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PubMed1994

Euthanasia in The Netherlands.

The practice of euthanasia in the Netherlands is often used as an argument in debates outside the Netherlands--hence a clear description of the Dutch situation is important. This article summarises recent data and discusses conceptual issues and relevant characteristics of the system of health care. Special emphasis is put on regulation, including relevant data on notification and prosecution. Besides the practice of euthanasia the Dutch are confronted with the gaps in reporting of cases to the public prosecutor and the existence of cases of ending a life without an explicit request. Nevertheless, the "Dutch experiment" need not inevitably lead down the slippery slope because of the visibility and openness of this part of medical practice. This will lead to increased awareness, more safeguards, and improvement of medical decisions concerning the end of life.

Advance Directives↗
PubMed2004

Euthanasia: above ground, below ground.

The key to the euthanasia debate lies in how best to regulate what doctors do. Opponents of euthanasia frequently warn of the possible negative consequences of legalising physician assisted suicide and active euthanasia (PAS/AE) while ignoring the covert practice of PAS/AE by doctors and other health professionals. Against the background of survey studies suggesting that anything from 4% to 10% of doctors have intentionally assisted a patient to die, and interview evidence of the unregulated, idiosyncratic nature of underground PAS/AE, this paper assesses three alternatives to the current policy of prohibition. It argues that although legalisation may never succeed in making euthanasia perfectly safe, legalising PAS/AE may nevertheless be safer, and therefore a preferable policy alternative, to prohibition. At a minimum, debate about harm minimisation and the regulation of euthanasia needs to take account of PAS/AE wherever it is practised, both above and below ground.

Attitude of Health Personnel↗
PubMed1990

Fatal attraction: the ethical and clinical dilemma of patient-therapist sex.

This article reviews the existing literature on the subject of patient-therapist sexual contact. Seven point one percent to 10.9% of male therapists and 1.9% to 3.5% of female therapists admit to engaging in intimate contact with patients. Offenders tend to justify their behaviour as being at least innocuous if not beneficial for the patients. The consequences to the patients include increased psychological and psychosomatic complaints, greater mistrust and anger towards men, hospitalization and suicide. Transference and countertransference issues which account for this behaviour are explored as is the issue of post-termination involvement. Education of physicians and residents concerning the temptations and dangers of this type of contact is strongly recommended.

Attitude of Health Personnel↗
PubMed1995

Organ transplantation as a transformative experience: anthropological insights into the restructuring of the self.

Transplantation represents in the popular mind the pinnacle of biomedical knowledge and skill. Its feasibility depends upon the management of conflicting cultural values surrounding death and dying, where diverse parties consider bodies and their parts to be personal property, sacred entities, or offerings to the common good. Specifically within the specialized transplant community, viable organs are scarce, socially valuable resources. The ideology that guides transplant professionals, however, is rife with contradictions: close inspection reveals unease over definitions of death and rights to body parts. Ideological disjunction arises from the competing needs to personalize and to objectify organs and bodies. Organ recipients struggle with these contradictory messages as they rebuild their sense of self and self-worth following transplantation. This transformative process is explored by analyzing professional writings and data generated from ethnographic research in the United States. The study ends by examining transformed identity as fictionalized and extended biography.

Adaptation, Psychological↗
PubMed1991

Limiting resuscitation: emerging policy in the emergency medical system.

Patients, families, and physicians frequently decide that a hospitalized patient will forgo cardiopulmonary resuscitation and document this decision with a do-not-resuscitate (DNR) order. In community settings (home, nursing home, hospice), these orders may conflict with paramedics' standing orders to provide cardiopulmonary resuscitation whenever it is medically indicated. We did a nationwide telephone survey of state offices for coordination of emergency medical services (EMS) to see how the states deal with this potential conflict. We identified eight states that have specific policies enabling EMS personnel to accept DNR orders for patients being transported by ambulance. State officials identified administrative complexities and legal concerns as the primary barriers to enacting prehospitalization DNR policies. We also identified 21 local EMS systems that have developed policies for accepting orders to withhold life-sustaining treatment. Four types of policy models, characterized according to procedure for validating DNR orders and telephone accessing the EMS system, show that regulatory reform can address policy barriers in the absence of enabling legislation.

Attitude of Health Personnel↗
PubMed1988

Giving life, giving death: ethical problems of high-technology medicine.

High-technology medicine, such as dialysis and transplantation is limited and nowhere can all potential beneficiaries receive it. Although very successful, high-technology medicine sometimes makes dying to a cruel spectacle and patients whose lives depend on a machine want to stop. The resulting ethical questions revolve around just distribution of life support - giving life, and withdrawal of life support in giving death. We investigated distributive justice of life-support by setting the number of patients accepted for dialysis in relation to those who died of renal failure and by setting the transplanted patients in relation to those waiting on chronic dialysis. In both Sweden and in the USA, and in both dialysis and transplantation, older patients received less treatment than younger ones. Seventy-year old people had less than 1/10 the chance of 20-40 year old of receiving dialysis and less than 1/30 chance of receiving a transplant. Women had between 70%-90% the chance of men of receiving dialysis and transplantation in both countries. Black people were more often dialyzed, but less often transplanted in the USA. Neither in Sweden, nor in the USA has distributive justice been achieved in dialysis and transplantation. Similar problems have been reported in other areas of high-technology medicine. We studied withdrawal, i.e. passive euthanasia, in chronic dialysis patients and found that 10% of all patients who begun dialysis died because it was stopped, although there was no medical or technical reason. Stopping caused 22% of all dialysis deaths. Half of those who died because dialysis was stopped, made the decision to stop treatment themselves. The other half was incompetent and families and physicians decided to discontinue treatment and let the patient die. The competent and incompetent patients were similar and the decisions seem to have been made on the same ground in both groups suggesting that families and physicians are appropriate surrogate decision-makers for incompetent patients. Home dialysis patients withdrew from dialysis, three times more often than center dialysis patients. The decision did not seem to harm the surviving relatives, but the relatives complained of poor physician communication. Old patients had shorter survival on dialysis, were more often excluded from, and stopped dialyses ten times more often than young patients. However, the ratio of mortality on dialysis compared to the mortality in the population at large was higher in young than in old patients and the self-reported quality of life of the old patients was particularly high.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2001

[Development of new antineoplastic agents: 10 years of active clinical research marked by the evolution of treatment, from an empirical to a rational approach].

In addition to well-known cytotoxic agents in the treatment of cancer, promising novel cytotoxic and biologic agents are being investigated. The combination of classical cytotoxic drugs or radiotherapy, along with these new molecules specifically targeted at numerous points in intracellular signalling, cell cycle control, and the cancer cell environment, represents our best hope for improved outcome in systemic cancer therapy. This report summarizes the phase I clinical studies with these novel anticancer agents, performed and supervised the last ten years by the author at the chemotherapy unit of the Jules Bordet Institute.

Antineoplastic Agents↗
PubMed2005

Self-determination: analysis of the concept and implications for research in palliative care.

This paper analyzes the evolution and the definition, current use, and application of the concept of self-determination in palliative care research and practice. Undertaken as a foundation for the development of a palliative care research program, the analysis considers selected historical, bioethical, legal, clinical, and relevant medical and nursing health-care literature on adults with chronic and terminal illness. Based on a synthesis of the literature, a conceptual definition is proposed and ways of integrating the concept of self-determination into palliative care intervention research are identified.

Humans↗
PubMed1990

Ethical reasoning associated with the feeding of terminally ill elderly cancer patients. An international perspective.

An international nursing research study examined the ethical decision-making of "good and experienced" registered nurses in eight countries. The subjects were asked about their decision to feed or not to feed a hypothetical terminally ill, mentally alert, elderly cancer patient who refuses to eat. Cultural variations were demonstrated in the decisions as well as differences in ethical justification. The majority of nurses who would not feed appeared to use the principle of autonomy, whereas nurses who would feed the patient used beneficence as justification. Conditions under which nurses would change their decision to either feed or not feed the patient against her will included doctor's orders and lack of peer support for the decision. The majority of nurses clearly experienced a dilemma.

Adult↗