Nationwide survey to evaluate the decision-making process in euthanasia requests in Belgium : do specifically trained 2nd physicians improve quality of consultation?

Background: Following the 2002 enactment of the Belgian law on euthanasia, which requires the consultation of an independent second physician before proceeding with euthanasia, the Life End Information Forum (LEIF) was founded which provides specifically trained physicians who can act as mandatory consultants in euthanasia requests. This study assesses quality of consultations in Flanders and Brussels and compares these between LEIF and non-LEIF consultants. Methods: A questionnaire was sent in 2009 to a random sample of 3,006 physicians in Belgium from specialties likely involved in the care of dying patients. Several questions about the last euthanasia request of one of their patients were asked. As LEIF serves the Flemish speaking community (i.e. region of Flanders and the bilingual Brussels Capital Region) and no similar counterpart is present in Wallonia, analyses were limited to Flemish speaking physicians in Flanders and Brussels. Results: Response was 34%. Of the 244 physicians who indicated having received a euthanasia request seventy percent consulted a second physician in their last request; in 30% this was with a LEIF physician. Compared to non-LEIF physicians, LEIF physicians were more often not a colleague (69% vs 42%) and not a co-attending physician (89% vs 66%). They tended to more often discuss the request with the attending physician (100% vs 95%) and with the family (76% vs 69%), and also more frequently helped the attending physician with performing euthanasia (44% vs 24%). No significant differences were found in the extent to which they talked to the patient (96% vs 93%) and examined the patient file (94% vs 97%). Conclusion: In cases of explicit euthanasia requests in Belgium, the consultation procedure of another physician by the attending physician is not optimal and can be improved. Training and putting at disposal consultants through forums such as LEIF seems able to improve this situation. Adding stipulations in the law about the necessary competencies and tasks of consulting physicians may additionally incite improvement. Irrespective of whether euthanasia is a legal practice within a country, similar services may prove useful to also improve quality of consultations in various other difficult end-of-life decision-making situations

Establishing specialized health services for professional consultation in euthanasia: experiences in the Netherlands and Belgium

<p>Abstract</p> <p>Background</p> <p>The Netherlands, Belgium, and Luxembourg have adopted laws decriminalizing euthanasia under strict conditions of prudent practice. These laws stipulate, among other things, that the attending physician should consult an independent colleague to judge whether the substantive criteria of due care have been met. In this context initiatives were taken in the Netherlands and Belgium to establish specialized services providing such consultants: Support and Consultation for Euthanasia in the Netherlands (SCEN) and Life End Information Forum (LEIF) in Belgium. The aim of this study is to describe and compare these initiatives.</p> <p>Methods</p> <p>We studied and compared relevant documents concerning the Dutch and Belgian consultation service (e.g. articles of bye-laws, inventories of activities, training books, consultation protocols).</p> <p>Results</p> <p>In both countries, the consultation services are delivered by trained physicians who can be consulted in cases of a request for euthanasia and who offer support and information to attending physicians. The context in which the two organisations were founded, as well as the way they are organised and regulated, is different in each country. By providing information on all end-of-life care matters, the Belgian LEIF seems to have a broader consultation role than the Dutch SCEN. SCEN on the other hand has a longer history, is more regulated and organised on a larger scale and receives more government funding than LEIF. The number of training hours for physicians is equal. However, SCEN-training puts more emphasis on the consultation report, whereas LEIF-training primarily emphasizes the ethical framework of end-of-life decisions.</p> <p>Conclusion</p> <p>In case of a request for euthanasia, in the Netherlands as well as in Belgium similar consultation services by independent qualified physicians have been developed. In countries where legalising physician-assisted death is being contemplated, the development of such a consultation provision could also be considered in order to safeguard the practice of euthanasia (as it can provide safeguards to adequate performance of euthanasia and assisted suicide).</p

Screening plants for resistance/susceptibility to plant-parasitic nematodes

This chapter provides information on the methods for initial screening to determine the resistance or susceptibility of plants, cultivars or breeding lines to plant parasitic nematodes. Specific protocols for screening and further resistance breeding on several plant-nematode combinations are described and practical guidelines for screening of Musa germplasm and several screening procedures for cyst nematodes are presented

Host plant effects on hatching of root-knot nematodes

Dormancy and the hatching response enable hatching of many plant-parasitic nematodes to be synchronised with the presence of host plants. There is evidence that the host plant, especially during the onset of senescence, influences the physiology of the developing, unhatched juveniles. Hatching of juveniles of Meloidogyne is primarily temperature driven and usually Occurs without requiring stimulus from host root diffusates. However, root diffusates sometimes stimulate hatching and research has demonstrated that hatching of some species of Meloidogyne is influenced by the host plant. Thus, there are parallels between some root-knot and cyst nematodes in aspects of their hatching response in relation to survival, and understanding these characteristics is an important basis for effective management strategies

Vertical distribution of the plant-parasitic nematode, Meloidogyne chitwoodi, under field crops

The root-knot nematode Meloidogyne chitwoodi is a severe pest on sandy soils in Belgium and causes quality damage to economically important crops such as carrot, potato and black salsify. Pre-planting soil sampling to detect infestations has proven useful to farmers when taking decisions on the crop rotation. To develop an adequate sampling strategy, the vertical distribution of M. chitwoodi was examined under summer barley, carrot, fodder beet, bean, marigold and black fallow on two fields with a sandy soil. Soil samples were collected at monthly intervals from April 2004 to April 2006. Cores were taken to a depth of 70 cm and split into 10 cm segments. Nematodes were extracted by zonal centrifugation. Fodder beet increased the population of M. chitwoodi immensely; carrot was also a good host. Barley was a moderate host and under bean and marigolds the population decreased. The relative distribution of M. chitwoodi over the different soil layers during two successive years was consistent in each field. The different successions with good, moderate and poor hosts did not influence this distribution significantly. A logistic model was fitted to the mean cumulative percentages of nematodes at increasing soil depth. Farmers are advised to take soil samples for detection of M. chitwoodi immediately after harvest, especially after crops with a long field period. Adapting the depth of the cores taken to the vertical distribution of the population can increase the chances of detection. Our results suggest that this distribution is persistent in crop rotations and depends on field characteristics

Quality damage on carrots (Daucus carota L.) caused by the root-knot nematode Meloidogyne chitwoodi

In the Belgian provinces Antwerp and Limburg, the root-knot nematode, Meloidogyne chitwoodi, is widespread. These regions are important production areas of carrot, Daucus carota, for the processing industry. Nineteen carrot cultivars were screened for potential resistance for M. chitwoodi. Egg masses of M. chitwoodi were found on all cultivars. However, there were no egg masses on more than 80% of plants of cvs Berlanda, Bolero, Chantenay, Nantucket and Parmex. By contrast, on cvs ABK, Douceur, Maxi and Merida egg masses were formed on all of the tested plants. To gain information about the damage caused by M. chitwoodi, carrots were grown in soil infected with different densities of nematodes. There was no effect of M. chitwoodi on the length, width and weight of the carrot taproot. Damage caused by M. chitwoodi was manifested by severe galling near the lenticels. Inoculation of nematodes 6 weeks after the carrots emerged resulted in a higher percentage of infected carrots and damaged taproots compared with earlier inoculation times. The effect of the time of harvest on nematode infection and damage was examined. When harvested 100 days after sowing in soil with low nematode densities (two second-stage juveniles (J2)/100 g soil), no damage was reported. Harvesting 120 and 140 days after sowing resulted in 10 and 20% damaged carrots, respectively. With initial M. chitwoodi densities of 25 J2/100 g soil, the percentage of damaged taproots increased from 10% when harvested 100 days after sowing to 70% when harvested 140 days after sowing. In a field trial, 11.5% of the carrots were damaged after a field period of 139 days and the initial M. chitwoodi population increased from 3 to I I I J2/100 g soil. It is recommended that growing carrots in M. chitwoodi-infested fields should be avoided. However, damage can be limited in fields with low initial nematode populations when the growing period is reduced

Lowering quality damage in open-field vegetables caused by Meloidogyne chitwoodi and M. fallax in the Low Countries

The Low Countries (the Netherlands and Belgium) provide some of the best agricultural soils in the world for open-field vegetable production rendering high yields per hectare. Since the 1990s, pre-harvest quality control of carrots (Daucus carota) and black salsify (Scorzonera hispanica) showed an increase in tap root damage with severe galling and rough surface rendering the infected vegetables unprocessable. This quality damage was caused by the polyphagous root-knot nematodes Meloidogyne chitwoodi and M. fallax. This chapter discusses the geographical distribution, damage symptoms, economic impact, recommended integrated management, and management optimization of M. chitwoodi and M. fallax. Future research requirements and future developments are also mentioned