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The preponderance of women among persons who request and receive euthanasia and assisted suicide based on a psychiatric condition, as shown by data from The Netherlands and Belgium, is virtually unexplored. We provide a critical discussion of this gender gap, and propose that it can inform a key debate point in the controversy over the practice, namely its conflict with suicide prevention. [ABSTRACT FROM AUTHOR]

This study explored the experiences and views of Dutch nurses on the content, function, dissemination and implementation of their codes of ethics. A total of 39 participants, who differed in age, qualifications, length of work experience and health care setting, took part in focus groups. The findings revealed common unfamiliarity with and a rather implicit use of codes, and negative comments on the growing number of codes available in the Netherlands. Limited dissemination, implementation and functioning of codes of ethics were also identified. The findings were discussed using concepts from the literature, nursing practice and personal experience. [ABSTRACT FROM AUTHOR]

Euthanasia was first legalised in the Netherlands in 2002, followed by similar legislation in Belgium the same year. Since the beginning, however, only the Netherlands included the possibility for minors older than 12 years to request euthanasia. In 2014, the Belgian Act legalising euthanasia was amended to include requests by minors who possess the capacity of discernment. This amendment sparked great debate, and raised difficult ethical questions about when and how a minor can be deemed competent. We conducted a systematic review of argument-based literature on euthanasia in minors. The search process followed PRISMA guidelines. Thirteen publications were included. The four-principle approach of medical ethics was used to organise the ethical arguments underlying this debate. The justification for allowing euthanasia in minors is buttressed mostly by the principles of beneficence and respect for autonomy. Somewhat paradoxically, both principles are also used in the literature to argue against the extension of legislation to minors. Opponents of euthanasia generally rely on the principle of non-maleficence.Conclusion: The present analysis reveals that the debate surrounding euthanasia in minors is at an early stage. In order to allow a more in-depth ethical discussion, we suggest enriching the four-principle approach by including a care-ethics approach. What is Known: • The Netherlands and Belgium are the only two countries in the world with euthanasia legislation making it possible for minors to receive euthanasia. • This legislation provoked great debate globally, with ethical arguments for and against this legislation. What is New: • A systematic description of the ethical concepts and arguments grounding the debate on euthanasia in minors, as reported in the argument-based ethics literature. • A need has been identified to enrich the debate with a care-ethics approach to avoid oversimplifying the ethical decision-making process. [ABSTRACT FROM AUTHOR]

Background: Irremediability is a key requirement for euthanasia and assisted suicide for psychiatric disorders (psychiatric EAS). Countries like the Netherlands and Belgium ask clinicians to assess irremediability in light of the patient's diagnosis and prognosis and 'according to current medical understanding'. Clarifying the relevance of a default objective standard for irremediability when applied to psychiatric EAS is crucial for solid policymaking. Yet so far, a thorough examination of this standard is lacking., Methods: Using treatment-resistant depression (TRD) as a test case, through a scoping review in PubMed, we analyzed the state-of-the-art evidence for whether clinicians can accurately predict individual long-term outcome and single out irremediable cases, by examining the following questions: (1) What is the definition of TRD; (2) What are group-level long-term outcomes of TRD; and (3) Can clinicians make accurate individual outcome predictions in TRD?, Results: A uniform definition of TRD is lacking, with over 150 existing definitions, mostly focused on psychopharmacological research. Available yet limited studies about long-term outcomes indicate that a majority of patients with long-term TRD show significant improvement over time. Finally, evidence about individual predictions in TRD using precision medicine is growing, but methodological shortcomings and varying predictive accuracies pose important challenges for its implementation in clinical practice., Conclusion: Our findings support the claim that, as per available evidence, clinicians cannot accurately predict long-term chances of recovery in a particular patient with TRD. This means that the objective standard for irremediability cannot be met, with implications for policy and practice of psychiatric EAS.

Aim: This paper reports a study testing the content and face validity and internal consistency of the Dutch version of the Aging Sexual Knowledge and Attitudes Scale., Background: The ability of older residents to sexually express themselves is known to be influenced by the knowledge and attitudes of nursing home staff towards later-life sexuality. Although the Aging Sexual Knowledge and Attitudes Scale is a widely used instrument to measure this, there is no validated, Dutch translation available., Design: Instrument development., Method: Following a standard forward/backward translation into Dutch, the scale was further adapted for use in Flemish nursing home settings. Content and face validity and user-friendliness were assessed. The psychometric properties were determined by means of an exploratory study. Data were collected from March-April 2011 at eight Flemish nursing homes. Reliability was assessed using internal consistency and item-total correlations., Results: Both subscales of the Flemish adaptation showed acceptable content validity. The face validity and user-friendliness were deemed favourable with hardly any remarks given by the expert panel. The Cronbach's α was 0.80 and 0.88 for the knowledge and attitude subscales, respectively. The item-total correlations ranged from 0.21-0.48 for the knowledge section and from 0.09-0.68 for the attitude subscale., Conclusion: We conclude from our study that the Dutch version of the scale has acceptable to good psychometric properties. The Flemish adaptation therefore seems to be a valuable instrument for studying nursing staff's knowledge and attitudes towards aged sexuality in Flanders., (© 2013 Blackwell Publishing Ltd.)

Aims and Objectives: To explore nurses' experiences with nurse-physician communication during artificial nutrition or hydration (ANH) decision-making in hospitalised patients with dementia., Background: Artificial nutrition or hydration decision-making often occurs in patients with dementia. Effective communication between professionals is extremely challenging in this population, because these patients are unable to communicate their treatment wishes., Design: Qualitative interview design., Methods: Between April 2008 and June 2009, we conducted 21 interviews with nurses from nine different hospitals geographically spread throughout Flanders (Belgium). Interviews were audiotaped and later transcribed. Data processing involved (1) simultaneous and systematic data collection and analysis, (2) constant forwards-backwards wave, (3) continuous dialogue with the data and (4) interactive team processes., Results: The interviews showed that communication with physicians is the central instrument the nurses used in their attempts to realise their perception of 'the best possible care'. From the nurses' perspective, we distinguished three mutually connected factors that affected the effectiveness of nurse-physician communication during artificial nutrition or hydration decision-making: the physicians' attitude towards the nurses, the nurses' attitude towards the physicians and the forms of communication used by the nurses. The complex interaction between these three factors resulted in a range of nurses' perceptions, varying from positive to negative. The direction of their perceptions depended on the extent to which they succeeded or failed to use nurse-physician communication as an instrument to realise the 'best care'., Conclusion: Nurse-physician communication was the most important instrument determining whether nurses succeeded or failed to actively act as a patient's representative and whether nurses achieved the best possible care in co-operation with physicians., Relevance to Clinical Practice: To reach optimal care and nurse job satisfaction, nurse-physician communication during artificial nutrition or hydration decision-making should be an open dialogue characterised by mutual respect and understanding., (© 2012 Blackwell Publishing Ltd.)

Aims and Objectives: The aims of this study were to translate the Care-Q into Dutch, adapt it for use in oncological care settings in Flanders and explore its psychometric properties in oncology patients., Background: The 'good nurse' is a difficult concept to measure. Patients' experiences are essential for understanding what characterises good nurses in the oncology setting. Although the Care-Q is one of the most widely used instruments to measure cancer patients' perceptions of good nurses, no translated, validated instrument has been developed for Flanders., Design: A quantitative, descriptive, non-experimental research design was used., Method: We translated the Care-Q into Dutch, adapted it and assessed its face and content validity. Its psychometric properties were examined in 100 oncology patients. Internal consistency was assessed using Cronbach's alpha coefficient, and test-retest reliability was assessed using Wilcoxon matched pairs test and Spearman's rho coefficient. Factor structure was studied using explorative factor analysis derived from principal component analysis with varimax rotation, and the user-friendliness was examined using descriptive statistics., Results: Several items from the original Care-Q were removed or adapted, and new items were added. The content validity index was 0·83. Five reliable, consistent and meaningful subscales were identified that explained 49·7% of the total variance: good nurses are empathic (towards patients and family), professional, patient-centred, respectful and communicative. Cronbach's alpha was 0·92 for the whole instrument and 0·65-0·81 for the subscales. User-friendliness was deemed favourable., Conclusions: The Flemish adaptation of the Care-Q has favourable psychometric properties. It appears to be a useful instrument for studying cancer patients' perceptions of good nurses in Flanders., Relevance to Clinical Practice: The Flemish adaptation of the Care-Q is useful for helping nurses to reflect critically on the care they offer and to adapt and improve care to the real needs and expectations of patients with cancer., (© 2011 Blackwell Publishing Ltd.)