BACKGROUND:Euthanasia has been legally performed in the Netherlands since 2002. Respect for patient's autonomy is the underpinning ethical principal. However, patients have no right to euthanasia, and physicians have no obligation to provide it. Although over 3000 cases are conducted per year in the Netherlands, there is little known about how decision-making occurs and no guidance to support this difficult aspect of clinical practice. AIM:To explore the decision-making process in cases where patients request euthanasia and understand the different themes relevant to optimise this decision-making process. DESIGN:A qualitative thematic analysis of interviews with patients making explicit requests for euthanasia, most-involved relative(s) and treating physician. PARTICIPANTS/SETTING:Thirty-two cases, 31 relatives and 28 treating physicians. Settings were patients' and relatives' homes and physicians' offices. RESULTS:Five main themes emerged: (1) initiation of sharing views and values about euthanasia, (2) building relationships as part of the negotiation, (3) fulfilling legal requirements, (4) detailed work of preparing and performing euthanasia and (5) aftercare and closing. CONCLUSIONS:A patient's request for euthanasia entails a complex process that demands emotional work by all participants. It is characterised by an intensive period of sharing information, relationship building and negotiation in order to reach agreement. We hypothesise that making decisions about euthanasia demands a proactive approach towards participants' preferences and values regarding end of life, towards the needs of relatives, towards the burden placed on physicians and a careful attention to shared decision-making. Future research should address the communicational skills professionals require for such complex decision-making.

译文

背景:自2002年以来,大头菜已在荷兰合法地进行。尊重患者的自主权是道德原则的基础。但是,患者没有安乐死的权利,医生也没有义务提供安乐死。尽管荷兰每年进行3000多例,但对于如何进行决策知之甚少,也没有指导来支持这一临床实践的困难方面。
目的:探讨患者需要安乐死的情况下的决策过程,并了解与优化该决策过程相关的不同主题。
设计:对明确要求安乐死,涉及最多的亲属和主治医师的患者进行访谈的定性主题分析。
参加者/地点:32例,31名亲属和28名主治医师。设置地点是患者和亲戚的住所以及医生的办公室。
结果:出现了五个主要主题:(1)开始就安乐死分享观点和价值;(2)建立关系作为谈判的一部分;(3)满足法律要求;(4)准备和执行安乐死的详细工作;(5) )的善后服务和关闭。
结论:患者对安乐死的要求涉及一个复杂的过程,需要所有参与者进行情感上的努力。它的特点是需要长时间共享信息,建立关系和进行谈判以达成协议。我们假设,关于安乐死的决策需要采取积极的方法来对待参与者关于生命终结的偏好和价值观,亲戚的需要,医生的负担以及对共同决策的认真关注。未来的研究应解决专业人员进行此类复杂决策所需的沟通技巧。

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