Background
Assisted suicide | Someone makes the means of death available but does not act as the direct agent of death |
Euthanasia | A medical professional administers a lethal dose of medication to intentionally end a patient’s life |
Hastened death | Someone who acts on their desire to control the circumstances of their death with or without assistance from another individual |
Physician assisted suicide | A medical provider writes a prescription for a lethal dose of a drug to be self-administered by a competent, terminally ill patient |
Suicide | Self-caused death |
Method
Review question
Review design
Search strategy
Database searches
Terms | MeSH terms |
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1. Suicide OR assisted suicide OR assisted dying OR aid in dying OR death with dignity OR active euthanasia AND | “suicide” “suicide, assisted” “suicide, attempted” “euthanasia, active, voluntary” |
2. Hospice care OR hospices OR hospice and palliative nursing OR palliative care OR palliative medicine AND | “hospice care” “hospices” “hospice and palliative nursing” “palliative care” “palliative medicine” “terminal care” |
3. Professional OR clinician OR physician OR nurse OR social worker OR chaplain AND | “health personnel” “attitude of health personnel” clinician*, physician*, social worker*, chaplain*, nurse* |
4. Experiences | Experience* |
Selection criteria
Inclusion | Exclusion | |
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Population | Professionals in a palliative care and hospice context: nurses, physicians, social workers, chaplains working in locations where assisted dying is allowed | Patients, public, other carers. Locations where assisted dying, including euthanasia and assisted suicide is not allowed |
Intervention | Hastened Death, Euthanasia, Suicide, Assisted Suicide, Physician Assisted Suicide | |
Outcomes | Professionals’ experiences with patients who died by suicide, self-administered medications prescribed by clinician, or administration of medications by clinician with intent to hasten death | Research that does not include information about direct experiences: involvement, attitudes, communication, views |
Study design | Any research method/design | Opinion pieces; editorials |
Reporting (language/time period) | English Data obtained from reports from inception to present | Studies conducted prior to implementation of assisted dying laws, code, or ruling of each country or state |
Assessment of quality
Data extraction and method of synthesis
Overview of studies
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Five studies are from Belgium, nine from the Netherlands, two from Switzerland, 13 from the United States, and one is from Canada.
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Only three of the 30 studies include information about experiences of hastened death that is not assisted suicide (self-administered lethal dose of medication) or euthanasia (lethal medication injected by professional); Ganzini et al. [32] investigate the phenomenon of patients who voluntarily refuse food and fluids, and Anquinet et al. [33] compare euthanasia with continuous deep sedation.
Results
Reference | Participants | Study Methods | Data Year | Research Focus | Setting | Terminology Used in Study |
---|---|---|---|---|---|---|
Belgium | ||||||
Anquinet L et al. (2013) [33] | Two groups of physicians (n = 8) and two groups of nurses (n = 13) | Qualitative focus groups | 2010 | Similarities and differences between the practice of continuous sedation until death and the practice of euthanasia. | Homecare and hospital setting-palliative care unit support team | Physician Assisted Death; Euthanasia |
Cohen J et al. (2012) [45] | Physicians 480-Flanders; 305-Wallonia | Postal survey | 2008 and 2009 | Cultural differences between Walloon and Flemish physicians affecting euthanasia practice | Unspecified | Euthanasia |
Dierckx De Casterlé, et al. (2010) [46] | 18 nurses | Qualitative in-depth interviews | 2005–2006 | Nursing care for patients requesting euthanasia in general hospitals in Flanders, Belgium | Included palliative care units | Euthanasia |
Inghelbrecht, E., et al. (2010) [47] | 1678 nurses | Second phase of two-phase postal survey | 2007–2008 | Nurses involvement inconsistent in decisions about euthanasia or drugs to end a patients’ life, and nurses administer life-ending drugs even though it is not regulated | Homecare, care homes, hospital | Euthanasia by patients’ request; Administration of life ending medications without patients’ explicit request |
Meeussen, K., et al. (2011) [48] | 205 GPs | Structured phone survey | 2005–2006 | Investigated how many patients expressed a wish for euthanasia, documentation of these requests, experiences with these requests, and how it was handled | Focused on patients who died at home | Euthanasia |
Canada | ||||||
Beuthin, R., et al. (2018) [49] | 17 nurses | Qualitative interviews | 2016 | Explored nurses experiences of MAiD | Hospital, hospice, home settings | Medical Assistance in Dying (MAiD), euthanasia, assisted suicide |
Netherlands | ||||||
Dees, M. K., et al. (2013) [50] | 32 cases, 31 relatives, 28 physicians | Qualitative interviews | 2008–2009 | Explores decision-making process in cases where patients request euthanasia | Homes or physicians’ offices | Euthanasia |
Georges, J. J., et al. (2008) [51] | 30 GPs | Qualitative in-depth interviews | 2002–2003 | Describes experiences of general practitioners (GPs) in Netherlands dealing with a request for euthanasia from a terminally ill patient. | Unspecified | Euthanasia |
Francke, A. L., et al. (2016) [52] | 587 respondents (65%) Nurses and CNAs | Postal survey | 2011 | To give insight into Dutch nursing staff’s attitudes and involvement regarding euthanasia | Unspecified | Euthanasia |
Norwood, F. (2007) [53] | 10 physicians included in study | Ethnographic study: Foucauldian discourse | 2001 | Euthanasia, general practice, and end-of-life discourse in the Netherlands | Home | Euthanasia |
Pasman, H. R., et al. (2013) [54] | 11 physicians and 9 patients, 3 relatives | Qualitative Interviews | 2005–2007 | What happens after request for euthanasia is refused | Unspecified | Euthanasia or Physician Assisted Suicide (EAS) |
Snijdewind, M. C., et al. (2014) [55] | 28 physicians 26 relatives | Qualitative in-depth interviews | November 2011–April 2012 | According to the physicians and relatives, what are the characteristics of the complexities that can arise from the moment someone requests EAS? | Unspecified | Physician Assisted Suicide; Euthanasia |
Van Bruchem-van de Scheur, G., et al. (2007) [35] | 500 district nurses-86% response rate. 81.6% (408) used for analysis | Postal survey | 2003 | Euthanasia and physician assisted suicide in the Dutch home care sector: the role of the district nurse | 55 home care organisations | Physician Assisted Suicide; Euthanasia |
Van Bruchem-van de Scheur, G.,et al. (2008) [34] | 1509 nurses; 1179 responses analysed (78.1%) | Telephone survey | 2003 | The role of nurses in euthanasia and physician-assisted suicide in the Netherlands | Hospital, nursing homes and home care | Physician Assisted Suicide; Euthanasia |
Van Marwijk, H., et al. (2007) [56] | 22 physicians | Qualitative, four focus groups | 2003 | Impact of euthanasia on primary care physicians in the Netherlands | Primary care | Euthanasia; Assisted Suicide |
Switzerland | ||||||
Otte, I. C., et al. (2016) [57] | 23 General Practitioners (GPs) | Qualitative interviews | 2012–2013 | Barriers to professional communication about Physician Assisted Suicide | Unspecified | Physician Assisted Suicide |
Gamondi, C., et al. (2017) [28] | 23 palliative care physicians | Qualitative study | 2015 | Physician responses to assisted suicide requests | Unspecified | Assisted Suicide |
United States | ||||||
Carlson, B, et al. 2005 [43] | 50 out of 77 hospice chaplains (65% response) | Postal survey | 2003 | Attitudes and experiences of hospice chaplains with patients requesting physician assisted suicide | Hospice home care | Physician-Assisted Suicide (PAS); Oregon Death with Dignity Act (ODDA) |
Chin, et al. 1999 [58] | 14 physicians | Qualitative interviews | Report of 1998 data | First year’s experience with legalised assisted suicide in Oregon | Unspecified | Physician-Assisted Suicide |
Clymin, J., et al. 2012 [59] | 582 out of 7500 nurses | Qualitative component of email survey | 2010 | Nurses knowledge of the Death with Dignity Act | Unspecified | Death With Dignity Act (DWDA) Physician Assisted Death (PAD) |
Dobscha, SK, et al. 2004 [36] | 35 physicians | Qualitative semi-structured interviews | 2000 | Physicians responses to requests for assisted suicide | Unspecified | DWDA; Assisted Suicide |
Ganzini, L., et al. 2003 [37] | 35 physicians | Qualitative in-depth interviews | 2000 | Oregon physicians’ perceptions of patients who request assisted suicide | Unspecified | Assisted Suicide |
Ganzini, L., et al. 2000 [39] | 2649 of 4053 physicians (65% response) | Postal survey | 1999 | Physicians’ experiences with the Oregon Death with Dignity Act | Unspecified | Oregon Death with Dignity Act |
Ganzini, L., et al. 2001 [38] | 2641 physicians (65% response) | Postal survey | 1999 | Physicians’ attitudes/experiences with end-of-life care since passage of the Oregon Death with Dignity Act | Unspecified | DWDA |
Ganzini, L., et al. 2002 [40] | 307 nurses and social workers of 545 (72–78% response) | Postal survey | 2001 | Experiences of nurses and social workers with hospice patients who requested suicide assistance | Hospice home care | Assisted Suicide |
Ganzini, L., et al. 2003 [32] | 307 nurses of 429 (72% response) | Postal survey | 2001 | Nurses’ experiences with hospice patients who refuse food and fluids to hasten death | Hospice home care | Voluntary Refusal of Food and Fluids (VRFF) Physician Assisted Suicide (PAS) |
Harvath, et al. 2006 [41] | 20 nurses and social workers | Qualitative interviews | Not clearly stated | Dilemmas encountered by hospice workers when patients wish to hasten death | Hospice home care | Physician Assisted Suicide; Hastened Death |
Miller, L. et al. 2004 [42] | 306 nurses and 85 social workers (72–78% response) | Postal survey | 2001 | Attitudes/experiences of Oregon hospice nurses and social workers regarding assisted suicide | Hospice home care | Assisted Suicide; Oregon Death with Dignity Act (ODDA) |
Norton, E. M. & Miller, P. J. 2012 [44] | 9 social workers | Focus group | Since passing of the law | Social workers discuss DWDA | Hospice home care | DWDA |
International (Netherlands and Oregon) | ||||||
Voorhees, J. R., et al. (2014) [61] | 36 physicians | Qualitative semi-structured interviews | 2007–2008 | Physicians’ experiences in the United States and the Netherlands | No | Physician-Assisted Dying (PAD) |