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Cited by 28Palliative and Oncologic CarePalliative Care and End-of-Life IssuesEthics and bioethics in healthcare

The attitudes, role & knowledge of mental health nurses towards euthanasia because of unbearable mental suffering in Belgium: A pilot study

Demedts, Dennis, Roelands, Marc, Libbrecht, Julien, Bilsen, Johan·2018·Journal of Psychiatric and Mental Health Nursing
DOI 10.1111/jpm.12475
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Abstract

Accessible summary: What is known about the subject?: Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002 under strict conditions of careful practice. UMS euthanasia occurs fairly rarely in Belgium, but the frequency has increased substantially over the past few years. Although most mental health nurses play an important role and are supportive of euthanasia in general, their role, attitude and knowledge when it comes to UMS euthanasia were unknown until now. What this paper adds to existing knowledge?: Most mental health nurses in Belgium appear to be supportive towards UMS euthanasia and where UMS euthanasia is carried out, mental health nurses are often involved in the preceding decision‐making process. Mental health nurses critically reflect on the interpretation and application of the legal euthanasia criteria as experienced in their daily work with their patients, and identify several problems. After a rather quiet period in Belgium, the public ethical debate regarding UMS euthanasia has recently been reopened and intensified. What are the implications for practice?: Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia. This applies at several levels: legal, healthcare policy, bedside care and education. Specific attention must be paid within the UMS euthanasia process to ensure adequate cooperation between physicians, nurses and patients. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions. Introduction: Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002, under certain circumstances that govern careful practice. Despite the legal framework, there are specific difficulties and concerns regarding UMS euthanasia. Mental health nurses are often involved in the process, but little is known about their attitudes towards UMS euthanasia, their role and their knowledge. Aim: To determine the attitudes, role and knowledge of mental health nurses regarding UMS euthanasia. Methods: A cross‐sectional survey was performed at a convenience sample of four psychiatric hospitals in Belgium (n = 133) as a pilot study. Self‐administered questionnaires were provided to mental health nurses. Results: Half the nurses in our sample had been involved at least once in the process of UMS euthanasia. A large majority of mental health nurses were supportive of UMS euthanasia. Nurses show differences in attitudes related to the different psychiatric pathologies of the patients, and in whether or not minors are involved. In some cases, they believed that the mental suffering of psychiatric patients can be unbearable and irreversible and that psychiatric patients can be competent to voluntarily request UMS euthanasia. Nurses stated that they have an important role in the UMS euthanasia process, but also demanded more knowledge and clear guidelines to implement the procedure. Discussion: Nurses have a key role regarding UMS euthanasia but face several challenges: the recent process, resistance to a multidisciplinary approach by psychiatrists and an unclear role defined by the legal framework. Nurses do not appear to have a common voice on the topic and the development of clear guidelines appears to be essential. Social recovery can offer a way out of an UMS euthanasia request, but it will not always offer a solution. Implications for Practice: Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia at various levels: bedside practice, healthcare management, education and policy. A form of systematic cooperation between nurses, physicians and patients can contribute to the utmost careful decision‐making process needed in these cases. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions.

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  • A lack of training and expertise from healthcare professionals could impede the introduction of MAiD-MD in the healthcare system.

    “A lack of training and expertise from healthcare professionals could impede the introduction of MAiD-MD in the healthcare system [55, 56].”

    From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [56]

  • Some healthcare professionals feel ill-prepared to follow the law, failing to know how it applies to patients and how to apply it without discrimination.

    “Some healthcare professionals feel ill-prepared to follow the law, failing to know how it applies to patients [56] and how to apply it without discrimination [33] (e.g., without being influenced by biases against mental disorders).”

    From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [56]

  • Dutch psychiatric nurses are supportive of patients with different mental disorders to make an informed decision about MAiD-NT, and the majority feel themselves able to address and discuss the issue with their patients.

    “Dutch psychiatric nurses are also supportive of patients with different mental disorders to make an informed decision about MAiD-NT [44] and the majority feel themselves able to address and discuss the issue with their patients [45].”

    From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [44]

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Authors
Demedts, D., Roelands, M., Libbrecht, J., & Bilsen, J.
Affiliations
  • Vrije Universiteit Brussel (BE)
  • Erasmus Brussels University of Applied Sciences and Arts (BE)
Corresponding author
Demedts, Dennis
ORCID
Venue
Journal of Psychiatric and Mental Health Nursing
Publisher
Wiley
Published
2018-07-02
Volume
25
Issue
7
Pages
400-410
ISSN
  • 1351-0126 (ISSN-L)
  • 1365-2850
DOI
10.1111/jpm.12475
OpenAlex
W2804335248
Cited by
28
References
35
Citations by year
2026: 1 · 2024: 7 · 2023: 3 · 2022: 7 · 2021: 6 · 2020: 2 · 2019: 2
FWCI
2.38
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of Psychiatric and Mental Health Nursing (publishedVersion)
  • PubMed (publishedVersion)
  • VUBIR (Vrije Universiteit Brussel) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
psychiatric nurses, nurses' role, nurses' knowledge, euthanasia decision-making, psychiatric hospitals, Belgium, end-of-life care, nurse training, interdisciplinary collaboration, nurses' emotions, psychological suffering
MeSH terms
Adult, Attitude of Health Personnel, Belgium, Euthanasia, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Nursing Staff, Hospital, Pilot Projects, Psychiatric Nursing, Young Adult

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