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      Medical Assistance in Dying — Implementing a Hospital-Based Program in Canada

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          Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe.

          The increasing legalization of euthanasia and physician-assisted suicide worldwide makes it important to understand related attitudes and practices.
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            From margins to centre: a review of the history of palliative care in cancer.

            Palliative care and hospices have developed rapidly since the late 1960s. The pioneering work of Cicely Saunders was instrumental in drawing attention to the end-of-life care needs of patients with advanced malignant disease. Palliative care began to be defined as a subject of activity in the 1970s and came to be synonymous with the physical, social, psychological, and spiritual support of patients with life-limiting illness, delivered by a multidisciplinary team. Palliative care services have developed in many settings and have often been closely related to oncology. The worldwide need for this type of care remains much greater than the available provision, but there are encouraging signs of recognition by policymakers and influential bodies, and interest in palliative care has never been greater. This paper charts the modern history of such care around the world and concludes on some current issues and future challenges.
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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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                Author and article information

                Journal
                New England Journal of Medicine
                N Engl J Med
                New England Journal of Medicine (NEJM/MMS)
                0028-4793
                1533-4406
                May 25 2017
                May 25 2017
                : 376
                : 21
                : 2082-2088
                Article
                10.1056/NEJMms1700606
                28538128
                e5faa81e-314e-450a-ad9a-62ae3b638bc0
                © 2017
                History

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