Indian Study by Shekhawat et al. (2023)
Background
Euthanasia is a controversial subject, and the discussion in India was propelled by the 2009 Aruna Ramchandra Shanbaug v. Union of India and other cases in the Supreme Court. An activist sought a stoppage of artificial feeding for a patient to die with dignity. The court opposed the position but observed in its ruling that there existed a need to develop policies on euthanasia for the big country (Shekhawat et al., 2023). The study evaluated doctors’ knowledge, attitudes, and practices regarding euthanasia.
Methods
Ethical approval is sought from the institutional ethics committee. Primary data was collected through questionnaires administered to 200 doctors chosen from the tertiary care center. All participants were asked to provide informed consent, and those who declined were not considered (Shekhawat et al., 2023). Data were analyzed using SPSS 26.0, and the chi-square test was used to check differences in the responses based on gender and age.
Results
The mean age and experience of the respondents were 32.34 ± 5.88 and 4.95 ± 5.44 years, respectively. Most respondents were Hindu, male, and married, with 71% being medical postgraduates and about 65% resident doctors. 50% were aware of the regulations on euthanasia in India, with 7% and 47% believing that active and passive euthanasia are legal.
54.5% consider that voluntary euthanasia is justifiable, with 42.5% indicating that the opinion should be based on the treating doctor. 59.5% reported encountering terminally ill patients, with 75% and 80% indicating that patients and relatives had requested to end life, respectively. 85.5% of the doctors said they discussed the topic (Shekhawat et al., 2023). Gender differences were observed in the alternate decision maker. Results on the age were significantly different, with those over 30 supporting euthanasia.
Discussion
Euthanasia imposes a substantial ethical dilemma on doctors and nurses. The study shows that 80% of the participants support euthanasia for terminally ill patients, which is inconsistent with other findings due to differences in the study period, the population, the method used, and the country’s laws. However, the views supporting euthanasia are similar to other findings. Euthanasia is supported by Indians for various reasons, with the decision maker expected to be the doctor or next of kin (Shekhawat et al., 2023). The findings could be more generalizable due to a small sample size in one part of the country.
Norwegian Study by Hol et al. (2022)
Background
Assisted dying that involves euthanasia and physician-assisted suicide is not permitted in Norway and is considered unethical. Studies show that clinical nurses receive demands for assisted dying from patients. Some nurses may be willing to support euthanasia even though different factors may influence their perspectives. However, in Norway, little is known about the impact of assisted death on nurses (Hol et al., 2022). The study aims to assess the attitudes of Norwegian clinical nurses toward assisted dying and whether nurses receive requests for aid from patients.
Methods
The study utilized a descriptive cross-sectional design. The research population involved 734 participants from all health regions of Norway, and data were collected using a questionnaire from October 2017 to February 2018. Data was collected on socio-demographic features, nurses’ place of work, and department.
The participants were required to register their views on a 5-point Likert scale, with the highest point of 5 denoting strongly agree and the lowest point of 1 denoting strongly disagree. The data were analyzed using Stata 16 and IBM SPSS version 26 (Hol et al., 2022). The Norwegian Regional Committee for Medical and Health Research Ethics, Central Norway, issued ethical approval.
Results
Descriptive statistics showed that the participants comprised 38%, 90%, and 42% of those aged 20-29, female, and had postgraduate education, respectively. About 58% of the nurses indicated they encountered at least one occasion when patients requested help to die. High rates were reported among nurses in palliative care (88%) and pulmonary wards (70%) (Hol et al., 2022).
Most nurses agreed that assisted dying should be legalized in Norway. The nurses’ attitudes were influenced by age and education, with a higher preference for assisted dying reported among younger professionals and those with a bachelor’s education. Gender, religion, and experience did not significantly influence the results among different nurses.
Discussion
Overall, over 56% and 48% of the participants agreed that physician-assisted suicide and euthanasia should be legalized among patients with terminal illnesses and short life expectancy. The level of agreement was, however, more restrictive than that of the general Norwegian people. More people requested help in assisted dying due to a high level of autonomy and freedom to define their death in difficult medical circumstances.
Pulmonary and palliative ward nurses’ requests were high due to the difference between a hospital and private home care. The elevated preference for the legalization of assisted dying among young nurses is consistent with findings in other studies, albeit at a low level compared to general public support (Hol et al., 2022). The study is limited by excluding nurses serving in nursing homes and small hospitals, so they do not represent the views of the entire nursing population in the country.
Canadian Study by Freeman et al. (2019)
Background
The debate on assisted dying could favor advocates for palliative care. Canada has legalized Medical Assistance in Dying (MAiD) for its citizens. Still, there are concerns over ethics, conscience rights, and eligibility and access. Patients and families commonly approach palliative care nurses to answer their queries about end-of-life and MAiD. The palliative care philosophy opposes quickening death or participation in the process, which challenges palliative care nurses, hence the need to explore their views (Freeman et al., 2019). The key objective of the study is to investigate the perspectives of Ontario palliative care nurses on MAiD.
Methods
The researchers employed a descriptive cross-sectional research design. They used convenience sampling to choose 1850 practicing palliative care nurses in Ontario. Data were collected using mailed letters sent to the nurses from November 2017 to February 2018 (Freeman et al., 2019). The questionnaires used the Nurse Attitudes Toward Medical Assistance in Dying Scale (NATMS) and the National Coalition for Hospice and Palliative Care (2018) guidelines. The researchers sought ethical clearance from an academic institution, and informed consent was sought from all participants.
Results
Data were analyzed using IBM SPSS Statistics Version 25. Two hundred thirty-nine observations were screened, and the data were cleaned for analysis. Most of the respondents were between 40 and 60 years old. Close to 94%, 72%, 70%, and 68% were female, registered nurses, married, and belonged to organized religion.
Faith was found to have personal importance and was the most significant explanatory variable in the study. 46% supported MAiD in hospice residential care settings, while 54% were unsure (Freeman et al., 2019). 67% supported notifying patients that MAiD is not allowed before admission, while 55% suggested that any MAiD should be referred.
Discussion
The results showed nurses’ moderate attitudes toward MAiD. The nurses also supported that patients could choose their death, as 77% indicated they would personally request MAiD (Freeman et al., 2019). Age, experience, and religion did not influence the findings—more positive attitudes toward MAiD among those with perceived expertise in the social matters of palliative care. More research is needed to describe how MAiD can be integrated into the health care system.
References
Freeman, L. A., Pfaff, K. A., Kopchek, L., & Liebman, J. (2019). Investigating palliative care nurse attitudes towards medical assistance in dying: An exploratory cross‐sectional study. Journal of Advanced Nursing, 76(2), 535–545. Web.
Hol, H., Vatne, S., Oroy, A., Rokstad, A. M. M., & Opdal, O. (2022). Norwegian nurses’ attitudes toward assisted dying: A cross-sectional study. Nursing: Research and Reviews, 12, 101–109. Web.
Shekhawat, R. S., Kanchan, T., Saraf, A., Ateriya, N., Meshram, V. P., Setia, P., Rathore, M., Shekhawat, R. S., Kanchan, D. T., Saraf, A., Ateriya, N., Meshram, V., Setia, P., & Rathore, M. (2023). Knowledge, attitude, and practices (KAP) of medical professionals on euthanasia: A study from a tertiary care center in India. Cureus, 15(2). Web.