BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: PURPOSE:Health state values are by convention anchored to 'perfect health' and 'death.' Attitudes toward death may consequently influence the valuations. We used attitudes toward euthanasia (ATE) as a sub-construct for attitudes toward death. We compared the influence on values elicited with time trade-off (TTO), lead-time TTO (LT-TTO) and visual analogue scale (VAS).Since the 'death' anchor is most explicit in TTO, we hypothesized that TTO values would be most influenced by ATE. METHODS:Respondents valued eight EQ-5D health states with VAS, then TTO (n = 328) or LT-TTO (n = 484). We measured ATE on a scale from -2 (fully disagree) to 2 (fully agree) and used multiple linear regressions to predict VAS, TTO, and LT-TTO values by ATE, sex, age, and education. RESULTS:A one-point increase on the ATE scale predicted a mean TTO value change of -.113 and LT-TTO change of -.072. Demographic variables, but not ATE, predicted VAS values. CONCLUSIONS:TTO appears to measure ATE in addition to preferences for health states. Different ways of incorporating death in the valuation may impact substantially on the resulting values. 'Death' is a metaphysically unknown concept, and implications of attitudes toward death should be investigated further to evaluate the appropriateness of using 'death' as an anchor.

背景与目标： 目的：按照惯例，将健康状态值锚定为“完美健康”和“死亡”。因此，对死亡的态度可能会影响估值。我们将对安乐死的态度（ATE）作为对死亡态度的子构造。我们比较了时间权衡（TTO），提前期TTO（LT-TTO）和视觉模拟量表（VAS）对价值产生的影响。由于``死亡''锚在TTO中最为明确，因此我们假设TTO值受ATE影响最大。
方法：受访者使用VAS评估了八个EQ-5D健康状态，然后是TTO（n = 328）或LT-TTO（n = 484）。我们以从-2（完全不同意）到2（完全同意）的量度了ATE，并使用多元线性回归通过ATE，性别，年龄和学历来预测VAS，TTO和LT-TTO值。
结果：ATE量表上的单点上升预测平均TTO值变化为-.113，而LT-TTO变化为-.072。受众特征变量（而不是ATE）是预测的VAS值。
结论：除了对健康状态的偏好外，TTO似乎还可以测量ATE。将死亡纳入估值的不同方式可能会严重影响最终价值。 “死亡”是一个形而上学上未知的概念，应进一步研究对死亡态度的影响，以评估使用“死亡”作为锚点的适当性。

BACKGROUND & AIMS: AIM:This paper reports the findings of a survey that investigated whether Flemish Catholic hospitals and nursing homes had developed written ethics policies on euthanasia and how the role of nurses was described in these policies. BACKGROUND:International research shows undeniably that nurses are confronted with patients requesting euthanasia. Euthanasia has been legal in Belgium since 2002 and in Holland since 2001. Because of the vagueness in formal documents and policies on the role of nurses in euthanasia, there is an increasing need to establish institutional ethics policies that clearly describe the role of nurses in the euthanasia process. METHODS:We used a cross-sectional descriptive mail questionnaire to survey the general directors of Catholic hospitals and nursing homes in Belgium (Flanders). Data were collected between October 2003 and February 2004. RESULTS:Of the 298 institutions targeted for survey, 81% of hospitals, 62% of nursing homes returned completed questionnaires. Of these, 79% of the hospitals and 30% of the nursing homes had a written ethics policy on euthanasia. The ethics policies of 87% of the hospitals and 77% of the nursing homes explicitly addressed the role of nurses in the euthanasia process. In the majority of hospitals and nursing homes, the ethics policies addressed the conscientious objections of nurses to euthanasia. Most hospitals and nursing homes voluntarily communicated their ethics policies to the nurses they employed. CONCLUSION:The written ethics policies of most Catholic healthcare institutions give explicit attention to the role of nurses in the euthanasia process. However, the meaning and content of the role of nurses, as indicated in these ethics policies, continue to be an issue. Further research is needed to verify how these policies are actually implemented within the institutions and whether they contribute to better support for nurses and to ethical care for patients.

背景与目标： 目的：本文报道了一项调查的结果，该调查调查了佛兰德天主教医院和疗养院是否制定了关于安乐死的书面道德政策，以及在这些政策中如何描述护士的作用。
背景：国际研究无可否认地表明，护士正面临要求安乐死的患者。自2002年以来，安乐死在比利时就已成为法律，自2001年以来在荷兰已成为法律。由于正式文件和政策对安乐死中护士的角色含糊不清，因此越来越需要建立明确描述护士在安乐死中角色的制度伦理政策。安乐死过程。
方法：我们使用横断面描述性邮件调查表对比利时（法兰德斯）天主教医院和疗养院的总负责人进行了调查。在2003年10月至2004年2月之间收集了数据。
结果：在调查的298个机构中，有81％的医院，62％的疗养院返回了已完成的问卷。其中，有79％的医院和30％的疗养院都制定了关于安乐死的书面道德政策。 87％的医院和77％的疗养院的道德政策明确规定了护士在安乐死过程中的作用。在大多数医院和疗养院中，道德政策解决了护士出于良心拒服安乐死的问题。大多数医院和疗养院都自愿向雇用的护士传达了他们的道德政策。
结论：大多数天主教医疗机构的书面道德政策都明确关注了护士在安乐死过程中的作用。但是，正如这些道德政策所指出的那样，护士角色的含义和内容仍然是一个问题。需要进一步研究以验证这些政策在机构中的实际执行情况，以及它们是否有助于更好地支持护士并为患者提供道德护理。

BACKGROUND & AIMS: :There have been intensive debates about euthanasia and attempts to change laws on euthanasia in all countries. What doctors and particularly oncologists think about euthanasia must be taken into consideration, as their voices are crucial in this dialogue. The aim of this study was to find out how Turkish doctors approach euthanasia in the context of cancer. A questionnaire was used to collect data from 85 oncologists out of a total 800 in active oncology practice. Of the oncologists surveyed, 43.8% did not object to euthanasia. Some 33.7% had been asked to perform euthanasia and 41.5% believed that euthanasia was performed secretly although it is against the law in Turkey. Forty-two doctors (50.6%) noted that they had withdrawn treatment in patients. Doctors who encounter terminally ill patients with cancer should update their knowledge about patients' rights and euthanasia. Doctors, who are often asked to perform euthanasia, especially in the cancer setting, can help to illuminate the debates about euthanasia.

背景与目标： ：关于安乐死的争论一直很激烈，所有国家都试图改变有关安乐死的法律。必须考虑医生（尤其是肿瘤学家）对安乐死的看法，因为他们的声音在此次对话中至关重要。这项研究的目的是找出土耳其医生如何在癌症的背景下实施安乐死。在活跃的肿瘤学实践中，总共使用了800份问卷调查表，从85位肿瘤学家那里收集了数据。在接受调查的肿瘤学家中，有43.8％的人不反对安乐死。约有33.7％的人被要求进行安乐死，而41.5％的人认为安乐死是秘密进行的，尽管这违反了土耳其的法律。四十二名医生（50.6％）指出他们已撤回患者的治疗。遇到绝症的癌症患者的医生应更新有关患者权利和安乐死的知识。通常被要求执行安乐死的医生，尤其是在癌症环境中的医生，可以帮助阐明有关安乐死的争论。

BACKGROUND & AIMS: :'Terminal discharges' are carried out in Singapore for patients who wish to die at home. However, if due diligence is not exercised, parallels may be drawn with euthanasia. We present a theoretical discussion beginning with the definition of terminal discharges and the reasons why they are carried out in Singapore. By considering the intention behind terminal discharges and utilising a multidisciplinary team to deliberate on the clinical, social and ethical intricacies with a patient- and context-specific approach, euthanasia is avoided. It is hoped that this will provide a platform for professionals in palliative medicine to negotiate challenging issues when arranging a terminal discharge, so as to avoid the pitfall of committing euthanasia in a country such as Singapore where euthanasia is illegal. It is hoped that a set of guidelines for terminal discharges may someday be realised to assist professionals in Singapore and around the world.

背景与目标： ：“终末放电”在新加坡针对希望在家中死亡的患者进行。但是，如果不进行尽职调查，可能会与安乐死相似。我们从终端放电的定义以及在新加坡进行放电的原因开始，进行理论讨论。通过考虑最终出院的意图并利用多学科团队以针对患者和具体情况的方法来研究临床，社会和伦理上的复杂性，可以避免安乐死。希望这将为姑息医学专业人士在安排最终出院时谈判具有挑战性的问题提供一个平台，从而避免在安乐死为非法的新加坡等国家实施安乐死的陷阱。希望有朝一日能实现一套关于码头排放的指导方针，以协助新加坡和世界各地的专业人员。

BACKGROUND & AIMS: :This article is presented as a defence of voluntary active euthanasia from a virtue perspective and it is written with the objective of generating debate and challenging the assumption that killing is necessarily vicious in all circumstances. Practitioners are often torn between acting from virtue and acting from duty. In the case presented the physician was governed by compassion and this illustrates how good people may have the courage to sacrifice their own security in the interests of virtue. The doctor's action created huge tensions for the nurse, who was governed by the code of conduct and relevant laws. Appraising active euthanasia from a virtue perspective can offer a more compassionate approach to the predicament of practitioners and clients. The tensions arising from the virtue versus rules debate generates irreconcilable difficulties for nurses. A shift towards virtue would help to resolve this problem and support the call for a change in the law. The controversial nature of this position is acknowledged. The argument is put forward on the understanding that many practitioners will not agree with the conclusions reached.

背景与目标： ：本文从美德的角度提出了对自愿性主动安乐死的辩护，其目的是引起辩论并挑战一种假设，即在所有情况下凶杀必定是恶性的。从业者常常在以德行事和以职责行事之间陷入困境。在这个案例中，医生受到同情心的约束，这说明了好人可能有勇气为了美德而牺牲自己的安全感。医生的举动给护士带来了巨大的压力，护士受到行为守则和相关法律的约束。从美德的角度评估积极的安乐死可以为从业者和客户的困境提供更富有同情心的方法。美德与规则辩论引发的紧张关系给护士带来了无法调和的困难。向美德的转变将有助于解决这个问题，并支持对法律进行修改的呼吁。这一立场的争议性质得到了承认。提出这一观点的前提是，许多从业者不同意所得出的结论。

BACKGROUND & AIMS: OBJECTIVE:Euthanasia has been considered unethical for most of the history of medicine. Recently it has been legalised in some countries, including parts of Australasia. We describe the recent history of euthanasia, paying attention to the extension of criteria that impact on the poor, elderly and vulnerable members of society in countries that currently have legalised this. In four of the five countries where euthanasia is legalised, there have been extensions of its criteria, either by revision of legislation or changes in practice. CONCLUSIONS:We suggest that this dynamic can be halted by international agreements of medical societies to shun involvement in euthanasia, as has been the case with other legal interventions that stigmatise. We may, as we have in the past, need to work collectively to meet this ethical challenge.

背景与目标： 目的：在大多数医学史上，欧亚大陆被认为是不道德的。最近，它已在一些国家（包括大洋洲的部分地区）合法化。我们描述了安乐死的最新历史，并注意在目前已将其合法化的国家中扩大对贫困，老年人和弱势群体的影响的标准。在安乐死合法化的五个国家中，有四个国家通过修订法规或改变惯例来扩大其标准。
结论：我们认为，与其他带有耻辱的法律干预措施一样，可以通过国际医学会的协议制止这种动态，从而避免参与安乐死。与过去一样，我们可能需要集体努力应对这一道德挑战。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :Medical students and physicians should possess basic knowledge concerning medical ethics and palliative care. The aim of the study was to explore the knowledge on the end-of-life ethics and palliative care in third-year medical students and physicians during internal medicine specialty training and their attitude towards breaking bad news and euthanasia. A voluntary and anonymous questionnaire survey with the participation of 401 students and 217 physicians filled after lectures concerning ethics for medical students and after palliative medicine course for physicians during internal medicine specialty training. A total of 28 % students and 24 % physicians (p = 0.282) were ready to reveal full information to advanced cancer patients. A total of 82 % of students and 90 % of physicians (p = 0.008) would not practice euthanasia; 67 % of students and 75 % of physicians (p = 0.039) were opponents of euthanasia legalisation. A total of 70 % doctors and 23 % students indicated oral as the most preferable route of morphine administration. A total of 74 % physicians and 43 % students stated that there is no maximal dose of morphine; 64 % of doctors and 6 % of students indicated constipation as a constant adverse effect of morphine. Breaking bad news is a significant difficulty for both students and physicians. There is a small percentage of those tending to practice euthanasia and bigger accepting its legalisation with fewer physicians than students. In contrast to medical students, the majority of physicians have knowledge concerning chronic morphine use in the treatment of cancer patients.

背景与目标： ：医学生和医师应具备有关医学伦理和姑息治疗的基本知识。这项研究的目的是探索在内部医学专业培训期间对三年级医学生和医师的临终道德和姑息治疗的知识，以及他们对突发新闻和安乐死的态度。一项自愿性匿名调查表调查包括401名学生和217名医生，参加了关于内科医学专业课程的有关医学生的道德讲座和针对医生的姑息医学课程之后的调查。共有28％的学生和24％的医生（p = 0.282）准备向晚期癌症患者透露全部信息。共有82％的学生和90％的医生（p = 0.008）不实行安乐死； 67％的学生和75％的医生（p = 0.039）反对安乐死合法化。总共70％的医生和23％的学生表示口服是吗啡最优选的给药途径。共有74％的医生和43％的学生表示，没有最大剂量的吗啡。 64％的医生和6％的学生表示，便秘是吗啡的持续不良反应。打破坏消息对学生和医生都是很大的困难。只有一小部分人倾向于实行安乐死并更多地接受安乐死的合法化，而医生人数少于学生。与医学生相反，大多数医生都具有有关慢性吗啡在癌症患者治疗中的知识。

BACKGROUND & AIMS: :In April 2004 the Parliamentary Assembly of the Council of Europe debated a report from its Social, Health and Family Affairs Committee (the Marty Report), which questioned the Council of Europe's opposition to legalising euthanasia. This article exposes the Report's flaws, not least its superficiality and selectivity.

背景与目标： ：2004年4月，欧洲委员会议会对社会，健康和家庭事务委员会的一份报告（《马蒂报告》）进行了辩论，该报告质疑欧洲委员会反对安乐死合法化的反对意见。本文揭示了该报告的缺陷，尤其是其肤浅和选择性。

BACKGROUND & AIMS: The regulation of euthanasia by the criminal law has tended to be one of the more contentious areas of medical law, and continues to be the subject of debate. Few areas of the criminal law have been so consistently the target of reformist pressure, and certainly few areas have so strongly resisted change. Understandably, legislators are unwilling to involve themselves in a matter of law reform which engenders such moral disagreement, and it is significant that only two jurisdictions-The Netherlands and the Australian Northern Territories-have made any substantial change in their legal practice in this area. In other countries, including the UK, the courts and legislators have consistently refused to remove the fundamental criminal law objection to the practice of euthanasia. This is not to say, of course, that the courts have failed to recognise the medical subtleties in medical treatment at the end of life; in several important decisions, the courts in Britain have considered the boundaries of the criminal law's protection of life and have offered guidelines for doctors facing the delicate issues associated with treating the dying patient. Yet, in spite of several helpful decisions from the courts, the basic principle remains firmthe criminal law does not countenance the taking of life, no matter how good the motive. This means that there are very clear legal limits to the extent to which doctors can follow their individual consciences in this area.

背景与目标： 刑法对安乐死的管制已趋于成为医学法中争议较大的领域之一，并且仍然是辩论的主题。很少有刑法领域如此一贯地成为改革派压力的目标，当然，很少有领域如此强烈地抵制变革。可以理解的是，立法者不愿意参与导致这种道德分歧的法律改革，而且很重要的一点是，只有两个司法管辖区（荷兰和澳大利亚北领地）在该领域的法律实践有了实质性的改变。在包括英国在内的其他国家，法院和立法者一直拒绝取消对安乐死做法的基本刑法异议。当然，这并不是说法院没有意识到生命的尽头是医疗中的医疗微妙之处。在几项重要判决中，英国法院考虑了刑法保护生命的界限，并为面对死亡患者的棘手问题的医生提供了指导。然而，尽管法院作出了一些有益的判决，但基本原则仍然坚定：无论动机如何，刑法都不容忍生命的夺取。这意味着在此方面医生可以遵循自己的良知有非常明确的法律限制。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: BACKGROUND:The Netherlands and Belgium legalized euthanasia in 2002. AIM:In this study we describe and compare cases of reported euthanasia and physician-assisted suicide in the first 5 years of legislation. DESIGN/SETTING/PARTICIPANTS:The databases of the cases reported in Belgium and the Netherlands were made available by the review committees. We compared characteristics of all cases reported between September 2002-December 2007. RESULTS:In the Netherlands 10,319 cases were reported, in Belgium 1917. Gender and age distributions were similar in both countries. Most patients suffered from cancer (83-87%), but patients more often suffered from diseases of the nervous system in Belgium (8.3% vs. 3.9%). In the Netherlands, reported euthanasia more often occurred at home compared with Belgium (81% vs. 42%), where it occurred more often in hospital (52% vs. 9%). In the Netherlands, all cases were based on the oral request of a competent patient. In Belgium, 2.1% of the reported cases was based on an advance directive. CONCLUSIONS:We conclude that countries debating legislation must realise that the rules and procedures for euthanasia they would agree upon and the way they are codified or not into law may influence the practice that develops once the legislation is effected or what part of that practice is reported.

背景与目标： 背景：荷兰和比利时于2002年将安乐死合法化。
目的：在这项研究中，我们描述并比较了立法的头5年内报告的安乐死和医生协助自杀的案例。
设计/案情/参加者：比利时和荷兰报告的案件数据库由审查委员会提供。我们比较了2002年9月至2007年12月之间报告的所有病例的特征。
结果：在荷兰，1917年报告了10,319例病例。两个国家的性别和年龄分布相似。在比利时，大多数患者患有癌症（83-87％），但比利时患者更常患有神经系统疾病（8.3％对3.9％）。在荷兰，与比利时（81％比42％）相比，安乐死在家中发生的频率更高（后者在医院里发生的频率更高（52％对9％））。在荷兰，所有病例均基于有能力的患者的口头要求。在比利时，报告的病例中有2.1％是基于预先医疗指示。
结论：我们得出结论，辩论立法的国家必须认识到，他们将同意的安乐死规则和程序以及将其编纂为法律或不纳入法律的方式可能会影响立法一旦生效或报告了该行为的哪一部分，就会发展这种行为。 。

BACKGROUND & AIMS: OBJECTIVE:To determine the prevalence, development, stance, and communication of written institutional ethics policies on euthanasia in Flemish hospitals. METHODS:Cross-sectional mail survey of general directors of all hospitals (n=81) in Flanders, Belgium. RESULTS:Of the 81 hospitals invited to participate, 71 (88%) completed the questionnaire. Of these, 45 (63%) had a written ethics policy on euthanasia. The Belgian Act on Euthanasia and centrally developed guidelines of professional organisations were the most frequently mentioned reasons for and sources used in developing ethics policies on euthanasia in hospitals. Up to one-third of hospitals reported that they developed the policy upon request from physicians or nurses, or after being confronted with a euthanasia request. Development and approval of institutional ethics policies occurred within a multidisciplinary context involving clinicians, ethicists, and hospital administrators. The majority of hospitals restrictively applied the euthanasia law by introducing palliative procedures in addition to legal due care criteria. Private Catholic hospitals, in particular, were more likely to be restrictive: euthanasia is not permitted or is permitted only in exceptional cases (in accordance with legal due care criteria and additional palliative care procedures). The majority of hospitals took the initiative to communicate the policy to hospital physicians and nurses. CONCLUSIONS:Since the enactment of the Belgian Act on Euthanasia in 2002, the debate on how to deal with euthanasia requests has intensified in Flemish hospitals. The high prevalence of written institutional ethics policies on euthanasia and other medical end-of-life decisions is one possible outcome of this debate.

背景与目标： 目的：确定法兰德斯医院安乐死的书面制度伦理政策的流行，发展，立场和沟通。
方法：对比利时法兰德斯所有医院（n = 81）的总负责人进行横断面邮件调查。
结果：在被邀请参加的81家医院中，有71家（88％）填写了问卷。其中，有45（63％）人制定了关于安乐死的书面道德政策。比利时《安乐死法》和集中制定的专业组织指南是制定医院安乐死道德政策的最常提及的原因和来源。多达三分之一的医院报告说，他们是应医师或护士的要求或在面对安乐死要求后制定了该政策。机构伦理政策的制定和批准是在涉及临床医生，伦理学家和医院管理人员的多学科背景下进行的。大多数医院除了采用法定应有的护理标准外，还通过采用姑息治疗程序来严格执行安乐死法。特别是私立天主教医院更有可能受到限制：安乐死或仅在特殊情况下才允许安乐死（根据法律适当护理标准和其他姑息治疗程序）。大多数医院都主动将政策传达给医院的医生和护士。
结论：自2002年《比利时安乐死法》颁布以来，佛兰芒医院就如何处理安乐死的要求展开了激烈的辩论。关于安乐死和其他医疗临终决定的书面制度伦理政策的普遍性是这种辩论的一种可能结果。

BACKGROUND & AIMS: :This article addresses ethical issues in the conduct of ethnographic research with vulnerable study participants, such as individuals with cognitive impairment. Seven ethical issues emerged from this case study, in which a participant diagnosed with Alzheimer's disease wished to pursue euthanasia in Switzerland: (a) How to protect the participant's autonomy while ensuring his decision had not resulted from untreated depression or modifiable social factors; (b) How to interpret self-harm; (c) How to protect the research team members' "mandated reporter" status; (d) How to counteract the attractive qualities of pro-euthanasia videos depicting an easy end to personal suffering; (e) How to find a better alternative to the common practice of reporting self-harm cases to Adult Protective Services and then removing these cases from studies; (f) How to leverage a participant's trust to address these issues; and (g) Whether researchers should do anything further to help address unmet needs in similar situations.

背景与目标： ：本文针对具有脆弱性研究参与者（例如认知障碍者）的人种志研究开展过程中的伦理问题。该案例研究提出了七个道德问题，其中被诊断患有阿尔茨海默氏病的参与者希望在瑞士进行安乐死：（a）如何在保护参与者的自主权的同时，确保自己的决定不是由未治疗的抑郁症或可改变的社会因素引起的； （b）如何解释自我伤害； （c）如何保护研究小组成员的“法定报告人”地位； （d）如何抵消安乐死的录像带所具有的引人入胜的品质，这些录像描绘了容易遭受个人痛苦的情况； （e）如何找到一种更好的替代方法来代替向成人保护服务处报告自我伤害案件，然后将这些案件从研究中删除的普遍做法； （f）如何利用参与者的信任来解决这些问题； （g）研究人员是否应采取进一步措施，以解决类似情况下未满足的需求。