Search

Background Methods Results Conclusions The number of patients with dementia who are granted euthanasia or assisted suicide (EAS) increases yearly in the Netherlands. By law, patients need to be decisionally competent or have an advance directive. Assessment of decisional capacity is challenging as dementia progressively affects cognitive performance. We aimed to assess qualitatively which factors, and how, influence the judgment of decisional capacity in EAS cases with dementia.We performed a qualitative study of 60 dementia EAS case summaries published by the Dutch regional euthanasia review committees between 2012 and 2021. Included reports were evaluated using the grounded theory approach. All quotes related to decisional capacity were coded independently by two researchers and compared in an iterative process to formulate an overarching framework on the assessment of decisional capacity. We selected 20 patients who had an advance directive and were judged to be decisionally compromised, as well as a selection of 40 EAS cases judged to be decisionally competent, half of which also had an advance directive (purposive sampling).Decisional capacity was present in every case report. Predefined, external criteria were rarely described explicitly, but physicians indirectly referred to the (cognitive) criteria set by Appelbaum and Grisso. Whether the thresholds for these dimensional criteria were met was influenced by six supporting factors (level of communication, psychiatric comorbidity, personality, presence of an advance directive, consistency of the request, and, finally, the patient–physician relationship) that also directly contributed to the judgment of capacity. The involved physicians and executed investigations were the two contextual factors providing a background.Decisional capacity regarding euthanasia is a multidimensional construct, often implicitly assessed and influenced by supporting and contextual factors. The subjectivity of the final judgment poses ethical and legal issues and argues for continuous quality improvement processes. [ABSTRACT FROM AUTHOR]

Almost a year after the enactment of the law regulating euthanasia in Spain, public opinion was shocked to learn that a defendant in criminal proceedings obtained medical assistance in dying following injuries sustained in an exchange of gunfire with the police after having committed a series of severe crimes. Although there are very few cases in the world where prisoners have received euthanasia, the one we will discuss in this article is the only known case where both the public prosecutor's office and the private prosecutors judicially opposed the defendant's euthanasia. This article aims to offer a new perspective on the ethical legitimacy of detainees' access to euthanasia: the ethics of caring solidarity. To do this, we will first place the case in its legal context. Subsequently, we will address the two main arguments proposed in the literature to justify euthanasia in detention: respect for the autonomy of the detainee and the principle of equivalence of care. Finally, after having identified serious shortcomings in both arguments, we will argue that the perspective of caring solidarity offers a better ethical basis for people in detention's access to euthanasia. [ABSTRACT FROM AUTHOR]

In light of the proposed expansion of eligibility for physician aid in dying (PAD) in Canada to people with psychiatric disorders, there is a new subset of individuals seeking PAD—those with poverty‐induced depression. The dominant account defending the expansion is known as the "parity argument." Defenders of the parity argument maintain that the expansion of PAD to those with psychiatric conditions is needed to reflect that the seriousness of a patient's suffering does not depend on the cause of that suffering. Parity accounts, as they stand, would allow cases of poverty‐induced depression to qualify. I raise a moral dilemma that the parity theorist must face considering this new subset of cases—expanding access to PAD, without adequate social protections, could produce more social inequality by aiming to reduce it. I propose six recommendations that policy‐makers should consider before expanding PAD given these cases, social injustice, and the social determinants of mental health. [ABSTRACT FROM AUTHOR]

This essay examines the impact of linguistic choices on the perception and regulation of assisted dying, particularly in Canada. It argues that euphemistic terms like "medical assistance in dying" and its acronym, "MAID," serve to normalize the practice, potentially obscuring its moral gravity. This contrasts with what is seen in Belgium and the Netherlands, where terms like "euthanasia" are used, as well as in France and the United Kingdom, where terminology remains divisive and contested. By tracing the evolution of these terms and what they reveal about different cultural and legal approaches, this essay sheds light on the politics of language in end‐of‐life discourses. It suggests that the shift toward euphemistic language reflects a broader discomfort with death that can shape public attitudes and legal frameworks. It calls for a more transparent, philosophically grounded approach to terminology and suggests that continued debate about semantics is necessary to capture the complexities and ethical significance of assisted dying. [ABSTRACT FROM AUTHOR]

Colombia was one of the first countries to decriminalise euthanasia. However, what is known in the international academic literature about the country's regulations is scarce and outdated. Such lack of information on the situation in Latin America is even more evident in the case of Peru, where the Lima Superior Court of Justice set a precedent by allowing a person to have access to euthanasia in 2021. Ecuador, which has just decriminalised euthanasia for all its citizens in February 2024, risks being similarly absent from the international dialogue. This article summarises for the first time all the regulations in force regarding euthanasia in Latin America, through a study of primary sources in Spanish, and analyses some of the convergences between these three neighbouring countries. [ABSTRACT FROM AUTHOR]

This study surveyed South Australian medical oncologists to capture their perceptions, willingness to participate and perceived barriers and motivations to participation in voluntary assisted dying (VAD) activities. Approximately 70% of surveyed medical oncologists reported familiarity with VAD legislation. Less than half of physicians (39.1%) reported willingness to participate in any VAD activities, and the rate of conscientious objection was 22%. The top barriers to participation were lack of time and uncertainty given no prior experience. These results demonstrate both a low rate of conscientious objection and a low rate of willingness to participate at the point of VAD implementation in South Australia, and identify barriers to participation that are largely logistical. [ABSTRACT FROM AUTHOR]

The proposal to allow assisted dying for people who are not severely ill reignited the Dutch end‐of‐life debate when it was submitted in 2016. A key criticism of this proposal is that it is too radical a departure from the safe and well‐functioning system the Netherlands already has. The goal of this article is to respond to this criticism and question whether the Dutch system really can be described as safe and well functioning. I will reconsider the usefulness of the suffering criterion, and I will ultimately argue this criterion should be rejected altogether. Instead, we should consider moving towards an autonomy‐only approach to assisted dying. This would resolve some significant issues occurring under the current system of assisted dying in the Netherlands and ultimately make the process safer and better functioning. I will then consider some possible objections to adopting an autonomy‐only approach and provide some preliminary responses to these also. I will finally highlight some potential areas where further research may be necessary, namely, how to mitigate the effect of external factors such as poverty or other life aspects that may have the potential to distort the individual's ability to make autonomous decisions. I will also consider some possible international lessons that can be taken from both current as well as the proposed practice in the Netherlands. [ABSTRACT FROM AUTHOR]

Introduction: Assisted dying (AD) has been legalised in a small but growing number of jurisdictions globally, including Canada and Australia. Early research in both countries demonstrates that, in response to access barriers, patients and caregivers take action to influence their individual experience of AD, as well as AD systems more widely. This study analyses how patients and caregivers suggest other decision‐makers in AD systems should address identified issues. Methods: We conducted semistructured, qualitative interviews with patients and caregivers seeking AD in Victoria (Australia) and three Canadian provinces (British Columbia, Ontario and Nova Scotia). Data were analysed using reflexive thematic analysis and codebook template analysis. Results: Sixty interviews were conducted with 67 participants (65 caregivers, 2 patients). In Victoria, this involved 28 interviews with 33 participants (32 caregivers, 1 patient) about 28 patient experiences. In Canada, this involved 32 interviews with 34 participants (33 caregivers, 1 patient) about 33 patient experiences. We generated six themes, corresponding to six overarching suggestions by patients and caregivers to address identified system issues: (1) improved content and dissemination of information about AD; (2) proactively develop policies and procedures about AD provision; (3) address institutional objection via top‐down action; (4) proactively develop grief resources and peer support mechanisms; (5) amend laws to address legal barriers; and (6) engage with and act on patient and caregiver feedback about experiences. Conclusion: AD systems should monitor and respond to suggestions from patients and caregivers with firsthand experience of AD systems, who are uniquely placed to identify issues and suggestions for improvement. To date, Canada has responded comparatively well to address identified issues, whereas the Victorian government has signalled there are no plans to amend laws to address identified access barriers. This may result in patients and caregivers continuing to take on the burdens of acting to address identified issues. Patient or Public Contribution: Patients and caregivers are central to this research. We interviewed patients and caregivers about their experiences of AD, and the article focuses on their suggestions for addressing identified barriers within AD systems. Patient interest groups in Australia and Canada also supported our recruitment process. [ABSTRACT FROM AUTHOR]

Background: In the context of nationwide law reform, New South Wales (NSW) became the last state in Australia to legalise voluntary assisted dying (VAD) – commencing 28 November 2023. Clinicians have divergent views regarding VAD, with varying levels of understanding, support, and willingness to be involved, and these may have a significant impact on the successful implementation. Aims: To understand levels of support, understanding and willingness to be involved in VAD among clinical staff across NSW during implementation of VAD. Methods: A multisite, cross‐sectional online survey of clinicians across four local health districts, assessing relevant demographics, awareness of and support for VAD legislation and willingness to be involved in different levels of VAD‐related clinical activities. Results: A total of 3010 clinical staff completed the survey. A majority of participants were aware of VAD legislation in NSW (86.35%) and supportive of it (76%), with nursing and allied health clinicians significantly more likely than medical specialists to express support. Among medical specialists, support was statistically more likely in those who did not care for patients at the end of life and those with limited knowledge of the legislation. Willingness of medical specialists to perform key roles was significantly lower, with 41.49% willing to act in coordinating or consulting roles, and only 23.21% as administering practitioners. Conclusions: The majority of clinical staff surveyed across NSW supported VAD legislation. While many eligible clinicians were reluctant to be actively involved, sufficient numbers appear willing to provide VAD services, indicating that successful implementation should be possible. [ABSTRACT FROM AUTHOR]

Although considerable gains in survival have been observed in developed countries, particularly in the last stretch of life, part of these additional years of life are lived in bad health. In this context, a number of actions/inactions that limit or may limit life span are becoming increasingly common. Demography and quantitative sociology are well‐positioned to make a significant contribution to the measurement of the consistency of different end‐of‐life interventions, to the examination of differences over time, space and among different social groups, and to the analysis of the behaviors and attitudes of different stakeholders (the sufferers, their relatives, health care personnel, public opinion). We focus here on euthanasia and assisted suicide (EAS). First, we discuss changes in public opinion on EAS in developed countries. Second, we analyze the diffusion and temporal trends of EAS, with a particular focus on Switzerland, the Netherlands, and Belgium; three countries for which it is also possible to consider the connections between the diffusion of EAS and palliative care. Third, we consider several differential aspects of the spread of EAS (mainly by sex, age, and cause of death). [ABSTRACT FROM AUTHOR]

Objective: This paper examines neurologists' approaches to exit strategies (ESs), such as euthanasia and physician‐assisted suicide, in patients with amyotrophic lateral sclerosis (PALS) in two European countries. Methods: In a nationwide anonymous survey, we collected responses from 237 Polish and 228 German neurologists, focusing on their practices and beliefs about ESs, as well as their viewpoints on life‐sustaining measures (LSMs) (percutaneous endoscopic gastrostomy, non‐invasive, and invasive ventilation). To analyze the data, we employed statistical methods, including Mann–Whitney U, Kruskal–Wallis, chi‐square tests, Spearman's rank correlation, and multiple regression analysis. Results: One third of the neurologists initiated the discussion about ESs with PALS. Half were ready to have this conversation upon patient's request. Age, gender, religiousness, and nationality were closely associated with this approach. One in 9 neurologists received a request to terminate an LSM, whereas 1 in 10 to implement an ES. German neurologists and palliative care trainees acquired both demands more commonly. Neurologists quoted a low quality of life, decreased mood, and being a burden to the family/closest ones as primary reasons for a wish to hasten death among PALS. Although the majority expressed a willingness to terminate an LSM at a request of the patient, most opposed the legalization of euthanasia. Younger and less religious individuals were more likely to favor accepting euthanasia. Conclusion: Neurologists vary significantly in their approaches to terminal care. Complex relationships exist among personal indices, shared beliefs, and current practices. [ABSTRACT FROM AUTHOR]

Some individuals facing dementia contemplate hastening their own death: weighing the possibility of living longer with dementia against the alternative of dying sooner but avoiding the later stages of cognitive and functional impairment. This weighing resonates with an ethical and legal consensus in the United States that individuals can voluntarily choose to forgo life‐sustaining interventions and also that medical professionals can support these choices even when they will result in an earlier death. For these reasons, whether and how a terminally ill individual can choose to control the timing of their death is a topic that cannot be avoided when considering the dementia trajectory. With a focus on the U.S. context, this landscape review considers the status of provisions that would legally permit people facing dementia to hasten death with appropriate support from medical professionals. This review can be used to plan and guide clinical and legal practitioner discussion and policy development concerning evolving questions not fully covered by existing medical decision‐making provisions. [ABSTRACT FROM AUTHOR]

This essay looks closely at metaphors and other figures of speech that often feature in how Americans talk about dementia, becoming part of cultural narratives: shared stories that convey ideas and values, and also worries and fears. It uses approaches from literary studies to analyze how cultural narratives about dementia may surface in conversations with family members or health care professionals. This essay also draws on research on a notable social effect of legalizing medical aid in dying: patients may find it easier to bring up a range of concerns, regardless of whether they have any interest in hastening their own death. The essay proposes that health care professionals rethink an idea prominent within their own culture: that conversations about the end of a person's life are inherently difficult. This framing may make it hard for people facing dementia to bring up their concerns about what lies ahead. We suggest a different way to think about these conversations, using the metaphor of "opening the door" to represent inviting a patient to bring up issues of deepest concern. [ABSTRACT FROM AUTHOR]

According to the "discrimination argument," it would be discriminatory and hence impermissible to categorically exclude people with mental illness (PMI) from access to assisted suicide (AS) if AS is accessible to people with somatic illnesses. In objection to this, it could be argued that excluding PMI is not discriminatory, but rather based on their inability to meet certain eligibility criteria for AS. Which criteria are deemed necessary depends on the approach taken to justifying AS. In this article, we describe two distinct ethical approaches to justifying AS and the eligibility criteria they entail and examine whether PMI can fulfill these criteria. A widespread "joint" approach based on beneficence and autonomy assumes that AS is justified when it alleviates the severe and irremediable suffering of a person who autonomously requests AS. An alternative, exclusively autonomy‐based approach assumes that providing AS is justified when a person's request is autonomous, regardless of whether AS is in her best interests. The latter approach underlies an important judgment of the German Federal Constitutional Court from 2020. We argue that PMI can in principle fulfill both beneficence‐ and autonomy‐based eligibility criteria for AS, and that a blanket exclusion of all PMI from AS is thus discriminatory on either approach. However, depending on which approach is taken, there are differences regarding the subgroups of PMI that would be eligible for AS. Whether the exclusion of specific PMI is discriminatory therefore depends on how we understand and justify AS. [ABSTRACT FROM AUTHOR]

This document is a collection of abstracts from the International Journal of Psychology, covering a range of topics related to psychology and mental health. The abstracts discuss the need for more research on decision-making in hastening death, the role of psychologists in this context, and the legal challenges to Canadian legislation on medical assistance in dying. Other abstracts explore topics such as ethical bonds transformation in Taiwanese bereaved families, the experiences of terminal cancer caregivers, and the grief of families who have lost a member to work accidents. The collection also includes abstracts on engagement with death in films, the experiences of individuals who have attempted suicide, and various other topics related to psychology and mental health. [Extracted from the article]

Aim: Patient‐ and physician‐associated barriers impact the effectiveness of basal insulin (BI) titration in the management of type 2 diabetes (T2D). We evaluated the experiences of patients with T2D and physicians with BI titration education. Materials and Methods: In this observational, cross‐sectional study, patients with T2D and physicians treating patients with T2D were identified by claims in the Optum Research Database and were invited to complete a survey. Eligible patients had 12 months of continuous health‐plan enrolment with medical and pharmacy benefits during the baseline period, and recent initiation of BI therapy. Eligible physicians had initiated BI for ≥1 eligible patient with T2D during the past 6 months. Results: In total, 416 patients and 386 physicians completed the survey. Ninety per cent of physicians reported treating ≥50 patients with T2D; 66% treated ≥25% of patients with BI. Whereas 74% of patients reported that BI titration was explained to them by a physician, 96% of physicians reported doing so. Furthermore, 20% of patients stated they were offered educational materials whereas 56% of physicians reported having provided materials. Physicians had higher expectations of glycaemic target achievement than were seen in the patient survey; their main concern was the patients' ability to titrate accurately (79%). Conclusions: There is a marked difference in patients' and physicians' experiences of BI titration education. Novel tools and strategies are required to enable effective BI titration, with more educational resources at the outset, and ongoing access to tools that provide clear, simple direction for self‐titration with less reliance on physicians/health care providers. [ABSTRACT FROM AUTHOR]

Background: Eligibility to access the Victorian voluntary assisted dying (VAD) legislation requires that people have a prognosis of 6 months or less (or 12 months or less in the setting of a neurodegenerative diagnosis). Yet prognostic determination is frequently inaccurate and prompts clinician discomfort. Based on functional capacity and clinical and biochemical markers, prognostic tools have been developed to increase the accuracy of life expectancy predictions. Aims: This review of prognostic tools explores their accuracy to determine 6‐month mortality in adults when treated under palliative care with a primary diagnosis of cancer (the diagnosis of a large proportion of people who are requesting VAD). Methods: A systematic search of the literature was performed on electronic databases Medline, Embase and Cinahl. Results: Limitations of prognostication identified include the following: (i) prognostic tools still provide uncertain prognoses; (ii) prognostic tools have greater accuracy predicting shorter prognoses, such as weeks to months, rather than 6 months; and (iii) functionality was often weighted significantly when calculating prognoses. Challenges of prognostication identified include the following: (i) the area under the curve (a value that represents how well a model can distinguish between two outcomes) cannot be directly interpreted clinically and (ii) difficulties exist related to determining appropriate thresholds of accuracy in this context. Conclusions: Prognostication is a significant aspect of VAD, and the utility of the currently available prognostic tools appears limited but may prompt discussions about prognosis and alternative means (other than prognostic estimates) to identify those eligible for VAD. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the association between polymyxin B (PMB) exposure and acute kidney injury (AKI) and analyze the risk factors for PMB‐induced AKI in critically ill patients. Plasma concentrations of PMB were determined using an ultraperformance liquid chromatography–tandem mass spectrometer in intensive care unit patients who were administered PMB. Univariate and multivariate analyses were conducted to identify risk factors. A receiver operating characteristic curve was constructed to assess the discriminant power of the factors and to identify the cutoff value for AKI. The white blood cell count and estimated area under the concentration–time curve (AUC) of patients administered PMB were independent risk factors for PMB‐induced AKI, where AUC were calculated using a first‐order pharmacokinetic equation based on the mid‐dosing interval concentration (C1/2t) and peak concentration. The area under the receiver operating characteristic curve of the final model was 0.805 (95% confidence interval, 0.690–0.921). The cutoff value for the combined predictor was 0.57. Alternatively, when using C1/2t, which was strongly correlated with AUC, as the only independent risk factor, the analysis showed that the 3.47 μg/ml threshold provides favorable differentiation between the AKI and non‐AKI groups. These results provide insightful information for therapeutic drug monitoring–guiding PMB dosing in clinical practice. [ABSTRACT FROM AUTHOR]

Oral corticosteroids (OCS) are commonly prescribed for acute, self‐limited conditions, despite studies demonstrating toxicity. Studies evaluating longitudinal OCS prescribing in the general population are scarce and do not compare use across countries. This study investigated and compared OCS prescription patterns from 2009 to 2018 in the general populations of the United States, Taiwan, and Denmark. This international population‐based longitudinal cohort study used nationwide claims databases (United States: Optum Clinformatics Data Mart; de‐identified; Taiwan: National Health Insurance Research Database; and Denmark: National Prescription and Patient Registries/Danish National Patient Registry) to evaluate OCS prescribing. We classified annual OCS duration as short‐term (1–29 days), medium‐term (30–89 days), or long‐term (≥90 days). Longitudinal change in annual prevalence of OCS use and physician prescribing patterns were reported. Among 54,630,437 participants, average annual percentage of overall OCS use was 6.8% in the United States, 17.5% in Taiwan, and 2.2% in Denmark during 2009–2018. Prevalence of OCS prescribing increased at an average annual rate of 0.1%–0.17%, mainly driven by short‐term prescribing to healthy adults. One‐quarter to one‐fifth of OCS prescribing was associated with a diagnosis of respiratory infection. Family practice and internal medicine physicians were among the highest OCS prescribers across countries and durations. Age‐ and sex‐stratified trends mirrored unstratified trends. This study provides real‐world evidence of an ongoing steady increase in OCS use in the general populations of the United States, Taiwan, and Denmark. This increase is largely driven by short‐term OCS prescribing to healthy adults, a practice previously viewed as safe but recently shown to incur substantial population‐level risk. [ABSTRACT FROM AUTHOR]

In 1997, when Oregon became the first U.S. jurisdiction authorizing medical aid in dying (MAID), its law included a requirement that patients be legal residents of the state. Other U.S. jurisdictions legalizing MAID followed Oregon in adopting residency requirements. Recent litigation challenges the legality, as well as the justification, for such requirements. Facing such challenges, Oregon and Vermont eliminated their MAID residency requirements. More states could follow this move, for, in certain circumstances, the U.S. Constitution's privileges and immunities clause protects citizens' right to travel to secure medical care. Policy considerations could also motivate states to reexamine whether such requirements are justified in light of existing evidence of how MAID laws have been applied. [ABSTRACT FROM AUTHOR]

The article focuses on the implementation of voluntary assisted dying (VAD) in Queensland, highlighting the legislative framework, processes for accessing VAD, and statistics related to its implementation. Topics include VAD substance prescription and administration, medical practitioner opinions around VAD, and challenges faced in VAD practice, including concerns about stigma and practitioner support.

Canadian nursing practice has been profoundly influenced by the legalization of medical assistance in dying in 2016, requiring that nurses navigate new and sometimes highly challenging experiences. Findings from our longitudinal studies of nurses' experiences suggest that these include deep emotional responses to medical assistance in dying, an urgency in orchestrating the perfect death, and a high degree of relational impact, both professionally and personally. Here we propose a theoretical explanation for these experiences based upon a relational ontology. Drawing upon the work of Wildman, we understand a relational ontology to be one in which relationships are more fundamentally central than the conceptual entities that provide the context to practice. It is in a relationship that conceptual entities, and their affiliated values, are created and recreated. Seen as causal, relationships have ontological status, with important implications for how we consider the concepts of death, suffering, and time in this context. From a conceptual perspective, suffering is primarily self‐defined based upon personal histories, time reflects the potential remaining until death, and death is primarily biological and amoral, although social discourses of a good and bad death surround the death trajectory. However, within a relational ontology of medical assistance in dying, these understandings shift. Death becomes primarily social rather than biological, suffering is shared, and time until death is now clearly delimited. Accordingly, nurses assume a profound responsibility for influencing outcomes that are authentically person‐centered. These understandings provide important insights into nurses' experiences, enabling us to recognize the causal effects, both intended and unintended, of nurses' relational practices amidst the complexities of assisted death. Drawing on such a perspective, we find implications for how we provide spaces for nurses to reflect on, and have conversations about, their experiences with some of the greatest mysteries of life—death, suffering, and time. [ABSTRACT FROM AUTHOR]

Introduction: This study explores the assessments of mental health clinicians working with suicidal patients who requested access to medical assistance in dying (MAiD). Methods: A sample of convenience completed an online questionnaire about their experiences with suicidal patients. Respondents described their encounters with 227 suicidal patients: 44 requested access to MAiD, and 183 did not. Data were analyzed using chi‐squared and simple t‐test to identify differences between the respondents' descriptions of the two groups. Results: Results noted differences between patients who experience suicide ideation and request MAiD (SPM), and those who experience suicide ideation and do not (SP). Overall, the SPM group was older, more physical health concerns, chronic pain, existential distress, and less hope. Many had experienced several episodes of mental health care and medication trials, though unlike the SP group, they had a split between accessing a little care and a lot of care. They also engaged in less suicide planning, and some had no history of suicide attempts. Conclusion: It is important that mental health clinicians learn to differentiate between MAiD requests due to an ongoing and irremediable mental disorder, and MAiD requests in response to circumscribed psychological suffering that could be relieved via a change in circumstances and/or access to different treatment options amenable to the patient. [ABSTRACT FROM AUTHOR]

For example, in Belgium and the Netherlands, both euthanasia and DCD procedures need to be strictly separated, to prevent a patient choosing euthanasia because they can then donate organs. Keywords: Death; Euthanasia, active; Tissue and organ procurement; Transplantation EN Death Euthanasia, active Tissue and organ procurement Transplantation 202 205 4 09/05/23 20230904 NES 230904 All Australian states have passed voluntary assisted dying (VAD) legislation. Organ donation following euthanasia: international practice Organ donation after euthanasia is currently performed in Belgium, the Netherlands, Spain and Canada. Statistics from international jurisdictions From 2012 to January 2022, organ donation after euthanasia in the Netherlands was performed 85 times.[13] In Spain in 2021, organ donation after euthanasia was only performed in seven cases from 656 DCD donors. [Extracted from the article]

Objectives: Medical Assistance in Dying (MAiD) has been legal in Canada since June 2016. A person can receive MAiD if their suffering cannot be relieved under conditions that they consider acceptable. Informed consent requires that the person requesting MAiD has received all the information needed to make their decision; that is, medical diagnosis and prognosis, available treatments including palliative care. The evaluation of unbearable suffering is known to be challenging as suffering is often psychological, existential, and social in nature. While interventions to relieve suffering exist, it is unclear how suffering is assessed and addressed in the literature on MAiD practice. No scoping review exists on the topic in Canada. The aim of this study was to understand how the concept of suffering was approached within the Canadian MAiD grey (GL) and scientific (peer‐reviewed) literature (SL), specifically: 1‐ How suffering is defined and assessed in the context of MAiD in Canada and 2‐ Which interventions in response to suffering are recommended within the process of obtaining informed consent for MAiD and throughout the process of MAiD itself. Methods: A scoping review was conducted based on PRISMA‐SR guidelines. SL articles (N = 1027) were identified from a review of 6 databases and GL documents (N = 537) were obtained from the provinces of Quebec, Ontario and British Columbia. Documents were analyzed using NVivo with coding by two‐raters and continuous team discussions. Results: A multidimensional definition of suffering, akin to the concept of total pain, is used. The assessment of suffering is based upon patients' reports. Tools to aid in the assessment are not comprehensively covered. Specific interventions to address suffering were often focused on active listening and the management of physical symptoms. No specific interventions were mentioned and there was no reference to clinical practice guidelines in the grey literature to address other components of suffering. The use of a multidisciplinary approach is suggested without specifying the nature of involvement. Conclusions: Our review indicates that published guidelines of MAID assessments could include clearer structure around the assessment and management of suffering, with suggestions of tools that may help clarify types of suffering and reference to clinical practice guidelines and interventions to holistically attend to patient suffering with an attention on non‐physical symptoms. Guidelines would benefit from clearer explanations of how members of an interdisciplinary teams could be coherently coordinated. [ABSTRACT FROM AUTHOR]

The idea of commercial‐assisted suicide lives a marginal existence in the bioethical literature, despite its significant presence in popular culture. The practice of commercial‐assisted suicide (CAS) is defined as suicide assistance performed for a financial reward through a contractual agreement between a customer and a service‐provider, who does not necessarily need to be a medical professional. While CAS does indeed offer some potential solutions regarding the moral controversies surrounding physician‐assisted suicide (PAS), I defend the idea that adopting it as policy ultimately proves morally indefensible and practically inefficient. This is due to the fact that the commodification of a given good necessarily implies the creation of a market of said good; as such, what I propose in this paper is a moral and practical evaluation of a market of CAS. In order to do so, I first examine the arguments in favor of CAS as put forward by Roland Kipke, who argues that any liberal defense of PAS necessarily implies a defense of CAS. In the first section, I argue against this idea using the liberal values of autonomy and equality of opportunity. In the second section of the paper, I argue that a market of CAS would be gravely dysfunctional due to one particular characteristic of death, namely, that is not compensable ex post. I conclude by arguing that while the practice of CAS may not prove morally problematic, the inevitable market that it will create should it be legalized most certainly will. [ABSTRACT FROM AUTHOR]

The article discusses the use of voluntarily stopping eating and drinking (VSED) as a bridge to Medical Aid in Dying (MAID) for patients with dementia who are not eligible for MAID based solely on their dementia diagnosis. The authors respond to critiques of MAID and argue for expanded access to MAID, stating that it promotes value-concordant care and that recent changes in MAID laws have been carefully vetted and enacted in response to evidence and demand. They also advocate for further extension of the VSED bridge to other patients with serious, irreversible, intolerable conditions. [Extracted from the article]

The article discusses the expansion of assisted suicide and the proposal to use voluntarily stopping eating and drinking (VSED) as a bridge to medical aid in dying (MAID) for patients with mild cognitive impairment or early dementia. The authors oppose this proposal, stating that it is part of a larger strategy to expand medicalized suicide. They argue that expanding assisted suicide laws can blur ethical lines, devalue the lives of individuals with disabilities, and lead to an increase in all forms of intentional self-initiated death. The authors advocate for compassionate palliative and hospice care as alternatives to assisted suicide. [Extracted from the article]

Background: We tested the hypothesis of supporters of assisted dying that assisted suicide (AS) might be able to prevent cases of conventional suicide (CS). Methods: By using data from the Federal Statistical Office, we analyzed the long‐term development of 30,756 self‐initiated deaths in Switzerland over a 20‐year period (1999–2018; CS: n = 22,018, AS: n = 8738), focusing on people suffering from cancer who died from AS or CS. Results: While cancer was the most often listed principal disease for AS (n = 3580, 41.0% of AS cases), cancer was listed in only a small minority of CS cases (n = 832, 3.8% of CS cases). There was a significant increase in the absolute number of cancer‐associated AS cases: comparing four 5‐year periods, there was approximately a doubling of cases every 5 years (1999–2003: n = 228 vs.2004–2008: n = 474, +108% compared with the previous period; 2009–2013: n = 920, +94%; 2014–2018: n = 1958, +113%). The ratio of cancer‐associated AS in relationship with all cancer‐associated deaths increased over time to 2.3% in the last observation period (2014–2018). In parallel, the numbers of cancer‐associated CS showed a downward trend only at the beginning of the observation period (1999–2003, n = 240 vs. 2004–2008, n = 199, −17%). Thereafter, the number of cases remained stable in the subsequent 5‐year period (2009–2013, n = 187, −6%), and increased again toward the most recent period (2014–2018, n = 206, +10%). Conclusion: The assumption that, with the increasingly accessible option of AS for patients with cancer, CS suicide will become "superfluous" cannot be confirmed. There are strong reasons indicating that situations and circumstances of cancer‐associated CS are different from those for cancer‐associated AS. [ABSTRACT FROM AUTHOR]

Background: Autism spectrum disorder (ASD) is characterized by high heritability estimates and recurrence rates; its genetic underpinnings are very heterogeneous and include variable combinations of common and rare variants. Array‐comparative genomic hybridization (aCGH) offers significant sensitivity for the identification of copy number variants (CNVs), which can act as susceptibility or causal factors for ASD. Methods: The aim of this study was to evaluate both diagnostic yield and clinical impact of aCGH in 329 ASD patients of Italian descent. Results: Pathogenic/likely pathogenic CNVs were identified in 50/329 (15.2%) patients, whereas 89/329 (27.1%) carry variants of uncertain significance. The 10 most enriched gene sets identified by Gene Ontology Enrichment Analysis are primarily involved in neuronal function and synaptic connectivity. In 13/50 (26.0%) patients with pathogenic/likely pathogenic CNVs, the outcome of array‐CGH led to the request of 25 additional medical exams which would not have otherwise been prescribed, mainly including brain MRI, EEG, EKG, and/or cardiac ultrasound. A positive outcome was obtained in 12/25 (48.0%) of these additional tests. Conclusions: This study confirms the satisfactory diagnostic yield of aCGH, underscoring its potential for better, more in‐depth care of children with autism when genetic results are analyzed also with a focus on patient management. [ABSTRACT FROM AUTHOR]

Objective: To review the recent literature on the proposed entity of "terminal anorexia nervosa." Method: Review of recent literature on the concept of "terminal AN" as well as past and supporting work. Results: The cases and proposed definitions are reviewed, as is the growing literature on this topic. Problems exist with predicting outcomes and thus, determining futility, as well as about capacity for decision‐making. Discussion: To make decisions about treatment futility, the existing database for predicting AN course and treatment response must expand greatly. In addition, while decisional capacity is central to the debate, its determination may be unusually complex in this situation. The gaps identified point to extensive needs for future research, but they also indicate that the concept of "terminal AN" cannot be defined at present and should not be used. Public Significance: Anorexia nervosa is challenging to treat, and it often lasts for years. There is debate about whether palliative care or medical aid in dying should be considered. Identifying who has a terminal case of AN is important for this question, but we have limited ability to predict a given individual's outcome at present, and there are concerns about the ability of those with AN to make treatment decisions. This means the concept of "terminal AN" should not currently be used. [ABSTRACT FROM AUTHOR]

Assisted dying legislation is available to support adult deaths in multiple international jurisdictions. In Canada, a parliamentary committee has recommended extending Medical Assistance in Dying (MAID) legislation to include 'competent mature minors'. Even though such a policy change would affect young people, to date formal discussions about MAID for minors have excluded them. No empirical studies have elicited youth perspectives on including them in future legislation. This qualitative descriptive study uses focus groups to explore young people's perspectives on MAID and its potential extension to include minors using methodological and theoretical commitments to participatory research and children's agency. Our participants explored philosophical and medical dimensions of MAID, including pain and suffering, the choice to die, and how MAID enables a peaceful, controlled death. They unpacked the concept of maturity vis‐à‐vis age and a child/adult binary, using these reflections to posit safeguards for ensuring minors' MAID requests would be fairly evaluated. Finally, they explored relational dimensions of dying, paying particular attention to the impact of MAID on grievers. Our results illustrate that young people are capable and keen to contribute toward discussions and decisions about MAID. Our study supports the participation of young people in any extension of MAID, as well as in other high‐stakes matters that may affect them, challenging dominant assumptions that underestimate their capacities to do so. [ABSTRACT FROM AUTHOR]

Organ donation after voluntary assisted dying (VAD) in Australia may potentially increase organ transplant rates. Despite significant international experience with donation after VAD, there has been little discussion of this in Australia. We review potential ethical and practical concerns relating to donation after VAD and advocate action to establish programmes in Australia that ensure safe, ethical and effective donation after VAD. [ABSTRACT FROM AUTHOR]

The median age of voluntary assisted dying applicants is similar in Victoria and Western Australia (about 73 years).[[15]] Most had advanced cancer (Victoria: 82%; Western Australia: 68%), neurodegenerative diseases (especially motor neurone disease), or organ failure, and most were receiving palliative care (Victoria: 81%; Western Australia: 85%). Keywords: Euthanasia; Terminal care; Legislation, medical EN Euthanasia Terminal care Legislation, medical 208 210 3 09/05/23 20230904 NES 230904 Until six years ago, there were no voluntary assisted dying laws in Australia, despite strong public support and fifty attempts in parliaments around the country. During 2021-22, voluntary assisted dying was involved in 0.58% of all deaths in Victoria,[15] and 1.1% of all deaths in Western Australia.[16] It is involved in 0.59% of deaths in Oregon,[18] where self-administered assisted dying has been available since 1998 for people expected to live less than six months. 17 Sellars M, White B, Yates P, Willmott L. Medical practitioners' views and experiences of being involved in voluntary assisted dying in Victoria, Australia: a qualitative interview study among participating doctors. [Extracted from the article]

The aim of this article is to present and critically investigate a type of argument against legalising assisted dying on request (ADR) for patients who are terminally ill and experiencing suffering. This type of argument has several variants. These—which we call 'autonomy‐based arguments' against legalising ADR—invoke different specifications of the premise that we ought not to respect requests for assistance in dying made by terminally ill and suffering patients because the basic conditions of autonomy cannot be met in scenarios where such requests are made. Specifically, it is argued either (1) that as a result of pain, anxiety or desperation, terminally ill patients are not competent decision makers or (2) that legalisation of ADR would lead to social pressure or in other ways change the patient's context of choice in ways that make such requests nonautonomous. We argue that these types of arguments are problematic in light both of empirical studies and the fact that we usually judge that it is morally right to respect the wishes and decisions of dying people even if they suffer. [ABSTRACT FROM AUTHOR]

Background: Cancer patients form a notable proportion of requestors for physician‐assisted suicide (PAS). This manuscript provides data on German oncologists' views concerning due criteria for the assessment of requests for PAS and quality assurance. Methods: The German Society of Haematology and Medical Oncology (DGHO) has conducted a survey among its members to elicit data about practices and views on regulating PAS in March 2021. Descriptive analysis and bivariate logistic regression of quantitative data on socio‐demographic and other determinants possibly associated with respondents' views on PAS as well as content analysis of qualitative data were performed. Results: About 57.1% (n = 425) of respondents (n = 745) indicated that they had been asked for information about PAS by patients. Information about palliative (92.7%; n = 651) and psychological care options (85.6%; n = 598) was deemed most important in cases of requests for PAS. More than half of the respondents (57.6%; n = 429) were in favour of a formal expert assessment of decisional capacity and about 33.4% (n = 249) favoured a time span of 14 days between the counselling and prescription of a lethal drug. There was no association between participants who received more requests and a preference for disclosing publicly their willingness to assist with suicide. A majority of respondents requested measures of quality assurance (71.3%; n = 531). Conclusion: According to respondents' views, the regulation of PAS will require diligent procedures regarding the assessment of decisional capacity and counselling. The findings suggest that the development of adequate and feasible criteria to assess the quality of practices is an important task. [ABSTRACT FROM AUTHOR]

This study explores the perceptions of Norwegian nurses who have received assisted dying requests from terminally ill patients. Assisted dying is illegal in Norway, while in some countries, it is an option. Nurses caring for terminally ill patients may experience ethical challenges by receiving requests for euthanasia and assisted suicide. We applied a qualitative research design with a phenomenological hermeneutic approach using open individual interviews. A total of 15 registered nurses employed in pulmonary and oncology wards of three university hospitals and home care in one municipality were recruited. Four themes emerged from the analysis: (1) unprepared for the request; (2) meeting direct, indirect, and nonverbal requests; (3) working in a gray zone, and (4) feeling alone and powerless. The study found that nurses were unsure how to handle such requests due to professional uncertainty about assisted dying. Working in an environment where the topic is taboo made nurses morally uncertain, and some perceived this as moral distress. The hospital chaplain played a significant role in providing support to these nurses. [ABSTRACT FROM AUTHOR]

The ethical discussion of end‐of‐life decisions has been with us for some time. This article focuses specifically on medically assisted dying. Representative secular, professional, and faith‐based ethical arguments for and against it are briefly reviewed. With respect for the contributions of that ethical discourse, the article sees the decision for aid in dying as a spiritual matter of the trust and freedom of faith in the loving, intimate presence of the Triune God with us in the incarnate Christ, and his union with the Father and the Spirit. [ABSTRACT FROM AUTHOR]

The article discusses the current status of euthanasia laws in Chile, Peru, Ecuador, and Colombia. In Chile, a law from 2012 prohibits euthanasia and assisted suicide, and a bill to legalize euthanasia is currently pending in the senate. However, it is expected to be dismissed due to other pressing issues. In Peru and Ecuador, euthanasia is also prohibited but has been allowed in single cases by high courts. Colombia is the only country that has decriminalized medically assisted suicide and active euthanasia, but implementation may be challenging due to the influence of the Catholic Church and conservative politics. The author supports permissive regulation on euthanasia but emphasizes the need to move beyond rhetoric and focus on unbiased lawmaking. [Extracted from the article]

In the September‐October 2024 issue of the Hastings Center Report, two pieces examine attitudes toward and policy on medical aid in dying (MAID). An essay by Anna Elsner and colleagues analyzes terminology, including euphemistic language, used in Canada and other countries to refer to this practice. The authors recommend explicit public discussion of the values at stake in the use of this terminology. An article by Em Walsh concerns a subset of people who could become eligible for MAID under Canada's proposed expansion of eligibility for this assistance: people suffering from poverty‐induced depression. Cautioning that the expansion of PAD could exacerbate inequality, Walsh offers six recommendations for policy‐makers' consideration. The issue's lead article, by Eric Juengst and colleagues, focuses on governance issues that could be raised by human genome editing research that aims to strengthen individuals' resistance to disease beyond what is regarded as the human functional range. Juengst et al. identify and analyze three potential principles that could help policy‐makers navigate what can be a blurry line between goals of prevention and enhancement in human genome editing research. [ABSTRACT FROM AUTHOR]

The article presents a study which analyzed the demographic and clinical characteristics of people in the U.S. who pursued medical aid in dying (MAID) in 1998-2020. In the research, the rates of death by MAID were examined using the Wide-ranging Online Data for Epidemiological Research (WONDER) data from the Centers for Disease Control and Prevention (CDC). Also cited is the proposed integration of hospice and palliative care into non-cancer settings.

Many people are afraid they will, as they age or fall ill, become burdens to others. Some who fear this say they would be willing to hasten their own deaths—engaging in self‐sacrifice through suicide, assisted suicide, or euthanasia—to avoid it. Still, some bioethicists and other critics of medical aid in dying reject the idea that fear of being a burden can be a good reason for self‐sacrifice. They argue that dependency is nearly universal, emphasize that caregiving is a valuable pursuit, and raise concerns about the impact of aid‐in‐dying policies on vulnerable groups. After defining what it is to be a burden, articulating why being a burden is morally significant, and, crucially, distinguishing burdensomeness from what I call "mere dependency," I defend the intuition that self‐sacrifice can be justified by the desire to avoid being a burden and by the concern for the well‐being of one's caregivers that this choice implies. [ABSTRACT FROM AUTHOR]

The article focuses on the evolving debate around assisted dying, particularly questioning traditional eligibility criteria such as terminal illness and exploring issues related to advance directives and the role of healthcare professionals in providing assistance. Topics discussed include the reconsideration of eligibility thresholds, the problematic nature of advance directives, and the potential role of a newly created assisted dying profession.

Attempts to legalize assisted suicide has historically presented a unique set of political and procedural challenges in state legislatures, the result of which has been the overwhelming defeat of nearly 98% such attempts in the last 25 years. Only in recent years is this trend beginning to change. Vermont was the first state to adopt legislation in 2013, followed by California, and Washington DC in 2015. In 2018, Hawaii was added to the list and most recently, New Jersey, and Maine in 2019. Other trends have become evident as well. Whereas between 1995 and 2013 there was a median of nine bills introduced by six states in a given biennium, this has increased to 31 bills in 24 states between 2015 and 2019, And while until 2013, only two or three states at most would have more than a single bill in play, the median has now doubled to five states and Washington DC since 2015. This paper examines whether or not these recent trends are in fact, political strategies that could explain and potentially predict success in future sessions. We examine the efficacy of constancy (the perseverance of introducing bills over multiple sessions) and frequency (introducing multiple bills in the same session) using both the six successful attempts as well as 264 failed attempts since 1994. Comparing the common attributes of successful legalization as well as failures, perseverance cannot be ruled out as a beneficial variable, but can only be vindicated with more data in the future. There was no evidence across all the data to suggest that multiple bills contributed to success. The data also shows that ideological liberalism is currently a necessary but not sufficient condition to pass assisted suicide bills, although it is expected to become more significant as the issue settles down party lines. Increases in the number of bills, the number states with bills, and perhaps the number of bills introduced in a given state appears more as a response to environmental stimuli that makes bills appear more viable: namely previous state victories and shifts in public opinion. [ABSTRACT FROM AUTHOR]

Persons with mental disorders who are resistant to evidence‐based treatment can be referred to as patients with severe and persistent mental illness (SPMI). Some patients with SPMI develop a strong wish for assisted dying. Switzerland has the longest history of non‐medicalized assisted dying, which is considered a civil right even in non‐pathological situations. Public debate in Switzerland about the issue of suffering in the context of assisted dying is current and ongoing. The Swiss Academy of Medical Sciences recently revised its end‐of‐life policy and specified intolerable suffering due to severe illness or functional limitations (and acknowledged as such by a physician) as a core criterion for assisted dying. We argue that suffering is a necessary but insufficient condition for assisted dying, and that the criteria should also include decision‐making capacity and refractoriness of suffering. We further contend that suffering is a subjective experience that can only be quantified by the patient and cannot be objectively compared across individuals. Some patients with SPMI and refractory suffering who maintain decision‐making capacity will meet the criteria for assisted dying. We advocate for palliative psychiatric care that relinquishes any disease‐modifying therapy, accepts limited survival chances, and focuses on measures that enhance the patient's quality of life, understood in a very broad sense beyond only health‐related quality of life. This approach should also relieve suffering as much as possible while remaining open to the possibility of assisted dying following conscientious assessment of the criteria. [ABSTRACT FROM AUTHOR]

Keywords: Canis lupis familiaris; cytology; multiple cartilaginous exostosis; osteochondroma; osteosarcoma EN Canis lupis familiaris cytology multiple cartilaginous exostosis osteochondroma osteosarcoma 279 282 4 06/06/22 20220601 NES 220601 CASE PRESENTATION A 5-year-old male neutered Border collie mix was presented to a specialty clinic for evaluation of right pelvic limb lameness of a few weeks' duration. Because of the atypical location for an osteosarcoma and how common malignant transformation occurs in dogs with MCE, it is possible that the osteosarcoma arose from a previous exostosis on the ischium. Cytology, osteosarcoma, Canis lupis familiaris, multiple cartilaginous exostosis, osteochondroma. [Extracted from the article]

CAUSE AND EFFECT Withdrawal of life-sustaining treatment is, for the most part, settled ethics and law - protected as a right to bodily autonomy and to refuse medical therapy. The increased use of extracorporeal membrane oxygenation (ECMO) to support patients through critical illness has brought opportunities and challenges. This experience of withdrawal is important because many clinicians already feel ethically conflicted about withdrawing life-sustaining treatments, characterizing it as ethically problematic.[7] When patients, families, and clinicians can expect death to immediately follow deactivation, will that disturb the fragile narrative of I allowing death i ?. [Extracted from the article]

Should prisoners be allowed to access assisted suicide? Whereas the ethical and legal issues regarding assisted suicide have now been extensively discussed in the literature, surprisingly scarce attention has been given to the pressing issue of inmates requesting assistance in dying. Through an analysis supported by the Swiss legal framework, I first argue that the principle of equivalence in prison medicine, which states that prisoners ought to receive the same level of health care as the general population does not prove a solid basis in arguing for prisoners' right to assisted suicide. Over the course of the paper, I defend the view that the right to access assisted suicide is to be understood as a liberty that cannot be removed from incarcerated individuals. I argue that removing such a liberty cannot be consistently held within a legal framework where the death penalty does not exist, for doing so necessarily forgoes the State's ability to decide on when and how prisoners' lives end, in turn necessarily leaving them the liberty to end theirs when they decide so. I finally argue against the position that the capacity for autonomous choice is lacking in inmates by disentangling the particular features of the prison‐setting and show that the context of incarceration is not so substantially different from regular cases of suicide assistance that it warrants a difference in treatment. The position I propose proves important in order to both respect prisoners' rights and ensure they retain a minimum level of control over their existences. [ABSTRACT FROM AUTHOR]