Sunday, January 26, 2020
Attitudes Towards Euthanasia | Literature Review
Attitudes Towards Euthanasia | Literature Review Introduction This literature review is based upon peoples attitudes towards Euthanasia, which comes from the Greek meaning good death and in English means the killing of one person by another to relieve the suffering of that person and Physician Assisted Suicide (PAS), which is described as; a medical professional aiding a person who is incapable of the act themselves to commit suicide, (NHS, 2010). For this literature review, a literature search was performed using the Cochrane library, Science Direct, EBSCOhost and Sage using the key words: Assisted suicide Euthanasia Opinions Attitude United Kingdom Public Right to Die Assisted Dying Most of these words (with the exception of Assisted Suicide and Assisted Dying) were used in each of the search engines individually and also used to form sentences, however, the only electronic databases that gave this search the information it required was Sage. This provided a substantial amount of journals, a lot of the others used were subscription based or a fee was required, but from the free to use information two of the most relevant to the subject I wished to perform the review on were chosen. The two papers were chosen from surveys and studies performed in the United Kingdom, because it was decided to research what the thoughts and feelings of medical professionals were in a place where this practice was presently illegal. Use in the literature search, but this was difficult to come by. The titles of the three journals are: Legalisation of Euthanasia or Physician Assisted Suicide: Survey of Doctors Attitudes, and Opinions of the Legalised of Physician Assisted Suicide. Des pite not inputting the word physician into the search engine, a lot of the searches came up with types of journals which mention this anyway. This review will critically evaluate the information in the journals and will be compared with each other, discussing the disadvantages of the surveys and the advantages. The review will also include the various research methods used in the research. The Literature Review The first paper reviewed is in English by Clive Seale, PhD, from the Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, London and is called The legalisation of Euthanasia or Physician-Assisted Suicide: Survey of Doctors Attitudes. The protocol was to determine what doctors opinions about the legalisation of medically assisted dying (which includes the terms, euthanasia and physician-assisted suicide (PAS)) were and this was done in comparison with the opinions of the general public of the UK. The methodology was to send out structured questionnaires with a series of questions using qualitative methods and then analyse the results in a quantitative manner. In 2007, Binleys database (http://www.binleys.com) was used to send questionnaires to 8857 currently working medical practitioners all over the UK, this was broken down into 2829 (7%) GPs, 443 (43%) neurologists, 836 (21% of these were doctors) specialists in the care of the elderly, 462 (54% of thes e were also doctors) specialists in palliative medicine and 4287 workers in other hospital based specialities. This is quite a large sample to use and covers a wide range of specialities. It is not clear in what month in 2007 these questionnaires were sent out but follow-up letters were sent to non-respondents between November 2007 and April 2008 to enquire as to why they did not respond, in which 66 doctors in all responded with the most common reason being lack of time to complete the survey. Overall the response rate was 42.1% with specialists in palliative medicine being the most responsive with 67.3% of people returning their questionnaire, along with specialists in the care of the elderly (48.1%) neurologists (42.9%) other hospital specialties (40.1%) and GPs (39.3%). Despite the large sample of people, 42.1% of replies are quite disappointing, although it is a very emotive subject. The questions consisted of personal questions such as age, gender, grade, ethnic origin, and speciality of the respondent and, on average, the number of deaths attended. They were all asked four questions about their attitude towards euthanasia and assisted suicide, in order to obtain the questionnaire in full the author of the survey invited people to contact him. An email was sent: Appendix (a) and a reply was received the next day: Appendix (b). Previous surveys regarding this subject were performed in the Netherlands, Oregon (USA) and Belgium majority support from the medical profession has been important in passing permissive legislation in these countries. The keywords used in this study were assisted dying; euthanasia; physician-assisted suicide; right to die and terminal care. The distribution of questionnaires meant that the methodology used was right as it was discreet and reached a lot of people in a short amount of time, the only danger with this method was that the medical professionals did not have to respond which was shown in the return response of 42.1% there was no financial or other incentive as this would go against all ethical considerations. Ethical approval for this study was granted by the South East Research Ethics Committee. The results showed that those who were specialists in palliative medicine were more opposed to euthanasia or PAS being legalised than the other specialities, although this could be down to the higher response rate in this area. Those that expressed their religious beliefs were more opposed to the legalisation also. The study showed that the most widely held view was that British doctors do not s upport legalising assisted dying in either euthanasia or PAS; this differs from the British Social Attitudes (BSA) survey which has tracked changes in public opinion since 1984, and is the most consistent source of data (http://www.britsocat.com). The second paper reviewed is Survey of doctors opinions of the legalisation of physician assisted suicide by William Lee, Annabel Price, Lauren Rayner and Matthew Hotopf from the Institute of Psychiatry. Kings College, London. The protocol is similar to the first paper in that they were looking at practitioners opinions on euthanasia and PAS. The article begins by saying that there is wide support among the general public for assisted dying but not so much for those who care for the dying. The methodology was to send out a postal survey of a 1000 senior consultants and medical practitioners were selected randomly from the commercially available Informa Healthcare Medical Directory (2005/2006), retired doctors were excluded from the survey. Questionnaire were sent firstly in February 2007, 12 weeks later, in May, non-respondents were contacted and then six weeks later they were telephoned, it was discovered that that some of the possible contributors had moved, died or retired. This i nformation was adjusted to take this into account. The authors completed separate univariable (a single variable) and multivariable (containing more than one variable) predicting the outcomes using polytomous methods which would allow two outcomes to be predicted together. The response rate to the survey was 50% once the exclusions were accounted for, which is higher than the first paper and still gave a lot of date to work with. Included in the survey the authors included a brief outline of the Assisted Dying for the Terminally Ill Bill (2006) 32% of the doctors who responded had read some of the Bill. Gender, speciality and years in post had no effect on opposition or support for a new law. An interesting point noted is that the views of doctors who do not care for the dying tally with the general publics view, so there is some correlation there with 66% of those who never cared for the dying supporting a change in the law. The outcome of interest for the authors was to what level practitioners agreed with the statement: The law should not be changed to allow assisted suicide. A second outcome of interest was the level of agreement with the statement I would be prepared to prescribe a fatal drug to a terminally ill patient who was suffering unbearably, were that course of action to become legal. (Hotopf, et. al. 2007:3). The findings of this questionnaire can be found in Appendix (c). Both of these questions were determined using five-point Likert-type scales, used commonly in questionnaires, following this were converted into three-point scales comprising of agree, neither agree nor disagree and disagree with a change in law. The survey shows that senior doctors are split abut their views regarding a change in the law; fewer are in favour than the general public in the United Kingdom. These findings have been noted in the US, as well as Canada, Finland and the Netherlands as well as the UK. Ethical permission was gained from the Institute of Psychiatry, Kings College London Research Ethics Committee. Comparisons and Conclusions There are many comparisons between the two papers, for example, both sent out questionnaires to their target group, who were specialists in certain fields. However, the first paper surveyed over double the amount of people the second paper did but got less replies. Both studies were done in the same year but it is difficult to tell who started theirs first as the date for first paper is unknown other than it was performed in 2007. The second survey is far more in depth that the first one, and it suggests that qualitative research is needed to understand doctors views better whereas the first paper did not state which the preferred method was. The second paper suggests that doctors who oppose a change in the law comes from an over-optimistic credence in their ability to relieve the suffering of the dying. (Hotopf, et.al. 2007). It is possible to argue against this though and the knowledge and experience of patients who are dying influences views about PAS. Both compare the attitudes b etween the general public and the specialist doctors and note a big difference between them. On the whole both papers conducted a thorough and precise survey but there is room for further research and investigation. References Hotopf, L, Lee, W, Price, A, and Rayner, L. (2009) Survey of Doctors Opinions of the Legalisation of Physician-Assisted Suicide, Bio-Med Central, [Online], Available from: http://www.biomedcentral.com/content/pdf/1472-6939-10-2.pdf [Accessed: 22nd April 2010]. NHS (2010) Euthanasia and assisted suicide [Online], London. Available from: http://www.nhs.uk/Conditions/Euthanasiaandassistedsuicide/Pages/Definition.aspx [Accessed 22nd April 2010]. Seale, C. (2009) Legalisation of Euthanasia or Physician-Assisted Suicide: Survey of Doctors Attitudes, Palliative Medicine, [Online], Available from: http://pmj.sagepub.com/cgi/content/abstract/23/3/205 [Accessed 22nd April 2010]. Papers used in Literature Search: Hotopf, L, Lee, W, Price, A, and Rayner, L. Survey of Doctors Opinions of the Legalisation of Physician-Assisted Suicide. Seale, C Legalisation of euthanasia or physician-assisted suicide: survey of doctors attitudes. Appendix (a) Original Message From: Katy Marsland (08111890) [mailto:[emailprotected]] Sent: 26 April 2010 19:25 To: [emailprotected] Subject: A Questionnaire request. Dear Sir, I am at the University of Lincoln and am doing a literature review for my degree in Health and Social care involving your survey on the Legalisation of Euthanasia or Physician-Assisted Suicide: Survey of Doctors Attitudes, and was wondering if it were possible for you to forward me a copy of the questions in order to aid my review? Many thanks in advance Katy Marsland Reply: Here is the questionnaire. Clive (b) END OF LIFE DECISIONS IN MEDICAL PRACTICE: CONFIDENTIAL ENQUIRY PLEASE TICK THE BOXES TO INDICATE YOUR ANSWERS THANK YOU FOR YOUR ASSISTANCE à ¯Ã‚  ¯ General Background Questions Your age à ¯Ã‚  ¯ under 35 years of age à ¯Ã‚  ¯ 36 to 45 years of age à ¯Ã‚  ¯ 46 to 55 years of age à ¯Ã‚  ¯ 56 to 65 years of age à ¯Ã‚  ¯ over 65 years of age Your gender à ¯Ã‚  ¯ male à ¯Ã‚  ¯ female Your medical specialty à ¯Ã‚  ¯ General practice à ¯Ã‚  ¯ Palliative medicine à ¯Ã‚  ¯ Neurology à ¯Ã‚  ¯ Elderly Care à ¯Ã‚  ¯ Other, please specify Grading of your post à ¯Ã‚  ¯ Consultant à ¯Ã‚  ¯ Specialist registrar à ¯Ã‚  ¯ Associate specialist / staff grade à ¯Ã‚  ¯ SHO / HO / F1 / F2 à ¯Ã‚  ¯ GP principal à ¯Ã‚  ¯ GP registrar Please indicate the number of deaths, on average, for which you would be the treating or attendant doctor in the normal course of your duties Answer only one of (a), (b) or (c). (Please give the most accurate estimate you can) (a)_______________per week (b)_______________per month (c)_______________per year Have you been the treating or attendant doctor in the case of a death in the last 12 months? à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no Please go to question 30, on page 7 SPACE FOR COMMENTS ONCE YOU HAVE FINISHED THIS QUESTIONNAIRE Once you have completed this questionnaire, you can use this space to provide any clarifications to your answers or make other points PLEASE TRY TO RECALL AS CAREFULLY AS POSSIBLE THE MOST RECENT DEATH WITHIN THE LAST 12 MONTHS FOR WHICH YOU WERE ACTING AS THE TREATING OR ATTENDANT DOCTOR, AND ANSWER ALL OF THE QUESTIONS 1 TO 29 FOR THAT PARTICULAR DEATH It is, of course, impossible to do justice to all the finer nuances of decisions concerning the end of life in a short questionnaire. But please indicate those answers which approach the actual circumstances of this death as closely as possible. 1 Sex of the deceased à ¯Ã‚  ¯ male à ¯Ã‚  ¯ female 2 Age of the deceased (please estimate if unsure) à ¯Ã‚  ¯ under 1 year à ¯Ã‚  ¯ 1-9 years à ¯Ã‚  ¯ 10-19 years à ¯Ã‚  ¯ 20-29 years à ¯Ã‚  ¯ 30-39 years à ¯Ã‚  ¯ 40-49 years à ¯Ã‚  ¯ 50-59 years à ¯Ã‚  ¯ 60-69 years à ¯Ã‚  ¯ 70-79 years à ¯Ã‚  ¯ 80-89 years à ¯Ã‚  ¯ 90 years and over 3 Place of death à ¯Ã‚  ¯ hospital à ¯Ã‚  ¯ hospice à ¯Ã‚  ¯ care home à ¯Ã‚  ¯ deceaseds own home à ¯Ã‚  ¯ other (please specify) 4 Cause of death *This does not mean the mode of dying, such as heart failure, asphyxia, asthenia, etc: it means the disease, injury, or complication which caused death 1a Disease or condition directly leading to death* 1b Other disease or condition, if any, leading to 1 (a) 1c Other disease or condition, if any, leading to 1 (b) 2 Other significant conditions contributing to the death but not related to the disease or condition causing it 5 With respect to this death, when was your first contact with the patient? à ¯Ã‚  ¯ before or at the time of death: go to Question 6 à ¯Ã‚  ¯ after death: go to question 30, on page 7 6 How long had you known this patient? à ¯Ã‚  ¯ more than six months à ¯Ã‚  ¯ one to six months à ¯Ã‚  ¯ one to four weeks à ¯Ã‚  ¯ between one day and one week à ¯Ã‚  ¯ less than 24 hours Medical actions 7a 7b 7c Concerning this death, did you or a colleague: withhold a treatment* (or ensure that this was done)? withdraw a treatment* (or ensure that this was done)? use any drug to alleviate pain and/or symptoms? (please tick as many answers as apply) * IN THIS STUDY TREATMENT INCLUDES CARDIO-PULMONARY RESUSCITATION (CPR), ARTIFICIAL FEEDING AND/OR HYDRATION à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes (please specify treatments withheld) à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes (please specify treatments withdrawn) à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes, morphine or another opioid à ¯Ã‚  ¯ yes, benzodiazepine à ¯Ã‚  ¯ yes, other drug 8a 8b In withholding a treatment, did you or your colleague consider it probable or certain that this action would hasten the end of the patients life? In withdrawing a treatment, did you or your colleague consider it probable or certain that this action would hasten the end of the patients life? à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no treatment withheld à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no treatment withdrawn 9a 9b Concerning the drugs used to alleviate symptoms, (Questions 7c), were these administered knowing this would probably or certainly hasten the end of life? partly intending to end life? à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no drugs used to alleviate symptoms à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no drugs used to alleviate symptoms 10a 10b In withholding a treatment, did you or your colleague have the explicit intention of hastening the end of life? In withdrawing a treatment, did you or your colleague have the explicit intention of hastening the end of life? à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no treatment withheld à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no treatment withdrawn 11a 11b Was death caused by the use of a drug prescribed, supplied or administered by you or a colleague with the explicit intention of hastening the end of life (or of enabling the patient to end his or her own life?) If yes, who administered this drug (i.e. introduced it into the body)? à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ the patient à ¯Ã‚  ¯ you or another health care colleague à ¯Ã‚  ¯ a relative à ¯Ã‚  ¯ someone else NOTE: IF YOU ANSWERED NO TO ALL THE QUESTIONS ON THIS PAGE, GO TO QUESTION 23 Decision making NOTE: QUESTIONS 12 TO 22 REFER THE LAST-MENTIONED ACT OR OMISSION, THAT IS, THE LAST YES THAT YOU TICKED ON THE PREVIOUS PAGE (QUESTIONS 7 TO 11) 12 Which were the most important reasons for the last-mentioned act or omission? (please tick all that apply_ à ¯Ã‚  ¯ patient had pain à ¯Ã‚  ¯ patient had other symptoms à ¯Ã‚  ¯ request or wish of the patient à ¯Ã‚  ¯ request or wish of relatives à ¯Ã‚  ¯ expected further suffering à ¯Ã‚  ¯ no chance of improvement à ¯Ã‚  ¯ treatment would have been futile à ¯Ã‚  ¯ further treatment would have increased suffering à ¯Ã‚  ¯ other (please specify below) à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. 13 In your estimation, how much was the patients life shortened by the last mentioned act or omission? à ¯Ã‚  ¯ more than six months à ¯Ã‚  ¯ one to six months à ¯Ã‚  ¯ one to four weeks à ¯Ã‚  ¯ between one day and one week à ¯Ã‚  ¯ less than 24 hours à ¯Ã‚  ¯ life was probably not shortened at all 14 Did you or a colleague discuss the last-mentioned act or omission with the patient? à ¯Ã‚  ¯ yes, at the time of performing the act/omission or shortly before: go to Question 15 à ¯Ã‚  ¯ yes, some time beforehand: go to Question 15 à ¯Ã‚  ¯ no, no discussion: go to Question 19 15 At the time of this discussion, did you consider the patient had the capacity to assess his/her situation and make a decision about it? à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no 16 Did this discussion include the (probable or certain) hastening of the end of the patients life by this last-mentioned act or omission? à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no 17 Was the decision concerning the last mentioned act or omission made in response to an explicit request from the patient? à ¯Ã‚  ¯ yes, upon an oral request à ¯Ã‚  ¯ yes, upon a written request à ¯Ã‚  ¯ yes, upon both an oral and a written request à ¯Ã‚  ¯ no: go to Question 21 18 At the time of this request, did you consider the patient had the capacity to assess his/her situation and make a decision about it? à ¯Ã‚  ¯ yes: go to Question 21 à ¯Ã‚  ¯ no: go to Question 21 ONLY ANSWER QUESTIONS 19 and 20 IF YOUR ANSWER TO QUESTION 14 WAS NO, NO DISCUSSION 19 Did you consider the patient had the capacity to assess his/her situation and make a decision about it? à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no 20 Why was the last mentioned act or omission not discussed with the patient? (Please fill in as many answers as apply) à ¯Ã‚  ¯ patient was too young à ¯Ã‚  ¯ the last mentioned act or omission was clearly the best one for the patient à ¯Ã‚  ¯ discussion would have done more harm than good à ¯Ã‚  ¯ patient was unconscious à ¯Ã‚  ¯ patient had significant cognitive impairment à ¯Ã‚  ¯ patient was suffering from a psychiatric disorder à ¯Ã‚  ¯ other, please elaborate at the end of the questionnaire 21 Did you or a colleague discuss with anybody else the (possible) hastening of the end of the patients life before it was decided to take the last mentioned act or omission? (Please fill in as many answers as apply) à ¯Ã‚  ¯ with one or more medical colleagues à ¯Ã‚  ¯ nursing staff /other caregivers à ¯Ã‚  ¯ by partner/relatives of the patient à ¯Ã‚  ¯ someone else à ¯Ã‚  ¯ nobody 22 Which were the most important reasons for the last-mentioned act or omission? (please tick all that apply) à ¯Ã‚  ¯ patient had pain à ¯Ã‚  ¯ patient had other symptoms à ¯Ã‚  ¯ request or wish of the patient à ¯Ã‚  ¯ request or wish of relatives à ¯Ã‚  ¯ expected further suffering à ¯Ã‚  ¯ no chance of improvement à ¯Ã‚  ¯ further treatment would have been futile à ¯Ã‚  ¯ further treatment would have increased suffering à ¯Ã‚  ¯ other (please specify below à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦ NOTE: QUESTIONS FROM HERE ONWARDS SHOULD BE ANSWERED WHETHER OR NOT YOU ANSWERED YES TO ANY OF THE ACTS OR OMISSIONS MENTIONED ON PAGE 3 (QUESTIONS 7 TO 11) 23 Was an explicit request to hasten the end of the patients life made by any of the following? (Please tick all that apply) à ¯Ã‚  ¯ partners/relatives of the patient à ¯Ã‚  ¯ nursing or other care staff à ¯Ã‚  ¯ someone else à ¯Ã‚  ¯ no explicit request 24 As far as you know, did the patient ever express a wish for the end of his/her life to be hastened? à ¯Ã‚  ¯ yes, clearly: go to Question 25 à ¯Ã‚  ¯ yes, but not very clearly: go to Question 25 à ¯Ã‚  ¯ no: go to Question 26 25 Did the patients wish for this outcome reduce or disappear over time? à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes, in response to care provided à ¯Ã‚  ¯ yes, other reason 26 The treatment during the last week was mainly aimed at: à ¯Ã‚  ¯ recovery à ¯Ã‚  ¯ prolonging life à ¯Ã‚  ¯ support during the dying process 27 Which caregivers were involved in the care for the patient during the last month before death (beside yourself and as far as you know)? (please tick all that apply) Of those not involved, which ones might have helped? Involved Not involved and might have helped general practitioner à ¯Ã‚  ¯ à ¯Ã‚  ¯ specialist in pain relief à ¯Ã‚  ¯ à ¯Ã‚  ¯ palliative care team à ¯Ã‚  ¯ à ¯Ã‚  ¯ psychiatrist / psychologist à ¯Ã‚  ¯ à ¯Ã‚  ¯ nursing staff à ¯Ã‚  ¯ à ¯Ã‚  ¯ social care worker à ¯Ã‚  ¯ à ¯Ã‚  ¯ spiritual caregiver à ¯Ã‚  ¯ à ¯Ã‚  ¯ volunteer à ¯Ã‚  ¯ à ¯Ã‚  ¯ family member à ¯Ã‚  ¯ à ¯Ã‚  ¯ 28a 28b 28c 28d Was the patient continuously and deeply sedated or kept in a coma before death? Which medication was given for sedation? (please tick as many answers as apply) At what time before death was continuous sedation of the patient started? Which were the most important reasons for this sedation? (please tick all that apply) à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no: go to Question 29a à ¯Ã‚  ¯ midazolam à ¯Ã‚  ¯ other benzodiazepine à ¯Ã‚  ¯ morphine or another opioid à ¯Ã‚  ¯ other type of medication à ¯Ã‚  ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. hours before death à ¯Ã‚  ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. days before death à ¯Ã‚  ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. weeks before death à ¯Ã‚  ¯ patient had intractable pain à ¯Ã‚  ¯ patient had intractable psychological distress à ¯Ã‚  ¯ patient had other intractable symptoms à ¯Ã‚  ¯ request or wish of the patient à ¯Ã‚  ¯ request or wish of relatives à ¯Ã‚  ¯ other (please specify below à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦ 29a 29b 29c Did the patient receive morphine or another opioid during the last 24 hours before death? How much time before death was the administration of morphine or another opioid started? Which figure best illustrates the dosage of morphine or another opioid during the last 3 days before the patients death? à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no go to Question 30 à ¯Ã‚  ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. hours before death à ¯Ã‚  ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. days before death à ¯Ã‚  ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. weeks before death à ¯Ã‚  ¯ No increase à ¯Ã‚  ¯ Gradual increase à ¯Ã‚  ¯ Strong increase last day Attitudes and beliefs Questions 30 and 31 are about voluntary euthanasia (that is, when someone ends the life of another person at their request), worded in the same way as those used in surveys of general public opinion. 30 30a 30b First, a person with an incurable and painful illness, from which they will die for example, someone dying of cancer. Do you think that, if they ask for it, a doctor should ever be allowed by law to end their life, or not? And do you think that, if this person asks for it, a doctor should ever be allowed by law to give them lethal medication that will allow the person to take their own life? à ¯Ã‚  ¯ Definitely should be allowed à ¯Ã‚  ¯ Probably should be allowed à ¯Ã‚  ¯ Probably should not be allowed à ¯Ã‚  ¯ Definitely should not be allowed à ¯Ã‚  ¯ Definitely should be allowed à ¯Ã‚  ¯ Probably should be allowed à ¯Ã‚  ¯ Probably should not be allowed à ¯Ã‚  ¯ Definitely should not be allowed 31 31a 31b Now, how about a person with an incurable and painful illness, from which they will not die. Do you think that, if they ask for it, a doctor should ever be allowed by law to end their life, or not? And do you think that, if this person asks for it, a doctor should ever be allowed by law to give them lethal medication that will allow the person to take their own life? à ¯Ã‚  ¯ Definitely should be allowed à ¯Ã‚  ¯ Probably should be allowed à ¯Ã‚  ¯ Probably should not be allowed à ¯Ã‚  ¯ Definitely should not be allowed à ¯Ã‚  ¯ Definitely should be allowed à ¯Ã‚  ¯ Probably should be allowed à ¯Ã‚  ¯ Probably should not be allowed à ¯Ã‚  ¯ Definitely should not be allowed 32 Religion: what is your religion? à ¯Ã‚  ¯ None à ¯Ã‚  ¯ Christian (including Church of England, Catholic, Protestant and all other Christian denominations) à ¯Ã‚  ¯ Buddhist à ¯Ã‚  ¯ Hindu à ¯Ã‚  ¯ Jewish à ¯Ã‚  ¯ Muslim à ¯Ã‚  ¯ Sikh Any other religion, please write in 33 Religion: would you describe yourself as: à ¯Ã‚  ¯ extremely religious à ¯Ã‚  ¯ very religious à ¯Ã‚  ¯ somewhat religious à ¯Ã‚  ¯ neither religious nor non-religious à ¯Ã‚  ¯ somewhat non-religious à ¯Ã‚  ¯ very non religious à ¯Ã‚  ¯ extremely non religious à ¯Ã‚  ¯ cant choose 34 What is your ethnic group? Choose ONE section from A to E, then tick the appropriate box to indicate your ethnic group A White à ¯Ã‚  ¯ any White background B Mixed à ¯Ã‚  ¯ White and Black Caribbean à ¯Ã‚  ¯ White and Black African à ¯Ã‚  ¯ White and Asian à ¯Ã‚  ¯ Any Other Mixed background, please write in C Asian or Asian British à ¯Ã‚  ¯ Indian à ¯Ã‚  ¯ Pakistani à ¯Ã‚  ¯ Bangladeshi à ¯Ã‚  ¯ Any Other Asian background, please write in D Black or Black British à ¯Ã‚  ¯ Caribbean à ¯Ã‚  ¯ African à ¯Ã‚  ¯ Any Other Black background, please write in E Chinese or other ethnic group à ¯Ã‚  ¯ Chinese à ¯Ã‚  ¯ Any Other, please write in To clarify any answers or to make further comments, please use the space on page 1. Thank you for your help with this important survey. Now that you have finished the questionnaire, to ensure the anonymity of your answers you will need to do two things. Place the completed questionnaire in the reply-paid envelope, seal it and post it as soon as possible Post the reply-paid response notification card with your name on it if you wish to avoid receiving follow-up reminders. These two items will be received by different people in different locations and kept separate. It will not be possible to link your questionnaire with your name. This questionnaire has been sent to a random sample of 10,000 doctors. It will not be possible for the researchers or anyone else to use your replies to discover your identity or the identity of the patient on whose care you have reported. We understand that recalling events of this nature can be a distressing experience. If you wish to talk to someone about your feelings concerning end-of-life care, the Confidential Counselling Helpline of the British Medical Association can assist you. Their number is: 0645 200 169 (c) Euthanasia and Assisted Suicide in the United Kingdom A Research Proposal Part B By Katy Marsland 08111890 University of Lincoln Hand in Date: 4th May 2010 (1,352 Words) Julie Burton NUR2002M-0910 research Methods 2009/2010 Table of Contents: Page Title 26 Research Questions 27 Aims of Project 28 Initial Literature Review 29-30 Methodology 31 Ethical Considerations and Practical Constraints 32 Timetable for Dissertation Research 33-34 References 35 A Research Proposal 1. Title: Euthanasia and Assisted Suicide in the United Kingdom. 2. Research Questions Should Euthanasia and Assisted Suicide be made legal? What are the arguments for and against policy change in the United Kingdom? Which section of society is most supportive of a change in the law? Which section is most opposed and why? 3. Aims of Project This research aims to investigate, using secondary data, whether a change in the law is needed to clarify the position of euthanasia and assisted suicide in the United Kingdom, and whether this should be made legal just for those who are terminally ill or for
Saturday, January 18, 2020
Populism and the Jacksonian Democrats Essay
Question: In what ways were the late nineteenth-century Populists the heirs of the Jacksonian-Democrats with respect to overall objectives and specific proposals for reform? The Populists of the late nineteenth-century were in many aspects the heirs of the Jacksonian Democrats, carrying on the legacy and tradition left behind. The Populists were very similar to the Jacksonians in many of their overall objectives and specific reform proposals. During the Jacksonian Era from about 1828-1842, the Democrats set the standard to be carried on later by the Populists. The Jacksonian Democrats identified with the common man. They wanted all democrats to agree. In 1828, Andrew Jackson was elected president and he was later reelected in 1832. In the year of his reelection, Jackson established the spoils system to reform the government, removing some federal officeholders (â€Å"To the victor belong the spoils†) and made the right of elected officials to appoint their own followers to public office and established feature of American politics. Also in this year, Jackson vetoed the bill to recharter the Bank of the United States. This sets the tone for his, and the Democrats, ongoing battle with the Bank and its president, Nicholas Biddle, later to rise to climax when Jackson removed federal deposits from the Bank of the United States. A year later, in 1833, the nullification crisis erupted, pushing Jackson and his Democrats into another battle, this one with John Calhoun and nullification. Jackson insisted that nullification was treason and those implementing it were traitors. The nullification crisis was averted by compromise: the lowering of the tariff of 1828, the tariff of abominations, gradually be lowered. Jackson believed in a distinct, but simple theory of democracy, that it should offer â€Å"equal protection and equal benefits†to all its white male citizens and favor no region of class over another. This meant an assault on what he considered the citadels of the eastern aristocracy and an effort to extend opportunities to the rising classes of the west and south. It also meant a firm commitment to the continuing subjugation of African Americans and Indians, keeping these â€Å"dangerous†elements from the politic body to keep the white-male democracy they valued in preservation. Carrying on the Jacksonian legacy, the Populists were mostly farmers and industrial workers; they were the common man. They believed that wealth belonged to the working class, those who create the wealth, not the owners and a graduated income tax (as the income goes up, the tax rate goes up, so wealthier people pay more taxes than the poor). The Populists were champions of the workingman, pushing for better work conditions and a shorter workweek, as well as putting more money in the hands of the workers. One of the biggest reform proposals of the populists was bimetallism and free coinage of silver. Free coinage of silver would have increased the supply of money since silver was in easy circulation. An increase in the supply of money would generally lead to inflation unless the supply of goods and services by at least as much. As did many industrial workers fearing for their jobs, the Populists wanted to limit immigration. In carrying on the legacy left by the Jacksonian Democrats, the Populists exhibited many of the same ideas and proposals. The election of Andrew Jackson to the presidency in 1828 marked not only the triumph of a particular vision of government and democracy, it represented the emergence of a new political world. The Populists emergence in 1873 represented the emergence of a new political world as well. The Jacksonians may have represented and identified with the common man, but the Populists were the common man. During both eras, a main reform movement of each was to upset the eastern powers; Jackson was to defeat the stranglehold of the aristocratic east on the nation’s economic life; the Populists were set to defeat the stranglehold of the industrial east on the nation’s economic life. Both parties were champions of the common man, although it was the Populists championing themselves. The legacy and tradition left behind by the Jacksonian Democrats was aptly picked up by the Populists of the nineteenth-century.
Thursday, January 9, 2020
What You Dont Know About Problem Solution Essay Topics
What You Don't Know About Problem Solution Essay Topics The central area of the article that's the body will explain the issue in detail and provide a clear way to solve the issue also. As soon as you locate a service you prefer, don't neglect to look at my review of it. Solution is a procedure or action that settles the issue. The issue and solution essay writing procedure can be created easy when you've got a plan in mind. Key Pieces of Problem Solution Essay Topics Additionally, when writing an essay, it is likewise required to think about picking a topic that has a viable or practical solution. After that, write about the way in which the issue is usually resolved within the book in addition to your own ideas about how you would address the issue. When you're assigned to compose a problem-solution essay or research paper, picking a fantastic topic is the initial dilemma you have to work out. Writing a problem solution essay can be hard, particularly if you are the perso n choosing the topic. Choosing Good Problem Solution Essay Topics The feedback you get from any certain post updates in real-time and changes every moment. Task response you should be certain that you fully grasp the question and create the answers appropriately. Thinking up a thesis statement can be difficult, but it helps in case you pick a topic you feel strongly about. Writing an issue and solution essay might appear challenging in the beginning, but after you've got your subject, you're golden. Problem-solution essays argue for a specific remedy to an issue or demonstrate an urgent need to address the issue. Whichever problem solution topic you select, you're going to be able to earn every reader interested, raise some very important questions, and talk about the issues of urgent importance. The definition of an issue solution essay specifies it is supposed to contain identification of a specific problem with a corresponding solution or plan of the way to deal with the presented problem. If you don't have a thing to write about in regards to your essay it's an issue. A story which makes the problem seem essential and dramatic is the ideal way to begin a problem solution essay there are lots of issues on the planet, and should you need your reader to think yours is an important one to solve, you will need to catch their attention with something they'll remember. When writing an essay, you want to understand that however much you know about the topic, there's always more to learn. For some thing to turn into an exceptional powerful essay matter, it needs to be a controversial matter. What You Must Know About Problem Solution Essay Topics The argument concerning child nutritional issues, particularly being overweight, can be managed. You should state who will be responsible for implementing the issue and the way they'd go about doing it. A great topic might be something as easy as improving time management to address the issue of getting to school in time daily or as complex as finding ways to cut back the amount of violent crimes. Superior topics of interest will appear into reasons on the other side of the controversy and give potential solutions to help others understand people's position on the issue. During the duration of your academic career, whether at school or university, you'll almost certainly have to write a minumum of one problem solution essay. In case that you still have questions, a good idea is to seek advice from your teacher. In order for those students to fix a problem in a mathematics classroom they must first understand the issue or understand what they're requested to find or do. Each participating student or family is necessary to purchase a Student Publication. The Debate Over Problem Solution Essay Topics As stated earlier, there are 9 varieties of essays. Writing the essay Now that each one of the necessities of an essay are planned well, you can begin writing the essay. Hence, yo u've been provided with the simplest topic for problem solution essays, you can pick any on of the above mentioned and get started writing your essay immediately. Taking into account that lots of persuasive essays concern controversial topics, before writing, you might want to sit down and think of what your opinion on the topic actually is. It's feasible for you to find problem solution essays help if you make an order for your paper from us. You want to obey a certain structure as such kind of paper usually contains many components. You can open a chain reaction by means of your essay. Family abuse is just one of the burning problems of nowadays. Folks want the solutions to the issues that aren't costly. Lately, a great deal of working professionals are migrating to developed countries for the interest of jobs. UKWriting's writers are lots of the greatest in the uk. There are many problems, even on your own campus, which need to be resolved. The main issue for everyone who hopes to migrate to a huge city is that the price of living is probably going to be greater than it's in a little town or village. There are additionally some descriptions so you might secure the fullest picture of what a terrific topic ought to be. It's possible for you to discover some topics in lots of places. Otherwise, then the very first point to know is that you ought to start by viewing a range of topics before choosing one that's suitable. The variety of paragraphs are determined by the amount of solutions.
Wednesday, January 1, 2020
My I Wish You d Die - 816 Words
â€Å"I wish you’d die†I whispered on the night of July 22, 2013. I laid in bed thinking about my, unfortunately, biological father. I was comparing him to my step-dad. Did I think he could of ever been as close of a father like my step-dad? A few days ago he had promised to pick me up earlier that evening so that we could spend a whole day together the following day, but he never showed up. Many times this had happened and I couldn’t stand it no longer. I looked at the clock and it ticked slowly, it seemed to be more tired than I was. A second seemed like a minute, a minute seemed like an hour, the night seemed like an eternity. I anxiously waited for sleep to engulf me. Hours later when the night sky was no longer black, like the ocean†¦show more content†¦Ã¢â‚¬Å"Remember when I left to my room last night when Gabriel didn’t show up so that we could spend all day together today? Well, when I left to my room I just fell asleep right away†I lied. â€Å"Oh. I m sorry he didn’t show up honey†then she went on telling me how he was irrelevant in my life, despite him being my biological father. A few minutes later as I enjoyed a delicious cup of chocolate the house phone rang. I has offered to pick it up but my grandmother was already on her way. I sat in the kitchen sipping on my cup looking out the window. The sky had grown gray and I felt the hairs on my back stand up. My grandmother returned to the kitchen with eyes of sadness that stared at me as she stood under the arch. She tried to say something but no words were produced. â€Å"Is something wrong I said asked?†I had said as got up from my seat and made my way to the entrance of the kitchen. â€Å"Your mother is on the phone. She, she wants to talk to you†We made our way to the living room where the phone was kept. I reached the phone and slowly placed it next to my ear. â€Å"Hello?†I spoke with fear. â€Å"Christian†She had replied softly. â€Å"Is something wrong?†I asked as scenarios of what was possibly wrong with her took over my head. â€Å"Christian,†she sniffed. Had she been crying? â€Å"Mom what’s wrong?†I asked urgently. Did she have cancer? Was she going to die? â€Å"Your father, he
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