Abstract:
OBJECTIVES:Potentially life-shortening medical end-of-life practices (end-of-life decisions (ELDs)) remain subject to conceptual vagueness. This study evaluates how physicians label these practices by examining which of their own practices (described according to the precise act, the intention, the presence of an explicit patient request and the self-estimated degree of life shortening)they label as euthanasia or sedation. METHODS:We conducted a large stratified random sample of death certificates from 2007 (N=6927).The physicians named on the death certificate were approached by means of a postal questionnaire asking about ELDs made in each case and asked to choose the most appropriate label to describe the ELD. Response rate was 58.4%. RESULTS:In the vast majority of practices labelled as euthanasia, the self-reported actions of the physicians corresponded with the definition in the Belgian euthanasia legislation; practices labelled as palliative or terminal sedation lack clear correspondence with definitions of sedation as presented in existing guidelines. In these cases, an explicit life-shortening intention by means of drug administration was present in 21.6%, life shortening was estimated at more than 24 h in 51% and an explicit patient request was absentin 79.7%. DISCUSSION:Our results suggest that, unlike euthanasia,the concept of palliative or terminal sedation covers abroad range of practices in the minds of physicians. This ambiguity can be a barrier to appropriate sedation practice and indicates a need for better knowledge of the practice of palliative sedation by physicians.
journal_name
J Med Ethicsjournal_title
Journal of medical ethicsauthors
Deyaert J,Chambaere K,Cohen J,Roelands M,Deliens Ldoi
10.1136/medethics-2013-101854subject
Has Abstractpub_date
2014-07-01 00:00:00pages
505-7issue
7eissn
0306-6800issn
1473-4257pii
medethics-2013-101854journal_volume
40pub_type
杂志文章abstract:OBJECTIVE:To demonstrate Japanese doctors' and nurses' attitudes towards and practices of voluntary euthanasia (VE) and to compare their attitudes and practices in this regard. DESIGN:Postal survey, conducted between October and December 1999, using a self-administered questionnaire. PARTCIPANTS: All doctor members an...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.27.5.324
更新日期:2001-10-01 00:00:00
abstract::Understanding dental ethics as a field separate from its much better known counterpart, medical ethics, is a relatively new, but necessary approach in bioethics. This need is particularly felt in dental education and establishing a curriculum specifically for dental ethics is a challenging task. Although certain topic...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2011-100067
更新日期:2012-01-01 00:00:00
abstract::Over the past few decades, "Big Tobacco" has spread its tentacles across the developing world with devastating results. The global incidence of smoking has increased exponentially in Africa, Asia and South America and it is leading to an equally rapid increase in the incidence of smoking-induced morbidity and mortalit...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2008.027847
更新日期:2009-06-01 00:00:00
abstract::Kovacs argues that honorary authorship and regarding each co-author of multi-authored papers as if they were sole authors when the performance of researchers is being evaluated by their publications mean that we should require authors to identify what proportion of each publication should be attributed to each co-auth...
journal_title:Journal of medical ethics
pub_type: 评论,杂志文章
doi:10.1136/medethics-2012-100939
更新日期:2013-08-01 00:00:00
abstract::The Handicap Division of the Society for the Protection of the Unborn Child (SPUC) organized picketing of Britain's Medical Research Council to protest against trials of multivitamin supplementation for high-risk pregnant women to prevent development of spina bifida in the fetus. The trials have been condemned by man...
journal_title:Journal of medical ethics
pub_type: 新闻
doi:10.1136/jme.10.3.165
更新日期:1984-09-01 00:00:00
abstract::This paper explores the use of advance directives in clinical dementia research. The focus is on advance consent to participation of demented patients in non-therapeutic research involving more than minimal risks and/or burdens. First, morally relevant differences between advance directives for treatment and care, and...
journal_title:Journal of medical ethics
pub_type: 杂志文章,评审
doi:10.1136/jme.24.1.32
更新日期:1998-02-01 00:00:00
abstract::This paper argues the case for coming to see 'medical politics' as a topic or subject within medical education. First, its absence is noted from the wide array of paramedical subjects (medical ethics, history of medicine, the medical humanities, etc) currently given attention in both the medical education literature a...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2010.041277
更新日期:2011-10-01 00:00:00
abstract::In the light of increasing public mistrust, there is an urgent need to clarify the moral status of the medical profession and of the relationship of the clinician to his/her patients. In addressing this question, I first establish the coherence, within moral philosophy generally, of the concept of supererogation (the ...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.28.2.70
更新日期:2002-04-01 00:00:00
abstract::This paper makes two main claims: first, that the need to protect health professionals' moral integrity is what grounds the right to conscientious objection in health care; and second, that for a given claim of conscientious objection to be acceptable to society, a certain set of criteria should be fulfilled. The impo...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2011.043646
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVE:To determine the views of people with multiple sclerosis (MS) and professionals in relation to confidentiality, consent and access to data within a proposed MS register in the UK. DESIGN:Qualitative study using focus groups (10) and interviews (13). SETTING:England and Northern Ireland. PARTICIPANTS:68 peo...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2008.025304
更新日期:2009-02-01 00:00:00
abstract::On 9 May 2005, the Israeli Ministry of Health issued guidelines spelling out the conditions under which sex selection by preimplantation genetic diagnosis (PGD) for social purposes is to be permitted in Israel. This article first reviews the available medical methods for sex selection, the preference for children of a...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2007.023226
更新日期:2008-09-01 00:00:00
abstract::The practice of covertly administering medication is controversial. Although condemned by some as overly paternalistic, others have suggested that it may be acceptable if patients have permanent mental incapacity and refuse needed treatment. Ethical, legal, and clinical considerations become more complex when the ment...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2003.007336
更新日期:2005-05-01 00:00:00
abstract::In a recent article, Udo Schuklenk and Suzanne van de Vathorst argued in favour of a legal option of physician-assisted death for patients with 'treatment-resistant' depression. In this commentary, I contend that their argument neglects the important consideration of the professional integrity of physicians. In light ...
journal_title:Journal of medical ethics
pub_type: 评论,杂志文章
doi:10.1136/medethics-2015-103060
更新日期:2015-11-01 00:00:00
abstract::Are fake diagnoses and false or misleading certificates permissible means of helping patients? This question is examined in relation to four examples from Swedish health care: the sterilisation case, the asylum case, the virginity case, and the adoption case. We argue that both consequentialist and deontological ethic...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2006.018945
更新日期:2008-03-01 00:00:00
abstract::In this paper we question whether the concept of "genetic privacy" is a contradiction in terms. And, if so, whether the implications of such a conclusion, inevitably impact on how society comes to perceive privacy and responsibility generally. Current law and ethical discourse place a high value on self-determination ...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.25.2.144
更新日期:1999-04-01 00:00:00
abstract::Literary accounts of traumatic events can be more informative and insightful than personal testimonials. In particular, reference to works of literature can give us a more vivid sense of what it is like to receive a devastating diagnosis. In turn this can lead us to question some common assumptions about the nature of...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.24.2.123
更新日期:1998-04-01 00:00:00
abstract::Recognising that offers of payment to research participants can serve various purposes-reimbursement, compensation and incentive-helps uncover differences between participants, which can justify differential payment of participants within the same study. Participants with different study-related expenses will need dif...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2018-105140
更新日期:2019-05-01 00:00:00
abstract::Anne Barnhill and Franklin Miller dispute my claim that the prescriptions of placebo treatments to patients are not typically deceptive, and do not typically violate the patients' informed consent. However, Barnhill and Miller seriously mischaracterise my position in two ways, as well as failing to show that the proce...
journal_title:Journal of medical ethics
pub_type: 评论,杂志文章
doi:10.1136/medethics-2015-103082
更新日期:2016-10-01 00:00:00
abstract::Medical ethical analysis remains dominated by the principlist account first proposed by Beauchamp and Childress. This paper argues that the principlist model is unreflective of how ethical decisions are taken in clinical practice. Two kinds of medical ethical decisions are distinguished: biosocial ethics and clinical ...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2011-100136
更新日期:2012-04-01 00:00:00
abstract::The 'right to the truth' involves disclosing all the pertinent facts to a patient so that an informed decision can be made. However, this concept of a 'right to the truth' entails certain ambiguities, especially since it is difficult to apply the concept in medical practice based mainly on current evidence-based data ...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2009.033340
更新日期:2010-06-01 00:00:00
abstract::Giubilini and Minerva argue that the permissibility of abortion entails the permissibility of infanticide. Proponents of what we refer to as the Birth Strategy claim that there is a morally significant difference brought about at birth that accounts for our strong intuition that killing newborns is morally impermissib...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2020-106781
更新日期:2020-10-26 00:00:00
abstract::It is argued that the current policy of the British Medical Association (BMA) on conscientious objection is not aligned with recent human rights developments. These grant a right to conscientious objection to doctors in many more circumstances than the very few recognised by the BMA. However, this wide-ranging right m...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2015-103222
更新日期:2017-04-01 00:00:00
abstract::Several distinct arguments conclude that terminally ill patients have a right to a medically assisted death; two are especially influential: the autonomy argument and the non-harm argument. Both have proven convincing to many, but not to those who view the duty not to kill as an (almost) absolute constraint. Some phil...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2016-103575
更新日期:2017-06-01 00:00:00
abstract::Several prominent writers including Norman Daniels, James Sabin, Amy Gutmann, Dennis Thompson and Leonard Fleck advance a view of legitimacy according to which, roughly, policies are legitimate if and only if they result from democratic deliberation, which employs only public reasons that are publicised to stakeholder...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2017-104559
更新日期:2018-06-01 00:00:00
abstract::The rapid emergence and exploding usage of online social networking forums, which are frequented by millions, present clinicians with new ethical and professional challenges. Particularly among a younger generation of physicians and patients, the use of online social networking forums has become widespread. In this ar...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2009.029231
更新日期:2009-09-01 00:00:00
abstract::Jehovah's Witnesses are students of the Bible. They refuse transfusions out of obedience to the scriptural directive to abstain and keep from blood. Dr Muramoto disagrees with the Witnesses' religious beliefs in this regard. Despite this basic disagreement over the meaning of Biblical texts, Muramoto flouts the religi...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.25.6.469
更新日期:1999-12-01 00:00:00
abstract::This paper is not about the medical condition of AIDS. Nor is it about the history of the condition since it was first reported in Atlanta, Georgia in 1981. It looks rather, at the catalogue of legislative and other legal responses to the spread of AIDS. The paper analyses the AIDS condition in its historical context....
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.12.4.187
更新日期:1986-12-01 00:00:00
abstract:BACKGROUND:Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians' considerations in clinical prioritisation within this field is scarce. OBJECTIVES:To explore how clinicians understand their professional role in clinical prioritisation...
journal_title:Journal of medical ethics
pub_type: 杂志文章,多中心研究
doi:10.1136/jme.2007.020693
更新日期:2008-05-01 00:00:00
abstract::We propose a principle of sustainability to complement established principles used for justifying healthcare resource allocation. We argue that the application of established principles of equal treatment, need, prognosis and cost-effectiveness gives rise to what we call negative dynamics: a gradual depletion of the v...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2020-106644
更新日期:2021-02-01 00:00:00
abstract::A quiet revolution is occurring in the field of transplantation. Traditionally, transplants have involved solid organs such as the kidney, heart and liver which are transplanted to prevent recipients from dying. Now transplants are being done of the face, hand, uterus, penis and larynx that aim at improving a recipien...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2015-103348
更新日期:2017-11-01 00:00:00