Attitudes Towards Euthanasia | Literature Review

Attitudes Towards Euthanasia Literature ReviewIntroductionThis literature review is base upon peoples attitudes towards Euthanasia, which comes from the Greek meaning good death and in English means the killing of one psyche by a nonher to relieve the suffering of that person and Physician aid self-annihilation (PAS), which is described as a medical professional aiding a person who is incapable of the run themselves to commit suicide, (NHS, 2010). For this literature review, a literature search was performed using the Cochrane library, Science Direct, EBSCOhost and S historic period using the key wordsAssisted suicideEuthanasiaOpinionsAttitude unite Kingdom universalRight to DieAssisted DyingMost of these words (with the exception of Assisted Suicide and Assisted Dying) were apply in each of the search engines on an individual basis and also white plagued to form directences, however, the only electronic databases that gave this search the information it required was Sage. This provided a substantial amount of journals, a lot of the differents purposed were subscription establish or a fee was required, but from the free to single-valued function information boardinal of the approximately relevant to the subject I beseeched to perform the review on were chosen. The two accounts were chosen from stares and studies performed in the United Kingdom, because it was decided to research what the thoughts and feelings of medical professionals were in a place where this practice was presently illegal. Use in the literature search, but this was difficult to come by. The titles of the three journals are Legalisation of Euthanasia or Physician Assisted Suicide wad of Doctors Attitudes, and Opinions of the Legalised of Physician Assisted Suicide. Despite not inputting the word physician into the search engine, a lot of the searches came up with types of journals which mention this anyway.This review will critically evaluate the information in the journal s and will be compared with each other, discussing the disadvantages of the watchs and the advantages. The review will also include the various research methods used in the research.The Literature ReviewThe starting line paper reviewed is in English by Clive Seale, PhD, from the Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, London and is called The legalisation of Euthanasia or Physician-Assisted Suicide Survey of Doctors Attitudes. The communications protocol was to determine what reinstates opinions ab let out the legalisation of medically help last (which includes the terms, euthanasia and physician-assisted suicide (PAS)) were and this was done in comparison with the opinions of the general public of the UK. The methodology was to hop out out structured questionnaires with a series of questions using qualitative methods and then analyse the results in a quantitative manner. In 2007, Binleys database (http//www.binleys.com) was used to s destination questionnaires to 8857 shortly working medical practitioners all e very(prenominal)place the UK, this was broken down into 2829 (7%) GPs, 443 (43%) neurologists, 836 (21% of these were doctors) specialists in the solicitude of the elderly, 462 (54% of these were also doctors) specialists in palliative medicine and 4287 workers in other hospital based specialities. This is quite a large sample to use and covers a wide range of specialities. It is not clear in what month in 2007 these questionnaires were sent out but follow-up letters were sent to non-respondents between November 2007 and April 2008 to enquire as to why they did not respond, in which 66 doctors in all responded with the most common reason being lack of era to complete the survey. Overall the response rate was 42.1% with specialists in palliative medicine being the most reactive with 67.3% of people returning their questionnaire, along with specialists in the care of the elderly (48.1%) neurologists ( 42.9%) other hospital specialties (40.1%) and GPs (39.3%). Despite the large sample of people, 42.1% of replies are quite disappointing, although it is a truly emotive subject.The questions consisted of personal questions such as age, g block offer, grade, ethnic origin, and speciality of the respondent and, on average, the number of deaths attended. They were all asked four questions about their attitude towards euthanasia and assisted suicide, in order to obtain the questionnaire in full the author of the survey invited people to contact him. An email was sent Appendix (a) and a reply was received the next day Appendix (b). Previous surveys regarding this subject were performed in the Netherlands, Oregon (USA) and Belgium majority support from the medical profession has been important in passing permissive legislation in these countries.The keywords used in this lead were assisted anxious(p) euthanasia physician-assisted suicide right to die and terminal care. The distribution of questionnaires meant that the methodology used was right as it was discreet and reached a lot of people in a short amount of time, the only danger with this method was that the medical professionals did not have to respond which was shown in the return response of 42.1% there was no financial or other incentive as this would go against all good considerations. Ethical approval for this study was granted by the South East query Ethics Committee. The results showed that those who were specialists in palliative medicine were to a greater extent opposed to euthanasia or PAS being legalised than the other specialities, although this could be down to the higher response rate in this area. Those that expressed their religious beliefs were more opposed to the legalisation also. The study showed that the most widely held view was that British doctors do not support legalising assisted dying in either euthanasia or PAS this differs from the British loving Attitudes (BSA) survey which has tracked changes in public opinion since 1984, and is the most consistent source of data (http//www.britsocat.com).The second paper reviewed is Survey of doctors opinions of the legalisation of physician assisted suicide by William Lee, Annabel Price, Lauren Rayner and Matthew Hotopf from the Institute of Psychiatry. Kings College, London. The protocol is similar to the first paper in that they were looking at practitioners opinions on euthanasia and PAS. The article begins by look that there is wide support among the general public for assisted dying but not so much for those who care for the dying. The methodology was to send out a postal survey of a 1000 senior consultants and medical practitioners were selected randomly from the commercially available Informa Healthcare Medical Directory (2005/2006), retired doctors were excluded from the survey. Questionnaire were sent firstly in February 2007, 12 work weeks later, in may, non-respondents were contacted and then six weeks later they were telephoned, it was discovered that that some of the possible contributors had moved, died or retired. This information was ad unspoilted to take this into account. The authors completed separate univariable (a wizard variable) and multivariable (containing more than one variable) predicting the outcomes using polytomous methods which would allow two outcomes to be predicted together.The response rate to the survey was 50% once the exclusions were accounted for, which is higher than the first paper and unflurried gave a lot of date to work with. Included in the survey the authors included a brief outline of the Assisted Dying for the Terminally feverous Bill (2006) 32% of the doctors who responded had read some of the Bill. Gender, speciality and old age in post had no effect on opposition or support for a new law. An interesting point noted is that the views of doctors who do not care for the dying tally with the general publics view, so there is some correlatio n there with 66% of those who never cared for the dying supporting a change in the law. The outcome of interest for the authors was to what level practitioners agreed with the statement The law should not be changed to allow assisted suicide.A second outcome of interest was the level of agreement with the statement I would be prepared to prescribe a calamitous drug to a terminally ill enduring who was suffering unbearably, were that course of action to become legal. (Hotopf, et. al. 20073). The findings of this questionnaire can be found in Appendix (c). twain of these questions were determined using five-point Likert-type scales, used commonly in questionnaires, following this were converted into three-point scales comprising of agree, neither agree nor disagree and disagree with a change in law. The survey shows that senior doctors are split abut their views regarding a change in the law fewer are in favour than the general public in the United Kingdom. These findings have been noted in the US, as well as Canada, Finland and the Netherlands as well as the UK. Ethical permission was gained from the Institute of Psychiatry, Kings College London Research Ethics Committee.Comparisons and ConclusionsThere are many comparisons between the two papers, for example, twain sent out questionnaires to their target mathematical group, who were specialists in certain fields. However, the first paper surveyed over double the amount of people the second paper did but got less replies. Both studies were done in the akin year but it is difficult to narrate who started theirs first as the date for first paper is unknown other than it was performed in 2007. The second survey is far more in depth that the first one, and it suggests that qualitative research is needed to understand doctors views better whereas the first paper did not state which the preferred method was. The second paper suggests that doctors who oppose a change in the law comes from an over-optimistic cre dence in their ability to relieve the suffering of the dying. (Hotopf, et.al. 2007). It is possible to argue against this though and the knowledge and experience of longanimouss who are dying influences views about PAS. Both compare the attitudes between the general public and the specialist doctors and note a big difference between them. On the whole both papers conducted a thorough and precise survey but there is room for foster research and investigation.ReferencesHotopf, L, Lee, W, Price, A, and Rayner, L. (2009) Survey of Doctors Opinions of the Legalisation of Physician-Assisted Suicide, Bio-Med Central, Online, Available from http//www.biomedcentral.com/content/pdf/1472-6939-10-2.pdf Accessed twenty-second April 2010.NHS (2010) Euthanasia and assisted suicide Online, London. Available from http//www.nhs.uk/Conditions/Euthanasiaandassistedsuicide/Pages/Definition.aspx Accessed 22nd April 2010.Seale, C. (2009) Legalisation of Euthanasia or Physician-Assisted Suicide Survey of Doctors Attitudes, Palliative Medicine, Online, Available from http//pmj.sagepub.com/cgi/content/abstract/23/3/205 Accessed 22nd April 2010.Papers used in Literature SearchHotopf, L, Lee, W, Price, A, and Rayner, L. Survey of Doctors Opinions of theLegalisation of Physician-Assisted Suicide.Seale, C Legalisation of euthanasia or physician-assisted suicide survey of doctors attitudes.Appendix(a)Original MessageFrom Katy Marsland (08111890) mailtoemailprotectedSent 26 April 2010 1925To emailprotectedSubject A Questionnaire request.Dear Sir,I am at the University of Lincoln and am doing a literature review for mydegree in Health and Social care involving your survey on the Legalisationof Euthanasia or Physician-Assisted Suicide Survey of Doctors Attitudes,and was wondering if it were possible for you to forward me a copy of thequestions in order to aid my review?Many thanks in advanceKaty MarslandReplyhither is the questionnaire. Clive(b)END OF LIFE DECISIONS IN MEDICAL PRACTICE CONFI DENTIAL ENQUIRYPLEASE TICK THE BOXES TO INDICATE YOUR ANSWERSTHANK YOU FOR YOUR ASSISTANCE General Background QuestionsYour age under 35 years of age 36 to 45 years of age 46 to 55 years of age 56 to 65 years of age over 65 years of ageYour gender male person femaleYour medical specialty General practice Palliative medicine neurology Elderly Care another(prenominal)(prenominal), please plantGrading of your post Consultant Specialist registrar Associate specialist / staff grade SHO / HO / F1 / F2 GP principal GP registrarPlease indicate the number of deaths, on average, for which you would be the treating or attendant doctor in the normal course of your duties attend only one of (a), (b) or (c). (Please give the most accurate estimate you can)(a)_______________per week(b)_______________per month(c)_______________per yearHave you been the treating or attendant doctor in the case of a death in the last 12 months? yes no Please go to question 30, on page 7SPACE FOR COMMENTS former ly YOU HAVE FINISHED THIS QUESTIONNAIREOnce you have completed this questionnaire, you can use this space to provide any clarifications to your answers or make other pointsPLEASE hand over TO RECALL AS CAREFULLY AS POSSIBLE THE MOST RECENT DEATH WITHIN THE digest 12 MONTHS FOR WHICH YOU WERE ACTING AS THE TREATING OR nonessential DOCTOR, AND ANSWER ALL OF THE QUESTIONS 1 TO 29 FOR THAT PARTICULAR DEATHIt is, of course, impossible to do justice to all the finer nuances of decisions concerning the end of heart in a short questionnaire. But please indicate those answers which approach the actual circumstances of this death as closely as possible.1Sex of the deceased male female2Age of the deceased(please estimate if unsure) under 1 year 1-9 years 10-19 years 20-29 years 30-39 years 40-49 years 50-59 years 60-69 years 70-79 years 80-89 years 90 years and over3Place of death hospital hospice care home deceaseds own home other (please specify)4Cause of death*This does not mean the mod e of dying,such as heart failure, asphyxia, asthenia,etc it means the disease, injury, orcomplication which caused death1a Disease or find out directly leading to death*1b Other disease or condition, if any, leading to 1 (a)1c Other disease or condition, if any, leading to 1 (b)2 Other significant conditions contributing to the death but not related to the disease or condition causing it5With respect to this death, when was your first contact with the forbearing? before or at the time of death go to Question 6 after death go to question 30, on page 76How long had you known this long-suffering? more than six months one to six months one to four weeks between one day and one week less than 24 hoursMedical actions7a7b7cConcerning this death, did you or a fellerwithhold a discussion* (or ensure that this was done)?withdraw a treatment* (or ensure that this was done)?use any drug to alleviate pain and/or symptoms?(please tick as many answers as apply)* IN THIS STUDY TREATMENT INCLUD ES CARDIO-PULMONARY RESUSCITATION (CPR), ARTIFICIAL FEEDING AND/OR HYDRATION no yes (please specify treatments withheld). no yes (please specify treatments withdrawn). no yes, morphia or another opioid yes, benzodiazepine yes, other drug8a8bIn withholding a treatment, did you or your colleague consider it probable or certain that this action would hasten the end of the longanimouss flavor?In withdrawing a treatment, did you or your colleague consider it probable or certain that this action would hasten the end of the patients life? no yes no treatment withheld no yes no treatment withdrawn9a9bConcerning the drugs used to alleviate symptoms, (Questions 7c), were these administered intimate this would probably or certainly hasten the end of life?partly intending to end life? no yes no drugs used to alleviate symptoms no yes no drugs used to alleviate symptoms10a10bIn withholding a treatment, did you or your colleague have the hard-core intention of hastening the end of life?In with drawing a treatment, did you or your colleague have the explicit intention of hastening the end of life? no yes no treatment withheld no yes no treatment withdrawn11a11bWas death caused by the use of a drug prescribed, supplied or administered by you or a colleague with the explicit intention of hastening the end of life (or of enabling the patient to end his or her own life?)If yes, who administered this drug (i.e. introduced it into the body)? no yes the patient you or another health care colleague a relative someone else melody IF YOU ANSWERED NO TO ALL THE QUESTIONS ON THIS PAGE, GO TO QUESTION 23Decision makingNOTE QUESTIONS 12 TO 22 REFER THE LAST-MENTIONED ACT OR OMISSION, THAT IS, THE LAST YES THAT YOU TICKED ON THE PREVIOUS PAGE (QUESTIONS 7 TO 11)12Which were the most important reasons for the last-mentioned act or slackness?(please tick all that apply_ patient had pain patient had other symptoms request or wish of the patient request or wish of relatives expected further suffering no chance of improvement treatment would have been futile further treatment would have cast upd suffering other (please specify at a lower place).13In your estimation, how much was the patients life shortened by the last mentioned act or omission? more than six months one to six months one to four weeks between one day and one week less than 24 hours life was probably not shortened at all14Did you or a colleague discuss the last-mentioned act or omission with the patient? yes, at the time of performing the act/omissionor shortly before go to Question 15 yes, some time beforehand go to Question 15 no, no discussion go to Question 1915At the time of this discussion, did you consider the patient had the capableness to assess his/her situation and make a decision about it? yes no16Did this discussion include the (probable or certain) hastening of the end of the patients life by this last-mentioned act or omission? yes no17Was the decision concerning the last mentioned act or omission made in response to an explicit request from the patient? yes, upon an oral request yes, upon a written request yes, upon both an oral and a written request no go to Question 2118At the time of this request, did you consider the patient had the capacity to assess his/her situation and make a decision about it? yes go to Question 21 no go to Question 21ONLY ANSWER QUESTIONS 19 and 20 IF YOUR ANSWER TO QUESTION 14 WAS NO, NO DISCUSSION19Did you consider the patient had the capacity to assess his/her situation and make a decision about it? yes no20Why was the last mentioned act or omission not discussed with the patient?(Please fill in as many answers as apply) patient was too young the last mentioned act or omission was clearly the surpassone for the patient discussion would have done more harm than good patient was unconscious patient had significant cognitive impairment patient was suffering from a psychiatric disorder other, please elaborate at the end of the questionn aire21Did you or a colleague discuss with anybody else the (possible) hastening of the end of the patients life before it was decided to take the last mentioned act or omission?(Please fill in as many answers as apply) with one or more medical colleagues nursing staff /other caregivers by partner/relatives of the patient someone else nobody22Which were the most important reasons for the last-mentioned act or omission?(please tick all that apply) patient had pain patient had other symptoms request or wish of the patient request or wish of relatives expected further suffering no chance of improvement further treatment would have been futile further treatment would have increased suffering other (please specify belowNOTE QUESTIONS FROM HERE ONWARDS SHOULD BE ANSWERED WHETHER OR NOT YOU ANSWERED YES TO ANY OF THE ACTS OR OMISSIONS MENTIONED ON PAGE 3 (QUESTIONS 7 TO 11)23Was an explicit request to hasten the end of the patients life made by any of the following?(Please tick all that ap ply) partners/relatives of the patient nursing or other care staff someone else no explicit request24As far as you know, did the patient ever express a wish for the end of his/her life to be hastened? yes, clearly go to Question 25 yes, but not very clearly go to Question 25 no go to Question 2625Did the patients wish for this outcome reduce or disappear over time? no yes, in response to care provided yes, other reason26The treatment during the last week was mainlyaimed at recovery prolonging life support during the dying process27Which caregivers were involved in the care for the patient during the last month before death (beside yourself and as far as you know)?(please tick all that apply)Of those not involved, which ones might have helped? involvedNot involved andmight have helpedgeneral practitionerspecialist in pain reliefpalliative care teampsychiatrist /psychologistnursing staffsocial care workerspiritual caregivervolunteerfamily member28a28b28c28dWas the patient constantly and deeply sedated or unbroken in a coma before death?Which medication was given for sedation?(please tick as many answers as apply)At what time before death was continuous sedation of the patient started?Which were the most important reasons for this sedation?(please tick all that apply) yes no go to Question 29a midazolam other benzodiazepine morphine or another opioid other type of medication. hours before death. days before death. weeks before death patient had balking pain patient had intractable psychological distress patient had other intractable symptoms request or wish of the patient request or wish of relatives other (please specify below29a29b29cDid the patient receive morphine or another opioid during the last 24 hours before death?How much time before death was the administration of morphine or another opioid started?Which figure best illustrates the dosage of morphine or another opioid during the last 3 days before the patients death? yes no go to Question 30. hours before death. days before death. weeks before death No increase Gradual increase Strong increase last dayAttitudes and beliefsQuestions 30 and 31 are about voluntary euthanasia (that is, when someone ends the life of another person at their request), worded in the same way as those used in surveys of general public opinion.3030a30bFirst, a person with an incurable and painful illness, from which they will die for example, someone dying of cancer.Do you speak out that, if they ask for it, a doctor should ever be allowed by law to end their life, or not?And do you think that, if this person asks for it, a doctor should ever be allowed by law to give them lethal medication that will allow the person to take their own life? Definitely should be allowed credibly should be allowed Probably should not be allowed Definitely should not be allowed Definitely should be allowed Probably should be allowed Probably should not be allowed Definitely should not be allowed3131a31bNow, how about a p erson with an incurable and painful illness, from which they will not die.Do you think that, if they ask for it, a doctor should ever be allowed by law to end their life, or not?And do you think that, if this person asks for it, a doctor should ever be allowed by law to give them lethal medication that will allow the person to take their own life? Definitely should be allowed Probably should be allowed Probably should not be allowed Definitely should not be allowed Definitely should be allowed Probably should be allowed Probably should not be allowed Definitely should not be allowed32Religion what is your religion? None Christian (including Church of England, Catholic,Protestant and all other Christian denominations) Buddhist Hindu Jewish Muslim SikhAny other religion, please put out in33Religion would you describe yourself as extremely religious very religious somewhat religious neither religious nor non-religious somewhat non-religious very non religious extremely non religious c ant choose34What is your ethnic group?Choose ONE section from A to E, then tick the appropriate box to indicate your ethnic groupA flannel any White backgroundB Mixed White and Black Caribbean White and Black African White and Asian Any Other Mixed background, please write inC Asian or Asian British Indian Pakistani Bangladeshi Any Other Asian background, please write inD Black or Black British Caribbean African Any Other Black background, please write inE Chinese or other ethnic group Chinese Any Other, please write inTo clarify any answers or to make further comments, please use the space on page 1.Thank you for your help with this important survey.Now that you have finished the questionnaire, to ensure the anonymity of your answers you will need to do two things.Place the completed questionnaire in the reply-paid envelope, seal it and post it as soon as possiblePost the reply-paid response notification card with your name on it if you wish to avoid receiving follow-up reminders. These two items will be received by different people in different locations and kept separate. It will not be possible to link your questionnaire with your name.This questionnaire has been sent to a random sample of 10,000 doctors. It will not be possible for the researchers or anyone else to use your replies to discover your identity or the identity of the patient on whose care you have reported.We understand that recalling events of this nature can be a distressing experience. If you wish to talk to someone about your feelings concerning end-of-life care, the Confidential Counselling Helpline of the British Medical Association can assist you. Their number is 0645 200 169(c)Euthanasia and Assisted Suicide in the United KingdomA Research ProposalPart BBy Katy Marsland 08111890University of LincolnHand in Date 4th May 2010(1,352 Words)Julie BurtonNUR2002M-0910 research Methods2009/2010Table of Contents PageTitle 26Research Questions 27Aims of Project 28Initial Literature Review 29-30 Methodology 31Ethical Considerations and Practical Constraints 32Timetable for Dissertation Research 33-34References 35A Research Proposal1. TitleEuthanasia and Assisted Suicide in the United Kingdom.2. Research QuestionsShould Euthanasia and Assisted Suicide be made legal? What are the arguments for and against policy change in the United Kingdom? Which section of smart set is most supportive of a change in the law? Which section is most opposed and why?3. Aims of ProjectThis research aims to investigate, using secondary data, whether a change in the law is needed to clarify the position of euthanasia and assisted suicide in the United Kingdom, and whether this should be made legal just for those who are terminally ill or for