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      Common dedication to facilitating good dying experiences: Qualitative study of end-of-life care professionals’ attitudes towards voluntary assisted dying

      1 , 2 , 3 , 4
      Palliative Medicine
      SAGE Publications

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          Abstract

          Background:

          Debate about appropriate and ethically acceptable end-of-life choices is ongoing, which includes discussion about the legalization of voluntary assisted dying. Given health professionals’ role in caring for patients at the end life, their stance towards assisting a person with dying can have implications for policy development and implementation in jurisdictions where law changes are being considered.

          Aim:

          To explore end-of-life care professionals’ attitudes towards voluntary assisted dying 6 months prior to vote on legalization.

          Design:

          Qualitative study using textual data collected through semi-structured interviews. Purposive sampling strategy used to collect a broad representation of perspectives. Audio-recorded interviews were transcribed verbatim and subjected to qualitative descriptive analysis techniques.

          Participants:

          A total of 16 health professionals with experience in caring for people with life-limiting illness.

          Results:

          Participants reported two overarching positions grounded in differing moral philosophies with compelling arguments both for and against legalization of voluntary assisted dying. A third and common line of argument emerged from areas of shared concern and uncertainty about the practical consequences of introducing voluntary assisted dying. While a diversity of opinion was evident, all participants advocated for more public education and funding into end-of-life care services to make high-quality care equitable and widely available.

          Conclusion:

          Common dedication to reducing suffering and facilitating good dying experiences exists among experts despite their divergent views on voluntary assisted dying. Ongoing engagement with stakeholders is needed for practical resolution in the interest of developing health policy for best patient care.

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          Most cited references20

          • Record: found
          • Abstract: found
          • Article: not found

          Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care.

          In recognition of the ongoing discussion on euthanasia and physician-assisted suicide, the Board of Directors of the European Association for Palliative Care commissioned this white paper from the palliative care perspective.
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            Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying.

            Assisted dying is legal in four European countries and three American states. Elsewhere, particularly in more affluent or mainly Protestant countries, it remains controversial. Dominant headlines feature professional (medical, legal, religious) arguments versus celebrity campaigners; ordinary people are less clearly represented. To synthesise the international evidence of people's views and attitudes towards assisted dying in order to inform current debate about this controversial issue. Systematic review and mixed method synthesis of qualitative and survey data. Eleven electronic databases from inception to October 2011; bibliographies of included studies. Two reviewers independently screened papers and appraised quality. Qualitative results were extracted verbatim; survey results were summarised in a table. Qualitative data were synthesised using framework methods and survey results integrated where they supported, contrasted or added to the themes identified. Sixteen qualitative studies and 94 surveys were included; many participants considered the immediate relevance of assisted dying for them. Themes related to poor quality of life, a good quality of death, potential abuse of assisted dying and the importance of individual stance. People valued autonomy in death as much as in life. Attitudes were diverse, complex and related to definitions of unbearable suffering including physical, psycho-social and existential factors and were consistent regardless of social, economic, legal and health-care contexts. Our review sheds light on ordinary people's perspectives about assisted dying, when they are ill or disabled. Unbearable suffering is a key construct, and common factors are revealed that lead people to ask for help to die. The consistency of international views indicates a mandate for legislative and medical systems worldwide to listen and understand this.
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              Euthanasia and assisted suicide in selected European countries and US states: systematic literature review.

              Legal in some European countries and US states, physician-assisted suicide and voluntary active euthanasia remain under debate in these and other countries. The aim of the study was to examine numbers, characteristics, and trends over time for assisted dying in regions where these practices are legal: Belgium, Luxembourg, the Netherlands, Switzerland, Oregon, Washington, and Montana. This was a systematic review of journal articles and official reports. Medline and Embase databases were searched for relevant studies, from inception to end of 2012. We searched the websites of the health authorities of all eligible countries and states for reports on physician-assisted suicide or euthanasia and included publications that reported on cases of physician-assisted suicide or euthanasia. We extracted information on the total number of assisted deaths, its proportion in relation to all deaths, and socio-demographic and clinical characteristics of individuals assisted to die. A total of 1043 publications were identified; 25 articles and reports were retained, including series of reported cases, physician surveys, and reviews of death certificates. The percentage of physician-assisted deaths among all deaths ranged from 0.1%-0.2% in the US states and Luxembourg to 1.8%-2.9% in the Netherlands. Percentages of cases reported to the authorities increased in most countries over time. The typical person who died with assistance was a well-educated male cancer patient, aged 60-85 years. Despite some common characteristics between countries, we found wide variation in the extent and specific characteristics of those who died an assisted death.
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                Author and article information

                Journal
                Palliative Medicine
                Palliat Med
                SAGE Publications
                0269-2163
                1477-030X
                April 10 2019
                June 2019
                January 28 2019
                June 2019
                : 33
                : 6
                : 562-569
                Affiliations
                [1 ]Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
                [2 ]Swinburne University of Technology, Hawthorn, VIC, Australia
                [3 ]St Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
                [4 ]Faculty of Health, Deakin University, Burwood, VIC, Australia
                Article
                10.1177/0269216318824276
                30688145
                2d9e6771-b5e8-4d6c-b70d-71c7dbd67245
                © 2019

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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