Biomedical subjects

L J Materstvedt

Publications and source records attributed to L J Materstvedt.

4 recordsLinked to original sources

PubMed2002

Euthanasia and physician-assisted suicide in Scandinavia--with a conceptual suggestion regarding international research in relation to the phenomena.

This article analyses and compares recent research on Scandinavian physicians' attitudes towards, as well as their practice of, euthanasia and physician-assisted suicide. The studies discussed are quite dissimilar in their design, resulting in considerable difficulties as far as comparability is concerned. Such difficulties are common in these fields of research. As an intended contribution to the amendment of future research, we suggest what we take to be detailed and precise definitions of the terms euthanasia and physician-assisted suicide for use internationally. Our definitions, or interpretations, basically draw on the Dutch experience and understanding of these terms. The Dutch approach implies that acts of abstention from life-prolonging treatment, i.e., withholding and withdrawing treatment, and pain and symptom treatment that theoretically could shorten life (including terminal sedation) are to be considered 'normal medical practice'. Furthermore, death is seen as having natural causes in all of these acts. That, however, is not the case with euthanasia and physician-assisted suicide. When a physician performs either of these acts, he or she is required to state 'unnatural death' in the patient's death certificate. Our conceptual suggestions do not address the ethical status of the various medical decisions that are made with regard to the death of patients; our aim is conceptual clarity only. As far as euthanasia and physician-assisted suicide in Scandinavia is concerned, even though comparisons prove difficult, we do think some observations may be made: physicians from Norway, Denmark and Sweden display differences in both attitude and practice concerning these phenomena. Norwegian physicians are most restrictive with regard to attitude. Danish and Swedish physicians display a more liberal attitude, the latter being the most liberal. These findings did not fit the physicians' practice. Danish physicians have performed euthanasia and physician-assisted suicide more often than Norwegian physicians. Swedish physicians, even though they are the most liberal when it comes to attitude, appear never to have performed euthanasia and very seldom physician-assisted suicide.

Attitude of Health Personnel↗

PubMed2001

[Euthanasia in the Netherlands--and the debate in Norway].

The Netherlands is about to change the penal code so that starting in the autumn of 2001, euthanasia and physician-assisted suicide, will be lawful acts, provided that certain conditions are met. The concepts of "euthanasia" and "physician-assisted suicide" are defined in a detailed manner, congruent with Dutch theory and practice. In connection with these definitions, a sharp distinction is drawn between medicalized killing and withholding or withdrawing treatment, and it is demonstrated why so-called "active" and "passive" euthanasia are notions that make no sense in a Dutch context. The basic criteria for granting requests for euthanasia and physician-assisted suicide are introduced. The physician-patient relationship in the light of these practices is also a topic. It is pointed out that it is not uncommon that Dutch physicians find it emotionally burdensome to perform euthanasia. The claim that proper palliative treatment and care will work against patients' wish for euthanasia or physician-assisted suicide is discussed. From the public debate in Norway, one gets the impression that all humanists defend euthanasia and physician-assisted suicide. Yet there are prominent humanists amongst doctors who are distinctly opposed to these practices. On the other hand, in the Netherlands, we find hospital chaplains who defend euthanasia and physician-assisted suicide.

Ethics, Medical↗

PubMed2000

[Is terminal sedation active euthanasia?].

In order to be able to discuss the issue of whether or not terminal sedation is, or may be conceived of as, a form of help in dying, one needs to be very clear as to the meaning of the terms "help in dying" and "terminal sedation". In this article, we suggest what we take to be detailed and precise definitions of the two forms of voluntary help in dying--euthanasia and physician-assisted suicide. Our definitions (interpretations) basically draw on the Dutch experience and understanding. The Dutch approach implies that acts of abstention, i.e., withholding and withdrawing treatment, and pain and symptom treatment with possible life-shortening effect, including terminal sedation, are to be considered "normal medical practice". Furthermore, death is seen by almost all parties as having natural causes in all of these acts. We also suggest that "palliative sedation" should substitute the expression "terminal sedation". Furthermore, we discuss on what grounds this treatment strategy may be induced, including a presentation of criteria and guidelines that must be met; the issue of documentation of the strategy; palliative sedation in the light of the ethical principle of double effect; and in what way euthanasia could be concealed as palliative sedation. In closing, we comment briefly on the phenomenon of large differences between published cohorts with regard to the frequency of use of palliative sedation. This treatment strategy is open to be challenged both clinically and ethically, and all parties would benefit from a continuous debate over the legitimacy of, and the clinical need for, palliative sedation.

Attitude of Health Personnel↗

PubMed1999

[Hope].

This article deals with the phenomenon of hope in seriously ill and dying patients. Uncertainty is seen as a prerequisite for hope, fear as the "negative" side of hope. A scheme involving three particular kinds of hope is introduced: Hope on a daily basis; hope concerning a possible eternity; and hope based upon unrealistic premises. In a clinical setting, the question is: Taking into consideration the issues of how to inform and communicate with patients, how may the physician help the patient to express hope, and how may the physician contribute to reinforcing the patient's hope? Within palliative medicine, treatment may involve many aspects of a patient's life. It should be directed against the physical aspects of the disease, as well as the psychological, social, spiritual and existential dimensions of life. There are two fundamental questions patients with terminal cancer disease almost always ask: "Will the disease eventually cause my death?"; and, "Am I going to experience great pain and suffering?" These questions are clearly marked by hope. The hope that there will be little pain, for example, may not only relate to physical pain but to psychological and social pain as well.

Attitude to Death↗