Euthanasia is a term that often sparks heated debate, regardless of whether people are “for” or “against”. It is one of the most-debated ethical issues in recent decades as revealed by the considerable number of scientific publications, media coverage of specific cases, but also proposed bills in many countries. Despite it's popularity and the fact that public opinion polls indicate increasing support, euthanasia is still illegal in most countries. Nevertheless, one of the most significant challenge in order to have an informed debate on this issue is to determine what euthanasia essentially is. In popular discourse, for example, euthanasia is often associated with expressions such as “wanting to die with dignity”, “not wanting to be kept alive against one’s wishes”, “not wanting to suffer”, and “wanting to die rather than live in a certain condition”. But, logically, if in most countries euthanasia is illegal, does this mean that these wishes run counter to current practices, or even that dying with dignity be against the law? Of course not, but in the context of the debate on the legalisation of euthanasia, it is legitimate to wonder about the meaning of this loaded term. Among members of the public and even health care practitioners, the term euthanasia is apparently used to refer to situations ranging from the last injection allowing a person to pass from life to death in a context of incurable illness, through withholding treatment that would do more harm than good (futile treatment) and withdrawing life support that keeps the person alive (mechanical ventilation, feeding and hydration tubes), to relieving the pain and other symptoms of persons at the end of life whose next breath may well be their last. The use of adjectives “passive” and “active” with the term euthanasia, to describe legal and illegal practices, is undoubtedly associated with this common clustering of concepts. Given this situation, the objectives of this chapter are to delineate exactly what is meant by the term euthanasia, and to see how the variable interpretations of this term can lead to confusion and misunderstanding that often render debate pointless. Part 2 describes what euthanasia is now considered to consist in, and puts it in perspectives with other types of end-of-life decisions that characteristically arise in medical practice. Part 3 lists studies that have attempted to clarify people’s understandings of euthanasia and particularly in relation to other end-of-life practices. Part 4 discusses the interpersonal, societal and political issues raised by these varied understandings of euthanasia according to various groups.
Regular assessment of risk of violence is shown to be effective in reducing violence in mental health services.To evaluate health care providers' use of a violence risk assessment tool on a mental health unit and the facilitators for and barriers to its use.A descriptive study using the Dillman approach and informed by the Knowledge to Action framework was conducted.Twenty-six health care providers responded to the survey; 62% reported using the violence risk assessment tool available on their unit, but not on a daily basis. Common barriers were lack of knowledge of the tool, lack of resources and time, and negative attitudes toward patients. 42% of participants indicated the need for further training on violence risk assessment.Despite high exposure to violence, health professionals were not conducting daily risk assessments. The barriers and facilitators identified provide direction for interventions that are necessary if the daily use of violence risk assessment tools is to be increased.
Ultrasound tongue imaging has shown potential for speech-language pathologists (SLPs) to evaluate and treat persistent articulatory disorders. However, SLPs typically begin with low to no familiarity with ultrasound. Thus, this study investigated an important aspect of ultrasound device usability: learnability for SLPs. The project was funded by an NSERC Engage grant in partnership with Clarius Mobile Health. 12 SLPs learned to use two ultrasound devices: a wireless device, provided by our partner Clarius, and a traditional device, to record clips of their or the experimenter’s tongue. They then completed a questionnaire [French translation of the System Usability Scale (Brooke, 1996)]. Two expert judges evaluated the clips recorded by the SLPs for the choice of settings and the positioning of the probe. Results of the SUS show a better usability for the wireless device than the traditional device. SLPs appreciated the user-friendly tablet interface, possibly because they are already used to interacting with tablets. Clips analyses show a better choice of settings by the SLPs with the wireless device. The positioning of the probe, however, was better with the traditional device, possibly due to its smaller probe. In conclusion, US seems to have a good potential of usability in speech-language pathology, provided that SLPs receive training for US image interpretation. A traditional US device may require a longer learning period than a wireless model with tablet interface.
Mental health status may be closely related to an instability of intentions toward a premature death, but little is known about such instability following an explicit request for euthanasia or physician-assisted suicide (EAS) and patient characteristics associated with a change of mind.A questionnaire was sent to 6596 general practitioners in The Netherlands (response rate 60%). Of these, 1681 provided descriptions of the most recent explicit request for EAS they had received in the preceding 18 months.Symptoms of depression and anxiety were related to a change of mind, but no relationship was found with the total score of the NOSGER Mood Dimension. Multinomial regression analysis revealed that patients who changed their mind had more mental health problems and less mental clarity than those who died by EAS. They also had fewer general health problems, had less unbearable and pointless suffering (according to the physician), were less concerned about loss of dignity and alternative treatment options were more frequently available. A further analysis revealed that mental health problems were more prevalent among patients whose requests were refused than among those who changed their mind. The physicians' evaluations of the reasons why a patient requested EAS were similar to a more objective measure of the patient characteristics.These findings suggest that mental health status must be carefully assessed, and possible instability of desire must be taken into account in the course of a request for EAS. These results require replication, and future studies should adopt a prospective method.
Objectives Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over.Method The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times from February 2016 until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded.Results This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures.Conclusion Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions.
Ultrasound tongue imaging has shown potential for speech-language pathologists (SLPs) to evaluate and treat persistent articulatory disorders. However, SLPs typically begin with low to no familiarity with ultrasound. Thus, this study investigated an important aspect of ultrasound device usability: learnability for SLPs. The project was funded by an NSERC Engage grant in partnership with Clarius Mobile Health. Twelve SLPs learned to use two ultrasound devices: a wireless device, provided by our partner Clarius, and a traditional device, to record clips of their or the experimenter’s tongue. They then completed a questionnaire (French translation of the System Usability Scale (Brooke, 1996)). Two expert judges evaluated the clips recorded by the SLPs for the choice of settings and the positioning of the probe. Results of the SUS show a better usability for the wireless device than the traditional device. SLPs appreciated the user-friendly tablet interface, possibly because they are already used to interacting with tablets. Clips analyses show a better choice of settings by the SLPs with the wireless device. The positioning of the probe, however, was better with the traditional device, possibly due to its smaller probe. In conclusion, US seems to have a good potential of usability in speech-language pathology, provided that SLPs receive training for US image interpretation. A traditional US device may require a longer learning period than a wireless model with tablet interface.
Plusieurs facteurs influencent le deuil, dont le lien d’attachement et la cause du décès. Cet article explore l’expérience de deuil d’enfants d’âge adulte ayant perdu un parent en contexte d’aide médicale à mourir. Une étude qualitative inspirée de l’approche narrative et du modèle d’ajustement en double processus a été menée. Les données ont été recueillies auprès de six participants par le biais d’entretiens individuels en profondeur, accompagnés d’un questionnaire sociodémographique et de la tenue d’un journal de bord. Trois thèmes ont été identifiés lors de l’analyse : la temporalité, la quête de sens et les facteurs influençant le deuil. L’implication de ces thèmes dans l’expérience et le deuil des participants sera discutée et des recommandations pour la pratique professionnelle seront formulées.
