End-of-life decisions for people with intellectual disabilities, an interview study with patient representatives

Item does not contain fulltextBackground: Not much is known about the process of end-of-life decision-making for people with intellectual disabilities. Aim: To clarify the process of end-of-life decision-making for people with intellectual disabilities from the perspective of patient representatives. Design: A qualitative study based on semi-structured interviews, recorded digitally and transcribed verbatim. Data were analysed using Grounded Theory procedures. Participants: We interviewed 16 patient representatives after the deaths of 10 people with intellectual disabilities in the Netherlands. Results: The core category 'Deciding for someone else' describes the context in which patient representatives took end-of-life decisions. The patient representatives felt highly responsible for the outcomes. They had not involved the patients in the end-of-life decision-making process, nor any professionals other than the doctor. The categories of 'Motives' and 'Support' were connected to the core category of 'Deciding for someone else'. 'Motives' refers to the patient representatives' ideas about quality of life, prevention from suffering, patients who cannot understand the burden of interventions and emotional reasons reported by patient representatives. 'Support' refers to the support that patient representatives wanted the doctors to give to them in the decision-making process. Conclusions: From the perspective of the patient representatives, the process of end-of-life decision-making can be improved by ensuring clear roles and an explicit description of the tasks and responsibilities of all participants. Regular discussion between everyone involved including people with intellectual disabilities themselves can improve knowledge about each other's motives for end-of-decisions and can clarify expectations towards each other

Tree species identity outweighs the effects of tree species diversity and forest fragmentation on understorey diversity and composition

Background & aim – In general, biodiversity has positive effects on ecosystem functioning. In forests, understorey vegetation is influenced by both the composition and species richness of the overstorey through species-specific effects on environmental conditions at the forest floor. Forest fragmentation is also known to influence understorey vegetation composition and richness. However, the combined effects of tree species diversity and forest fragmentation have not been studied yet. With the TREEWEB research platform, consisting of 53 forest plots along a tree species diversity and forest fragmentation gradient, we aim to unravel the combined effects of tree species diversity, tree species identity and forest fragmentation on the understorey composition and diversity.Methods – The TREEWEB platform includes forest plots of three tree species richness levels, containing all possible species combinations of Quercus robur, Quercus rubra and Fagus sylvatica. Complete dilution is avoided in the design, allowing separation between tree species identity and diversity effects. Vegetation surveys were conducted in all plots to investigate the species richness, species diversity, compositional turnover and cover of the herb layer as well as the shrub layer cover.Key results – Within the TREEWEB platform, overstorey-understorey diversity relationships were mainly characterised by tree species identity effects. No clear effects of tree species diversity and forest fragmentation on understorey composition and diversity were found.Conclusion – Tree species identity effects were most important in explaining the observed patterns in the understorey vegetation. Further in-depth research will allow us to disentangle which mechanisms underlie these patterns and whether effects of fragmentation are more pronounced at higher trophic levels

Forest fragmentation modulates effects of tree species richness and composition on ecosystem multifunctionality

Forest fragments in highly disturbed landscapes provide important ecosystem services ranging from acting as biodiversity reservoir to providing timber or regulating hydrology. Managing the tree species richness and composition of these fragments to optimize their functioning and the deliverance of multiple ecosystem services is of great practical relevance. However, both the strength and direction of tree species richness and tree species composition effects on forest ecosystem multifunctionality may depend on the landscape context in which these forest remnants are embedded. Taking advantage of an observatory network of 53 temperate forest plots varying in tree species richness, tree species composition, and fragmentation intensity we measured 24 ecosystem functions spanning multiple trophic levels and analyzed how tree species diversity-multifunctionality relationships changed with fragmentation intensity. Our results show that fragmentation generally increases multifunctionality and strengthens its positive relationship with diversity, possibly due to edge effects. In addition, different tree species combinations optimize functioning under different fragmentation levels. We conclude that management and restoration of forest fragments aimed at maximizing ecosystem multifunctionality should be tailored to the specific landscape context. As forest fragmentation will continue, tree diversity will become increasingly important to maintain forest functioning