Marianne C Snijdewind1, Donald G van Tol2, Bregje D Onwuteaka-Philipsen3, Dick L Willems4. 1. Section of Medical Ethics, Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: m.c.snijdewind@amc.uva.nl. 2. Department of General Practice, University of Groningen, Groningen, The Netherlands. 3. EMGO Institute for Health and Care Research, Department of Public and Occupational Health, Expertise Center for Palliative Care, VU University Medical Center Amsterdam, The Netherlands. 4. Section of Medical Ethics, Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Abstract
CONTEXT: The practice of euthanasia and physician-assisted suicide (EAS) is always complex, but some cases are more complex than others. The nature of these unusually complex cases is not known. OBJECTIVES: To identify and categorize the characteristics of EAS requests that are more complex than others. METHODS: We held in-depth interviews with 28 Dutch physicians about their perception of complex cases of EAS requests. We also interviewed 26 relatives of patients who had died by EAS. We used open coding and inductive analysis to identify various different aspects of the complexities described by the participants. RESULTS: Complexities can be categorized into relational difficulties-such as miscommunication, invisible suffering, and the absence of a process of growth toward EAS-and complexities that arise from unexpected situations, such as the capricious progress of a disease or the obligation to move the patient. The interviews showed that relatives of the patient influence the process toward EAS. CONCLUSION: First, the process toward EAS may be disrupted, causing a complex situation. Second, the course of the process toward EAS is influenced not only by the patient and his/her attending physician but also by the relatives who are involved. Communicating and clarifying expectations throughout the process may help to prevent the occurrence of unusually complex situations.
CONTEXT: The practice of euthanasia and physician-assisted suicide (EAS) is always complex, but some cases are more complex than others. The nature of these unusually complex cases is not known. OBJECTIVES: To identify and categorize the characteristics of EAS requests that are more complex than others. METHODS: We held in-depth interviews with 28 Dutch physicians about their perception of complex cases of EAS requests. We also interviewed 26 relatives of patients who had died by EAS. We used open coding and inductive analysis to identify various different aspects of the complexities described by the participants. RESULTS: Complexities can be categorized into relational difficulties-such as miscommunication, invisible suffering, and the absence of a process of growth toward EAS-and complexities that arise from unexpected situations, such as the capricious progress of a disease or the obligation to move the patient. The interviews showed that relatives of the patient influence the process toward EAS. CONCLUSION: First, the process toward EAS may be disrupted, causing a complex situation. Second, the course of the process toward EAS is influenced not only by the patient and his/her attending physician but also by the relatives who are involved. Communicating and clarifying expectations throughout the process may help to prevent the occurrence of unusually complex situations.
Authors: Kirsten Evenblij; H Roeline W Pasman; Johannes J M van Delden; Agnes van der Heide; Suzanne van de Vathorst; Dick L Willems; Bregje D Onwuteaka-Philipsen Journal: BMC Fam Pract Date: 2019-12-17 Impact factor: 2.497
Authors: Simon J W Oczkowski; Diane E Crawshaw; Peggy Austin; Donald Versluis; Gaelen Kalles-Chan; Michael Kekewich; Dorothyann Curran; Paul Miller; Michaela Kelly; Ellen Wiebe; Andrea Frolic Journal: BMC Palliat Care Date: 2021-12-08 Impact factor: 3.234
Authors: Tharshika Thangarasa; Sarah Hales; Eryn Tong; Ekaterina An; Debbie Selby; Elie Isenberg-Grzeda; Madeline Li; Gary Rodin; Sally Bean; Jennifer A H Bell; Rinat Nissim Journal: J Gen Intern Med Date: 2021-07-21 Impact factor: 5.128