Plaisier, J.W. (Jan Willem) (2014) Euthanasie en dementie: het perspectief van patiënt en arts. thesis, Medicine.
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Abstract
The Netherlands legalized voluntary active euthanasia (VAE) in 2002, after about thirty years of public debate. Since then, Dutch physicians are no longer persecuted when carrying out VAE on patients within specific legal boundaries. Nevertheless, VAE remains subject of ongoing debate, especially considering patients with psychiatric disorders or dementia. However, the perspective of patients with dementia and that of nursing home physicians remains underexposed. The current study aims to scientifically approach these both perspectives. A qualitative study was performed, consisting of 8 interviews with patients, in which they discussed their views on end of life and VAE, from the project ‘Help demented! Patient and caregiver speak out’. In addition, 12 interviews were performed with nursing home physicians. Patients with dementia are mostly pessimistic about their distant future. Some of them intend to request VAE at some point in time. The contemporary practice considering VAE in the Netherlands is, however, not commonly known among participants. Participating nursing home physicians do not carry out euthanasia on patients living in nursing homes. Most frequently used motives are lack of competency and lack of communication abilities in these patients. Also, participants declare that they do not (or would not) carry out euthanasia in the presence of an advance directive on VAE, because patients can change their mind over the course of their illness. In contrast, nursing home physicians do take into account advance directives on VAE when making decisions about withdrawing potentially life sustaining treatments, together with assessments on quality of life and patient suffering. However, these latter concepts remain ill-defined. Nursing home physicians make a distinction between VAE and the withdrawal of potentially life sustaining treatments. The distinction was found to be related to the difference in psychological impact between these decisions on the physician. Application of concepts such as substituted judgment based on the presumed wishes of the patient, quality of life, and suffering remains inadequate. Presumably, decisions concerning end of life are best justified by a more objective model of patient’s best interest. Such needs to be developed.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Maeckelberghe, Dr. E.L.M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:01 |
| Last Modified: | 25 Jun 2020 11:02 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2174 |
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