Dataset Information

Attitudes of Psychiatric Nurses about the Request for Euthanasia on the Basis of Unbearable Mental Suffering(UMS).

ABSTRACT:

Introduction

When psychiatric patients express a wish for euthanasia, this should first and foremost be interpreted as a cry for help. Due to their close day-to-day relationship, psychiatric nurses may play an important and central role in responding to such requests. However, little is known about nurses' attitudes towards euthanasia motivated by unbearable mental suffering.

Objectives

The aim of this study was to provide insight into the attitudes and actions taken by psychiatric nurses when confronted with a patient's euthanasia request based on unbearable mental suffering (UMS).

Method

A questionnaire was sent to 11 psychiatric hospitals in the Flemish part of Belgium.

Results

The overall response rate was 70% (N = 627). Psychiatric nurses were frequently confronted with a request for euthanasia, either directly (N = 329, 53%) or through a colleague (N = 427, 69%). A majority (N = 536, 84%) did not object to euthanasia in a psychiatrically ill population with UMS. Confounding factors were the psychiatric diagnosis and the type of ward where the nurses were working. Most participants acknowledged a lack of knowledge and skills to adequately address the euthanasia request (N = 434, 71%). Nearly unanimously (N = 618, 99%), study participants indicated that dealing with euthanasia requests and other end-of-life issues should be part of the formal training of nurses.

Conclusion

The results highlight the need for ethically sound and comprehensive provision of care. Psychiatric nurses play an important role in dealing with the complex issue of requests for euthanasia. There is also a need for education, training and clear guidelines on the level of health care organizations.

SUBMITTER: De Hert M

PROVIDER: S-EPMC4689522 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Publications

Attitudes of Psychiatric Nurses about the Request for Euthanasia on the Basis of Unbearable Mental Suffering(UMS).

De Hert Marc M Van Bos Liesbet L Sweers Kim K Wampers Martien M De Lepeleire Jan J Correll Christophe U CU

PloS one 20151223 12

<h4>Introduction</h4>When psychiatric patients express a wish for euthanasia, this should first and foremost be interpreted as a cry for help. Due to their close day-to-day relationship, psychiatric nurses may play an important and central role in responding to such requests. However, little is known about nurses' attitudes towards euthanasia motivated by unbearable mental suffering.<h4>Objectives</h4>The aim of this study was to provide insight into the attitudes and actions taken by psychiatri ...[more]

PMID: 26700007

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Project description:BackgroundAlthough euthanasia and assisted suicide (EAS) in people with psychiatric disorders is relatively rare, the increasing incidence of EAS requests has given rise to public and political debate. This study aimed to explore support of the public and physicians for euthanasia and assisted suicide in people with psychiatric disorders and examine factors associated with acceptance and conceivability of performing EAS in these patients.MethodsA survey was distributed amongst a random sample of Dutch 2641 citizens (response 75%) and 3000 physicians (response 52%). Acceptance and conceivability of performing EAS, demographics, health status and professional characteristics were measured. Multivariable logistic regression analyses were performed.ResultsOf the general public 53% were of the opinion that people with psychiatric disorders should be eligible for EAS, 15% was opposed to this, and 32% remained neutral. Higher educational level, Dutch ethnicity, and higher urbanization level were associated with higher acceptability of EAS whilst a religious life stance and good health were associated with lower acceptability. The percentage of physicians who considered performing EAS in people with psychiatric disorders conceivable ranged between 20% amongst medical specialists and 47% amongst general practitioners. Having received EAS requests from psychiatric patients before was associated with considering performing EAS conceivable. Being female, religious, medical specialist, or psychiatrist were associated with lower conceivability. The majority (> 65%) of the psychiatrists were of the opinion that it is possible to establish whether a psychiatric patient's suffering is unbearable and without prospect and whether the request is well-considered.ConclusionThe general public shows more support than opposition as to whether patients suffering from a psychiatric disorder should be eligible for EAS, even though one third of the respondents remained neutral. Physicians' support depends on their specialization; 39% of psychiatrists considered performing EAS in psychiatric patients conceivable. The relatively low conceivability is possibly explained by psychiatric patients often not meeting the eligibility criteria.

Project description:Timely euthanasia is a fundamental part of safeguarding swine welfare by reducing suffering when compromised pigs are unable to recover. The quality and appropriateness of timely euthanasia rely mainly on the knowledge and experience of the individual caretaker but may also be affected by caretaker attitudes toward euthanasia. However, literature on caretaker attitudes toward swine euthanasia is lacking. This study investigated caretaker attitudes, perceived knowledge, and confidence in performing on-farm timely euthanasia. A total of 84 caretakers from eight swine farms (ranging in size from 1,300 to 7,000 sows) participated in a survey designed to investigate attitudes toward swine and swine euthanasia. Caretaker's ages ranged from 18 to 59 yr with an average work experience of 8.5 yr. The majority of participants worked in either farrowing or breeding units. Survey questions were designed to assess caretakers' attitudes and attributes (empathy affect, empathy attribution, attitudes toward pigs, feeling bad about euthanizing pigs, and assumptions about pigs' emotional capabilities), decision-making skills (confidence in identifying compromised pigs or relying on coworkers to make decisions), and euthanasia skillset (confidence in performing euthanasia, training, and perceived level of knowledge). Using cluster analysis to analyze survey answers, three distinct groups of caretakers were identified: 1) confident and empathetic; 2) Confident, knowledgeable, and detached; and 3) unconfident and lacking knowledge. The survey results showed that empathy attribution was strongly correlated with empathy affect (r = 0.571, P < 0.01) and that empathy affect and empathy attribution were higher in female caretakers compared with male caretakers (P < 0.05). A risk analysis that included previously identified clusters showed that females were more likely to be grouped among caretakers that were confident and empathetic (P = 0.04), and caretakers with more than 2 yr of swine experience were more likely to be grouped as confident and skilled (P = 0.01), while the unconfident and empathetic were more likely to have had less than 2 yr of experience (P = 0.04). This study provides important information about variability in caretaker experience as well as their attitudes toward pigs and timely euthanasia. Increased knowledge about swine caretaker attitudes may be used to implement training and euthanasia protocols to increase both human and pig welfare on farm.

Project description:BackgroundThe medical-ethical dilemmas related to euthanasia and physician-assisted suicide (EAS) in psychiatric patients are highly relevant in an international context. EAS in psychiatric patients appears to become more frequent in the Netherlands. However, little is known about the experiences of psychiatrists with this practice. This study aims to estimate the incidence of EAS (requests) in psychiatric practice in The Netherlands and to describe the characteristics of psychiatric patients requesting EAS, the decision-making process and outcomes of these requests.MethodsIn the context of the third evaluation of the Dutch Euthanasia Act, a cross-sectional study was performed between May and September 2016. A questionnaire was sent to a random sample of 500 Dutch psychiatrists. Of the 425 eligible psychiatrists 49% responded. Frequencies of EAS and EAS requests were estimated. Detailed information was asked about the most recent case in which psychiatrists granted and/or refused an EAS request, if any.ResultsThe total number of psychiatric patients explicitly requesting for EAS was estimated to be between 1100 and 1150 for all psychiatrists in a one year period from 2015 to 2016. An estimated 60 to 70 patients received EAS in this period. Nine psychiatrists described a case in which they granted an EAS request from a psychiatric patient. Five of these nine patients had a mood disorder. Three patients had somatic comorbidity. Main reasons to request EAS were 'depressive feelings' and 'suffering without prospect of improvement'. Sixty-six psychiatrists described a case in which they refused an EAS request. 59% of these patients had a personality disorder and 19% had somatic comorbidity. Main reasons to request EAS were 'depressive feelings' and 'desperate situations in several areas of life'. Most requests were refused because the due care criteria were not met.ConclusionsAlthough the incidence of EAS in psychiatric patients increased over the past two decades, this practice remains relatively rare. This is probably due to the complexity of assessing the due care criteria in case of psychiatric suffering. Training and support may enable psychiatrists to address this sensitive issue in their work better.

Project description:Nursing students are confronted with euthanasia during their internship and certainly during their later career but they feel inadequately prepared in dealing with a euthanasia request. This study presents a simulation module focused on euthanasia and evaluates nursing students' perceptions after they have completed the simulation practice. The 'euthanasia module' consisted of a preparatory online learning module, a good-practice video, an in-vivo simulation scenario, and a debriefing session. The module's content was validated by four experts in end-of-life care. The module was completed by three groups of students from two different University Colleges (n = 17 in total). The students were divided into three groups: one with no previous simulation education experience, one with all students having previous experience, and another with a mix of experiences. After completing the entire module, each group had a discussion regarding their perceptions and expectations concerning this simulation module. Thematic content analysis was conducted on audio-recorded group interviews using NVIVO® software, involving initial open coding, transformation into specific themes and subthemes through axial coding, and defining core themes through selective coding, with data analysis continuing until data saturation was reached. Students generally found the online learning module valuable for background information, had mixed perceptions of the good-practice video, and appreciated the well-crafted scenarios with the taboo of euthanasia emerging during simulations, while the debriefing process was seen as enhancing clinical reasoning abilities. Students considered the simulation module a valuable addition to their education and nursing careers, expressing their satisfaction with the comprehensive coverage of the sensitive topic presented without sensationalism or taboos. This subject holds significance for nations with established euthanasia laws and those lacking such legal frameworks. The findings of this study can aid teachers in developing and accessing euthanasia simulation training programs, contributing to broader education's emphasis on integrating euthanasia-related knowledge and skills.

Dataset Information

Attitudes of Psychiatric Nurses about the Request for Euthanasia on the Basis of Unbearable Mental Suffering(UMS).

Introduction

Objectives

Method

Results

Conclusion

Publications

Attitudes of Psychiatric Nurses about the Request for Euthanasia on the Basis of Unbearable Mental Suffering(UMS).

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