of respondents, respectively. Shared decision-making between parents and physicians for neonates in end-of-life situations was supported by 65.6% of participants (1388). In situations where shared decision-making was not possible, 73.4% of respondents (1019 of 1388) put the ultimate decision to the parents. The magnitude of the associations was low between sociodemographic factors and views on ethical issues and customary practices involved in end-of-life decisions for neonates. Conclusions and Relevance: Results of this cross-sectional study suggested that most respondents were not aware of the national German recommendations for euthanasia and withdrawal of life-prolonging treatment for sick and extremely preterm newborns. When counseling parents of periviable newborns, clinicians may need to exert more effort in explaining the legal and ethical framework; a highly individualized approach is warranted.
(AN 175036079); ISSN: 25743805
CINAHL Complete

Correction: Doing our best and doing no harm: A focused ethnography of staff moral experiences of providing palliative care at a Medecins Sans Frontieres pediatric hospital in Cox's Bazar, Bangladesh

Thu, 25 Jan 2024 00:00:00 +0000

PLoS One. 2024 Jan 25;19(1):e0298091. doi: 10.1371/journal.pone.0298091. eCollection 2024.

ABSTRACT

[This corrects the article DOI: 10.1371/journal.pone.0288938.].

PMID:38271439 | PMC:PMC10810480 | DOI:10.1371/journal.pone.0298091

Public Attitudes Toward Ethics and Practices in End-of-Life Decision-Making for Neonates

Thu, 25 Jan 2024 00:00:00 +0000

JAMA Netw Open. 2024 Jan 2;7(1):e2353264. doi: 10.1001/jamanetworkopen.2023.53264.

ABSTRACT

IMPORTANCE: Attitudes toward end-of-life decision-making in neonatology have been studied in physicians and other health care professionals and are mostly shaped by their clinical education and work experiences. In contrast, attitudes among the general public have not yet been investigated.

OBJECTIVE: To assess (1) attitudes in the general public toward euthanasia and withdrawal of life-prolonging treatment in neonates with severe life-limiting conditions, (2) knowledge of current German recommendations, and (3) values in the German society regarding ethical issues and proxy decisions at the beginning of life.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was performed in Germany and used an exploratory design to analyze responses to an interview conducted by an independent, established commissioned polling institute in March and April 2022. Participants were 16 years or older, with German language fluency and comprehension and living in Germany.

MAIN OUTCOMES AND MEASURES: Knowledge about recommendations for euthanasia and withdrawal of life-prolonging treatment as well as personal attitudes toward (1) euthanasia and withdrawal of life-prolonging treatment and (2) surrogate end-of-life decision-making for newborn infants were assessed.

RESULTS: The study included 2116 participants (1077 females [50.9%]; mean [SD] age 52.1 [18.7] years). Of the participants, 16.8% (311 of 1851) reported knowing the German recommendations for euthanasia and withdrawal of life-prolonging treatment for neonates. Euthanasia and withdrawal of life-prolonging treatment were supported by 64.7% (1369 of 2116) and 77.9% (1649 of 2116) of respondents, respectively. Shared decision-making between parents and physicians for neonates in end-of-life situations was supported by 65.6% of participants (1388). In situations where shared decision-making was not possible, 73.4% of respondents (1019 of 1388) put the ultimate decision to the parents. The magnitude of the associations was low between sociodemographic factors and views on ethical issues and customary practices involved in end-of-life decisions for neonates.

CONCLUSIONS AND RELEVANCE: Results of this cross-sectional study suggested that most respondents were not aware of the national German recommendations for euthanasia and withdrawal of life-prolonging treatment for sick and extremely preterm newborns. When counseling parents of periviable newborns, clinicians may need to exert more effort in explaining the legal and ethical framework; a highly individualized approach is warranted.

PMID:38270948 | PMC:PMC10811557 | DOI:10.1001/jamanetworkopen.2023.53264

Drugs, delirium, and ethics at the end of life

Fri, 19 Jan 2024 00:00:00 +0000

J Am Geriatr Soc. 2024 Jan 19. doi: 10.1111/jgs.18766. Online ahead of print.

ABSTRACT

For older persons with delirium at the end of life, treatment involves complex trade-offs and highly value-sensitive decisions. The principles of beneficence, nonmaleficence, respect for autonomy, and justice establish important parameters but lack the structure necessary to guide clinicians in the optimal management of these patients. We propose a set of ethical rules to guide therapeutics-the canons of therapy-as a toolset to help clinicians deliberate about the competing concerns involved in the management of older patients with delirium at the end of life. These canons are standards of judgment that reflect how many experienced clinicians already intuitively practice, but which are helpful to articulate and apply as basic building blocks for a relatively neglected but emerging ethics of therapy. The canons of therapy most pertinent to the care of patients with delirium at the end of life are as follows: (1) restoration, which counsels that the goal of all treatment is to restore the patient, as much as possible, to homeostatic equilibrium; (2) means-end proportionality, which holds that every treatment should be well-fitted to the intended goal or end; (3) discretion, which counsels that an awareness of the limits of medical knowledge and practice should guide all treatment decisions; and (4) parsimony, which maintains that only as much therapeutic force as is necessary should be used to achieve the therapeutic goal. Carefully weighed and applied, these canons of therapy may provide the ethical structure needed to help clinicians optimally navigate complex cases.

PMID:38240387 | DOI:10.1111/jgs.18766

Exploring the role of AI in classifying, analyzing, and generating case reports on assisted suicide cases: feasibility and ethical implications

Tue, 02 Jan 2024 00:00:00 +0000

Front Artif Intell. 2023 Dec 14;6:1328865. doi: 10.3389/frai.2023.1328865. eCollection 2023.

ABSTRACT

This paper presents a study on the use of AI models for the classification of case reports on assisted suicide procedures. The database of the five Dutch regional bioethics committees was scraped to collect the 72 case reports available in English. We trained several AI models for classification according to the categories defined by the Dutch Termination of Life on Request and Assisted Suicide (Review Procedures) Act. We also conducted a related project to fine-tune an OpenAI GPT-3.5-turbo large language model for generating new fictional but plausible cases. As AI is increasingly being used for judgement, it is possible to imagine an application in decision-making regarding assisted suicide. Here we explore two arising questions: feasibility and ethics, with the aim of contributing to a critical assessment of the potential role of AI in decision-making in highly sensitive areas.

PMID:38164497 | PMC:PMC10757918 | DOI:10.3389/frai.2023.1328865

Ethical and Practical Considerations of Perimortem Gamete Procurement for Palliative Care Providers.

Mon, 01 Jan 2024 05:00:00 +0000

Journal of Pain & Symptom Management; 01/01/2024
(AN 174688505); ISSN: 08853924
CINAHL Complete

The Moral Dilemma of Euthanasia Through the Eyes of the Medical Society in Bulgaria

Mon, 01 Jan 2024 00:00:00 +0000

Cureus. 2023 Nov 28;15(11):e49615. doi: 10.7759/cureus.49615. eCollection 2023 Nov.

ABSTRACT

INTRODUCTION: With the development of human society, the question of the value and inviolability of human life begins to occupy a central place in the various social strata and social structures. With the adoption of the Universal Declaration of Human Rights after the Second World War, the basic postulates protecting the right to inviolability of human life were laid. The question focused on euthanasia has been discussed in several European countries, such as Germany, Ireland, France, and Italy, leading to considerable interest in the medical community in Bulgaria.

MATERIALS AND METHODS: A prospective study was performed using approved sample cards, analyzing the general knowledge of the medical community in the Republic of Bulgaria about euthanasia and assisted suicide over a period of four months, between January 2023 and May 2023. In this process, 623 people were surveyed, and the questionnaire included several targeted questions through electronically generated samples on the Microsoft Forms platform. The target group had doctors with and without a specialty in various fields of hospital and pre-hospital care, dentists, and students from the fields of medicine and dentistry.

RESULTS AND DISCUSSION: The results show that the majority of medical professionals clearly state their positive opinion on the adoption of a law to legalize euthanasia in the Republic of Bulgaria, clearly taking into account the fact that the right to life has always been and always will be the most absolute and fundamental human right. Contrary to the above, it is implied that it is inevitably linked to a quality and fulfilling life without suffering. Identically, they also answered that a person should have the right to know exactly when to end his own life. The medical society in Bulgaria clearly shows its positive opinion regarding the idea that the different forms of euthanasia (active euthanasia and assisted suicide) should be defined as morally and legally permissible. Our research confirms the Bulgarian medical community's opinion that the subject of the problems of euthanasia and its legal regulation are already ripe for public discussion, similar to many other European countries.

CONCLUSION: The actual issue of euthanasia as a conclusion raises several questions related to the process of acceptance of standard algorithms for action in such cases where the same action is legalized by law. It also includes the process of acceptance of strict regulations by the countries for the so-called negative phenomenon "death tourism" and several other administrative actions related to the mandatory registration of every case of euthanasia, the implementation of mandatory consultations with a psychiatrist and psychologist for patients seeking euthanasia as the only possible option, and providing possible alternatives regarding their illness. This is the unchangeable cornerstone for standardizing the legalization process and acceptance of "good death" in Bulgaria. In its essence, euthanasia creates both a social and an ethical conflict in our modern society, appearing at the same time as a kind of "stress test" for the health system.

PMID:38161811 | PMC:PMC10755339 | DOI:10.7759/cureus.49615

Methodological and ethical challenges in designing and conducting research at the end of life: A systematic review of qualitative and textual evidence

Tue, 19 Dec 2023 00:00:00 +0000

Int J Nurs Pract. 2023 Dec 19:e13224. doi: 10.1111/ijn.13224. Online ahead of print.

ABSTRACT

AIM: This systematic review aims to identify methodological and ethical challenges in designing and conducting research at the end of life from the perspective of researchers and provide a set of recommendations.

BACKGROUND: Conducting research with patients and family carers facing end-of-life issues is ethically and methodologically complex.

DESIGN: A systematic review was conducted.

DATA SOURCES: Four databases (MEDLINE, EMBASE, CINAHL, PsycInfo) were searched from inception until the end of 2021 in February 2022.

REVIEW METHODS: The Preferred Reporting Items for Systematic Reviews was followed, and the JBI Approach to qualitative synthesis was used for analysis.

RESULTS: Seventeen of 1983 studies met inclusion criteria. Data were distilled to six main themes. These included (1) the need for flexibility at all stages of the research process; (2) careful attention to timing; (3) sensitivity in approach; (4) the importance of stakeholder collaboration; (5) the need for unique researcher skills; and (6) the need to deal with the issue of missing data.

CONCLUSION: The findings illuminate several considerations that can inform training programmes, ethical review processes and research designs when embarking on research in this field.

PMID:38113927 | DOI:10.1111/ijn.13224

Ethical dilemmas at the end of life: a reflection from the Philosophical Perspective of Luigina Mortari

Wed, 06 Dec 2023 00:00:00 +0000

Rev Bras Enferm. 2023 Dec 4;76Suppl 3(Suppl 3):e20220759. doi: 10.1590/0034-7167-2022-0759. eCollection 2023.

ABSTRACT

OBJECTIVES: to reflect on the ethical dilemmas involved in the care of patients at the end of their lives.

METHODS: this is a theoretical-reflective study based on the ethics of care proposed by Luigina Mortari.

RESULTS: discussing care involves addressing the ways of being inherent to human existence and understanding the unique characteristics of this condition. Ethical care constitutes an action driven by interest in the other and by the perception of their need. Ethical dilemmas are a part of end-of-life care, making it essential to maintain respectful assistance that considers the patient's autonomy, using strategies for expressing their wishes, and ensuring continuous clear and empathetic communication among all those involved in providing care.

FINAL CONSIDERATIONS: issues related to being, stemming from one's reality of dependency and vulnerability, contribute to the emergence of ethical dilemmas present in care actions.

PMID:38055527 | PMC:PMC10695058 | DOI:10.1590/0034-7167-2022-0759

Physicians' attitudes towards ethical issues and end‐of‐life decision‐making for pediatric patients with unresponsive wakefulness syndrome: An international survey.

Fri, 01 Dec 2023 05:00:00 +0000

Developmental Medicine & Child Neurology; 12/01/2023
(AN 173396592); ISSN: 00121622
CINAHL Complete

The case of Genevieve Lhermitte's euthanasia between psychiatric evaluation, legal aspects and ethical reflection

Thu, 30 Nov 2023 00:00:00 +0000

Riv Psichiatr. 2023 Nov-Dec;58(6):305-309. doi: 10.1708/4143.41411.

ABSTRACT

A recent euthanasia case in Belgium has garnered attention due to its particularly dramatic aspects, sparking clinical and ethical questions about end-of-life choices in cases of mental suffering. A 56-year-old woman, convicted of the murder of her five minor children and sentenced to life imprisonment, has been granted euthanasia for "irreversible psychological suffering". The clinical and psychodynamic aspects of the case, primarily deduced from press reports, are highly complex and give rise to numerous clinical, medico-legal, and bioethical questions. These include inquiries into the true nature of psychopathology, its actual irreversibility, its impact on the ability to express a euthanasia request with adequate awareness, the preserved capacity for self-determination, and broader issues related to end-of-life requests from patients with mental disorders. These aspects are considered in the context of the legislation in various European countries. The unique details of this case underscore the critical challenges associated with these complex issues.

PMID:38032035 | DOI:10.1708/4143.41411

Understanding regional variation in euthanasia using geomedical frameworks: a critical ethical reflection.

Wed, 29 Nov 2023 05:00:00 +0000

Research in Health Services & Regions; 11/29/2023
Considerable geographical variation in the uptake of euthanasia has been reported: some municipalities in the Netherlands have a 25 times higher euthanasia rate than other municipalities. Current 'geomedical' frameworks for interpreting practice variation in health care utilization seem inadequately tailored to understand regional variation in morally controversial procedures such as euthanasia. The aim of this conceptual article is threefold: i) to add relevant medical ethical principles to current frameworks; ii) to provide a four-step ethical-geomedical model for the interpretation of geographical differences in the utilization of health care in general and for ethically controversial treatments in specific; iii) to gain better understanding of the existing geographical variation in the incidence of euthanasia by using this framework in our analysis.
(AN 173894045); ISSN: 27309827
Health Business Elite

Relationship Between Intensive Care Nurses' Attitudes and Behaviors Toward End-of-Life Care and Ethical Attitudes.

Wed, 01 Nov 2023 04:00:00 +0000

Dimensions of Critical Care Nursing; 11/01/2023
Background: Nurses are in a central position to improve care for dying patients and their families by challenging current end-of-life practices in their settings. Nurses who care for such patients experience the associated ethical dilemmas. However, the relation between their attitude and behavior regarding end-of-life care and their ethical attitudes is not known. Objectives: The aim of this study was to examine the relation between the attitudes and behaviors of intensive care unit nurses to end-of-life care and their ethical attitudes in the care process. Methods: The research was conducted in Antalya, one of themost populous provinces in Turkey, with 287 intensive care nurses working in 4 different hospitals. The research data were collected between June 30 and August 30, 2021. Self-report data were collected using a Nurses' Description Form, the Attitudes and Behaviors of ICU Nurses to End-of-Life Care Scale, and the Ethical Attitude Scale for Nursing Care. Results: Themean score of the intensive care nurses for attitude and behaviors to end-of-life care was 62.36 ± 13.22, and their mean score for ethical attitude for nursing care was 149.76 ± 24.98. Conclusion: It was found that intensive care nurses' attitudes and behaviors to end-of-life care had a positive correlation on their ethical attitudes in the care process (P < .001). Discussion: It would be of interest to understand how these attitudes impact clinical decision-making for the ultimate understanding of whether nurses' attitudes can be a barrier to the delivery of quality end-of-life care.
(AN 172785295); ISSN: 07304625
CINAHL Complete

Assistant nurses' experiences of thirst and ethical dilemmas in dying patients in specialized palliative care—A qualitative study.

Wed, 01 Nov 2023 04:00:00 +0000

Journal of Advanced Nursing (John Wiley & Sons, Inc.); 11/01/2023
Aims: To describe assistant nurses' experiences of thirst and ethical challenges in relation to thirst in terminally ill patients in specialized palliative care (PC) units. Design: A qualitative, reflexive thematic design with an inductive analysis was used. Methods: Data were collected during November 2021–January 2023. Twelve qualitative interviews with assistant nurses working in five different specialized PC units in different hospitals in Sweden were conducted. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. The study was guided by the Standards for Reporting Qualitative Research (SRQR). Results: Two main themes were found in this study. (1) 'A world of practice for thirst relief' where assistant nurses present a task‐oriented world where the knowledge of thirst is an experience‐based unspoken knowledge where mainly routines rule. (2) Ethical challenges presents different ethical problems that they meet in their practice, such as when patients express thirst towards the end of their life but are too severely ill to drink or when they watch lack of knowledge in the area among other health professionals. Conclusion: Thirst in dying patients is a neglected area that assistant nurses work with, without communicating it. Their knowledge of thirst and thirst relief are not expressed, seldom discussed, there are no policy documents nor is thirst documented in the patient's record. There is a need for nurses to take the lead in changing nursing practice regarding thirst. Patient or Public Contribution: No patient or public contribution. Impact: In palliative care, previous studies have shown that dying patients might be thirsty. Assistant nurses recognize thirst in dying patients, but thirst is not discussed in the team. Nurses must consider the patient's fundamental care needs and address thirst, for example in the nursing process to ensure patients quality of life in the last days of life. Reporting Method: The study was guided by the SRQR. What does this Article Contribute to the Wider Global Clinical Community?: Thirst is a distressing symptom for all humans. However, when a patient is dying, he or she loses several functions and can no longer drink independently. The knowledge from this article contributes to our understanding of current practice and shows an area that requires immediate attention for the improvement of fundamental palliative care delivery.
(AN 172894664); ISSN: 03092402
CINAHL Complete

Ethics of Love for End-of-Life Care: Beyond Autonomy and Efficiency.

Wed, 01 Nov 2023 04:00:00 +0000

American Journal of Bioethics; 11/01/2023
(AN 173227792); ISSN: 15265161
CINAHL Complete

To the Editor...Annas GJ, Kummer HB. Preventing the Slide down the Slippery Slope from Assisted Suicide to Euthanasia While Protecting the Rights of People with Disabilities Who Are “Not Dead Yet.” American Journal of Bioethics. 2023;23(9):20-22.

Wed, 01 Nov 2023 04:00:00 +0000

American Journal of Bioethics; 11/01/2023
(AN 173227812); ISSN: 15265161
CINAHL Complete

A Disabled Bioethicist's Critique of Canada's Medical Assistance in Dying (MAID).

Wed, 01 Nov 2023 04:00:00 +0000

American Journal of Bioethics; 11/01/2023
(AN 173227796); ISSN: 15265161
CINAHL Complete

Ethics of Love for End-of-Life Care: Beyond Autonomy and Efficiency

Wed, 25 Oct 2023 00:00:00 +0000

Am J Bioeth. 2023 Nov;23(11):76-78. doi: 10.1080/15265161.2023.2256274. Epub 2023 Oct 25.

NO ABSTRACT

PMID:37879016 | DOI:10.1080/15265161.2023.2256274

A Disabled Bioethicist's Critique of Canada's Medical Assistance in Dying (MAID)

Wed, 25 Oct 2023 00:00:00 +0000

Am J Bioeth. 2023 Nov;23(11):102-104. doi: 10.1080/15265161.2023.2256278. Epub 2023 Oct 25.

NO ABSTRACT

PMID:37879007 | DOI:10.1080/15265161.2023.2256278

Maintaining High-Touch in High-Tech Digital Health Monitoring and Multi-Omics Prognostication: Ethical, Equity, and Societal Considerations in Precision Health for Palliative Care

Fri, 20 Oct 2023 00:00:00 +0000

OMICS. 2023 Oct;27(10):461-473. doi: 10.1089/omi.2023.0120.

ABSTRACT

Advances in digital health, systems biology, environmental monitoring, and artificial intelligence (AI) continue to revolutionize health care, ushering a precision health future. More than disease treatment and prevention, precision health aims at maintaining good health throughout the lifespan. However, how can precision health impact care for people with a terminal or life-limiting condition? We examine here the ethical, equity, and societal/relational implications of two precision health modalities, (1) integrated systems biology/multi-omics analysis for disease prognostication and (2) digital health technologies for health status monitoring and communication. We focus on three main ethical and societal considerations: benefits and risks associated with integration of these modalities into the palliative care system; inclusion of underrepresented and marginalized groups in technology development and deployment; and the impact of high-tech modalities on palliative care's highly personalized and "high-touch" practice. We conclude with 10 recommendations for ensuring that precision health technologies, such as multi-omics prognostication and digital health monitoring, for palliative care are developed, tested, and implemented ethically, inclusively, and equitably.

PMID:37861713 | DOI:10.1089/omi.2023.0120

Euthanasia in Colombia: Experience in a palliative care program and bioethical reflections

Wed, 18 Oct 2023 00:00:00 +0000

Dev World Bioeth. 2023 Oct 18. doi: 10.1111/dewb.12430. Online ahead of print.

ABSTRACT

The increased prevalence of advanced-stage chronic diseases has augmented the need for palliative care teams. In Colombia, although the legislation promotes palliative care development, people still die without receiving management from a palliative care team. In addition, judiciary regulations regarding euthanasia have generated public confusion and ethical conflicts among members of the palliative care teams. Therefore, this study aimed to perform a bioethical reflection on the relationship between palliative care and euthanasia supported by data on euthanasia requests in a palliative care program. This reflection is based on retrospective and descriptive observational data, collected in two highly complex hospitals in Bogotá, Colombia. A total of 50 euthanasia requests were identified, of which 62% met the defined criteria, 16% did not, and 22% were not considered by the interdisciplinary committee for the right to die with dignity due to early death. All patients were treated and followed up by a palliative care team until their death. This study considered that palliative care could be a complement management for patients requesting euthanasia based on their experience by supporting the decision-making, alleviating suffering, and providing emotional support in the last days of life.

PMID:37850490 | DOI:10.1111/dewb.12430

The Physician-Assisted Suicide Pathway in Italy: Ethical Assessment and Safeguard Approaches

Fri, 13 Oct 2023 00:00:00 +0000

J Bioeth Inq. 2023 Oct 13. doi: 10.1007/s11673-023-10302-2. Online ahead of print.

ABSTRACT

Although in Italy there is currently no effective law on physician-assisted suicide or euthanasia, Decision No. 242 issued by the Italian Constitutional Court on September 25, 2019 established that an individual who, under specific circumstances, has facilitated the implementation of an independent and freely-formed resolve to commit suicide by another individual is exempt from criminal liability. Following this ruling, some citizens have submitted requests for assisted suicide to the public health system, generating a situation of great uncertainty in the application processes. As a matter of fact, shared and defined procedures are lacking as Decision 242/2019 merely added some principles on which the legislature will have to base its future intervention. This paper analyses the advisory role that the Decision attributes to territorial ethics committees with the aim of stimulating discussions on their role in oversight mechanisms. The proposed conclusion is that the envisaged role does not appear consistent with the functions of these bodies and is ultimately substantially undefined and unjustified.

PMID:37831290 | DOI:10.1007/s11673-023-10302-2

Adaptation and validation of the Brazilian version of the Measure of Moral Distress for Healthcare Professionals (MMD-HP BR) in the context of palliative care.

Wed, 11 Oct 2023 04:00:00 +0000

BMC Palliative Care; 10/11/2023
Background: The Measure of Moral Distress for Health Care Professionals (MMD-HP) scale corresponds to the update of the globally recognized Moral Distress Scale–Revised (MDS-R). Its purpose is to measure moral distress, which is a type of suffering caused in a professional prevented from acting according to one's moral convictions due to external or internal barriers. Thus, this study has the objective to translate, culturally adapt, and validate the Brazilian version of the MMD-HP BR in the context of Palliative Care (PC). Methods: The study had the following steps: translation, cross-cultural adaptation and validation. The MMD-HP BR is composed of 27 Likert-rated items for frequency and intensity of moral distress. In total, 332 health professionals who work in PC participated in the study, 10 in the pre-test stage, and 322 in the validation stage. Results: It was possible to identify six factors, which together explain 64.75% of the model variation. The reliability of Cronbach's alpha was 0.942. In addition, the score was higher in those who are considering or have already left their positions due to moral distress, compared to those who do not or have never had such an intention. Conclusions: MMD-HP BR is a reliable and valid instrument to assess moral distress in the PC context. It is suggested that the scale be standardized in other healthcare contexts, such as clinical settings. In addition, further research on moral distress is encouraged to identify and reduce the phenomenon and its consequences.
(AN 172915860); ISSN: 1472684X
CINAHL Complete

Adaptation and validation of the Brazilian version of the Measure of Moral Distress for Healthcare Professionals (MMD-HP BR) in the context of palliative care

Wed, 11 Oct 2023 00:00:00 +0000

BMC Palliat Care. 2023 Oct 11;22(1):154. doi: 10.1186/s12904-023-01277-3.

ABSTRACT

BACKGROUND: The Measure of Moral Distress for Health Care Professionals (MMD-HP) scale corresponds to the update of the globally recognized Moral Distress Scale-Revised (MDS-R). Its purpose is to measure moral distress, which is a type of suffering caused in a professional prevented from acting according to one's moral convictions due to external or internal barriers. Thus, this study has the objective to translate, culturally adapt, and validate the Brazilian version of the MMD-HP BR in the context of Palliative Care (PC).

METHODS: The study had the following steps: translation, cross-cultural adaptation and validation. The MMD-HP BR is composed of 27 Likert-rated items for frequency and intensity of moral distress. In total, 332 health professionals who work in PC participated in the study, 10 in the pre-test stage, and 322 in the validation stage.

RESULTS: It was possible to identify six factors, which together explain 64.75% of the model variation. The reliability of Cronbach's alpha was 0.942. In addition, the score was higher in those who are considering or have already left their positions due to moral distress, compared to those who do not or have never had such an intention.

CONCLUSIONS: MMD-HP BR is a reliable and valid instrument to assess moral distress in the PC context. It is suggested that the scale be standardized in other healthcare contexts, such as clinical settings. In addition, further research on moral distress is encouraged to identify and reduce the phenomenon and its consequences.

PMID:37821873 | PMC:PMC10566136 | DOI:10.1186/s12904-023-01277-3

Moral distress and end-of-life care.

Sun, 01 Oct 2023 04:00:00 +0000

American Nurse Journal; 10/01/2023
(AN 173001727); ISSN: 26899272
CINAHL Complete