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Patients' views on end-of-life practices that hasten death: a qualitative study exploring ethical distinctions.
Ann Palliat Med. 2020 Jun 24 [Online ahead of print]AP

Abstract

BACKGROUND

Assisted dying (AD) is currently of wide interest due to legislative change. Its relationship to other end-of-life practices such as palliative sedation (PS) is the subject of ongoing debate. The aim of this article is to describe the perspectives of a group of New Zealanders with life-limiting illness, who want or would consider AD, on the provision of end of life services, including assisted death, withdrawal of lifeprolonging treatment and symptom management with opioids or PS.

METHODS

We recruited 14 people with life-limiting illness and life expectancy of less than a year. Their mean age was 61 (range, 34-82) years and half were enrolled in Hospice. An additional six family members were also interviewed and included in analysis. We asked them about why they would consider AD if it was available. Interview transcripts were inductively analyzed consistent with thematic analysis. We compared the findings to prevailing ethical frameworks.

RESULTS

Most of the participants viewed current palliative care practices, such as pain relief with opioids and symptom management with PS, as hastening death, in contrast to some medical research which concludes that proportional therapeutic doses do not hasten death. Some participants did not agree with the 'doctrine of double effect' ('DDE') and saw such practices as 'slow euthanasia' and 'covert euthanasia'. They implied such practices were performed without patient consent, though they did not conceive of this as murder. Participants asserted that active and passive practices for ending life were morally equivalent, and preferred to choose the time of death over other legal means for death.

CONCLUSIONS

This article contributes to what is known about how patients perceive end-of-life practices that potentially hasten death. There is a divide in what medical ethics and most health professionals and what some patients consider active hastening death. Participants' perspective was consistent with a consequentialist framework whereas deontology often guides medical ethics at the end of life. Participants' challenge to the interpretation of legal end-of-life practices as AD represents an epistemic contest to the foundation of medical knowledge, authority and ethics and therefore carries implications for preferences in care, communication and palliative care practice.

Authors+Show Affiliations

Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand. jessica.young@otago.ac.nz.Bioethics Centre, University of Otago, Dunedin, New Zealand.Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand.Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32648455

Citation

Young, Jessica E., et al. "Patients' Views On End-of-life Practices That Hasten Death: a Qualitative Study Exploring Ethical Distinctions." Annals of Palliative Medicine, 2020.
Young JE, Winters J, Jaye C, et al. Patients' views on end-of-life practices that hasten death: a qualitative study exploring ethical distinctions. Ann Palliat Med. 2020.
Young, J. E., Winters, J., Jaye, C., & Egan, R. (2020). Patients' views on end-of-life practices that hasten death: a qualitative study exploring ethical distinctions. Annals of Palliative Medicine. https://doi.org/10.21037/apm-20-621
Young JE, et al. Patients' Views On End-of-life Practices That Hasten Death: a Qualitative Study Exploring Ethical Distinctions. Ann Palliat Med. 2020 Jun 24; PubMed PMID: 32648455.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patients' views on end-of-life practices that hasten death: a qualitative study exploring ethical distinctions. AU - Young,Jessica E, AU - Winters,Janine, AU - Jaye,Chrystal, AU - Egan,Richard, Y1 - 2020/06/24/ PY - 2020/7/11/entrez KW - Analgesics KW - double effect principle KW - ethics KW - euthanasia KW - medical KW - opioid KW - palliative care JF - Annals of palliative medicine JO - Ann Palliat Med N2 - BACKGROUND: Assisted dying (AD) is currently of wide interest due to legislative change. Its relationship to other end-of-life practices such as palliative sedation (PS) is the subject of ongoing debate. The aim of this article is to describe the perspectives of a group of New Zealanders with life-limiting illness, who want or would consider AD, on the provision of end of life services, including assisted death, withdrawal of lifeprolonging treatment and symptom management with opioids or PS. METHODS: We recruited 14 people with life-limiting illness and life expectancy of less than a year. Their mean age was 61 (range, 34-82) years and half were enrolled in Hospice. An additional six family members were also interviewed and included in analysis. We asked them about why they would consider AD if it was available. Interview transcripts were inductively analyzed consistent with thematic analysis. We compared the findings to prevailing ethical frameworks. RESULTS: Most of the participants viewed current palliative care practices, such as pain relief with opioids and symptom management with PS, as hastening death, in contrast to some medical research which concludes that proportional therapeutic doses do not hasten death. Some participants did not agree with the 'doctrine of double effect' ('DDE') and saw such practices as 'slow euthanasia' and 'covert euthanasia'. They implied such practices were performed without patient consent, though they did not conceive of this as murder. Participants asserted that active and passive practices for ending life were morally equivalent, and preferred to choose the time of death over other legal means for death. CONCLUSIONS: This article contributes to what is known about how patients perceive end-of-life practices that potentially hasten death. There is a divide in what medical ethics and most health professionals and what some patients consider active hastening death. Participants' perspective was consistent with a consequentialist framework whereas deontology often guides medical ethics at the end of life. Participants' challenge to the interpretation of legal end-of-life practices as AD represents an epistemic contest to the foundation of medical knowledge, authority and ethics and therefore carries implications for preferences in care, communication and palliative care practice. SN - 2224-5839 UR - https://www.unboundmedicine.com/medline/citation/32648455/Patients'_views_on_end-of-life_practices_that_hasten_death:_a_qualitative_study_exploring_ethical_distinctions L2 - https://doi.org/10.21037/apm-20-621 DB - PRIME DP - Unbound Medicine ER -
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