Swiss Families' Experiences of Interactions with Providers during Assisted Suicide:A Secondary Data Analysis of an Interview Study

Context: Families are known to be involved in assisted dying and their involvement can be influenced by many factors. Objectives: To explore how Swiss families interact with health care professionals and right-to-die associations regarding assisted suicide and their choices around disclosure. Methods: A secondary data analysis on a cross-sectional qualitative interview study conducted in the Italian- and French-speaking parts of Switzerland was conducted. Interviews with 28 bereaved family members were analyzed using framework analysis. Results: Two main themes were identified: (1) Interactions with physicians and right-to-die associations. (2) Choices about disclosing their experiences. In general, families believed that assisted suicide is a private matter, to be pursued mainly outside the medical field and involved physicians only when necessary. Families appeared to deliberately limit interaction with physicians and to be more comfortable interacting with the right-to-die associations. Some participants presumed a clear choice between assisted suicide or palliative care. Disclosing to others the decision, and preparation of assisted suicide emerged to be an important emotional burden for families. Some family members preferred to restrict disclosure before and after assisted suicide, by sometimes not informing other family members until the final days. Conclusion s : In Switzerland, there is limited interaction between families and health care professionals concerning assisted suicide decisions, whereas families reported more open interactions with right-to-die associations. It is recommended that the needs of families should be reflected in health policies, taking into consideration the different contexts where assisted dying is permitted

Family members' experiences of assisted dying : A systematic literature review with thematic synthesis

BACKGROUND: Families' experiences of assisted dying are under-investigated and families are rarely considered in clinical guidelines concerning assisted dying. AIM: To systematically review family experiences of assisted dying. DESIGN: A systematic literature review using thematic synthesis. DATA SOURCES: MEDLINE, Embase, CINAHL, AMED (Allied and Complementary Medicine) and PsycINFO databases (January 1992 to February 2019). Studies investigating families' experiences on the practice of legalised assisted dying were included. We excluded studies prior to legalisation within the jurisdiction, secondary data analysis and opinion papers. RESULTS: Nineteen articles met the inclusion criteria. Publications were derived from four countries: The Netherlands, United States (Oregon, Washington and Vermont), Canada and Switzerland. Dutch studies predominately investigated family involvement in euthanasia, while Swiss and American studies only reported on assisted suicide. Eleven studies had a qualitative design, using predominately in-depth interviews; seven were retrospective surveys. Five analytical themes represented families' experiences in assisted dying: (1) context of the decision, (2) grounding the decision, (3) cognitive and emotional work, (4) experiencing the final farewell and (5) grief and bereavement. The results showed that families can be very involved in supporting patients seeking assisted dying, where open communication is maintained. Family involvement appeared to be influenced by the type of legislation in their country and the families' perception of the social acceptability of assisted dying. CONCLUSION: Our data confirm that families across all jurisdictions are involved in assisted suicide decision and enactment. Family needs are under-researched, and clinical guidelines should incorporate recommendations about how to consider family needs and how to provide them with evidence-based tailored interventions

Competências centrais em cuidados paliativos: um guia orientador da EAPC sobre educação em cuidados paliativos: parte 1

A Associação Europeia de Cuidados Paliativos (European Association for Palliative Care, EAPC) descreve as competências centrais que os profissionais da saúde e das ciências sociais envolvidos nos cuidados paliativos devem possuir, num guia orientador consensual elaborado por Claudia Gamondi, Philip Larkin e Sheila Payneinfo:eu-repo/semantics/publishedVersio

Competências centrais em cuidados paliativos: um guia orientador da EAPC sobre educação em cuidados paliativos: parte 1

A Associação Europeia de Cuidados Paliativos (European Association for Palliative Care, EAPC) descreve as competências centrais que os profissionais da saúde e das ciências sociais envolvidos nos cuidados paliativos devem possuir, num guia orientador consensual elaborado por Claudia Gamondi, Philip Larkin e Sheila Payneinfo:eu-repo/semantics/publishedVersio

The experiences of families who support a patient who dies from assisted suicide in Switzerland

Background Permissive legislation about assisted dying is increasing internationally. While patients’ and health care professionals’ rights, duties, and needs are considered in guidelines, the experience of patients’ families remains under-researched. Aim To investigate the experience of family members with patients, health care professionals and right to die associations when the patient is in the process of seeking assisted suicide. Methods (i) A systematic literature review was performed about families’ experiences with a family member who died with assisted dying, in jurisdictions where it is it is legally permissible using thematic synthesis. (ii) An empirical qualitative interview study to investigate Swiss families’ reflections of their experiences when a family member is considering assisted suicide analysed deductively framework analysis. A secondary data analysis was performed using framework analysis to depict Swiss family members’ reflections on their interactions with health care professionals and right to die associations during the time their family members were considering assisted suicide. (iii) An empirical qualitative interview study with palliative care physicians to explore Swiss palliative care physicians’ accounts of interactions with patients and their families when they are considering assisted suicide analysed inductively with thematic analysis. Results The literature review (19 articles) showed that families across all jurisdictions are involved in assisted suicide decision and enactment, where open communication is maintained, and that family needs in this context are under-researched. The interview studies (28 relatives and 23 physicians) showed that Swiss family carers are often involved in the preparation of assisted suicide along with patients, irrespective of their personal values. Swiss palliative care physicians struggle to reconcile their ethical principles with the patients’ wishes to exercise their autonomy, and deplore the lack of legal and professional guidelines. The secondary analysis revealed that, in Switzerland, there is limited interaction about assisted suicide between families and health care professionals, where families report more open interactions with right-to-die associations. Conclusion It is argued that this thesis extends existing understanding of the role of family carers during assisted dying by (i) highlighting their active supporting role in many instances of this practice, (ii) describing the multiple moral and social tensions that result from this support, and (iii) drawing attention to the unmet needs of family caregivers, as well as treating physicians, in the context of assisted suicide

Quand accompagnement de fin de vie rime avec assistance au suicide : l’expérience des proches en Suisse latine

In Switzerland, assisted suicide is mainly accessible to the members of right-to-die organizations and its practice has increased in a specific legal context. The way the relatives are involved in this helping-to-die process is widely unknown. This article analyzes this singular end-of-life assistance and care, which takes place through a process where illness trajectories have to be reconciled with the standard procedure for assisted suicide. We highlight how the relatives are involved in a large range of emotional and instrumental activities in their daily lives: they are empathetic toward suffering, care, help get medical certificates, negotiate the day of the death and the choice of people to be informed about this decision

Euthanasia, assisted dying, and assisted suicide in palliative care settings:reports from the Netherlands, Switzerland, and Washington State (TH323)

In somatic medicine, diagnostic terms often refer to the disease processes that are the causes of patients' symptoms. The language used in some clinical textbooks and health information resources suggests that this is also sometimes assumed to be the case with diagnoses in psychiatry. However, this seems to be in tension with the ways in which psychiatric diagnoses are defined in diagnostic manuals, according to which they refer solely to clusters of symptoms. This paper explores how theories of reference in the philosophy of language can help to resolve this tension. After the evaluation of descriptive and causal theories of reference, I put forward a conceptual framework based on two-dimensional semantics that allows the causal analysis of diagnostic terms in psychiatry, while taking seriously their descriptive definitions in diagnostic manuals. While the framework is presented as a solution to a problem regarding the semantics of psychiatric diagnoses, it can also accommodate the analysis of diagnostic terms in other medical disciplines