Snijdewind Marianne C, van Tol Donald G, Onwuteaka-Philipsen Bregje D, Willems Dick L
Section of Medical Ethics, Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of General Practice, University of Groningen, Groningen, The Netherlands.
J Pain Symptom Manage. 2014 Dec;48(6):1125-34. doi: 10.1016/j.jpainsymman.2014.04.016. Epub 2014 Jun 12.
The practice of euthanasia and physician-assisted suicide (EAS) is always complex, but some cases are more complex than others. The nature of these unusually complex cases is not known.
To identify and categorize the characteristics of EAS requests that are more complex than others.
We held in-depth interviews with 28 Dutch physicians about their perception of complex cases of EAS requests. We also interviewed 26 relatives of patients who had died by EAS. We used open coding and inductive analysis to identify various different aspects of the complexities described by the participants.
Complexities can be categorized into relational difficulties-such as miscommunication, invisible suffering, and the absence of a process of growth toward EAS-and complexities that arise from unexpected situations, such as the capricious progress of a disease or the obligation to move the patient. The interviews showed that relatives of the patient influence the process toward EAS.
First, the process toward EAS may be disrupted, causing a complex situation. Second, the course of the process toward EAS is influenced not only by the patient and his/her attending physician but also by the relatives who are involved. Communicating and clarifying expectations throughout the process may help to prevent the occurrence of unusually complex situations.
安乐死及医生协助自杀（EAS）的实施情况一直很复杂，但有些案例比其他案例更为复杂。这些异常复杂案例的本质尚不清楚。
识别并归类比其他案例更为复杂的EAS请求的特征。
我们对28名荷兰医生进行了深度访谈，了解他们对复杂EAS请求案例的看法。我们还采访了26名因EAS死亡患者的亲属。我们运用开放式编码和归纳分析来识别参与者所描述的复杂性的不同方面。
复杂性可分为关系方面的困难，如沟通不畅、隐匿的痛苦以及缺乏走向EAS的成长过程，以及由意外情况引发的复杂性，如疾病的反复无常进展或转移患者的义务。访谈表明，患者的亲属会影响走向EAS的过程。
首先，走向EAS的过程可能会受到干扰，从而导致复杂情况。其次，走向EAS的过程不仅受患者及其主治医生的影响，还受相关亲属的影响。在整个过程中沟通并明确期望可能有助于防止异常复杂情况的发生。
