A systematic review of stakeholder perspectives of dignity and assisted dying

Article

QUAH, Elaine Li Ying | CHUA, Keith Zi Yuan | LUA, Jun Kiat | WAN, Darius Wei Jun | CHONG, Chi Sum | LIM, Yun Xue | KRISHNA, Lalit

Introduction: The debate on assisted dying and its components, euthanasia and physician-assisted suicide has evolved with the emergence of the right to dignity and the wish to hasten death (WTHD). Whilst shaped by local legal and sociocultural considerations, appreciation of how patients, healthcare professionals and lawmakers relate notions of dignity to self-concepts of personhood and the desire for assisted dying will better inform and direct support of patients. Methods: A Systematic Evidence Based Approach guided systematic scoping review (SSR in SEBA) of perspectives of dignity, WTHD and personhood featured in PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL, Scopus databases and four key Palliative Care journals was conducted to address "what is the relationship between dignity and WTHD in the assisted dying debate?" The Ring Theory of Personhood (RToP) is adopted to guide study "How is dignity conceptualised by patients with WTHD?" and "what are prevailing perspectives on the role of assisted dying in maintaining a dying patient's dignity?" Results: 6947 abstracts were identified, 663 full text articles reviewed, and 88 articles included. The four domains identified revealed an evolving concept of dignity that influence positions taken with respect to requests for assisted dying that spur support, opposition and different dignity-conserving measures to circumnavigate assisted dying. Conclusion: Concepts of dignity constantly evolve throughout the patient's end of life journey. Understanding when and how these concepts of personhood change and trigger the fear of a loss of dignity or intractable suffering associated with a loss of dignity and spur WTHD could direct timely, individualised, and appropriate person-centred dignity conserving measures. We believe a RToP-based tool could fulfil this role and further study into the design of this tool is planned.

http://dx.doi.org/10.1016/j.jpainsymman.2022.10.004

Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 65»

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