Assisted suicide: clinical realities and ethical challenges

The increasing attention to assisted suicide, as evidenced by recent legislation, initiatives, court decisions, and research, propels the issue to a new level of importance and urgency within society and the health professions. Nurses cannot help but be confronted by and struggle with the complex moral and professional quandaries related to assisted suicide. Critical care nurses must continue to evaluate the implications of the possible legalization of assisted suicide and to define the boundaries of morally acceptable professional practice. The challenges to the roles and responsibilities of critical care nurses that might occur if assisted suicide were legalized must be thoughtfully and responsibly explored.     

Assisted suicide in dementia. Ethical considerations between paternalism and autonomy

This article discusses the problem of euthanasia presenting the case of an 82-year-old man with progressive dementia. Difficulties encountered during daily clinical work are described and analysed, in order to clarify decisions on ethical, legal and professional medical grounds. General decisions concerning life-sustaining measures may be qualitatively improved if the situation of the individual is constantly assessed and considered within the treatment process.     

Assisted suicide: implications for nurses and nursing

Assisted suicide is an issue of great importance to nurses. This issue reflects our values and beliefs as a society, calls for a clear and precise response as a profession, and challenges individual nurses to think about their own moral views. The history of the debate and the compelling moral arguments on both sides attest to the complexity of the issue and also suggest that it will not soon be resolved. The current position of the profession, as expressed in the ANA Code for Nurses and a specific position statement, were reviewed. The dilemma faced by the individual nurse who perceives an obligation to adhere to the guidelines specified by his or her profession's code and yet whose conscience dictates an act in violation of this code has been discussed as an instance of conscientious objection. While this analysis has been necessarily brief, it was intended to illustrate the importance of being clear about one's personal moral views and equally clear about one's duty to fulfil the obligations stemming from the profession's public statements. It is essential that the profession continue to explore the moral issues involved in requests for assistance in dying and provide additional guidelines for practicing nurses, with sound rationale for the profession's position.     

Encounter groups: Comparisons and ethical considerations.

Examines the evolution and nature of encounter groups, and whether or not there are any differences in the relative effectiveness of various encounter groups. Numerous ethical considerations are discussed, and some ethical guidelines for group leaders are suggested. (62 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assisted suicide of a selfish gene

Recombinant hepatitis B vaccination is widely used and severe side effects are rare. We describe 3 cases of vasculitis occurring after such immunization that are thought to have been vaccine induced. Vasculitides are now recognized as possible severe adverse side effects of immunization.     

Ethics and research: ethical considerations in clinical research

Two subjects are discussed: the use of placebo controls in clinical trials and informed consent. Particularly in trials of drugs for disorders for which there exist effective treatments, the use of placebo is still controversial, although anyhow in violation of the Declaration of Helsinki. Informed consent aims at giving a subject all the necessary information to allow him to decide, with full knowledge, whether to accept a particular treatment or experimental protocol. Its importance would seem, albeit essential, to be rather illusory.     

Lower limb amputation. 4: Some ethical considerations

For some people the prospect of amputation may offer an escape from the constant pain, infection and disability which have been part of their lives for many years. However, other may regard death as a preferable option. Denying treatment when the alternative prognosis is death causes much debate among healthcare professionals, families and carers. Ultimately, however, healthcare professionals must listen to the person in need of the amputation. The first article in this series illustrated the care pathway of a vascular patient, the second studied the surgical process of amputation and the third highlighted the importance of the nurse's role in the amputee's physiological, psychological and social care. This article, the last in the series, discusses the issues surrounding the person's decision not to have an amputation.     

Egg-sharing in assisted conception: ethical and practical considerations

The present acute shortage of eggs for donation cannot be overcome unless adequate guidelines are set to alleviate the anxieties regarding payments, in cash or kind, to donors. The current Human Fertilisation and Embryology Authority (HFEA) guidelines do not allow direct payment to donors but accept the provision of lower cost or free in vitro fertilization (IVF) treatment to women in recognition of oocyte donation to anonymous recipients. Egg-sharing achieved in this way enables two infertile couples to benefit from a single surgical procedure. However, the practical guidelines related to this approach are ill-defined at the present time leading to some justifiable uncertainty. A pilot study was therefore undertaken in order to establish the place of egg-sharing in an assisted conception programme. The current HFEA guidelines on medical screening of patients, counselling, age and rigid anonymity between the donor and recipient were followed. The study involved 55 women (25 donors and 30 recipients) in 73 treatment cycles involving fresh and frozen-thawed embryos. Donors were previous IVF patients who, regardless of their ability to pay, shared their eggs equally with matched anonymous recipients. They paid only for their consultations and tests right up to the point of being matched with a recipient. The sole recipient paid the cost applicable in egg donation of a single egg collection, although both received embryo transfers. The results indicate that although the recipients were older than the donors (41.4 +/- 0.9 versus 31.6 +/- 0.5 years), and there was no difference in the mean number of eggs allocated, the percentage fertilization rates, or the mean number of embryos transferred, there were more births per patient amongst recipients than amongst donors (30 versus 20%). We conclude that providing the donors are selected carefully, this scheme whereby a sub-fertile donor helps a sub-fertile recipient is a very constructive way of solving the problem of the shortage of eggs for donation. There are also the advantages of including a group of women who would otherwise be denied treatment. Problems related to 'patient coercion' can, in our view, be fully overcome by the application of strict common-sense safeguards. The ideal of pure altruism is not without its medical and moral risk. The success of egg-sharing depends on shared interests and a degree of altruism between the donor, the recipient and the centre. The current HFEA guidelines should be applauded for enabling a highly effective concept of mutual help to develop.     

Assisted suicide in Switzerland: when is it permitted?

This study assessed in vitro apical leakage in root canals filled with gutta-percha and Ketac-Endo using different dentin conditioning and filling techniques. The root canals of 63 single-rooted teeth were instrumented and randomly divided into the following four groups: group A--canals were irrigated with 25% tannic acid and filled with Ketac-Endo and a standardized gutta-percha cone; group B--canals were irrigated with 1% NaOCl and filled as in group A; group C--canals were irrigated with 25% tannic acid and filled with Ketac-Endo and a chloroform-softened gutta-percha cone adapted to the canal walls; group D--canals were irrigated with 1% NaOCl and filled with Grossman's sealer and laterally condensed gutta-percha. After storage for 72 hours at 37 degrees C and 100% humidity, the gutta-percha was removed to a level 4 mm short of the working length, using a Peeso reamer. Teeth were immersed in India ink for 48 hours and cleared, and the coronal extent of dye penetration examined under a binocular dissecting microscope at x 15 magnification. The mean value of leakage for group A was 0.86 mm, for group B 2.23 mm, for group C 2.34 mm, and for group D 0.56 mm. Tukey's multiple comparison test disclosed significant differences (P < 0.05) between group A and groups B and C, and between group D and groups B and C. Differences between groups A and D, as well as between groups B and C, were not significant.     

Physician-assisted suicide. Overview of the ethical debate

Eight hundred seventy-one Israeli adolescents, 375 boys and 496 girls, mean age 16.7 +/- 1, participated in this study. Twenty-three of them lost relatives in war and 19 in road accidents. All participants were administered the Brief Symptom Inventory (BSI), the General Well-being Scale (GWB), the Parental Bonding Instrument (PBI) and the Perceived Social Support-Family/Friend (PSS-Fa and PSS-Fr) measures. War-bereaved adolescents showed significantly higher scores in psychological well-being (GWB) and significantly lower scores in reported psychiatric symptoms (BSI) than accident-bereaved adolescents. War-bereaved adolescents also had significantly better BSI and GWB scores than the general nonbereaved adolescent population. These results persisted after controlling for family socio-economic status, gender, and the degrees of closeness of the deceased relative. War-bereaved adolescents did not differ either from accident-bereaved adolescents or from the nonbereaved general adolescent population in social and family support systems (PSS-Fr, PSS-Fa) and did not experience different basic parental attitudes (PBI). Results are discussed in terms of the different meanings ascribed to death in battle versus death in a road accident.     

Legal and ethical considerations of informed consent

The law of informed consent remains ineffective at resolving patient comprehension issues primarily because differing interpretations exist regarding who is responsible for the duty to inform. Court cases continue to set precedents for practicing physicians and other health care providers; however, other measures can be applied for effectual patient advocacy. Health care personnel should rewrite typical consent forms in simpler terms, use larger print, and create duplicate copies. If patients are given copies of the permits they sign, the can reread the forms at home when they are more comfortable. For true autonomy to exist in informed consent for surgical procedures, consent forms should contain patients' primary languages whenever possible, or an adequate interpreter should be made available. Surgeons, nurses, and other health care providers must become aware of their responsibilities related to informed consent for treatment. It is necessary for health care personnel to develop and use effective communication techniques and remember that although some patients are more visually attuned to new information, other patients may benefit more from listening or reading. The cases in this article show that a patient's autonomy is part of the informed consent process and the duty to inform the patient lies with the person performing the procedure. A more important issue, however, involves the patient's comprehension of the information given, because without it, the patient cannot achieve true autonomy in making decisions. Ensuring that all elements of informed consent are met to obtain informed consent will result in fewer malpractice claims, greater patient satisfaction, and an improved professional image. Nevertheless, nurses should make themselves aware of the state laws in which they practice, including their nurse practice acts. They then should advocate for patient rights by encompassing all elements of informed consent.     

Assisted suicide after discharge from the psychiatric clinic

Assisted suicide has become a topic often and controversally discussed in international literature. Psychiatry and mentally ill, however, have been neglected, probably because the question of competence of judgement and will are a major issue in this matter. Two cases are reported, one of a 60-year old man and a women of 87 years, who have committed suicide a few days after having been dismissed from stationary psychiatric care. The reason of admission had been a psychotic event with manifest AIDS-disease in the first, the public utterance of her wish to die with support of, the swiss "Help to Die" organization "Exit", in the latter. Ethics and means of preentive interventions in such cases are discussed.     

Addressing professional competence problems in trainees: Some ethical considerations.

Psychologists working as graduate student educators and clinical supervisors often encounter trainees who manifest problems of professional competence. At times, faculty members and supervisors may experience role conflict, ambiguity, and anxiety about how to respond to trainee competence problems. Psychologists engaged in the education, training, and credentialing of trainees are ethically and professionally obligated to balance their developmental and gatekeeping roles with respect to trainees. A discussion of several systemic concerns related to psychology's approach to competence problems is presented along with 3 expert commentaries that further elucidate the core issues from the vantage point of education, training, and licensure. Several recommendations for enhancing cooperation and excellent practice among psychologists who train and credential are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obesity: some psychological and physiological considerations

The case report of an obese patient deals with his background, history of life and its correlation to obesity. The causes, circumstances and habits of eating are almost a perfect expression of the traditional theories of obesity. This case report emphasizes the correlation between the psychiatric theory that divides the obese people into adult and juvenile types and the histological findings that obesity can be divided into hyperplastic and hypertrophic types according to the quality and quantity of the fat cells. In fact these two theories may be manifestations of the basic, yet unknown cause of obesity. A doubt to the classical theories is cast by the operation of jejunoileostomy which changes many personality characteristics which were considered primary in obesity.     

Germ-line therapy for mitochondrial disease: some ethical objections

In an effort to examine the functional neuroanatomy of semantic memory, we studied the relative cerebral blood flow of eight healthy young subjects using 15O-water positron emission tomography (PET). Relative to a visual baseline control condition, each of four visual matching-to-sample tasks activated components of the ventral visual processing stream, including the inferior occipital and temporal cortices. Contrasting the task with the highest semantic component, a variation on the Pyramids and Palm Trees paradigm, with a size discrimination task resulted in focal activation in the anterior inferior temporal lobe, focused in the parahippocampal gyrus. There was additional activation in BA47 of the inferior frontal cortex. These data replicate and extend previously reported results using similar paradigms, and are consistent with cognitive neuropsychological models that stress the executive role of BA47 in semantic processing tasks.