Nationwide survey to evaluate the decision-making process in euthanasia requests in Belgium: do specifically trained 2



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* 1 to 17 missing cases. FL= Flanders, BXL= Brussels

† comparison with physicians who did not consult. Fisher exact test for statistically significant differences between categories vs all other categories within the variable. Significant differences in bold.

‡ Fisher exact test for statistically significant differences between categories vs all other categories within the variable

Table 23: Extent to which criteria for quality of consultation are met according to whether the second physician is a LEIF physician or not





All*

N=170


LEIF physician (N=51)†

Not LEIF physician

(N=119) ‡



p-value

LEIF vs not-LEIF



The second physician













was not a colleague of the attending physician

71 (41.8)

35 (68.6)

36 (30.3)

<0.0001

was not a co-attending physician

111 (65.7)

47 (88.7)

64 (53.8)

<0.0001

did not know the patient

102 (60.4)

44 (86.3)

58 (49.2)

<0.0001

examined the patient file

161 (95.8)

48 (94.1)

113 (96.6)

0.435

talked to/examined the patient

155 (93.9)

48 (96.0)

107 (93.0)

0.725

made a written report

106 (62.8)

35 (72.9)

71 (67.0)

0.456

* 1 to 16 missing cases

† 1 to 3 missing cases

‡ 1 to 13 missing cases

Table 34: Additional tasks performed by the second physician according to whether the second physician is a LEIF physician or not





All

(N=170)*


LEIF physician (N=51)†

Not LEIF physician or not known

(N=119)‡


p-value

LEIF vs non-LEIF



The consultant













had a discussion with the attending physician

161 (96.4)

50 (100.0)

111 (94.9)

0.180

examined the patient file

161 (95.8)

48 (94.1)

113 (96.6)

0.435

had a conversation with the family

114 (71.3)

37 (75.5)

77 (69.4)

0.456

had a conversation with the caring team

80 (51.0)

23 (46.9)

57 (52.8)

0.606

had a conversation with another attending physician

55 (35.9)

10 (20.8)

45 (42.9)

0.011

asked for additional advice from a third physician

29 (18.7)

5 (10.4)

24 (22.4)

0.117

was present when euthanasia was performed

45 (30.4)

17 (37.0)

28 (27.5)

0.253

helped with performing euthanasia

46 (30.1)

21 (43.8)

25 (23.8)

0.022

helped with filling out the registration form

54 (36.0)

22 (45.8)

32 (31.4)

0.102
















* 2 to 22 missing cases

† 1 to 4 missing cases

‡ 1 to 16 missing cases

Table 45: Advice of consultant according to whether the second physician is a LEIF physician or not





All

(N=170)*


LEIF physician (N=51)

Not LEIF physician or not known

(N=119)†



p-value

LEIF vs non-LEIF



Consultant concluded that conditions for euthanasia were met

136 (80.5)

46 (90.2)

90 (76.3)

0.037

Extent to which the judgment of the consultant played a part













To a great extent

57 (33.5)

20 (39.2)

37 (31.1)

0.478

To some extent

45 (26.5)

9 (17.6)

36 (30.3)

0.124

Hardly

26 (15.3)

11 (21.6)

15 (12.6)

0.157

Not at all

39 (22.9)

11 (21.6)

28 (23.5)

0.843

* 3 missing cases

† 1 to 3 missing cases

1. Law concerning euthanasia May 28 2002 [in Dutch] L. Wet betreffende euthanasie. In 20-09-2002 (ART 16; 2002.

2. CHAMBAERE K, BILSEN J, COHEN J, ONWUTEAKA-PHILIPSEN B, MORTIER F, DELIENS L: Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey. Canadian Medical Association Journal 2010, 182:895-901.

3. Euthanasie FC-eE: Vierde verslag aan de wetgevenede kamer. pp. 66. http://www.leif.be/images/stories/FCEEC_-_Rapport_2008-2009.pdf; 2010:66.

4. Smets T, Bilsen J, Cohen J, Rurup M, Mortier F, Deliens L: Reporting of euthanasia in medical practice in Flanders, Belgium: cross sectional analysis of reported and unreported cases. British Medical Journal 2010, 341.

5. Cohen-Almagor R: First do no harm: pressing concerns regarding euthanasia in Belgium. Int J Law Psychiatry 2013, 36:515-521.

6. VAN WESEMAEL Y, COHEN J, ONWUTEAKA-PHILIPSEN B, BILSEN J, DELIENS L: Establishing specialized health services for professional consultation in euthanasia: experiences in the Netherlands and Belgium. BMC HEALTH SERVICES RESEARCH 2009, 9.

7. VAN WESEMAEL Y, COHEN J, ONWUTEAKA-PHILIPSEN B, BILSEN J, DISTELMANS W, DELIENS L: Role and Involvement of Life End Information Forum Physicians in Euthanasia and Other End-of-Life Care Decisions in Flanders, Belgium. HEALTH SERVICES RESEARCH 2009, 44:2180-2192.

8. Distelmans W: Een Waardig Levenseinde. Amsterdam/Antwerpen: Houtekiet; 2010.

9. Van Wesemael Y, Cohen J, Bilsen J, Smets T, Onwuteaka-Philipsen B, Distelmans W, Deliens L: Implementation of a service for physicians' consultation and information in euthanasia requests in Belgium. Health Policy 2012, 104:272-278.

10. Lloyd-Williams M, MacLeod RD: A systematic review of teaching and learning in palliative care within the medical undergraduate curriculum. Med Teach 2004, 26:683-690.

11. Hesselink BA, Pasman HR, van der Wal G, Soethout MB, Onwuteaka-Philipsen BD: Education on end-of-life care in the medical curriculum: students' opinions and knowledge. J Palliat Med 2010, 13:381-387.

12. Sullivan AM, Lakoma MD, Block SD: The status of medical education in end-of-life care: a national report. J Gen Intern Med 2003, 18:685-695.

13. Löfmark R, Mortier F, Nilstun T, Bosshard G, Cartwright C, Van Der Heide A, Norup M, Simonato L, Onwuteaka-Philipsen B, Consortium E: Palliative care training: a survey of physicians in Australia and Europe. J Palliat Care 2006, 22:105-110.

14. Buss MK, Lessen DS, Sullivan AM, Von Roenn J, Arnold RM, Block SD: A study of oncology fellows' training in end-of-life care. J Support Oncol 2007, 5:237-242.

15. Van Wesemael Y, Cohen J, Bilsen J, Smets T, Onwuteaka-Philipsen B, Deliens L: Process and Outcomes of Euthanasia Requests Under the Belgian Act on Euthanasia: A Nationwide Survey. Journal of Pain and Symptom Management 2011, 42:721-733.

16. Dillman D: The design and administration of mail surveys. Annu Rev Sociol 1991, 17:225-249.

17. Smets T, Cohen J, Bilsen J, Van Wesemael Y, Rurup M, Deliens L: Attitudes and Experiences of Belgian Physicians Regarding Euthanasia Practice and the Euthanasia Law. Journal of Pain and Symptom Management 2011, 41:580-593.

18. Onwuteaka-Philipsen B, Gevers JKM, van der Heide A, van Delden JJM, Pasman HRW, Rietjens JAC, Rurup ML, Buiting HM, Hanssen-de Wolf JE, Janssen AGJM, van der Maas PJ: Evaluation of Law Termination of Life on Request and Assisted Suicide (in Dutch) [Evaluatie Wet toetsing levensbeeindiging op verzoek en hulp bij zelfdoding]. In Programma evaluatie regelgeving (ZonMw ed. Den Haag: ZonMw; 2007.

19. Onwuteaka-Philipsen BD, van der Wal G: A protocol for consultation of another physician in cases of euthanasia and assisted suicide. J Med Ethics 2001, 27:331-337.

20. Cohen J, Van Wesemael Y, Smets T, Bilsen J, Deliens L: Cultural differences affecting euthanasia practice in Belgium: One law but different attitudes and practices in Flanders and Wallonia. Social Science & Medicine 2012, 75:845-853.

21. Jansen-van der Weide MC, Onwuteaka-Philipsen BD, van der Wal G: Granted, undecided, withdrawn, and refused requests for euthanasia and physician-assisted suicide. Arch Intern Med 2005, 165:1698-1704.

22. SMETS T, BILSEN J, VAN DEN BLOCK L, COHEN J, VAN CASTEREN V, DELIENS L: Euthanasia in patients dying at home in Belgium: interview study on adherence to legal safeguards. British Journal of General Practice 2010, 60:268-274.

23. Billings JA, Block S: Palliative care in undergraduate medical education. Status report and future directions. JAMA 1997, 278:733-738.

24. Paice E, Heard S, Moss F: How important are role models in making good doctors? BMJ 2002, 325:707-710.

25. Meier D, Isaacs S, Hughes R: Palliative Care: Transforming the Care of Serious Illness. Princeton: John Wiley and Sons; 2009.

26. Hayes RP, Stoudemire AS, Kinlaw K, Dell ML, Loomis A: Changing attitudes about end-of-life decision making of medical students during third-year clinical clerkships. Psychosomatics 1999, 40:205-211.

27. Wear D: "Face-to-face with It": medical students' narratives about their end-of-life education. Acad Med 2002, 77:271-277.

28. Jansen-van der Weide MC, Onwuteaka-Philipsen BD, van der Wal G: Quality of consultation and the project 'Support and Consultation on Euthanasia in the Netherlands' (SCEN). Health Policy 2007, 80:97-106.







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