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Similar features noted in hastened death and euthanasia cases
- Richard MacDonald (26 July 2003)
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SUPPORTER OF RIGHT TO EUTHANASIA
- Valerie Coast (29 July 2003)
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Keep religion out of my death
- Anne Shaw (30 July 2003)
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Inclusions and omissions
- John H Scotson (30 July 2003)
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Hope in the future
- Angela Cecilia Ireland (30 July 2003)
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Euthanasia and Complicated Grief
- Holly G Prigerson, Selby C Jacobs (5 August 2003)
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Bereavement in the elderly
- Frans Verhage, Heert J.Dokter, Em.Prof.of General Practice (2 February 2004)
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ideas re: euthanasia
- Fiona Sweeney (2 April 2005)
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Richard MacDonald, Medical Director, End of Life Choices 2060 Amanda Way #25, Chico, CA 95928
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The article comparing grief in loved ones and friends of euthanasia and "natural death" patients was interesting and confirming of what we have observed in our experience with giving information and support to those seeking hastened death in the United States. The Hemlock Society, now known as "End-of-Life Choices" has provided a service to its members for over four years, in a program called "Caring Friends". As well as giving explicit information on methods to hasten the dying process as peacefully as possible without fear of failure, trained volunteers with expert supervision, usually with a physician attending at the time of the chosen death, have supported more than 125 members who successfully found relief from the terminal suffering of illness. As the physician present at over 85 of these deaths, I had the privilege of being trusted to give reassurance and support to the patients as well as to those friends and loved ones present when death occurred. It has been our observation that much of the grieving has already occurred when a dying time is planned ahead. Resolution of family discord has been possible, farewells have been meaningful and very open. At the time of the death there is often an atmosphere similar to the celebration of life at a wake. We have noted laughter mingled with tears. Acceptance of the loss that is to come is apparent - this does not diminish the sense of loss or grief but may reduce the severity of those factors that one sees with an unexpected death. A planned death, as with euthanasia, can be rational and acceptable to the patient suffering an illness without hope of recovery as well as to the family and loved ones. It is unfortunate that it must be covertly accomplished in the United Kingdom as well as in America and most other countries. The experience in The Netherlands will hopefully help advance the concept of having more compassionate and merciful approaches to dying, permitting the patient, not the medical establishment, to be in control of these difficult but important decisions. Richard MacDonald, M.D. Past-President, World Federation of Right-to-Die Societies Competing interests: None declared |
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Valerie Coast, retired CH42 8QE
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As a lay person, I am glad that such research is being undertaken as it shows how much better we can make the difficult situations in which people find themselves. People are allowed to keep their dignity and as your results seem to indicate: there is no increase in request for assisted death families and friends seem better able to cope with bereavement people have the space and time to discuss openly with loved ones people have the chance for a loving farewell [ I experienced the early, unexpected death of my husband and not being able to say goodbye properly has been a life long sorrow ] . Doctors are, I understand, putting their careers at risk by helping people to die in secret. They should not have to take on this worry and burden. Society expects people to be responsible for everything in their lives - why can we not also be allowed responsibility for how and when we die? Thanks for this research Competing interests: None declared |
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Anne Shaw, Retired Retired
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I do not suppose that evidence from research projects that confirms the evidence from common sense, observation and experience, will enable our legislature to resist the pressure from the religious lobby against Voluntary Euthanasia. It is well established that fear, stress and anxiety affects the normal human physiology through their natural balancing systems, the sympathetic nervous system, endocrine system, auto-immune system etc., blocking the body's own protective mechanisms. In the situation of people dying from long drawn out, painful and debilitating conditions, the added fear and anxiety of agony to come, must add to their distress and worsen their symptoms and ability to cope with them. This must also have a traumatic effect on their family and carers, who must be desperate to be able to reassure the patient that they will not be left to suffer the unbearable. The whole business of death in agony in this country is an outrage to human sense and compassion. Adults who want to should be able to take control of their death in full knowledge and consultation with their doctors and carers. Those patients and doctors who do not want to make that choice, that is their choice, but they have no right to foist their religious views on those not of their beliefs. Their constant attempt to enforce their views on this as on abortion and the use of condoms is intollerable. Anne Shaw Competing interests: None declared |
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John H Scotson, Retired GP Retired
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This article is interesting for what is included and for what is not included. The ethical aspect of euthanasia or the intention to kill the patient cannot be judged by the reaction it produces in the surviving relatives and friends of the one who had been killed: the important statement is made by the authors “Our results should not be interpreted as a plea for euthanasia” We are not informed as to whether the relatives who had been questioned acquiesced in the lives of their relatives being deliberately brought to an end. This would have an important influence in their reaction to the death of the one who had been killed. Grief or the absence of grief at any one time does not mean that emotions will not alter with the passage of time. We are not informed about the time after death that questionnaires were completed. Competing interests: None declared |
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Angela Cecilia Ireland, support worker 1 Momfa Ave. Sk3
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Death is not an end but the beginning of eternity. The last moments on earth should be a preparation for eternal life. The person is made up of body, soul, mind and spirit. To exclude any of these in the care of the terminally ill is to fail them. How often is it the family that is the cause of a person asking for euthanasia. Is it really the sick person who is being shown the 'mercy'? It is easy to see how one may long for a loved one to be released from suffering in the short term but in the long term there will always be the knowledge that one was a factor is the shortening of the loved ones life and the anxiety of wondering what kind of eternity they had helped to provide for them. As a pensioner I am afraid to be admitted to hospital as I have lost trust in a profession that no longer holds life sacred. Competing interests: pro life |
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Holly G Prigerson, Associate Professor Yale Medical School 06519, Selby C Jacobs
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Dear Editor, We find the publication by Swarte et al. on the effects of euthansia on the bereavement of family and friends of the deceased to be interesting and important. The results demonstrating the cross-sectional association between euthanasia and lower rates of Complicated Grief (CG)is consistent with our own work demonstrating that preparation for the death is protective against CG (Barry, Kasl, Prigerson, 2002). We would like to take the opportunity, however, to clarify that the publication cited [Jacobs, Mazure, Prigerson (2000) ] describes the development and testing of a CG criteria set . No where do we state, as they write, that "Traumatic grief refers to situations where grief symptoms take too long or too short, are too intense are not intense enough, or come too late." CG is defined by us and others primarily with respect to the phenomenology of the disorder (eg, symptom profile). Further, we take issue with their statement that we have suggested that "euthanasia may induce traumatic grief" (citing the Jacobs et al. 2000) -- the assumption being that by saying traumatic/unnatural deaths heighten risk for CG would imply euthanasia would present such a risk. Indeed, we have reverted to the terminology of Complicated Grief, as opposed to Traumatic Grief, to avoid the etiologic assumption that the path to this disorder is paved by traumatic losses. Our research (eg, Prigerson et al. 2002) and the work of others (eg, Cleiren 1993; Dyregrov et al. 2003) actually show that the rate of CG does not differ by mode of death (traumatic vs. not). Rather, aspects such as kinship and attachment to the deceased are the primary risks for CG (Prigerson et al. 1997; 2002). For this reason, we were concerned that the PAS group consisted more of distant relations compared with the closer kinship relations of the control group (eg, children). Kinship was found to be a confounding factor and the models adjusted for this, yet the fact that "saying goodbye" in essence explained the association between euthanasia and CG was not surprising because it probably was proxy for felt closeness to the deceased. This reaction is not intended to undermine the importance of this study in demonstrating the reduction of CG as a potential benefit of euthanasia for the survivors. The intention is to clarify our thoughts on CG and not be attributed with suggesting euthanasia "induce traumatic grief." In fact, based on our own work we would have hypothesized the exact opposite. Competing interests: None declared |
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Frans Verhage, Em.Prof.of Medical Psychology 3723 BC Bilthoven the Netherlands, Heert J.Dokter, Em.Prof.of General Practice
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Editor During a qualitative study we investigated the grieving process of elderly people after the loss of their partner. We had two talks with nineteen husbands and wives of recently deceased partners of about seventy years of age. One talk six months and a second talk one year after the death. Most of the partners had died at home, from cancer or another terminal disease. One of the questions we wanted to answer was, if, after one year, there were still problems in coping with the loss. In respect to this question we made an observation that seems to us a supplement to the paper of Swarte et al. (2003). These authors studied the effects of euthanasia on the bereaved family and friends. They interprete their findings as a plea for talking openly about the forthcoming death while the mind of the patient is fully aware of his or her situation . Thus the talk between the patient and his or her relatives is of great importance.According to the euthanasia (two cases) we were also impressed by the openness with which this was discussed by the left behind partners in our population. We found that there is another important talk in the last phase of life, namely the one between the patient, the partner and the doctor. We observed that in those talks there often arise insolvable misunderstandings. For example a cardiologist tells the patient and his partner:"the heartmuscle is not working very well". The patient and his wife did not interprete this saying as referring to a lifethreatening situation with the unpleasant consequence that for the wife the death of her husband came as a shock. For us it was clear from both talks we had with them, that many of the partners could not get over such misunderstandings. They talked about it with indignation and our impression is that the left behind partner could not let loose what had happened. The feelings about these misunderstandings seem to us a barrier in the process of grieving. We think that it must be relatively simple to prevent these misunderstandings by asking:"Did you understand what I mean?" or something alike. As Swarte et al. argue, with this simple technique "the level of care and openness in all patients who are terminally ill" can be more free of conflicts. Competing interests: None declared |
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Fiona Sweeney, student nurse university of ulster, magee
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i am a final year nursing journal and euthanasia is my final assignment from a nursing perspective. i need access to case laws-can anyone direct me-i would really appreciate it. other suggestions on the arguments for and against would also be greatfully appreciated. thankyou- my email address is sweeney-f@ulst.ac.uk Competing interests: None declared |
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