Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-25T09:07:53.242Z Has data issue: false hasContentIssue false
  • English
  • Français

Medical decisions at the end of life: epidemiological and psychiatric aspects

Published online by Cambridge University Press:  11 October 2011

Fabrizio Starace
Fabrizio Starace*
Affiliation:
CERIFARC, Assessorato alla Sanità, Regione Campania, Napoli Istituto di Psichiatria, Università di Napoli SUNDepartment of Primary Care and Population Sciences, RFHSM, University of London, London, UK
*
Indirizzo per la corrispondenza: Dr. F. Starace, CERIFARC, Assessorato alia Sanità Regione Campania, Via S. Lucia 81, 80100 Napoli. Fax +39 081 7962533 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

Objective — Despite the ongoing moral and legal debate, there is still a paucity of empirical literature on the actual occurrence of Medical Decisions at the End of Life (MDEL). Moreover, the psychiatrist's role in this scenario is still unclear. Methods — This paper systematically reviews currently available literature on euthanasia (EU) and physician assisted suicide (PAS). Published articles were selected if they reported either: 1) prevalence estimates of patients' requests of EU/PAS; and/or 2) prevalence estimates of physicians' actual EU/PAS practices. Papers exploring the issue of MDEL-related psychiatric consultation have been also included in the review. Results — The empirical evidence reported in this paper shows that EU/PAS demands and acts are not uncommon in medical practice. A conservative estimate indicates that at least 10% of physicians have granted a request of EU/PAS. The involvement of consultation-liaison psychiatrists in MDELs seems to be relatively rare. Conclusions — Euthanasia and other MDELs require physicians' thoughtful evaluation of criteria guiding professional decision-making. To this purpose, epidemiological and psychosocial research can offer a valuable contribution.

Riassunto

Scopo — Il dibattito attuale sulle decisioni mediche di fine vita (DMFV) è caratterizzato da toni ed argomentazioni prevalentemente filosofici e confessionali. Scarsa attenzione è stata sinora rivolta a chiarire la reale diffusione di queste pratiche ed ancor meno esplorato risulta il ruolo che lo psichiatra e chiamato a svolgere in tale delicato contesto. Metodo — È stata condotta una revisione sistematica della letteratura degli ultimi dieci anni sulle DMFV, selezionando gli studi che riportavano: 1) stime della frequenza con cui i medici avevano ricevuto richieste di eutanasia (EU) e di assistenza al suicidio (SA); e/o 2) stime della frequenza con cui i medici avevano realmente praticato EU/SA. Sono stati inoltre passati in rassegna i lavori nei quali erano considerati i problemi relativi alia consulenza psichiatrica. Risultati — I risultati delle indagini esaminate documentano che le DMFV sono molto phi frequenti di quanto comunemente si ritenga. Una stima conservativa indica che almeno un medico su dieci ha praticato l'EU/SA. Una scarsa considerazione della consulenza psichiatrica è l'atteggiamento prevalente rilevato nei rari studi condotti sul tema. Conclusioni — L'eutanasia e le altre DMFV impongono alia coscienza ed alia pratica medica una riflessione profonda sui criteri che guidano l'agire umano e professionale degli operatori sanitari. Il contributo che la ricerca epidemiologica e psicosociale puo offrire al dibattito bioetico è indispensabile.

Keywords

decisioni mediche di fine vitaeutanasiasuicidio assistitoMedical Decisions at the End of Life (MDEL)euthanasiaphysician assisted suicide
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 7 , Issue 2 , August 1998 , pp. 135 - 146
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

BIBLIOGRAFIA

American Medical Association (1994). Euthanasia/physician-assisted suicide: lessons in the Dutch experience. Issues in Law & Medicine 10, 81–90.Google Scholar
Back, A.L., Wallace, J.I., Starks, H.E. & Pearlman, R.A. (1996). Physician-assisted suicide and euthanasia in Washington State. Patient requests and physician responses. Journal of American Medical Association 275, 919–925.CrossRefGoogle ScholarPubMed
Banazak, D.A. (1996). Late-life depression in primary care. How well are we doing? Journal of General and Internal Medicine 11, 163–167.CrossRefGoogle ScholarPubMed
Baume, P. & O'Malley, E. (1994). Euthanasia: attitudes and practices of medical practitioners. Medical Journal of Australia 161, 137–144.Google Scholar
Breitbart, W., Bruera, E., Chochinov, H. & Lynch, M. (1995). Neuropsychiatric syndromes and psychological symptoms in patients with advanced cancer. Journal of Pain and Symptom Management 10, 131–141.Google Scholar
Brown, J.H., Henteleff, P., Barakat, S. & Rowe, C.J. (1986). Is it normal for terminally ill patients to desire death? American Journal of Psychiatry 143, 208–211.Google ScholarPubMed
Cantor, N.L. (1996). Can health care providers obtain judicial intervention against surrogates who demand wmedically inappropriate» life support for incompetent patients? Critical Care Medicine 24, 883–887.CrossRefGoogle ScholarPubMed
Charlesworth, M. (1993). Bioethics in a Liberal Society. Cambridge University Press: London.Google Scholar
Di Mola, G., Borsellino, P., Brunelli, C., Gallucci, M., Gamba, A., Lusignani, M., Regazzo, C., Santosuosso, A., Tamburini, M. & Toscani, F. (1996). Attitudes toward euthanasia of physician members of the Italian Society for Palliative Care. Annals of Oncology 7, 907–911.CrossRefGoogle ScholarPubMed
Doukas, D.J., Waterhouse, D., Gorenflo, D.W. & Seid, J. (1995). Attitudes and behaviors on physician-assisted death: a study of Michigan oncologists. Journal of Clinical Oncology 13, 1055–1061.CrossRefGoogle Scholar
Emanuel, E., Fairclough, D.L., Daniels, E.R. & Clarridge, B.R. (1996). Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public. Lancet 347, 1805–1810.CrossRefGoogle ScholarPubMed
Fainsinger, R., Bruera, E., Miller, M.J., Hanson, J. & MacEachern, T. (1991). Symptom Control during the last week of life on a palliative care unit. Journal of Palliative Care 7, 5–11.Google ScholarPubMed
Folker, A.P., Holtug, N., Jensen, A.B., Kappel, K., Nielsen, J.K. & Norup, M., (1996). Experiences and attitudes towards end-of-life decisions amongst Danish physicians. Bioethics 10, 233–249.CrossRefGoogle ScholarPubMed
Forde, R., Aasland, O.G. & Falkum, E. (1997). The ethics of euthanasia: attitudes and practice among Norwegian physicians. Social Science and Medicine 45, 887–892.CrossRefGoogle ScholarPubMed
Fried, T.R., Stein, M.D., O'Sullivan, P.S., Brock, D.W. & Novack, D.H. (1993). Limits of patient autonomy. Physician attitudes and practices regarding life-sustaining treatments and euthanasia. Archives of Internal Medicine 153, 722–728.CrossRefGoogle ScholarPubMed
Ganzini, L., Lee, M.A., Heintz, R.T., Bloom, J.D. & Fenn, D.S. (1994). The effect of depression treatment on elderly patients' preferences for life-sustaining medical therapy. American Journal of Psychiatry 151, 1631–1636.Google Scholar
Ganzini, L., Fenn, D.S., Lee, M.A., Heintz, R.T. & Bloom, J.D. (1996). Attitudes of Oregon psychiatrists toward physician-assisted suicide. American Journal of Psychiatry 153, 1469–1475.Google ScholarPubMed
Groenewoud, J.H., Van der Maas, P.J., Van der Wai, G., Hengeveld, M.W., Tholen, A.J., Schdel, W.J. & Van der Heide, A. (1997). Physician-assisted death in psychiatry practice in the Netherlands. New England Journal of Medicine 336, 1795–1801.Google Scholar
Haghbin, Z., Streltzer, J. & Danko, G.P. (1996). Assisted suicide in AIDS: physicians' attitudes. In Proceedings of 149th Annual Meeting of the American Psychiatric Association (New York, May 1996).Google Scholar
Hanson, L.C., Danis, M., Mutran, E. & Keenan, N.L. (1994). Impact of patient incompetence on decisions to use or withhold life-sustaining treatment. American Journal of Medicine 97, 235–241.CrossRefGoogle ScholarPubMed
Hendin, H. (1994). Seduced by death: doctors, patients and the Dutch cure. Issues in Law and Medicine 20, 123–168.Google Scholar
Hendin, H. & Klerman, G. (1993). Physician-assisted suicide: the dangers of legalization. American Journal of Psychiatry 150, 143–145.Google ScholarPubMed
Huyse, F.J. & Van Tilburg, W. (1993). Euthanasia policy in the Netherlands: the role of consultation-liaison psychiatrists. Hospital and Community Psychiatry 44, 733–738.Google ScholarPubMed
Kinsella, T.D. & Verhoef, M.J. (1993). Alberta euthanasia survey: 1. Physicians' opinions about the morality and legalization of active euthanasia. Canadian Medical Association Journal 148, 1921–1926.Google Scholar
Kuhse, H. & Singer, P. (1988). Doctors' practices and attitudes regarding voluntary euthanasia. Medical Journal of Australia 148, 623–627.CrossRefGoogle ScholarPubMed
Kuhse, H., Singer, P., Baume, P., Clark, M. & Rickard, M. (1997). End of life decisions in Australian Medical practice. Medical Journal of Australia 166, 191–196.CrossRefGoogle ScholarPubMed
Lee, M.A., Nelson, H.D., Tilden, V.P., Ganzini, L., Schmidt, T.A. & Tolle, S.W. (1996). Legalizing assisted suicide. Views of physicians in Oregon. New England Journal of Medicine 334, 310–315.CrossRefGoogle ScholarPubMed
Magnani, K., Ercolani, M. & Grassi, L. (1997). Atteggiamento del medico nei confronti della richiesta di eutanasia e di suicidio assistito. In Atti del XVI Congresso Nazionale Societd Italiana di Medicina Psicosomatica (Parma, 1-4 maggio 1997).Google Scholar
Muller, M.T., Van der Wai, G., Van Eijk, J.T. & Ribbe, M.W. (1994). Voluntary active euthanasia and physician-assisted suicide in Dutch nursing homes: are the requirements for prudent practice propely met? Journal of the American Geriatrics Society 42, 624–629.CrossRefGoogle Scholar
Muller, M., Onwuteaka-Philipsen, B., Van der Wai, G., Van Eijk, J. & Ribbe, M. (1996). The role of the social network in active euthanasia and physician-assisted suicide. Public Health 110, 271–275.CrossRefGoogle ScholarPubMed
Overmyer, M. (1991). Physicians' view on the right to die. Physician's Management 1, 40–60.Google Scholar
Pereira, J., Hanson, J. & Bruera, E. (1997). The frequency and clinical course of cognitive impairment in patients with terminal cancer. Cancer 79, 835–842.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
Pijnenborg, L., Van der Maas, P.J., Van Delden, J.J. & Looman, C.W. (1993). Life-terminating acts without explicit request of patient. Lancet 341, 1196–1199.Google Scholar
Pijnenborg, L., Van Delden, J.J., Kardaun, J.W., Glerum, J.J. & Van der Maas, P.J. (1994). Nationwide study of decisions concerning the end of life in general practice in the Netherlands. British Medical Journal 309, 1209–1212.CrossRefGoogle ScholarPubMed
Quill, T.E., Tolle, S.W. & Annas, G.J. (1995). The Oregon Death ' with Dignity Act. New England Journal of Medicine 332, 1174–1175.Google ScholarPubMed
Royal Dutch Medical Association (1984). Standpunt Inzake Euthanasie. Medisch Contact: Amsterdam.Google Scholar
Sullivan, M.D. & Youngner, S.J. (1994). Depression, competence, and the right to refuse lifesaving medical treatment. American Journal of Psychiatry 151, 971–978.Google ScholarPubMed
Stevens, C.A. & Hassan, R. (1994). Management of death, dying and euthanasia: attitudes and practices of medical practitioners in South Australia. Journal of Medical Ethics 20, 41–46.Google Scholar
Uchitomi, Y., Okamura, H., Minagawa, H., Kugaya, A., Fukue, M., Kagaya, A., Oomori, N. & Yamawaki, S. (1995). A survey of Japanese physicians' attitudes and practice in caring for terminally ill cancer patients. Psychiatry and Clinical Neurosciences 49, 53–57.CrossRefGoogle ScholarPubMed
Van Der Maas, P.J., Van Delden, J.J., Pijnenborg, L. & Looman, C.W. (1991). Euthanasia and other medical decisions concerning the end of life. Lancet 338, 669–674.Google Scholar
Van der Maas, P.J., Van der Wai, G., Haverkate, I., De Graaf, C.L.M., Kester, J., Onwuteaka-Philipsen, B.D., Van der Heide, A., Bosma, J.M. & Willems, D.L. (1996). Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. New England Journal of Medicine 335, 1699–1705.Google Scholar
Van der Wai, G. & Dillmann, R.J.M. (1994). Euthanasia in the Netherlands. British Medical Journal 308, 1346–1349.Google Scholar
Van der Wai, G., Van Eijk, J.T., Leenen, H.J. & Spreeuwenberg, C. (1991a). Euthanasia and assisted suicide by physicians in the home situation. I. Diagnoses, age and sex of patients. Neder-lands Tijdschrift voor Geneeskunde 135, 1593–1598.Google Scholar
Van der Wai, G., Van Eijk, J.T., Leenen, H.J. & Spreeuwenberg, C. (1991b) Euthanasia and assisted suicide by physicians in the home situation. II. Suffering of the patients. Nederlands Tijdschrift voor Geneeskunde 135, 1599–1603.Google Scholar
Van der Wal, G., Van Eijk, J.T., Leenen, H.J. & Spreeuwenberg, C. (1992a). Euthanasia and assisted suicide. I. How often is it practised by family doctors in the Netherlands? Family Practice 9, 133–134.CrossRefGoogle ScholarPubMed
Van der Wal, G., Van Eijk, J.T., Leenen, H.J. & Spreeuwenberg, C. (1992b) The use of drugs for euthanasia and assisted suicide in family practice. Nederlands Tijdschrift voor Geneeskunde 136, 1299–1305.Google Scholar
Van der Wal, G., Van Eijk, J.T., Leenen, H.J. & Spreeuwenberg, C. (1992c). Euthanasia and assisted suicide. II. Do Dutch family doctors act prudently? Family Practice 9, 135–40.Google Scholar
Van der Wal, G., Muller, M.T., Christ, L.M., Ribbe, M.W. & Van Eijk, J.T. (1994). Voluntary active euthanasia and physician-assisted suicide in Dutch nursing homes: requests and administration. Journal of the American Geriatrics Society 42, 620–623.CrossRefGoogle ScholarPubMed
Van der Wal, G., Van der Maas, P.J., Bosma, J.M., Onwuteaka-Philipsen, B.D., Willems, D.L., Haverkate, I. & Kostense, P.J. (1996). Evaluation of the notification procedure for physician-assisted death in the Netherlands. New England Journal of Medicine 335, 1706–1711.CrossRefGoogle ScholarPubMed
Van Thiel, G., Van Delden, J., de Haan, K. & Huibers, A.K. (1997). Retrospective study of doctors' «end of life decisions» in caring for mentally handicapped people in institutions in the Netherlands. British Medical Journal 315, 88–91.CrossRefGoogle ScholarPubMed
Ventafridda, V., Ripamonti, C., De Conno, F., Tamburini, M. & Cassileth, B.R. (1990). Symptom prevalence and control during cancer patients' last days of life. Journal of Palliative Care 6, 7–11.Google Scholar
Verhoef, M.J. & Kinsella, T.D. (1993). Alberta euthanasia survey: 2. Physicians' opinions about the acceptance of active euthanasia as a medical act and the reporting of such practice. Canadian Medical Association Journal 148, 1929–1933.Google ScholarPubMed
Ward, B.J. & Tate, P.A. (1994). Attitudes among NHS doctors to requests for euthanasia. British Medical Journal 308, 1332–1334.CrossRefGoogle ScholarPubMed