KU Leuven, Institute for Media Studies, Parkstraat 45 box 3603, 3000, Leuven, Belgium.
Radboud University Medical Center, Radboud Institute for Health Sciences, department IQ healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
BMC Palliat Care. 2021 Jun 3;20(1):79. doi: 10.1186/s12904-021-00772-9.
Based on the case of palliative care and euthanasia in the Netherlands, this paper presents an analysis of frames and counter-frames used in the ongoing public debate about these two intertwined topics. Each (counter)frame presents a cultural theme that can act as a prism to give meaning to palliative care and/or euthanasia. Each frame comprehends a different problem definition, consequences and policy options. Typical word choices and metaphors are identified that can evoke these frames and the underlying reasoning. The frames do not belong to a specific stakeholder but a pattern can be seen in their use that is related to interests and ideology.
An inductive framing analysis was conducted of 2,700 text fragments taken from various Dutch newspapers, websites of stakeholders and policy documents in the period 2016-2018. After an extensive process of thematic coding, axial coding, selective coding and peer review seven frames and seven counter-frames about palliative care and euthanasia were constructed. Fifteen experts in the field of palliative and/or end-of-life care commented on the overview during a member check.
Two frames about palliative care were constructed: the Fear of death frame, which stresses the hopeless 'terminality' of palliative care and the Heavy burden frame, in which palliative care is too big a responsibility for the relatives of the patient. In addition, two counter-frames were constructed: palliative care as a contributor to Quality of life and Completion. With regard to euthanasia, five frames were identified that lead to a problematising definition: Thou shalt not kill, Slippery slope, Lack of willpower, I am not God, and Medical progress. Five counter-frames offer a non-problematising definition of euthanasia in the debate: Mercy, Prevention, Triumph of reason, Absolute autonomy, and Economic utility thinking.
The debate in the Netherlands on euthanasia and palliative care is characterized by a plurality of angles that goes beyond the bipolar distinction between the pros and cons of euthanasia and palliative care. Only with an overview of all potential frames in mind can an audience truly make informed decisions. The frame matrix is not only useful for policy makers to know all perspectives when joining public debate, but also to health care workers to get into meaningful conversations with their patients and families.
基于荷兰姑息治疗和安乐死的案例，本文对当前关于这两个相互交织的话题的公共辩论中使用的框架和反框架进行了分析。每个（反）框架呈现了一个文化主题，可以作为一个棱镜，赋予姑息治疗和/或安乐死意义。每个框架都包含了不同的问题定义、后果和政策选择。确定了典型的用词选择和隐喻，可以唤起这些框架和潜在的推理。这些框架不属于特定的利益相关者，但可以看到它们的使用模式与利益和意识形态有关。
对 2016-2018 年期间取自各种荷兰报纸、利益相关者网站和政策文件的 2700 个文本片段进行了归纳式框架分析。经过广泛的主题编码、轴向编码、选择性编码和同行评审，构建了关于姑息治疗和安乐死的七个框架和七个反框架。15 名姑息治疗和/或临终关怀领域的专家在成员检查期间对概述进行了评论。
构建了两个关于姑息治疗的框架：死亡恐惧框架，强调姑息治疗的无望“终局性”；沉重负担框架，其中姑息治疗对患者的亲属来说责任太大。此外，还构建了两个反框架：姑息治疗是提高生活质量和完成的贡献。关于安乐死，确定了五个导致问题定义的框架：不可杀人、滑坡、缺乏意志力、我不是上帝和医学进步。在辩论中，五个反框架提供了对安乐死的非问题定义：怜悯、预防、理性的胜利、绝对自主权和经济效用思维。
荷兰关于安乐死和姑息治疗的辩论的特点是存在多个角度，超出了安乐死和姑息治疗利弊的两极分化。只有全面了解所有潜在的框架，观众才能真正做出明智的决策。框架矩阵不仅对决策者在参与公共辩论时了解所有观点有用，对医疗保健工作者与患者及其家属进行有意义的对话也有用。
