Table 4 Impact of the euthanasia procedure on APCs’ clinical trajectory, in the context of their euthanasia request being neglected (N), rejected (R), assessed (A), granted (G) and put ‘on hold’ (P)
IMPACT ON THE CLINICAL TRAJECTORY | |
Favourable | Unfavourable |
Continuity of care (R, A, G) | No continuity of care (R) - Treatment abandonment by the patient (N) - Treatment abandonment by the caregiver (R) |
Open discussion about the death track within treatment trajectory - discussion of death ideation and euthanasia encapsuled in therapy (with respect, honesty and integrity) (R, A, G) - Being able to openly express the request and have it assessed (A, P) - Serene/caring talks about death (A, G, P) - Dialogic, compassionate approaches (A, G, P) | No discussion of the death track within treatment trajectory - talks on death ideation/euthanasia not being encapsuled in the existing treatment trajectory (R, A) |
New referrals & treatment approaches - Meaningful referral (R, A, G, P) *to new/additional treating physicians *to additional caregivers - Meaningful advices/suggestions (e.g. new diagnosis, reframing death ideation and other problems in life) - preparedness to continue treatment (R, A, G, P) - preparedness to halt acquired treatment resentments (G) - Encouraged/empowered to undergo further/additional diagnostic testing/ treatment options (A, G, P) | Referral & further treatment burden - no meaningful referral (R, A) - Burden of additional psychodiagnostics testing/therapy (A, G) Poor patient-commitment, just undergoing additional testing/treatment to get file approved/hiding behind irrelevant diagnoses/events/occupational therapy (A) |
Souring patient—physician relationship during the euthanasia trajectory - Directive approaches of physicians involved (A, G) - Breakdown in relationship with treating physician (e.g. when verbally attacked by the physician, being disinformed, useless referral) (R, A) - Mistrust in physicians involved (A) (cf. instrumental burden + in case of violation of confidentiality) | |