End of life decision-making, euthanasia, and physician assisted suicide in persons with neuropsychiatric conditions

神经精神疾病患者的临终决策、安乐死和医生协助自杀

• 批准号: 10471701
• 负责人: Scott Kim
• 金额: --
• 依托单位: CLINICAL CENTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10471701
• 关键词: Advance Directives; Area; Assisted Suicide; Bioethics; Biology; Clinical; Collaborations; Country; Decision Making; Dementia; Ethical Issues; Ethics; Euthanasia; Eye; Future; Gender; Geriatric Psychiatry; Guidelines; Human Rights; Judgment; Laws; Legal; Manuscripts; Medical; Medical Ethics; Medical Futility; Medicine; Methods; Modeling; Modernization; Netherlands; Oral; Patients; Persons; Philosophy; Physician-Assisted Suicides; Physicians; Policy Making; Population; Publishing; Reporting; Review Committee; Social Policies; Suicide; Surveys; Switzerland; Terminal Disease; Universities; Woman; analytical method; base; design; end of life; evidence base; ideation; neuropsychiatry; policy implication; professor; theories; treatment-resistant depression; trend

In the past year, we have conducted the following projects. 1. We have completed an analysis of the relationship between suicide, gender and psychiatric EAS, using modern theories of suicide (generally known as as ideation-to-action theories) to explore the ethical, clinical, and policy implications of overrepresentation of women in psychiatric EAS. The MS was published in BJPsychiatry. 3. Treatment resistant depression (TRD), psychiatric EAS, and the criterion of irremediability. One of the key criteria for psychiatric euthanasia in countries that allow it is irremediability and medical futility of the condition and the suffering arising from it. However, the current practice (as reflected in published reports that our group has studied extensively) relies on clinician judgments which may or may not reflect practices based on current evidence base. This project uses TRD as the paradigm condition and will provide a rigorous evidence-based review and analysis to answer the question: How reliable and valid is a clinician's judgment in making a prediction about a patients future clinical status and course? This project's main manuscript is now under review. 4. Using our analysis of concurrent request EAS (i.e., persons with dementia who received EAS while they were still deemed competent, rather than based on advance directives after they reach state of incapacity), we analyzed in depth the current practice in the Netherlands and the standards currently endorsed by the RTE (Dutch euthanasia review committees). We argued that contrary to the published guidelines, the Dutch practice for concurrent request dementia EAS does not seem to use a functional model of capacity and is more like an implementation of oral advance directive based EAS (which is technically not legal). This was published in J Medical Ethics. 5. We have recently completed a national survey of US population on whether they think advance request EAS for dementia should be legalized. The experimental survey design examined the impact of 6 specific ethical and practical challenges in the implementation of advance request EAS. This was published in Am J of Geriatric Psychiatry. 6. I recently published an analysis which argued that EAS should not be debated as a matter of a basic human right; if it is to be debated, it should be as a matter for social policy-making. Answering this question does not settle whether psychiatric EAS should be legal. But it will help us to see more clearly what it is that we are debating, and the implications of the different ways in which we debate it. This study covered areas in law, philosophy, and bioethics, and was published in Perspectives in Biology and Medicine. 7. Switzerland is one of the countries that allow physician-assisted deaths. In collaboration with Professor Rafael Cohen-Almagor from University of Hull, we continue our study of the Swiss practice through the eyes of the organizational and medical experts in that country.

在过去的一年里，我们开展了以下项目。 1. 我们已经完成了对自杀、性别和精神 EAS 之间关系的分析，利用现代自杀理论（通常称为观念到行动理论）来探讨自杀中女性比例过高的伦理、临床和政策影响。精神科 EAS。该 MS 发表在《BJPsychiatry》上。 3. 难治性抑郁症（TRD）、精神科EAS和不可治愈的标准。在允许精神科安乐死的国家，其关键标准之一是该病症及其造成的痛苦无法治愈且医疗无效。然而，当前的实践（正如我们小组广泛研究的已发表报告所反映的那样）依赖于临床医生的判断，这些判断可能反映也可能不反映基于当前证据基础的实践。该项目以TRD为范式条件，将提供严格的循证审查和分析来回答以下问题：临床医生在预测患者未来临床状态和病程时的判断有多可靠和有效？ 该项目的主要手稿目前正在审查中。 4. 通过对同时请求 EAS 的分析（即痴呆症患者在仍被视为有能力时接受 EAS，而不是在达到无行为能力状态后根据预先指示），我们深入分析了荷兰的当前做法，目前由 RTE（荷兰安乐死审查委员会）认可的标准。我们认为，与已发布的指南相反，荷兰针对并发请求痴呆症 EAS 的做法似乎没有使用能力的功能模型，而更像是基于口头预先指示的 EAS 的实施（这在技术上是不合法的）。该文章发表在《医学伦理学杂志》上。 5. 我们最近完成了一项针对美国人口的全国调查，调查他们是否认为针对痴呆症的提前申请 EAS 应该合法化。实验调查设计检验了实施预先请求 EAS 过程中 6 个具体道德和实际挑战的影响。该文章发表在《Am J of Geriatric Psychiatry》上。 6. 我最近发表了一篇分析文章，认为 EAS 不应作为基本人权问题进行辩论；如果要对此进行辩论，就应该将其作为社会决策的问题。回答这个问题并不能解决精神科 EAS 是否应该合法的问题。但这将帮助我们更清楚地看到我们正在辩论的是什么，以及我们辩论的不同方式的含义。这项研究涵盖了法律、哲学和生物伦理学领域，并发表在《生物学和医学展望》上。 7. 瑞士是允许医生协助死亡的国家之一。我们与赫尔大学的拉斐尔·科恩-阿尔马戈尔教授合作，通过该国组织和医学专家的视角继续研究瑞士的实践。