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Sample records for physician assistants

  1. Physician-assisted death.

    PubMed Central

    1995-01-01

    Physician-assisted death includes both euthanasia and assistance in suicide. The CMA urges its members to adhere to the principles of palliative care. It does not support euthanasia and assisted suicide. The following policy summary includes definitions of euthanasia and assisted suicide, background information, basic ethical principles and physician concerns about legalization of physician-assisted death. PMID:7632208

  2. The aeromedical physician assistant.

    PubMed

    Radi, Joshua; Brisson, Michael; Line, Michael

    2016-12-01

    The US Army aeromedical physician assistant (PA) serves aviation units in regards to crewmember medical readiness. All PAs are graduates of a 6-week flight surgeon course. They are responsible for conducting nearly 40% of the annual US Army flight physicals. This unique training and deployment illustrates the growing adaptability of PAs to assume a greater role in military medicine.

  3. Physician-assisted death

    PubMed Central

    Abrahao, Agessandro; Downar, James; Pinto, Hanika; Dupré, Nicolas; Izenberg, Aaron; Kingston, William; Korngut, Lawrence; O'Connell, Colleen; Petrescu, Nicolae; Shoesmith, Christen; Tandon, Anu; Vargas-Santos, Ana Beatriz

    2016-01-01

    Objective: To survey amyotrophic lateral sclerosis (ALS) health care providers to determine attitudes regarding physician-assisted death (PAD) after the Supreme Court of Canada (SCC) invalidated the Criminal Code provisions that prohibit PAD in February 2015. Methods: We conducted a Canada-wide survey of physicians and allied health professionals (AHP) involved in the care of patients with ALS on their opinions regarding (1) the SCC ruling, (2) their willingness to participate in PAD, and (3) the PAD implementation process for patients with ALS. Results: We received 231 responses from ALS health care providers representing all 15 academic ALS centers in Canada, with an overall response rate for invited participants of 74%. The majority of physicians and AHP agreed with the SCC ruling and believed that patients with moderate and severe stage ALS should have access to PAD; however, most physicians would not provide a lethal prescription or injection to an eligible patient. They preferred the patient obtain a second opinion to confirm eligibility, have a psychiatric assessment, and then be referred to a third party to administer PAD. The majority of respondents felt unprepared for the initiation of this program and favored the development of PAD training modules and guidelines. Conclusions: ALS health care providers support the SCC decision and the majority believe PAD should be available to patients with moderate to severe ALS with physical or emotional suffering. However, few clinicians are willing to directly provide PAD and additional training and guidelines are required before implementation in Canada. PMID:27178703

  4. The future for physician assistants.

    PubMed

    Cawley, J F; Ott, J E; DeAtley, C A

    1983-06-01

    Physician assistants were intended to be assistants to primary care physicians. Physicians in private practice have only moderately responded to the availability of these professionals. Cutbacks in the numbers of foreign medical graduates entering American schools for graduate medical education, concern for overcrowding in some specialties, and the economic and clinical capabilities of physician assistants have lead to new uses for these persons. Physician assistants are employed in surgery and surgical subspecialties; in practice settings in institutions such as medical, pediatric, and surgical house staff; and in geriatric facilities, occupational medicine clinics, emergency rooms, and prison health systems. The projected surplus of physicians by 1990 may affect the use of physician assistants by private physicians in primary care.

  5. Physician Assistant profession (PA)

    MedlinePlus

    ... medicine. The rest are involved in teaching, research, administration, or other nonclinical roles. PAs may practice in any setting in which a physician provides care. This allows doctors to focus their skills and knowledge in a more effective way. PAs ...

  6. Altruism and physician assisted death.

    PubMed

    Gunderson, M; Mayo, D J

    1993-06-01

    We assume that a statute permitting physician assisted death has been passed. We note that the rationale for the passage of such a statute would be respect for individual autonomy, the avoidance of suffering and the possibility of death with dignity. We deal with two moral issues that will arise once such a law is passed. First, we argue that the rationale for passing an assistance in dying law in the first place provides a justification for assisting patients to die who are motivated by altruistic reasons as well as patients who are motivated by reasons of self-interest. Second, we argue that the reasons for passing a physician assisted death law in the first place justify extending the law to cover some nonterminal patients as well as terminal patients.

  7. An intelligent assistant for physicians.

    PubMed

    Gavrilis, Dimitris; Georgoulas, George; Vasiloglou, Nikolaos; Nikolakopoulos, George

    2016-08-01

    This paper presents a software tool developed for assisting physicians during an examination process. The tool consists of a number of modules with the aim to make the examination process not only quicker but also fault proof moving from a simple electronic medical records management system towards an intelligent assistant for the physician. The intelligent component exploits users' inputs as well as well established standards to line up possible suggestions for filling in the examination report. As the physician continues using it, the tool keeps extracting new knowledge. The architecture of the tool is presented in brief while the intelligent component which builds upon the notion of multilabel learning is presented in more detail. Our preliminary results from a real test case indicate that the performance of the intelligent module can reach quite high performance without a large amount of data.

  8. A physician assistant rheumatology fellowship.

    PubMed

    Hooker, Roderick S

    2013-06-01

    A rheumatology postgraduate fellowship for physician assistants was inaugurated in 2004 as a pilot initiative to supplement shortages in rheumatologists. An administrative analysis documented that each PA trainee achieved a high level of rheumatology exposure and proficiency. Classes in immunology, rheumatology, and internal medicine augmented clinical training. Faculty and trainees considered PA postgraduate training in rheumatology worthwhile.

  9. Expansion of Physician Assistant Education.

    PubMed

    Cawley, James F; Eugene Jones, P; Miller, Anthony A; Orcutt, Venetia L

    2016-12-01

    Physician assistant (PA) educational programs were created in the 1960s to prepare a new type of health care practitioner. Physician assistant programs began as experiments in medical education, and later, they proved to be highly successful in preparing capable, flexible, and productive clinicians. The growth of PA educational programs in US medical education-stimulated by grants, public policy, and anticipated shortages of providers-has gone through 3 distinct phases. At present, such programs are in the midst of the third growth spurt that is expected to continue beyond 2020, as a large number of colleges and universities seek to sponsor PA programs and attain accreditation status. Characteristics of these new programs are described, and the implications of the current expansion of PA education are examined.

  10. A medical book collection for physician assistants

    PubMed Central

    Grodzinski, Alison

    2001-01-01

    Selecting resources for physician assistants is challenging and can be overwhelming. Although several core lists exist for nursing, allied health, and medical libraries, judging the scope and level of these resources in relation to the information needs of the physician assistant is difficult. Medical texts can be highly specialized and very expensive, in essence, “overkill” for the needs of the physician assistant. This bibliography is meant to serve as a guide to appropriate medical texts for physician assistants. Titles were selected from the Brandon/Hill list, Doody's Electronic Journal, and various other reference resources. Resources were evaluated based on the subject and scope, audience, authorship, cost, and currency. The collection includes 195 titles from 33 specialty areas. Standard texts in each area are also included. PMID:11465687

  11. Why not physician-assisted death?

    PubMed

    Manthous, Constantine A

    2009-04-01

    The Hippocratic Oath states "... I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect" (http://en.wikipedia.org/wiki/Hippocratic_Oath ). Physician-assisted suicide and euthanasia are topics that engender a strong negative response on the part of many physicians and patients. This article explores contributions of religion, Western medical mores, law, and emerging concepts of moral neurocognition that may explain our inherent aversion to these ideas. Religious texts, legal opinions, manifestos of medical ethics, medical literature, and lay literature. Our collective repudiation of physician-assisted death, in all its forms, has complex origins that are not necessarily rational. If great care is taken to ensure that a request for physician-assisted death is persistent despite exhaustion of all available therapeutic modalities, then an argument can be made that our rejection constrains unnecessarily the liberty of a small number of patients.

  12. Attitudes toward physician-assisted suicide among physicians in Vermont.

    PubMed

    Craig, Alexa; Cronin, Beth; Eward, William; Metz, James; Murray, Logan; Rose, Gail; Suess, Eric; Vergara, Maria E

    2007-07-01

    Legislation on physician-assisted suicide (PAS) is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians. To determine variables predictive of physicians' opinions on PAS in a rural state, Vermont, USA. Cross-sectional mailing survey. 1052 (48% response rate) physicians licensed by the state of Vermont. Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation (42% vs 34%). Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness (48% vs 33%). 30% of the respondents had experienced a request for assistance with suicide. Vermont physicians' opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor-patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management.

  13. [Physician-assisted suicide in dementia?].

    PubMed

    Lauter, H

    2011-01-01

    Physician-assisted suicide in Germany is limited by criminal law and disapproved by professional authorities. A physician who is willing to help a demented patient in terminating his life has to be definitely sure that the disease does not interfere with the patient's capacity for decision-making. In cases of early dementia the reason why assisted suicide will usually be requested is not the actual suffering of the patient but his negative expectations for the future. As long as there are sufficient opportunities for palliative care, the progressive course of the dementia process does not imply a state of unbearable suffering which could justify an assisted suicide. Nevertheless there may be certain circumstances--as for instance the value that an individual attributes to his integrity or to the narrative unity of his life--which might possibly provide an ethical justification for the assistance in life termination. A physician who helps a demented person in performing a suicidal act does not necessarily oppose essential principles of medical ethics. Yet, especially with regard to possible societal consequences of physician-assisted suicide in dementia, the rejecting attitude of medical authorities against that activity must be considered as well founded and legitimate. Deviations from these general guidelines ought to be respected as long as they are limited to exceptional situations and correspond to a thorough consideration of a physician's professional duties. They should remain open to public control, but not be ultimately specified by unequivocal normative regulations.

  14. 42 CFR 410.74 - Physician assistants' services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Physician assistants' services. 410.74 Section 410... Physician assistants' services. (a) Basic rule. Medicare Part B covers physician assistants' services only...). (2) The physician assistant— (i) Meets the qualifications set forth in paragraph (c) of this section...

  15. Leadership Attributes of Physician Assistant Program Directors

    ERIC Educational Resources Information Center

    Eifel, Raymond Leo

    2014-01-01

    Physician assistant (PA) program directors perform an essential role in the initiation, continuation, and development of PA education programs in the rapidly changing environments of both health care and higher education. However, only limited research exists on this academic leader. This study examined the leadership roles of PA program directors…

  16. Assessment of Stress in Physician Assistant Students

    ERIC Educational Resources Information Center

    Kuhn, Lisa; Kranz, Peter L.; Koo, Felix; Cossio, Griselda; Lund, Nick L.

    2005-01-01

    Twenty-seven full-time students within the Physician Assistant Studies Program at The University of Texas--Pan American were anonymously surveyed to determine their levels of stress while enrolled in their first semester. The majority of respondents reported that their stress levels at this point in the program tell within the moderate to…

  17. Assessment of Stress in Physician Assistant Students

    ERIC Educational Resources Information Center

    Kuhn, Lisa; Kranz, Peter L.; Koo, Felix; Cossio, Griselda; Lund, Nick L.

    2005-01-01

    Twenty-seven full-time students within the Physician Assistant Studies Program at The University of Texas--Pan American were anonymously surveyed to determine their levels of stress while enrolled in their first semester. The majority of respondents reported that their stress levels at this point in the program tell within the moderate to…

  18. Physician Assistant Programs. Summary. Third Revised Edition.

    ERIC Educational Resources Information Center

    Health Careers of Ohio, Columbus.

    The document provides information on the name of the program, the institution, prerequisites, length of course, and certificate or degree offered for 81 programs for the training of physician assistants as part of Operation MEDIHC (Military Experience Directed Into Health Careers). Fifty-three programs are in primary care; the remaining 28 are…

  19. Surgical physician assistants help solve contemporary problems.

    PubMed

    Blumm, Robert M; Condit, Doug

    2003-06-01

    Recent surveys performed by the AAPA estimate that in 2002 approximately 183 million visits were made to PAs and 223 million medications were prescribed or recommended by PAs. The AAPA estimates that just more than 46,000 PAs currently are in clinical practice, with New York and California having the largest numbers of practicing PAs. Helen Keller said, "The most pathetic person in the world is the person who has sight but no vision." Most individuals accept life and its shortcomings, but visionaries are different. They see not only that which is evident, but also that which exists in imagination. Visionary physicians and surgeons who aided in the creation of the physician assistant and use of PAs in surgery include: Eugene Stead, MD; John Kirklin, MD, FACS; E. Harvey Estes, Jr., MD; Richard Smith, MD, FACS; and Marvin Giledman, MD. They believed that well-educated nonphysicians could work alongside physicians as a team and, thus, expand the delivery of health care in America. PAs have crossed into the new millennium with new challenges. Together, as a team with supervising surgeons, PAs can meet the challenges and establish new alliances that will alleviate today's constraints. As Rear Adm. Kenneth P. Moritsugu, MD, MPH, Deputy Surgeon General, said, "Physician assistants are ideal partners and professionals in the nation's health system. They are colleagues with physicians to assure improved access to quality health care in a cost-effective manner.

  20. Are we facing a physician assistant surplus?

    PubMed

    Salsberg, Edward; Quigley, Leo

    2016-11-01

    The rapid growth in the physician assistant (PA) pipeline reflects in part a growing demand for health services that has created many opportunities for new PAs. However, the simultaneous growth in the production of physicians and NPs raises the question as to whether the nation will overproduce PAs and other clinicians. Although the growing supply of PAs will help meet the nation's healthcare needs, this study concludes that the job market for new PAs is likely to tighten. The authors recommend a system to track supply, demand, and distribution to inform the PA community and to encourage alignment of supply and demand.

  1. Physician-assisted death and the anesthesiologist.

    PubMed

    Mottiar, Miriam; Grant, Cameron; McVey, Mark J

    2016-03-01

    Although physician-assisted death (PAD) is established in certain countries, the legality and ethics of this issue have been debated for decades in Canada. The Supreme Court of Canada has now settled the issue of legality nationally, and as a result of the decision in Carter v. Canada, PAD (which includes both physician-assisted suicide and euthanasia) will become legal on February 6, 2016. It is difficult to predict the potential demand for PAD in Canada. This paper highlights other countries' experiences with PAD in order to shed light on this question and to forecast issues that Canadian physicians will face once the change to the law comes into effect. At present, there is no legislative scheme in place to regulate the conduct of PAD. Physicians and their provincial colleges may find themselves acting as the de facto regulators of PAD if a regulatory vacuum persists. With their specialized knowledge of pharmacology and interdisciplinary leadership, anesthesiologists may be called upon to develop protocols for the administration of PAD as well as to administer euthanasia. Canadian anesthesiologists currently have a unique opportunity to consider the complex ethical issues they will face when PAD becomes legal and to contribute to the creation of a regulatory structure that will govern PAD in Canada.

  2. National health insurance and the physician assistant.

    PubMed

    Godkins, T R

    1978-01-01

    Although American medicine has vastly improved the delivery of medical care during the last half-century, there are still many problems confronting our health care delivery system. The physician assistant concept is but one attempt of many to alleviate the problem of access to health care of an acceptable quality. Another concept is national health insurance as a measure to bridge the economic gaps in medical care not met by Medicare, Medicaid, and private health insurance; and to make better use of all health resources. Physician assistants can have a beneficial impact on health care under national health insurance by: improving access to care; keeping practice costs down; and improving the quality of care provided. A program of national health insurance will undoubtedly create increased public demand to provide more health services than currently offered by federal programs. National health insurance can succeed only if an appropriate financing mechanism is developed and valid attempts are made to utilize available manpower such as physician assistants. These issues are discussed.

  3. Physician-Assisted Death in Canada.

    PubMed

    Browne, Alister; Russell, J S

    2016-07-01

    The Criminal Code of Canada prohibits persons from aiding or abetting suicide and consenting to have death inflicted on them. Together, these provisions have prohibited physicians from assisting patients to die. On February 6, 2015, the Supreme Court of Canada declared void these provisions insofar as they "prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." This declaration of invalidity was scheduled to take effect one year (later extended by six months) after the ruling, to give the government time to put legislation in place. We trace the history of this decision, discuss how it has forever changed the debate on physician-assisted dying, and identify the issues that must be resolved to write the legislation. Of special importance here are the topics of access, safeguards, and conscientious objection.

  4. Physician Assistant and Nurse Practitioner Malpractice Trends.

    PubMed

    Brock, Douglas M; Nicholson, Jeffrey G; Hooker, Roderick S

    2016-07-25

    Trends in malpractice awards and adverse actions (e.g., revocation of provider license) following an act or omission constituting medical error or negligence were examined. The National Practitioner Data Bank was used to compare rates of malpractice reports and adverse actions for physicians, physician assistants (PAs), and nurse practitioners (NPs). During 2005 through 2014, there ranged from 11.2 to 19.0 malpractice payment reports per 1,000 physicians, 1.4 to 2.4 per 1,000 PAs, and 1.1 to 1.4 per 1,000 NPs. Physician median payments ranged from 1.3 to 2.3 times higher than PAs or NPs. Diagnosis-related malpractice allegations varied by provider type, with physicians having significantly fewer reports (31.9%) than PAs (52.8%) or NPs (40.6%) over the observation period. Trends in malpractice payment reports may reflect policy enactments to decrease liability. © The Author(s) 2016.

  5. A cost effective expert system to assist physicians: epileptologists' assistant.

    PubMed Central

    Ruchelman, M.; Krishnamurthy, K.; Hostetler, W.; Peterson, L. L.; Jungmann, J.; Doller, H. J.

    1992-01-01

    While medical expert systems helped demonstrate that artificial intelligence was possible, few medical systems have been heralded as practical successes. We believe that expert systems will be practical successes if they cost effectively handle most of a physician's workload (i.e., routine care). To accomplish this goal, technology must appear invisible to the user; the system must be intuitive and anticipate users' needs. "Epileptologists' Assistant" is an example of our approach of combining a graphical user interface with an expert system and data base in a system to help in a routine specialty clinic. The goal is for two nurses and a physician to handle the workload of three physicians while increasing the quality of care. The current system reduces physician time by 66%. Our ultimate goal is to create a unified family of systems for medical specialties. PMID:1482997

  6. A Spatial Analysis of Physician Assistant Programs.

    PubMed

    Forister, J Glenn; Stilp, Curt

    2017-06-01

    The Accreditation Review Commission on Education for the Physician Assistant projects a total of 273 accredited programs by the summer of 2020. Over the past 10 years, the number of Central Application Service for Physician Assistants (CASPA) applicants per seat has increased by 53%. However, no studies have addressed the current geographic relationship of applicants to programs and program growth. The purpose of this study was to describe the geospatial patterns and relationships of physician assistant (PA) programs and CASPA applicants. Program directory information for established (n = 159), satellite (n = 18), and new PA programs (n = 95) was mapped using ArcGIS software. Permanent US ZIP codes for PA applicants (n = 22,603) from the 2014 to 2015 CASPA admissions cycle were also mapped. Point data were used to calculate the nearest neighbor by program type. Correlation was used to measure the association between PA applicants, program class size, and state population metrics. Most of the 95 new PA programs were geographically close to established programs. The median distance of new programs to the nearest neighboring established program was 25.6 miles (mean 39, standard deviation 38). Both established and new PA programs were found to be highly clustered (Moran's I z score < 2.58, p = .01). The geographic distribution of the CASPA applicant pool was related to distribution of the US population, certified PAs, and practicing physicians. PA program growth has exceeded projections. The close proximity of new programs to established programs will likely result in continued competition for quality applicants, PA faculty members, and clinical training sites.

  7. Preserving 50 Years of Physician Assistant History.

    PubMed

    Carter, Reginald D; Ballweg, Ruth; Konopka-Sauer, Lori

    2017-10-01

    Physician assistants (PAs) have been making history for 50 years. For the past 15 years, the PA History (PAHx) Society has been working to make sure this history is not lost. The Society began in 2002 as a membership organization based at Duke University and since 2011 has been a supporting organization of the National Commission on Certification of Physician Assistants (NCCPA). Highly visible and active in the PA community, the Society encourages all PAs to understand their professional history and embrace it as a part of their professional identity. The Society, through the work of its board of trustees, historians, and staff, tells the story of the collective efforts of physicians, PAs, nurses, lawyers, educators, and policy makers to create a human innovation that has changed how medicine is practiced in the United States and, more recently, in other countries. The Society provides PA faculty and students access to a growing collection of historically relevant and primary source materials that can be used for educational, research, and literary purposes.

  8. Team Development Manual. Family Nurse Practitioner/Physician Assistant Program.

    ERIC Educational Resources Information Center

    Dostal, Lori

    A manual is presented to help incorporate team development into training programs for nurse practitioners, physician assistants, and primary care physicians. It is also directed to practitioners who wish to improve teamwork and is designed to improve the utilization of the nurse practitioners and physician assistants. A group of one or more…

  9. Team Development Curriculum. Family Nurse Practitioner/Physician Assistant Program.

    ERIC Educational Resources Information Center

    Dostal, Lori

    A curriculum consisting of four modules is presented to help nurse practitioners, physician assistants, and physicians develop team practices and improve and increase the utilization of nurse practitioners and physician assistants in primary care settings. The curriculum was prepared in 1981-1982 by the California Area Health Education Center…

  10. Team Development Manual. Family Nurse Practitioner/Physician Assistant Program.

    ERIC Educational Resources Information Center

    Dostal, Lori

    A manual is presented to help incorporate team development into training programs for nurse practitioners, physician assistants, and primary care physicians. It is also directed to practitioners who wish to improve teamwork and is designed to improve the utilization of the nurse practitioners and physician assistants. A group of one or more…

  11. Physician-Assisted Dying: Acceptance by Physicians Only for Patients Close to Death.

    PubMed

    Zenz, Julia; Tryba, Michael; Zenz, Michael

    2014-12-01

    This study reports on German physicians' views on legalization of euthanasia and physician-assisted suicide, comparing this with a similar survey of UK doctors. A questionnaire was handed out to attendants of a palliative care and a pain symposium. Complete answers were obtained from 137 physicians. Similar to the UK study, about 30% of the physicians surveyed support euthanasia in case of terminal illness and more support physician-assisted suicide. In contrast, in both countries, a great majority of physicians oppose medical involvement in hastening death in non-terminal illnesses. The public and parliamentary discussion should face this opposition to assisted suicide by pain and palliative specialists.

  12. A study of physicians' assistants in a rural setting.

    PubMed

    Miles, D L; Rushing, W A

    1976-12-01

    In an effort to improve the health care in a rural county in Southern Appalachia, physicians' assistants (MEDEX) have been employed in the offices of three general practitioners over a three-year period. This program was evaluated using a before-after and experimental-control (county) design, utilizing data both from physician office contracts and a continuing survey of the populations of the experimental and control counties. Results show the following: 1) utilization (average office visits per week) increased; 2) types of care (preventive versus curative) remained stable; 3) the hospitalization rate increased continuously during the three years for those physicians using physicians' assistants; and 4) the physicians' assistant functioned more as a physician substitute than as an assistant. It is concluded that although use of physicians' assistants may increase utilization rates, they may not reduce the long-range cost of medical care through providing more preventive or ambulatory (as opposed to hospital) care.

  13. 42 CFR 414.52 - Payment for physician assistants' services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... in paragraph (d) of this section. (a) For assistant-at-surgery services, 65 percent of the amount that would be allowed under the physician fee schedule if the assistant-at-surgery service was furnished by a physician. (b) For services (other than assistant-at-surgery services) furnished in...

  14. 42 CFR 414.52 - Payment for physician assistants' services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... specified in paragraph (d) of this section. (a) For assistant-at-surgery services, 65 percent of the amount that would be allowed under the physician fee schedule if the assistant-at-surgery service was furnished by a physician. (b) For services (other than assistant-at-surgery services) furnished in...

  15. 42 CFR 414.52 - Payment for physician assistants' services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... specified in paragraph (d) of this section. (a) For assistant-at-surgery services, 65 percent of the amount that would be allowed under the physician fee schedule if the assistant-at-surgery service was furnished by a physician. (b) For services (other than assistant-at-surgery services) furnished in...

  16. 42 CFR 414.52 - Payment for physician assistants' services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... in paragraph (d) of this section. (a) For assistant-at-surgery services, 65 percent of the amount that would be allowed under the physician fee schedule if the assistant-at-surgery service was furnished by a physician. (b) For services (other than assistant-at-surgery services) furnished in...

  17. 42 CFR 414.52 - Payment for physician assistants' services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... specified in paragraph (d) of this section. (a) For assistant-at-surgery services, 65 percent of the amount that would be allowed under the physician fee schedule if the assistant-at-surgery service was furnished by a physician. (b) For services (other than assistant-at-surgery services) furnished in...

  18. Two kinds of physician-assisted death.

    PubMed

    den Hartogh, Govert

    2017-08-23

    I argue that the concept 'physician-assisted suicide' covers two procedures that should be distinguished: giving someone access to humane means to end his own life, and taking co-responsibility for the safe and effective execution of that plan. In the first section I explain the distinction, in the following sections I show why it is important. To begin with I argue that we should expect the laws that permit these two kinds of 'assistance' to be different in their justificatory structure. Laws that permit giving access only presuppose that the right to self-determination implies a right to suicide, but laws that permit doctors to take co-responsibility may have to appeal to a principle of mercy or beneficence. Actually this difference in justificatory structure can to some extent be found in existing regulatory systems, though far from consistently. Finally I argue that if one recognizes a right to suicide, as Oregon and other American states implicitly do, and as the European Court of Human Rights has recently done explicitly, one is committed to permit the first kind of 'assistance' under some conditions. © 2017 John Wiley & Sons Ltd.

  19. Physician assistant students' attitudes towards a clinical doctoral degree.

    PubMed

    Menezes, Prema; Senkomago, Virginia; Coniglio, David

    2015-03-01

    The introduction of clinical doctorate degrees in several health professions has fueled the debate about an entry-level clinical doctorate in the physician assistant profession. However, there is limited knowledge of the attitudes of physician assistant students toward obtaining a clinical doctorate. All 147 accredited physician assistant programs in the United States were invited to participate in a Web-based survey conducted in January 2010; physician assistant students in any program year were eligible to participate. The survey examined physician assistant students' attitudes towards (a) enrolling in a clinical doctorate program, (b) additional schooling time, (c) monetary costs, and (d) perceived benefits of a clinical doctorate. Chi-square tests were conducted to examine differences in survey item responses and composite variables. From 37 states and 53 physician assistant programs, 1815 physician assistant students completed the survey and 1658 were included in this analysis. Nearly half (49.8%) of the responding physician assistant students overall had a positive attitude toward a clinical doctorate degree. More respondents favored than opposed enrolling in a clinical doctorate program if schooling time were an additional 12 months or less (55.5% vs 29.9%, P < .0001) and additional costs were between 20% and 29% of current expenditure (44.8% vs 36.4%, P < .0001). More than half (56.2%) of the physician assistant students considered perceived benefits (composite variable) as a reason to obtain a clinical doctorate. This large study comprising more than one-third of physician assistant programs and representing 80% of the US states with physician assistant programs finds that physician assistant students' interest in enrolling in a clinical doctorate program may be dependent on additional school time and monetary costs.

  20. Medical anthropology and the physician assistant profession.

    PubMed

    Henry, Lisa R

    2015-01-01

    Medical anthropology is a subfield of anthropology that investigates how culture influences people's ideas and behaviors regarding health and illness. Medical anthropology contributes to the understanding of how and why health systems operate the way they do, how different people understand and interact with these systems and cultural practices, and what assets people use and challenges they may encounter when constructing perceptions of their own health conditions. The goal of this article is to highlight the methodological tools and analytical insights that medical anthropology offers to the study of physician assistants (PAs). The article discusses the field of medical anthropology; the advantages of ethnographic and qualitative research; and how medical anthropology can explain how PAs fit into improved health delivery services by exploring three studies of PAs by medical anthropologists.

  1. The physician assistant profession and military veterans.

    PubMed

    Brock, Douglas M; Wick, Keren H; Evans, Timothy C; Gianola, F J

    2011-02-01

    The physician assistant (PA) profession originated to train former medics and corpsmen for a new civilian health care career. However, baccalaureate degree prerequisites to training present barriers to discharged personnel seeking to enter this profession. A survey was administered (2006-2007) to all MEDEX Northwest PA program graduates who had entered with military experience. The survey addressed attitudes toward the profession, PA education, and practice and how military experience influenced their education and careers. The response rate was 46.4%, spanning all branches of the military. Respondents reported military experience positively impacting ability to handle stress and work in health care teams and that patients and colleagues viewed their military background positively. Most (75.5%) respondents did not hold a bachelor's degree at matriculation. Veterans bring substantial health care training to the PA profession. However, program prerequisites increasingly present barriers to entry. Veterans' contributions to health care and the consequences of losing this resource are discussed.

  2. The 2013 census of licensed physician assistants.

    PubMed

    Hooker, Roderick S; Muchow, Ashley N

    2014-07-01

    A census of physician assistants in the United States is necessary to help legislators make policy decisions about the profession. In 2013, a PA status analysis was undertaken using a novel data source derived from state licensure. The Provider 360 Database was probed for all licensed PAs, and 84,064 were identified. Duplicates, sanctioned, deceased, and dual-licensed were reconciled. In the aggregate, the mean age was 42 years (median 45; mode 32; range 22-74) and 75% of US licensed PAs were women. Statewide distribution per capita ranged from 60 per 100,000 in Alaska to 3.9 per 100,000 in Mississippi; the US mean was 26.8. The robustness of this database draws on active licensure data to identify clinically active PAs. Such refinements and details contribute to health workforce research such as census, modeling, retirement trends, and labor participation rates.

  3. Supply of physician assistants: 2013-2026.

    PubMed

    Hooker, Roderick S; Muchow, Ashley N

    2014-03-01

    As part of healthcare reform, physician assistants (PAs) are needed to help mitigate the physician shortage in the United States. This requires understanding the population of clinically active PAs for accurate prediction purposes. An inventory projection model of PAs drew on historical trends, the PA stock, graduation estimates, retirement trends, and PA intent to retire data. A new source of licensed health professionals, Provider 360 Database, was obtained to augment association information. Program growth and graduate projections indicated an annual 4.7% trend in new entrants to the workforce, offset by annual attrition estimates of 2.9%. As of 2013, there were 84,064 licensed PAs in the United States. The stock and flow equation conservatively predicts the supply of PAs to be 125,847 by 2026. Although the number of clinically active PAs is projected to increase at least by half by 2026, substantial gaps remain in understanding career trends and early attrition influences. Furthermore, education production could be constrained by inadequate clinical training sites and scarcity of faculty.

  4. Views of United States Physicians and Members of the American Medical Association House of Delegates on Physician-assisted Suicide.

    ERIC Educational Resources Information Center

    Whitney, Simon N.; Brown, Byron W.; Brody, Howard; Alcser, Kirsten H.; Bachman, Jerald G.; Greely, Henry T.

    2001-01-01

    Ascertained the views of physicians and physician leaders toward legalization of physician-assisted suicide. Results indicated members of AMA House of Delegates strongly oppose physician-assisted suicide, but rank-and-file physicians show no consensus either for or against its legalization. Although the debate is adversarial, most physicians are…

  5. Views of United States Physicians and Members of the American Medical Association House of Delegates on Physician-assisted Suicide.

    ERIC Educational Resources Information Center

    Whitney, Simon N.; Brown, Byron W.; Brody, Howard; Alcser, Kirsten H.; Bachman, Jerald G.; Greely, Henry T.

    2001-01-01

    Ascertained the views of physicians and physician leaders toward legalization of physician-assisted suicide. Results indicated members of AMA House of Delegates strongly oppose physician-assisted suicide, but rank-and-file physicians show no consensus either for or against its legalization. Although the debate is adversarial, most physicians are…

  6. Beyond the Clinic: Physician Assistant Student Perspectives on Careers in Physician Assistant Education.

    PubMed

    Sasek, Cody; Kluznik, Jenny; Garrubba, Carl

    2016-09-01

    Professional training programs for physician assistants (PAs) have been rapidly expanding. The profession therefore needs to develop a sufficiently robust teaching workforce. This study surveyed current PA students from all Physician Assistant Education Association member programs to ascertain their level of interest in and understanding of careers in PA education, including faculty and precepting roles. The study revealed that interest was greatest in precepting roles. A higher level of education before attending a PA program correlated with a higher interest in PA education roles, although an education-related degree did not show a significant relationship with such roles. These and other study findings are important to consider as the profession continues to develop a pipeline to education careers for students and clinicians.

  7. Patients' views about physician participation in assisted suicide and euthanasia.

    PubMed

    Graber, M A; Levy, B I; Weir, R F; Oppliger, R A

    1996-02-01

    To elucidate the effect of physician participation in physician-assisted suicide and euthanasia on the physician-patient relationship. A questionnaire administered to 228 adult patients. A university-based family practice training program. We approached 230 individuals of at least 19 years of age who were patients in the study practice. These individuals were selected on the basis of age and gender to ensure a heterogeneous study population. Of these, 228 agreed to participate and completed the questionnaire. The majority of subjects felt that a physician who assists with suicide or performs euthanasia is capable of being a caring person (91% and 88%, respectively) and would still be able to offer emotional support to surviving family members (85% and 70%, respectively). Most also felt that a physician assisting in suicide or euthanasia would be as trustworthy as a nonparticipating physician to care for critically ill patients (90.5% and 84.6%, respectively). Five percent "likely would not" continue to see their physician if it was known that he or she assisted in suicide and 7.8% "likely would not" continue seeing their physician if it was known that this physician performed euthanasia. No individuals stated that they "definitely would not" continue seeing their doctor under either circumstance. Individuals who supported the ideas of physician-assisted suicide and euthanasia were more likely to think that a physician who assisted with suicide and euthanasia could perform well in the tasks noted above and would be more likely to continue seeing such a physician (p = .001). Participating in physician-assisted suicide and euthanasia does not markedly adversely affect the physician-patient relationship.

  8. Physician assistant education: an analysis of the Journal of Physician Assistant Education.

    PubMed

    Hocking, Jennie; Crowley, Diana; Cawley, James F

    2013-01-01

    The literature of a profession reflects its vitality, activity, and intellectual temperature. A thorough review of literature can reveal areas of growth and improvement as well as serve as a means to share relevant research accomplishments. As the physician assistant (PA) education profession continues to thrive and expand, it is important for the literature that reflects the profession to also develop and expand its audience. A retrospective, systematic analysis of published research articles in the Journal of Physician Assistant Education (JPAE) and its predecessor publication, Perspective on Physician Assistant Education, from 2001-2011 (N = 145) was conducted. Articles were organized by study topic, cohort of interest, and methodology and further analyzed to determine respective response rates and frequency of topics. Nearly one-fourth of all articles considered were dedicated to studying various PA curricula. Methodological approaches used in these studies tended toward Internet-based surveys, but telephone-based surveys retained the highest response rate (97%). Among study subjects (cohorts) examined, the most frequently studied cohort consisted of PA students, who displayed high response rates (74.4%). The total number of articles published in JPAE increased annually; study methodology reflects a predominance of survey research approaches. Analysis from this review of 10 years of JPAE content suggests that studies using effective methodology to gain high response rates, those that have more sophisticated designs and use appropriate statistical measures, and those that aim to reach a more diverse pool of cohorts may be future goals.

  9. 75 FR 62451 - National Physician Assistants Week, 2010

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-12

    ... Documents#0;#0; ] Proclamation 8579 of October 6, 2010 National Physician Assistants Week, 2010 By the... shortages. During National Physician Assistants Week, we honor these dedicated medical professionals and.... As we recognize their countless contributions this week, we also pay tribute to the kind and...

  10. Racial and ethnic differences in physician assistant salaries.

    PubMed

    Jacobson, Cardell K; Smith, Darron T

    2015-06-01

    Two recent reports using different data sets concluded that female physician assistants (PAs) earn substantially less than male PAs. Similar data comparing the effect of race and ethnicity on salary have not been compiled. This article examines the possibility of racial and ethnic salary disparities in PA salaries using data from the 2009 survey of members of the American Academy of Physician Assistants.

  11. Legalizing physician-assisted suicide: some thoughts and concerns.

    PubMed

    Koenig, H G

    1993-08-01

    Surveys show that most Americans favor the decriminalization of physician-assisted suicide in certain circumstances. Several states are now considering legislation to bring this about and make the United States the first place in the civilized world where physician aid in dying is sanctioned. In the Netherlands, where physician-assisted suicide is practiced but officially remains illegal, 85% of assisted suicides occur in the elderly, and most involve the help of general practitioners. In the United States, family physicians provide health care to many older adults with chronic or terminal illness whose numbers will increase as the elderly population expands. The legalization of physician-assisted suicide would affect the way American physicians practice medicine in unpredictable ways, yet physicians are participating relatively little in deliberations concerning this issue. The problem of suffering in persons with chronic and terminal illness cannot be ignored. Compassionate, effective, and ethical solutions must be found. As a former family physician and now geriatric psychiatrist, I review the pros and cons of physician-assisted suicide (emphasizing arguments against legalization) and encourage family physicians to debate this matter.

  12. Euthanasia and physician-assisted suicide.

    PubMed

    Swarte, N B; Heintz, A P

    1999-12-01

    In the Netherlands there are about 9700 explicit requests for euthanasia or physician-assisted suicide (EAS) each year, of which approximately 3600 are granted. Other countries have criticized the Dutch policy concerning EAS. It has been suggested that palliative care in the Netherlands is not adequate and that euthanasia is often requested by patients with depression. In addition, this criticism is partly based on the firm stance that 'human life has an absolute value and a human being has under no circumstances the right of self-determination over his or her own life'. Many aspects of EAS are currently the focus of attention in the literature. In this review the following aspects of EAS are discussed: ethics, judicial questions, the relationship between depression and euthanasia, and the impact of EAS on members of the family. Also, the current situation concerning EAS in the Netherlands is summarized and described. Despite the fact that EAS have been widely discussed in the literature, the association between depression and the number of requests for EAS remains to be discovered. It is also not yet known what the effects of EAS are on members of the family, and whether unnatural death causes a higher incidence of complicated grief.

  13. Motivations for physician-assisted suicide.

    PubMed

    Pearlman, Robert A; Hsu, Clarissa; Starks, Helene; Back, Anthony L; Gordon, Judith R; Bharucha, Ashok J; Koenig, Barbara A; Battin, Margaret P

    2005-03-01

    To obtain detailed narrative accounts of patients' motivations for pursuing physician-assisted suicide (PAS). Longitudinal case studies. Sixty individuals discussed 35 cases. Participants were recruited through advocacy organizations that counsel individuals interested in PAS, as well as hospices and grief counselors. Participants' homes. We conducted a content analysis of 159 semistructured interviews with patients and their family members, and family members of deceased patients, to characterize the issues associated with pursuit of PAS. Most patients deliberated about PAS over considerable lengths of time with repeated assessments of the benefits and burdens of their current experience. Most patients were motivated to engage in PAS due to illness-related experiences (e.g., fatigue, functional losses), a loss of their sense of self, and fears about the future. None of the patients were acutely depressed when planning PAS. Patients in this study engaged in PAS after a deliberative and thoughtful process. These motivating issues point to the importance of a broad approach in responding to a patient's request for PAS. The factors that motivate PAS can serve as an outline of issues to explore with patients about the far-reaching effects of illness, including the quality of the dying experience. The factors also identify challenges for quality palliative care: assessing patients holistically, conducting repeated assessments of patients' concerns over time, and tailoring care accordingly.

  14. Motivations for Physician-assisted Suicide

    PubMed Central

    Pearlman, Robert A; Hsu, Clarissa; Starks, Helene; Back, Anthony L; Gordon, Judith R; Bharucha, Ashok J; Koenig, Barbara A; Battin, Margaret P

    2005-01-01

    OBJECTIVE To obtain detailed narrative accounts of patients' motivations for pursuing physician-assisted suicide (PAS). DESIGN Longitudinal case studies. PARTICIPANTS Sixty individuals discussed 35 cases. Participants were recruited through advocacy organizations that counsel individuals interested in PAS, as well as hospices and grief counselors. SETTING Participants' homes. MEASUREMENTS AND RESULTS We conducted a content analysis of 159 semistructured interviews with patients and their family members, and family members of deceased patients, to characterize the issues associated with pursuit of PAS. Most patients deliberated about PAS over considerable lengths of time with repeated assessments of the benefits and burdens of their current experience. Most patients were motivated to engage in PAS due to illness-related experiences (e.g., fatigue, functional losses), a loss of their sense of self, and fears about the future. None of the patients were acutely depressed when planning PAS. CONCLUSIONS Patients in this study engaged in PAS after a deliberative and thoughtful process. These motivating issues point to the importance of a broad approach in responding to a patient's request for PAS. The factors that motivate PAS can serve as an outline of issues to explore with patients about the far-reaching effects of illness, including the quality of the dying experience. The factors also identify challenges for quality palliative care: assessing patients holistically, conducting repeated assessments of patients' concerns over time, and tailoring care accordingly. PMID:15836526

  15. Attitudes and practices of physicians regarding physician-assisted dying in minors.

    PubMed

    Pousset, Geert; Mortier, Freddy; Bilsen, Johan; Cohen, Joachim; Deliens, Luc

    2011-10-01

    To investigate attitudes towards physician-assisted death in minors among all physicians involved in the treatment of children dying in Flanders, Belgium over an 18-month period, and how these are related to actual medical end-of-life practices. Anonymous population-based postmortem physician survey. Flanders, Belgium. Physicians signing death certificates of all patients aged 1-17 years who died between June 2007 and November 2008. Attitudes towards physician-assisted death in minors and actual end-of-life practices in the deaths concerned. 124 physicians for 70.5% of eligible cases (N=149) responded. 69% favour an extension of the Belgian law on euthanasia to include minors, 26.6% think this should be done by establishing clear age limits and 61% think parental consent is required before taking life-shortening decisions. Cluster analysis yielded a cluster (67.7% of physicians) accepting of, and a cluster (32.2% of physicians) reluctant towards physician-assisted death in minors. Controlling for physician specialty and patient characteristics, acceptant physicians were more likely to engage in practices with the intention of shortening a patient's life than were reluctant physicians. A majority of surveyed Flemish physicians appear to accept physician-assisted dying in children under certain circumstances and favour an amendment to the euthanasia law to include minors. The approach favoured is one of assessing decision-making capacity rather than setting arbitrary age limits. These stances, and their connection with actual end-of-life practices, may encourage policy-makers to develop guidelines for medical end-of-life practices in minors that address specific challenges arising in this patient group.

  16. Physician assistants and their intent to retire.

    PubMed

    Coombs, Jennifer; Hooker, Roderick S; Brunisholz, Kim

    2013-07-01

    To determine predictors of physician assistants (PAs) to retire or to permanently leave clinical practice. The intent was to create a measure of retention and attrition for purposes of forecasting PA supply. All PAs 55 years or older who were nationally certified in 2011 were surveyed. Statistical analysis included descriptive measures utilizing means, standard deviations, range, and proportions for all survey questions. Univariable analysis using χ² test for the categorical variables determined gender differences in participants' intent to retire. A studentized t test analysis for continuous variables was used to compare differences across genders. The estimated time interval until retirement was calculated using reported values from participants and then subtracting their projected retirement age from current age. The same calculation was used for estimating PA career length from date of graduation to retirement. For all analyses, a P value < .05 was considered statistically significant. A total of 12,005 were eligible and surveyed online; 4767 responded (38%). The mean age was 60 years and the years in clinical practice was 25. When asked to predict a retirement date or age, the mean duration of working beyond age 55 years was 12 years (range 5 to 21). Most respondents reported being confident they were on track to retire with an adequate income. The significant differences that emerged were that men were more confident than women in preparing to retire, having enough money for medical expenses, and being able to live comfortably in retirement. Men more than women stated that, if forced to retire, they were more confident in the preparation to do so. PAs 55 years and older report they are likely to delay retirement from practice until age 67 years, on average. Women were less confident than men in retirement preparation. This age prediction expands career projections and refines forecasting models for the profession. Correlations based on expectation

  17. Faith and reason and physician-assisted suicide.

    PubMed

    Kaczor, Christopher

    1998-08-01

    Aquinas's conception of the relationship of faith and reason calls into question the arguments and some of the conclusions advanced in contributions to the debate on physician-assisted suicide by David Thomasma and H. Tristram Engelhardt. An understanding of the nature of theology as based on revelation calls into question Thomasma's theological argument in favor of physician-assisted suicide based on the example of Christ and the martyrs. On the other hand, unaided reason calls into question his assumptions about the nature of death as in some cases a good for the human person. Finally, if Aquinas is right about the relationship of faith and reason, Engelhardt's sharp contrast between "Christian" and "secular" approaches to physician-assisted suicide needs reconsideration, although his conclusions about physician-assisted suicide would find support.

  18. Physician-assisted death with limited access to palliative care.

    PubMed

    Barutta, Joaquín; Vollmann, Jochen

    2015-08-01

    Even among advocates of legalising physician-assisted death, many argue that this should be done only once palliative care has become widely available. Meanwhile, according to them, physician-assisted death should be banned. Four arguments are often presented to support this claim, which we call the argument of lack of autonomy, the argument of existing alternatives, the argument of unfair inequalities and the argument of the antagonism between physician-assisted death and palliative care. We argue that although these arguments provide strong reasons to take appropriate measures to guarantee access to good quality palliative care to everyone who needs it, they do not justify a ban on physician-assisted death until we have achieved this goal. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. U.K. physicians' attitudes toward active voluntary euthanasia and physician-assisted suicide.

    PubMed

    Dickinson, George E; Lancaster, Carol J; Clark, David; Ahmedzai, Sam H; Noble, William

    2002-01-01

    A comparison of the views of geriatric medicine physicians and intensive care physicians in the United Kingdom on the topics of active voluntary euthanasia and physician-assisted suicide revealed rather different attitudes. Eighty percent of geriatricians, but only 52% of intensive care physicians, considered active voluntary euthanasia as never justified ethically. Gender and age did not play a major part in attitudinal differences of the respondents. If the variability of attitudes of these two medical specialties are anywhere near illustrative of other physicians in the United Kingdom, it would be difficult to formulate and implement laws and policies concerning euthanasia and assisted suicide. In addition, ample safeguards would be required to receive support from physicians regarding legalization.

  20. Retention of Physician Assistants in Rural Health Clinics

    ERIC Educational Resources Information Center

    Henry, Lisa R.; Hooker, Roderick S.

    2007-01-01

    Context: Improvement of rural health care access has been a guiding principle of federal and state policy regarding physician assistants (PAs). Purpose: To determine the factors that influence autonomous rural PAs (who work less than 8 hours per week with their supervising physician) to remain in remote locations. Methods: A qualitative…

  1. Physician’s Assistants Attitudes and Performance

    DTIC Science & Technology

    1978-06-01

    Sick Call 2 Physicals Exams 43 ’Heekend Sick Call 2 Field Duty/Down Range 29 Preventive Med Officer 2 Stockade 27 OIC 2 Sports coverage 21 Lecturer...Psychiatry Primary/Health Care Clinic 23 Podiatry Aid Station/Squadron Air Station 19 Surgery In Bn 15 Where Needed Dispensary 13 Delivering Babies...in ER 1 Dealing with TM Problem 1 As Physician under supervision 1 Replacement for GMO 1 Podiatry /Orthopedics 1 Help physician TMC level deal with

  2. Physician-assisted suicide: legal and ethical considerations.

    PubMed

    Darr, Kurt

    2007-01-01

    As medicine's technical limits have become increasingly clear, Americans seem more willing to address end-of-life decisionmaking. A major development during the 1990s was physician assistance in dying: physician-assisted suicide in Michigan, Oregon's Death with Dignity Act, and developments in Europe, most notably The Netherlands. This evolution toward recognizing the appropriateness of assistance in dying raises legal and ethical issues for physicians and healthcare institutions such as nursing facilities and acute care hospitals. These issues include the effects on providers' values systems, the trust between patient and provider, and the "slippery slope" that voluntary, active assistance in dying will become involuntary, active assistance. This Article addresses the policy issues that institutions must confront in a changing environment.

  3. Nurse practitioners, certified nurse midwives, and physician assistants in physician offices.

    PubMed

    Park, Melissa; Cherry, Donald; Decker, Sandra L

    2011-08-01

    The expansion of health insurance coverage through health care reform, along with the aging of the population, are expected to strain the capacity for providing health care. Projections of the future physician workforce predict declines in the supply of physicians and decreasing physician work hours for primary care. An expansion of care delivered by nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs) is often cited as a solution to the predicted surge in demand for health care services and calls for an examination of current reliance on these providers. Using a nationally based physician survey, we have described the employment of NPs, CNMs, and PAs among office-based physicians by selected physician and practice characteristics.

  4. Self-Directed Learning in Physician Assistant Education: Learning Portfolios in Physician Assistant Programs.

    PubMed

    Neal, Jeremy H; Neal, Laura D M

    2016-12-01

    Self-directed learning (SDL) portfolios are underused in the educational process and should be considered by physician assistant (PA) programs. Clinicians such as PAs are responsible for self-identifying their learning needs, competencies, and ongoing educational requirements. This article introduces an outline for SDL in the PA profession, for direct use by learners and indirect use by educators. Without a plan, many professionals may lack the insight, motivation, and knowledge needed to improve their skill set and establish goals for individual lifelong learning. This study conducted a review of the literature. Then, by incorporating SDL portfolios into PA educational methodologies, it constructed a concept map for individuals to monitor, self-direct, and actively participate in their own learning in academic settings and throughout their career.

  5. Physician assistant program characteristics and faculty credentials on physician assistant national certifying exam pass rates.

    PubMed

    Bushardt, Reamer L; Booze, Loraine E; Hewett, Mary L; Hildebrandt, Carol; Thomas, Suzanne E

    2012-01-01

    Determination of the ideal terminal degree for physician assistants (PAs) and academic preparedness of PA educators have received much attention in recent years. This investigation, completed in 2009, sought to describe the current state of PA training programs, specifically regarding Carnegie classification, percent conferring master's degrees, number of full-time faculty, percent of faculty--both principal and other full-time faculty--with doctoral degrees, student-to-faculty ratio, and first-time graduate Physician Assistant National Certifying Exam (PANCE) pass rates. A secondary aim was to determine if any of these variables predict PANCE pass rates. This study combined existing data obtained from multiple Internet resources including PA program websites and the PAEA Faculty Directory to determine the number of faculty, faculty credentials, number of students, and PANCE reports. Faculty members were categorized by highest degree attained. Linear regression was used to examine whether any of the programmatic variables were significant predictors of PANCE pass rates. Two of four predictors were significant--whether the program conferred a master's degree (Beta = 0.54, t = 7.25, P = .001) and student-to-faculty ratio (Beta = -0.21, t = 2.63, P = .01). Mean number of full-time faculty per training program was eight (SD = 4, range = 2-36). The mean percent of full-time faculty members with doctorates per training program was 17.6% (SD = 17.7%, range = 0-80%). These results, if replicated, suggest that if a program is seeking to increase its student performance on the PANCE, it may be more helpful to focus resources on improving student-to-faculty ratio, regardless of whether or not the faculty are doctoral level.

  6. Emotional and psychological effects of physician-assisted suicide and euthanasia on participating physicians.

    PubMed

    Stevens, Kenneth R

    2006-01-01

    This is a review and evaluation of medical and public literature regarding the reported emotional and psychological effects of participation in physician-assisted suicide (PAS) and euthanasia on the involved physicians. Articles in medical journals, legislative investigations and the public press were obtained and reviewed to determine what has been reported regarding the effects on physicians who have been personally involved in PAS and euthanasia. The physician is centrally involved in PAS and euthanasia, and the emotional and psychological effects on the participating physician can be substantial. The shift away from the fundamental values of medicine to heal and promote human wholeness can have significant effects on many participating physicians. Doctors describe being profoundly adversely affected, being shocked by the suddenness of the death, being caught up in the patient's drive for assisted suicide, having a sense of powerlessness, and feeling isolated. There is evidence of pressure on and intimidation of doctors by some patients to assist in suicide. The effect of countertransference in the doctor-patient relationship may influence physician involvement in PAS and euthanasia. Many doctors who have participated in euthanasia and/or PAS are adversely affected emotionally and psychologically by their experiences.

  7. [Euthanasia and physician assisted suicide: what is the problem?].

    PubMed

    Álvarez-Del Río, Asunción

    2014-01-01

    Some persons with refractory and unbearable suffering caused by an illness or medical condition wish to die by euthanasia or physician assisted suicide in order to have a certain and painless death. Physicians who agree to help a patient to die have previously confirmed that his/her illness cannot be cured, his/her suffering cannot be relieved and he/ she is of sound mind. Being well informed of his/her condition, the patient arrives to the conclusion that in his/her situation being death is better that being alive. How to explain that there are very few places in which physicians are allowed to help their patients to die? The main arguments against legalizing physician-assisted death are analyzed in this article.

  8. Physician assistants in English primary care teams: a survey.

    PubMed

    Drennan, Vari M; Chattopadhyay, Kaushik; Halter, Mary; Brearley, Sally; de Lusignan, Simon; Gabe, Jonathon; Gage, Heather

    2012-09-01

    Ensuring that health care teams have a mix of skilled professionals to meet patient need, safely and effectively, is a priority in all health services. The United Kingdom, like a number of other countries, have been exploring the contribution physician assistants, who are well established in the United States of America, can make to health care teams including primary care. This study investigated the employment of physician assistants in English primary care and their contribution through an electronic, self report, survey. Sixteen physician assistants responded, who were working in a variety of types of general practice teams. A range of activities were reported but the greatest proportion of their time was described as seeing patients in booked surgery appointments for same day/urgent appointments. The scope of the survey was limited and questions remain as to patient and professional responses to a new professional group within English primary care.

  9. Religion and nurses' attitudes to euthanasia and physician assisted suicide.

    PubMed

    Gielen, Joris; van den Branden, Stef; Broeckaert, Bert

    2009-05-01

    In this review of empirical studies we aimed to assess the influence of religion and world view on nurses' attitudes towards euthanasia and physician assisted suicide. We searched PubMed for articles published before August 2008 using combinations of search terms. Most identified studies showed a clear relationship between religion or world view and nurses' attitudes towards euthanasia or physician assisted suicide. Differences in attitude were found to be influenced by religious or ideological affiliation, observance of religious practices, religious doctrines, and personal importance attributed to religion or world view. Nevertheless, a coherent comparative interpretation of the results of the identified studies was difficult. We concluded that no study has so far exhaustively investigated the relationship between religion or world view and nurses' attitudes towards euthanasia or physician assisted suicide and that further research is required.

  10. Euthanasia and physician-assisted death.

    PubMed

    Macleod, A D Sandy

    2012-12-14

    Medical practitioners do not have the knowledge and expertise to participate competently and reliably in selecting those fit to be offered euthanasia and assisted suicide. Issues relating to the clinically assessment of such requests by the terminally ill, diagnostic errors, prognosis, competency, and mental health status are, as yet, not adequately scientifically resolved.

  11. Severe Burnout Is Common Among Critical Care Physician Assistants.

    PubMed

    Bhatt, Muneer; Lizano, Danny; Carlese, Anthony; Kvetan, Vladimir; Gershengorn, Hayley Beth

    2017-08-23

    To determine the prevalence of and risk factors for burnout among critical care medicine physician assistants. Online survey. U.S. ICUs. Critical care medicine physician assistant members of the Society of Critical Care Medicine coupled with personal contacts. None. We used SurveyMonkey to query critical care medicine physician assistants on demographics and the full 22-question Maslach Burnout Inventory, a validated tool comprised of three subscales-emotional exhaustion, depersonalization, and achievement. Multivariate regression was performed to identify factors independently associated with severe burnout on at least one subscale and higher burnout scores on each subscale and the total inventory. From 431 critical care medicine physician assistants invited, 135 (31.3%) responded to the survey. Severe burnout was seen on at least one subscale in 55.6%-10% showed evidence of severe burnout on the "exhaustion" subscale, 44% on the "depersonalization" subscale, and 26% on the "achievement" subscale. After multivariable adjustment, caring for fewer patients per shift (odds ratio [95% CI]: 0.17 [0.05-0.57] for 1-5 vs 6-10 patients; p = 0.004) and rarely providing futile care (0.26 [0.07-0.95] vs providing futile care often; p = 0.041) were independently associated with having less severe burnout on at least one subscale. Those caring for 1-5 patients per shift and those providing futile care rarely also had a lower depersonalization scores; job satisfaction was independently associated with having less exhaustion, less depersonalization, a greater sense of personal achievement, and a lower overall burnout score. Severe burnout is common in critical care medicine physician assistants. Higher patient-to-critical care medicine physician assistant ratios and provision of futile care are risk factors for severe burnout.

  12. Why Don't More Physicians Support Assisted Death?

    PubMed

    Downar, James

    2014-01-01

    In this issue of Healthcare Papers, Maureen Taylor and Sandra Martin make a compelling case for the medical community to speak out in favour of physician-assisted death (PAD) in Canada. As a member of the medical community, I want to echo that call to my colleagues. But I also want to explain my own evolution in thinking about PAD, in the hope that this will help non-physicians understand why this is such a difficult issue for physicians to tackle. I also hope that it will convince some of my colleagues to heed Taylor and Martin's call to speak out in favour of PAD.

  13. An Ethical Review of Euthanasia and Physician-assisted Suicide.

    PubMed

    Banović, Božidar; Turanjanin, Veljko; Miloradović, Anđela

    2017-02-01

    In the majority of countries, active direct euthanasia is a forbidden way of the deprivation of the patients' life, while its passive form is commonly accepted. This distinction between active and passive euthanasia has no justification, viewed through the prism of morality and ethics. Therefore, we focused on attention on the moral and ethical implications of the aforementioned medical procedures. Data were obtained from the Clinical Hospital Center in Kragujevac, collected during the first half of the 2015. The research included 88 physicians: 57 male physicians (representing 77% of the sample) and 31 female physicians (23% of the sample). Due to the nature, subject and hypothesis of the research, the authors used descriptive method and the method of the theoretical content analysis. A slight majority of the physicians (56, 8%) believe that active euthanasia is ethically unacceptable, while 43, 2% is for another solution (35, 2% took a viewpoint that it is completely ethically acceptable, while the remaining 8% considered it ethically acceptable in certain cases). From the other side, 56, 8% of respondents answered negatively on the ethical acceptability of the physician-assisted suicide, while 33% of them opted for a completely ethic viewpoint of this procedure. Out of the remaining 10, 2% opted for the ethical acceptability in certain cases. Physicians in Serbia are divided on this issue, but a group that considers active euthanasia and physician-assisted suicide as ethically unacceptable is a bit more numerous.

  14. An Ethical Review of Euthanasia and Physician-assisted Suicide

    PubMed Central

    BANOVIĆ, Božidar; TURANJANIN, Veljko; MILORADOVIĆ, Anđela

    2017-01-01

    Background: In the majority of countries, active direct euthanasia is a forbidden way of the deprivation of the patients’ life, while its passive form is commonly accepted. This distinction between active and passive euthanasia has no justification, viewed through the prism of morality and ethics. Therefore, we focused on attention on the moral and ethical implications of the aforementioned medical procedures. Methods: Data were obtained from the Clinical Hospital Center in Kragujevac, collected during the first half of the 2015. The research included 88 physicians: 57 male physicians (representing 77% of the sample) and 31 female physicians (23% of the sample). Due to the nature, subject and hypothesis of the research, the authors used descriptive method and the method of the theoretical content analysis. Results: A slight majority of the physicians (56, 8%) believe that active euthanasia is ethically unacceptable, while 43, 2% is for another solution (35, 2% took a viewpoint that it is completely ethically acceptable, while the remaining 8% considered it ethically acceptable in certain cases). From the other side, 56, 8% of respondents answered negatively on the ethical acceptability of the physician-assisted suicide, while 33% of them opted for a completely ethic viewpoint of this procedure. Out of the remaining 10, 2% opted for the ethical acceptability in certain cases. Conclusion: Physicians in Serbia are divided on this issue, but a group that considers active euthanasia and physician-assisted suicide as ethically unacceptable is a bit more numerous. PMID:28451551

  15. The attitudes of Greek physicians and lay people on euthanasia and physician-assisted suicide in terminally ill cancer patients.

    PubMed

    Parpa, Efi; Mystakidou, Kyriaki; Tsilika, Eleni; Sakkas, Pavlos; Patiraki, Elisabeth; Pistevou-Gombaki, Kyriaki; Galanos, Antonis; Vlahos, Lambros

    2006-01-01

    The purpose of this article is to explore the attitudes of lay people and physicians regarding euthanasia and physician-assisted suicide in terminally ill cancer patients in Greece. The sample consisted of 141 physicians and 173 lay people. A survey questionnaire was used concerning issues such as euthanasia, physician-assisted suicide, and so forth. Many physicians (42.6%) and lay people (25.4%, P = .002) reported that in the case of a cardiac and/or respiratory arrest, there would not be an effort to revive a terminally ill cancer patient. Only 8.1% of lay people and 2.1% of physicians agreed on physician-assisted suicide (P = .023). Many of the respondents, especially physicians, supported sedation but not euthanasia or physician-assisted suicide. However, many of the respondents would prefer the legalization of a terminally ill patient's hastened death.

  16. How family practice physicians, nurse practitioners, and physician assistants incorporate spiritual care in practice.

    PubMed

    Tanyi, Ruth A; McKenzie, Monica; Chapek, Cynthia

    2009-12-01

    To investigate how primary care family practice providers incorporate spirituality into their practices in spite of documented barriers. A phenomenological qualitative design was used. Semi-structured interviews were conducted with three physicians, five nurse practitioners, and two physician assistants. Five major theme clusters emerged: (1) discerning instances for overt spiritual assessment; (2) displaying a genuine and caring attitude; (3) encouraging the use of existing spiritual practices; (4) documenting spiritual care for continuity of care; (5) managing perceived barriers to spiritual care. Findings support that patients' spiritual needs can be addressed in spite of documented barriers. Techniques to assist providers in providing spiritual care are discussed and directions for future research are suggested.

  17. Physician-assisted death. Opinions of a sample of Mexican physicians.

    PubMed

    Lisker, Rubén; Alvarez Del Rio, Asunción; Villa, Antonio R; Carnevale, Alessandra

    2008-05-01

    There is insufficient information on what Mexicans think of physician-assisted death, a problem that is currently being discussed in our legislative bodies. This paper discusses the findings among a sample of physicians. The sample was formed by 2097 physicians from several specialties employed by a Mexican government health system, distributed throughout the country. Each physician received a structured questionnaire exploring what they thought of two different scenarios related to physician-assisted death: 1) intolerable suffering of patients; and 2) persistent vegetative state (PVS). Questions included data on several personal characteristics of the respondents and two open-ended questions asking the reasons why they answered the main questions as they did. There was an overall response rate of 47.3%. Approximately 40% agreed with physicians helping terminally ill patients request to die because of intolerable suffering caused by incurable diseases, whereas 44% said no and the rest were undecided. This was statistically different from the answers to the scenario where the relatives of a patient in a PVS ask their physician to help him or her die, where 48% of respondents said yes, and 35% said no. The main reasons to say yes in both scenarios were respect for patients or family autonomy and to avoid suffering, whereas those opposed cited other ethical and mainly religious considerations. The variable with the highest probability to approve both scenarios was of a legal nature, whereas strong religious beliefs were against accepting physician-assisted death. The group was evenly divided with approximately 40% each between those for and against the idea of helping die a patient and approximately 20% were undecided.

  18. Treatment-resistant depression and physician-assisted death.

    PubMed

    MIller, Franklin G

    2015-11-01

    In a recent article, Udo Schuklenk and Suzanne van de Vathorst argued in favour of a legal option of physician-assisted death for patients with 'treatment-resistant' depression. In this commentary, I contend that their argument neglects the important consideration of the professional integrity of physicians. In light of this consideration, coupled with uncertainty about whether additional interventions with the patient can improve quality of life and restore the will to live, it is not appropriate to include patients with 'treatment-resistant' depression within a legal option of physician-assisted death. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. Nurse Practitioners, Physician Assistants and Certified Nurse Midwives in California.

    ERIC Educational Resources Information Center

    California Univ., San Francisco. Center for California Health Workforce Studies.

    Surveys were mailed to all nurse practitioners (NPs), physician assistants (PAs) and certified nurse midwives (CNMs) registered in California, asking questions about education, labor force participation, specialty, and location and type of practice site, as well as the demographic characteristics of these professionals and their patients. Response…

  20. Supervisory Skills and Challenges: A Handbook for Physician Assistants.

    ERIC Educational Resources Information Center

    Glennon, Virginia B.; Greenberg, Suzanne B.

    A handbook for supervisors of students training as physician assistants is presented, based in part on workshops and interviews conducted at Northeastern University (Massachusetts). Topics include: the role and attributes of the supervisor, needs of adult learners and adult learning styles, beginning the supervisory process, use of skills in…

  1. Acceptability for French People of Physician-Assisted Suicide

    ERIC Educational Resources Information Center

    Frileux, Stephanie; Sastre, Maria Teresa Munoz; Antonini, Sophie; Mullet, Etienne; Sorum, Paul Clay

    2004-01-01

    Our aim was to understand better how people judge the acceptability of physician-assisted suicide (PAS). We found that, for people in France of all ages and for elderly people with life-threatening illnesses, acceptability is an additive combination of the number of requests for PAS, the patient's age, the amount of physical suffering, and the…

  2. Characteristics of Persons Approving of Physician-Assisted Death

    ERIC Educational Resources Information Center

    Blevins, Dean; Preston, Thomas A.; Werth, James L., Jr.

    2005-01-01

    The present study describes the characteristics and attitudes of non-terminally ill persons who support physician-assisted death (PAD) along with their expectations and preferences for care in the future. Participants (N=101) completed a survey assessing current affect and attitudes and those expected if terminally ill. Participants' responses…

  3. Counselors and the Legalization of Physician-Assisted Suicide.

    ERIC Educational Resources Information Center

    Kiser, Jerry D.

    1996-01-01

    With the shift in Americans' beliefs regarding legalizing physician-assisted suicide for the terminally ill, counselors must be prepared to counsel clients who have decided to end their lives. For counselors to avoid violating the ethical guidelines established by the American Counseling Association (ACA) regarding these clients, a reevaluation of…

  4. Factors Predicting Physician Assistant Faculty Intent to Leave

    ERIC Educational Resources Information Center

    Coniglio, David Martin

    2013-01-01

    An increasing demand for education of physician assistants (PAs) has resulted in rapid growth in the number of PA educational programs. Faculty for these programs may be recruited from existing programs. Understanding faculty turnover intention is important to guide faculty development and to improve faculty retention. The purpose of this research…

  5. Physician Assistant and Nurse Practitioner Prescribing: 1997-2002

    ERIC Educational Resources Information Center

    Hooker, Roderick S.; Cipher, Daisha J.

    2005-01-01

    Context: Physician assistants (PAs) and nurse practitioners (NPs) have licensure to practice in all states and they have prescriptive authority in 47 and 40 states, respectively. However, there have been no published studies from a national standpoint comparing urban and rural settings. Purpose: The objective of this study was to describe the…

  6. Physician Assistant and Nurse Practitioner Prescribing: 1997-2002

    ERIC Educational Resources Information Center

    Hooker, Roderick S.; Cipher, Daisha J.

    2005-01-01

    Context: Physician assistants (PAs) and nurse practitioners (NPs) have licensure to practice in all states and they have prescriptive authority in 47 and 40 states, respectively. However, there have been no published studies from a national standpoint comparing urban and rural settings. Purpose: The objective of this study was to describe the…

  7. Perceptions of physician assistants regarding direct-to-consumer advertising.

    PubMed

    Anzalone, Justin; Mathews, Asha; Suprenant, Michael; Herman, Lawrence

    2012-02-01

    Of 1,254 practicing physician assistants (PAs) who completed a survey, 91% were familiar with direct-to-consumer advertising (DTCA). When asked about their general perception, 96% of PAs were neutral or unfavorable towards DTCA. PAs felt that DTCA encouraged patients to make atypical medication requests, overlook the PA's medical opinion, and seek other health care providers.

  8. Why physician-assisted suicide perpetuates the idolatory of medicine.

    PubMed

    Cherry, Mark J

    2003-01-01

    Adequate response to physician-assisted suicide and euthanasia depends on fundamental philosophical and theological issues, including the character of an appropriate philosophically and theologically anchored anthropology, where the central element of traditional Christian anthropology is that humans are created to worship God. As I will argue, Christian morality and moral epistemology must be nested within and understood through this background Christian anthropology. As a result, I will argue that physician-assisted suicide and euthanasia can only be one-sidedly and inadequately appreciated through rational appeal to central values, such as "human dignity" and "self determination", or through "sola scriptura" biblical interpretation, or individual judgments of conscience. Adequately addressing physician-assisted suicide and euthanasia will depend on a more fundamental spiritual-therapeutic approach. This cluster of moral, epistemological, anthropological, and bioethical claims will be explored by drawing on the texts of St. Basil the Great, St. Maximos the Confessor, and St. Isaac the Syrian. Their reflections on medicine, the human good, and its relationship to worship, spiritual therapy, and God will be used as a basis to indicate a broader philosophical perspective, which will be needed to avoid a one-sided, incomplete approach to the challenges of physician-assisted suicide and euthanasia. Medical morality, I argue, is best understood within categories that transcend the right, the good, the just, and the virtuous; namely, the holy.

  9. Counselors and the Legalization of Physician-Assisted Suicide.

    ERIC Educational Resources Information Center

    Kiser, Jerry D.

    1996-01-01

    With the shift in Americans' beliefs regarding legalizing physician-assisted suicide for the terminally ill, counselors must be prepared to counsel clients who have decided to end their lives. For counselors to avoid violating the ethical guidelines established by the American Counseling Association (ACA) regarding these clients, a reevaluation of…

  10. A Cooperative Education Program for Nurse Practitioners/Physician's Assistants.

    ERIC Educational Resources Information Center

    Fowkes, Virginia; And Others

    1979-01-01

    Traditionally, nurse practitioners and physician's assistants have been trained separately. In l977, the Family Nurse Practitioner Program at the University of California, Davis, and the Primary Care Associate Program at Stanford University merged clinical curricula. The cooperative program is described and its first year evaluated. (Author/JMD)

  11. Acceptability for French People of Physician-Assisted Suicide

    ERIC Educational Resources Information Center

    Frileux, Stephanie; Sastre, Maria Teresa Munoz; Antonini, Sophie; Mullet, Etienne; Sorum, Paul Clay

    2004-01-01

    Our aim was to understand better how people judge the acceptability of physician-assisted suicide (PAS). We found that, for people in France of all ages and for elderly people with life-threatening illnesses, acceptability is an additive combination of the number of requests for PAS, the patient's age, the amount of physical suffering, and the…

  12. Characteristics of Persons Approving of Physician-Assisted Death

    ERIC Educational Resources Information Center

    Blevins, Dean; Preston, Thomas A.; Werth, James L., Jr.

    2005-01-01

    The present study describes the characteristics and attitudes of non-terminally ill persons who support physician-assisted death (PAD) along with their expectations and preferences for care in the future. Participants (N=101) completed a survey assessing current affect and attitudes and those expected if terminally ill. Participants' responses…

  13. Non-physician practitioners in radiation oncology: advanced practice nurses and physician assistants.

    PubMed

    Kelvin, J F; Moore-Higgs, G J; Maher, K E; Dubey, A K; Austin-Seymour, M M; Daly, N R; Mendenhall, N P; Kuehn, E F

    1999-09-01

    With changes in reimbursement and a decrease in the number of residents, there is a need to explore new ways of achieving high quality patient care in radiation oncology. One mechanism is the implementation of non-physician practitioner roles, such as the advanced practice nurse (APN) and physician assistant (PA). This paper provides information for radiation oncologists and nurses making decisions about: (1) whether or not APNs or PAs are appropriate for their practice, (2) which type of provider would be most effective, and (3) how best to implement this role. Review of the literature and personal perspective. Specific issues addressed regarding APN and PA roles in radiation oncology include: definition of roles, regulation, prescriptive authority, reimbursement, considerations in implementation of the role, educational needs, and impact on resident training. A point of emphasis is that the non-physician practitioner is not a replacement or substitute for either a resident or a radiation oncologist. Instead, this role is a complementary one. The non-physician practitioner can assist in the diagnostic work-up of patients, manage symptoms, provide education to patients and families, and assist them in coping. This support facilitates the physician's ability to focus on the technical aspects of prescribing radiotherapy.

  14. Discussing physician-assisted dying: physicians' experiences in the United States and the Netherlands.

    PubMed

    Voorhees, Jennifer R; Rietjens, Judith A C; van der Heide, Agnes; Drickamer, Margaret A

    2014-10-01

    This study aims to further our understanding of the experiences of physicians when discussing physician-assisted dying (PAD) within the context of doctor-patient relationships in various sociolegal settings. Although patients bring up PAD in diverse settings, little is known about how physicians experience these discussions, and such experiences have not been directly compared across countries. A total of 36 physicians in the Netherlands and the United States (including Oregon) were interviewed using individual semistructured interview guides. Interviews were conducted by a single interviewer, audiotaped, and independently transcribed. Inductive qualitative analysis, aided by NVivo7 software, directed purposive sampling of physicians until saturation was met. Multiple coders in a multidisciplinary team analyzed emerging themes and developed theory. PAD discussions, which ranged from theoretical discussions to actual requests, could be gateways to discussions of other end-of-life issues important to patients and could strengthen doctor-patient relationships. Physicians found discussions to be emotionally intense, but often rewarding. Where PAD was legal, physicians utilized existing criteria to guide communication, and discussions were open and honest with patients and colleagues. Where PAD was illegal, conversations were less explicit, and physicians dealt with requests in relative isolation. In addition, physicians' views of their professional role, patients' rights, and religion influenced both their willingness to have and the content of PAD discussions. Discussion of PAD is an energy-consuming, yet potentially enriching part of the doctor-patient relationship. Legal guidelines may help to provide structure and support for physicians when patients broach the topic of PAD. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. Analysis of 2011 physician assistant education debt load.

    PubMed

    Moore, Miranda A; Coffman, Megan; Cawley, James F; Crowley, Diana; Miller, Anthony; Klink, Kathleen

    2017-03-01

    This study seeks to investigate how physician assistants (PAs) finance their education and to characterize the educational debt of PA students. Data from the 2011 American Academy of PAs (AAPA)-Physician Assistant Education Association Graduating Student Survey were used to explore the educational debt of PA students. The median total educational debt of a PA student graduating in 2011 was $80,000. Little financial assistance, other than student loans, is available to PA students. Eighty-five percent of PA students report owing some PA education debt amount, with 23% owing at least $100,000. This study provides a baseline look at PA student debt loads as a starting point for more detailed and robust research into new graduate specialty choices and PA career migration into other specialties. Further research is needed to explore the effect of student debt on students' specialty choices.

  16. The Perceptions of Changing the Entry-Level Degree for Physician Assistants to a Clinical Doctorate among Physician Assistant Students

    ERIC Educational Resources Information Center

    Swanchak, Lori E.

    2010-01-01

    Background: The recent advancements in medicine and the subsequent need for additional clinical training have resulted in the awarding of Clinical Doctorate (CD) Degrees for several allied health professionals. Few studies have been conducted within the physician assistant (PA) profession related to changing the entry-level degree for PAs to a…

  17. Dutch nurses' attitudes towards euthanasia and physician-assisted suicide.

    PubMed

    van Bruchem-van de Scheur, Ada; van der Arend, Arie; van Wijmen, Frans; Abu-Saad, Huda Huijer; ter Meulen, Ruud

    2008-03-01

    This article presents the attitudes of nurses towards three issues concerning their role in euthanasia and physician-assisted suicide. A questionnaire survey was conducted with 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The study was conducted in the Netherlands between January 2001 and August 2004. The results show that less than half (45%) of nurses would be willing to serve on committees reviewing cases of euthanasia and physician-assisted suicide. More than half of the nurses (58.2%) found it too far-reaching to oblige physicians to consult a nurse in the decision-making process. The majority of the nurses stated that preparing euthanatics (62.9%) and inserting an infusion needle to administer the euthanatics (54.1%) should not be accepted as nursing tasks. The findings are discussed in the context of common practices and policies in the Netherlands, and a recommendation is made not to include these three issues in new regulations on the role of nurses in euthanasia and physician-assisted suicide.

  18. Nurse Practitioner and Physician's Assistant Clinics in Rural California

    PubMed Central

    Morgan, Walter A.; Sullivan, Nancy D.

    1980-01-01

    The primary health care needs of at least 26 rural California communities are being served by nurse practitioners (NP's) or physician's assistants (PA's). All of these have physician supervision and support. NP's and PA's have proved to be acceptable and effective. With 230 rural areas in California identified as having unmet health care needs, this type of service is likely to increase and should be supported. NP/PA clinics serve total populations or concentrate on Indians, Chicanos or the poor. Many barriers have been overcome, especially over the past four years, to allow these clinics to flourish and increase in number. The availability of nurse practitioners and physician's assistants has increased due to support to schools and to school policies. Clinic funding has greatly improved; federal funds for general rural clinics, Indians, migrants, family planning and maternalchild health have been greatly supplemented by California state funds. Beginning in 1978, rural NP and PA services can be reimbursed by Medicare and Medi-Cal (California's Medicaid program). Since 1975 state laws have defined PA and NP roles broadly, and these roles are more precisely defined at the local level. Although nurse practitioners and physician's assistants generally cannot prescribe or dispense drugs (a major problem in many clinics), demonstration legislation allows special pilot projects to do both. As remaining funding and legal problems are corrected, NP's and PA's will serve an even greater role in rural areas. PMID:6104383

  19. Attitudes toward physician‐assisted suicide among physicians in Vermont

    PubMed Central

    Craig, Alexa; Cronin, Beth; Eward, William; Metz, James; Murray, Logan; Rose, Gail; Suess, Eric; Vergara, Maria E

    2007-01-01

    Background Legislation on physician‐assisted suicide (PAS) is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians. Objective To determine variables predictive of physicians' opinions on PAS in a rural state, Vermont, USA. Design Cross‐sectional mailing survey. Participants 1052 (48% response rate) physicians licensed by the state of Vermont. Results Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation (42% vs 34%). Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness (48% vs 33%). 30% of the respondents had experienced a request for assistance with suicide. Conclusions Vermont physicians' opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor–patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management. PMID:17601867

  20. The Assisted Dying Bill and the role of the physician.

    PubMed

    Mullock, Alexandra

    2015-08-01

    This article explores the role of the physician in the Assisted Dying Bill, which is currently progressing through the House of Lords. The Supreme Court decision in Nicklinson and Others has alerted Parliament to the possibility that the current prohibition against assisted suicide may breach Article 8 of the European Convention in relation to the right to choose how to end one's life. In this article, the role of healthcare professionals in the proposed legalisation of physician-assisted suicide is examined, together with consideration of key ethical concerns over who might be permitted to access assisted dying. Whether the proposed law presents an ethically sound alternative to the current prohibition against assisting in suicide is not clear, but Parliament must now respond in order to address human rights issues and the call to legalise medically assisted suicide. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Experience with physician assistants in a Canadian arthroplasty program

    PubMed Central

    Bohm, Eric R.; Dunbar, Michael; Pitman, David; Rhule, Chris; Araneta, Jose

    2010-01-01

    Background Recent increases in orthopedic surgical services in Canada have added further demand to an already stretched orthopedic workforce. Various initiatives have been undertaken across Canada to meet this demand. One successful model has been the use of physician assistants (PAs) within the Winnipeg Regional Health Authority (WRHA). This study documents the effect of PAs working in an arthroplasty practice from the perspective of patients and health care providers. We also describe the costs, time savings for surgeons and the effects on surgical throughput and waiting times. Methods We calculated time savings by the use of a daily diary kept by the PAs. Surgeons’, residents’, nurses’ and patients’ opinions about PAs were recorded by use of a selfadministered questionnaire. We calculated costs using forgone general practitioner (GP) surgical assist fees and salary costs for PAs. We obtained information about surgical throughput and wait times from the WRHA waitlist database. Results In this study, PAs “saved” their supervising physician about 204 hours per year; this time can be used for other clinical, administrative or research duties. Physician assistants are regarded as important members of the health care team by surgeons, nurses, orthopedic residents and patients. When we compared the billing costs with those that would have been generated by the use of GP surgical assists, PAs were essentially cost neutral. Furthermore, they potentially freed GPs from the operating room to spend more time delivering primary care. We found that use of the double operating room model facilitated by PAs increased the surgical throughput of primary hip and knee replacements by 42%, and median wait times decreased from 44 weeks to 30 weeks compared with the preceding year. Conclusion Physician assistants integrate well into the care team and can increase surgical volumes to reduce wait times in a cost-effective manner. PMID:20334742

  2. Physician assistant wages and employment, 2000-2025.

    PubMed

    Quella, Alicia; Brock, Douglas M; Hooker, Roderick S

    2015-06-01

    This study sought to assess physician assistant (PA) wages, make comparisons with other healthcare professionals, and project their earnings to 2025. The Bureau of Labor Statistics PA employment datasets were probed, and 2013 wages were used to explore median wage differences between large employer categories and 14 years of historical data (2000-2013). Median wages of PAs, family physicians and general practitioners, pharmacists, registered nurses, advanced practice nurses, and physical therapists were compared. Linear regression was used to project the PA median wage to 2025. In 2013, the median hourly wage for a PA employed in a clinical role was $44.70. From 2000 to 2013, PA wages increased by 40% compared with the cumulative inflation rate of 35.3%. This suggests that demand exceeds supply, a finding consistent with similar clinicians such as family physicians. A predictive model suggests that PA employment opportunities and remuneration will remain high through 2025.

  3. Incorporating physician assistants and physician extenders in the contemporary interventional oncology practice.

    PubMed

    Hong, Kelvin; Georgiades, Christos S; Hebert, Jillyn; Wahlin, Tamara; Mitchell, Sally E; Geschwind, Jean-Francois H

    2006-09-01

    Interventional radiology (IR) has been for the last few years undergoing a transformation from a service oriented to a clinically oriented specialty. With increasing oncologic procedures and patient volume, the balance between quality clinical care, and the time constraints on the busy interventionalist pull in opposing forces. The need for greater clinical support staff in the IR practice is unquestionable. Physician Assistants (and other Physician Extenders) have been in the medical field since the 1960s with intensive clinical training, capabilities of providing patient care and ability to generate revenue income more than justifies their place in the IR. The contemporary model of a clinical orientated service within IR for cancer patients undergoing interventional oncology procedures should include Physician Extenders as a vital part of the team allowing delivery of high-quality patient care.

  4. Roles and responsibilities of physician assistants practicing in Mohs surgery.

    PubMed

    Gaffney, Samantha; Goldgar, Constance; Hyde, Mark

    2012-10-01

    An estimated 30% of members of the American College of Mohs Surgery (ACMS) are using physician assistants (PAs). In Mohs surgery, the surgeon and the pathologist are the same person, so understanding which tasks are being delegated to PAs working in Mohs surgery is important. Our survey explores the number of PAs working with Mohs surgeons and the tasks delegated to PAs in this specialty.

  5. Will a physician assistant improve your dermatology practice?

    PubMed

    Baker, K E

    2000-09-01

    A physician assistant (PA) is a licensed health care professional and dependent practitioner. The profession began in the 1960s and accredited programs now number 110 nationwide. PAs practice in every specialty, including dermatology, and their clinical duties vary tremendously. Research has shown enhanced productivity and increased patient satisfaction in practices using PAs. Most third-party payers cover services provided by PAs, making them ideally suited in this era of increasing managed care.

  6. Vitalism revitalized.... Vulnerable populations, prejudice, and physician-assisted death.

    PubMed

    Mayo, David J; Gunderson, Martin

    2002-01-01

    One of the most potent arguments against physician-assisted death hinges on the worry that people with disabilities will be subtly coerced to accept death prematurely. The argument is flawed. There is nothing new in PAD: the risk of coercion is already present in current policies about end of life care. And to hold that any such risk is too much is tacitly to endorse vitalism and to deny that people with disabilities are capable of choosing authentically.

  7. Physician assisted suicide: the great Canadian euthanasia debate.

    PubMed

    Schafer, Arthur

    2013-01-01

    A substantial majority of Canadians favours a change to the Criminal Code which would make it legally permissible, subject to careful regulation, for patients suffering from incurable physical illness to opt for either physician assisted suicide (PAS) or voluntary active euthanasia (VAE). This discussion will focus primarily on the arguments for and against decriminalizing physician assisted suicide, with special reference to the British Columbia case of Lee Carter vs. Attorney General of Canada. The aim is to critique the arguments and at the same time to describe the contours of the current Canadian debate. Both ethical and legal issues raised by PAS are clarified. Empirical evidence available from jurisdictions which have followed the regulatory route is presented and its relevance to the slippery slope argument is considered. The arguments presented by both sides are critically assessed. The conclusion suggested is that evidence of harms to vulnerable individuals or to society, consequent upon legalization, is insufficient to support continued denial of freedom to those competent adults who seek physician assistance in hastening their death.

  8. When is physician assisted suicide or euthanasia acceptable?

    PubMed Central

    Frileux, S; Lelievre, C; Munoz, S; Mullet, E; Sorum, P

    2003-01-01

    Objectives: To discover what factors affect lay people's judgments of the acceptability of physician assisted suicide and euthanasia and how these factors interact. Design: Participants rated the acceptability of either physician assisted suicide or euthanasia for 72 patient vignettes with a five factor design—that is, all combinations of patient's age (three levels); curability of illness (two levels); degree of suffering (two levels); patient's mental status (two levels), and extent of patient's requests for the procedure (three levels). Participants: Convenience sample of 66 young adults, 62 middle aged adults, and 66 older adults living in western France. Main measurements: In accordance with the functional theory of cognition of N H Anderson, main effects, and interactions among patient factors and participants' characteristics were investigated by means of both graphs and ANOVA. Results: Patient requests were the most potent determinant of acceptability. Euthanasia was generally less acceptable than physician assisted suicide, but this difference disappeared when requests were repetitive. As their own age increased, participants placed more weight on patient age as a criterion of acceptability. Conclusions: People's judgments concur with legislation to require a repetition of patients' requests for a life ending act. Younger people, who frequently are decision makers for elderly relatives, place less emphasis on patient's age itself than do older people. PMID:14662811

  9. On Legalizing Physician-Assisted Death for Dementia.

    PubMed

    Dresser, Rebecca

    2017-07-01

    Last November, soon after Colorado became the latest state to authorize physician-assisted suicide, National Public Radio's The Diane Rehm Show devoted a segment to legalization of "physician assistance in dying," a label that refers to both physician-assisted suicide and voluntary active euthanasia. Although the segment initially focused on PAD in the context of terminal illness in general, it wasn't long before PAD's potential application to dementia patients came up. A caller said that her mother had Alzheimer's disease and was being cared for at great expense. Suspecting that she will suffer the same fate, the caller reported that she had included in her will "my specific request that if I should be diagnosed, and it is legal to do so, I would like to opt out of a life and many years of suffering." A few countries, such as the Netherlands and Belgium, already allow PAD for dementia in certain circumstances. It wouldn't be surprising to see a U.S. legalization effort in the coming years. © 2017 The Hastings Center.

  10. Gaps in the supply of physicians, advance practice nurses, and physician assistants.

    PubMed

    Sargen, Michael; Hooker, Roderick S; Cooper, Richard A

    2011-06-01

    Based on the goals of health care reform, growth in the demand for health care will continue to increase the demand for physicians and, as physician shortages widen, advanced practice nurses (APNs) and physician assistants (PAs) will play larger roles. Together with physicians they constitute a workforce of "advanced clinicians." The objective of this study was to assess the capacity of this combined workforce to meet the future demand for clinical services. Projections were constructed to the year 2025 for the supply of physicians, APNs, and PAs, and these were compared with projections of the demand for advanced clinical services, based on federal estimates of future spending and historic relationships between spending and the health care labor force. If training programs for APNs and PAs grow as currently projected but physician residency programs are not further expanded, the aggregate per capita supply of advanced clinicians will remain close to its current level, which will be 20% less than the demand in 2025. Increasing the numbers of entry-level (PGY1) residents by 500 annually will narrow the gap, but it will remain >15%. The nation faces a substantial shortfall in its combined supply of physicians, APNs, and PAs, even under aggressive training scenarios, and deeper shortages if these scenarios are not achieved. Efforts must be made to expand the output of clinicians in all 3 disciplines, while also strengthening the infrastructure of clinical practice and facilitating the delegation of tasks to a broadened spectrum of caregivers in new models of care. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Oregon emergency physicians' experiences with, attitudes toward, and concerns about physician-assisted suicide.

    PubMed

    Schmidt, T A; Zechnich, A D; Tilden, V P; Lee, M A; Ganzini, L; Nelson, H D; Tolle, S W

    1996-10-01

    To determine emergency physicians' (EPs') attitudes toward physician-assisted suicide (PAS), factors associated with those attitudes, current experiences with attempted suicides in terminally ill persons, and concerns about the impact of legalizing PAS on emergency medicine practice. A cross-sectional, anonymous mailed survey was taken of EPs in the state of Oregon. Of 356 eligible physicians, 248 (70%) returned the survey. Of the respondents, 69% indicated that PAS should be legal, 65% considered PAS consistent with the physician's role, and 19% believed that it is immoral. The respondents were concerned that patients might feel pressure if they perceived themselves to be either a care burden on others (82%) or a financial stress to others (69%). Only 37% indicated that the Oregon initiative has enough safeguards to protect vulnerable persons. Support for legalization was not associated with gender, age, or practice location. Respondents with no religious affiliation were most supportive of PAS (p < 0.001), and Catholic respondents were least suppportive (p = 0.03). A majority (58%) had treated at least 1 terminally ill patient after an apparent overdose. Most respondents (97%) indicated at least 1 circumstance for which they would sometimes be willing to let a terminally ill patient die without resuscitation after PAS if the Oregon initiative becomes law: if verified with an advance directive from the patient (81%), with documentation in writing from the physician (73%), after speaking to the primary physician (64%), if a competent patient verbally confirmed intent (60%), or if the family verbally confirmed intent (52%). Although the majority of Oregon EPs favor the concept of legalization of PAS, most have concerns that safeguards in the Oregon initiative are inadequate to protect vulnerable patients. These physicians would consider not resuscitating terminally ill patients who have attempted suicide under the law's provisions, only in the setting of

  12. Recent historical perspectives regarding medical euthanasia and physician assisted suicide.

    PubMed

    Pappas, D M

    1996-04-01

    Medical assistance in the termination of life, whether euthanasia or assisted suicide, is arguably one of the most hotly debated topics as we approach the millenium. While euthanasia has been a subject of controversy for thousands of years, the historical influences vis a vis the medical profession are primarily rooted in the past century. This chapter seeks to explore some of the recent historical developments which have had an impact on the emergence of medical euthanasia and physician assisted suicide. The objective is to juxtapose events in a way that relates historical fact (and fiction) to current events and debates. Sociology, law and theology have each a view and impact in this arena; however, they are deliberately left to the side, so as to allow for a longitudinal landscape.

  13. [Euthanasia and physician-assisted suicide : Attitudes of physicians and nurses].

    PubMed

    Zenz, J; Tryba, M; Zenz, M

    2015-04-01

    The current debate about end-of-life decisions in Germany focuses on physician-assisted suicide (PAS). However, there is only limited information available on physicians' attitudes towards euthanasia or PAS, and no data on nurses' attitudes. The aim is to explore attitudes of physicians and nurses with a special interest in palliative care and pain medicine using a case-related questionnaire. An anonymous questionnaire, consisting of eight questions, was distributed to all participants of a palliative care congress and a pain symposium. The questions focused on two scenarios: (1) a patient with an incurable fatal illness, (2) a patient with an incurable but nonfatal illness. The question was: Should euthanasia or physician-assisted suicide (PAS) be allowed. In addition, the participants were asked what they wanted for themselves if they were the patient concerned. A total of 317 questionnaires were analyzed; the return rate was 70 %. The general support for euthanasia and PAS was high: 40.5 % supported euthanasia in case of a fatal illness ("definitely…", "probably should be allowed"), 53.5 % supported PAS. The support decreased in case of a nonfatal illness; however, it increased when the participants were asked about their attitudes if they were the patient concerned. Nurses were more open towards euthanasia and PAS. In physicians the rejection of PAS was directly related to a higher level of qualification in the field of palliative care. The fact that nurses had a more positive attitude towards euthanasia and PAS and that all respondents accepted life-ending acts for themselves more than for their patients hints to still existing severe deficits in Germany.

  14. Nurse Practitioner and Physician's Assistant Clinics in Rural California

    PubMed Central

    Morgan, Walter A.

    1980-01-01

    Twenty-six rural California clinics have employed nurse practitioners (NP's) or physician's assistants (PA's) to meet the primary health care needs of local communities. Of the 24 NP's and 5 PA's involved, 11 were men and 18 were women. Their average age was 37, and all but five were trained in California. The clinics, with less than 50 percent on-site physician supervision, averaged 19 miles in distance from the nearest physician (ranging up to 63 miles). More than half the clinics were satellites of central, physician-staffed, nonprofit clinics, a third were community-administered and two were private. Half served a whole community, a quarter were established to serve Indians and a quarter to serve Chicanos. Each NP or PA saw an average of 13 patients a day. All nonprivate clinics received subsidies from a variety of local, state and federal funds. Four of the clinics had closed or had no medical staff at the time of our survey. NP/PA clinics are proving to be a feasible and valuable means of offering essential health care needs to remote communities. PMID:6103602

  15. An analysis of job satisfaction among physician assistants in Taiwan.

    PubMed

    Liu, Chi-Ming; Chien, Ching-Wen; Chou, Pesus; Liu, Jorn-Hon; Chen, Victor Tze-Kai; Wei, Jeng; Kuo, Ying-Yu; Lang, Hui-Chu

    2005-07-01

    The physician assistant (PA) is a relatively new medical specialty that developed to manage the shortage of resident physicians and to ensure that patients receive high-quality health care in today's increasingly complex and demanding medical environment. PAs in Taiwan are not governed by laws and regulations, and the absence of legislation to define their roles and responsibilities can lead to confusion in the work environment and potential communication barriers with coworkers and supervising physicians. The purpose of this exploratory study was to examine the environmental and sociodemographic factors that influence job satisfaction and job-related communication among PAs in Taiwan. The data source, a self-administered mail survey, was sent to 196 PAs working within medical facilities in northern, central, and southern Taiwan. The response rate to the survey was 71.01%. There was a strong correlation between communication satisfaction and job satisfaction among respondents. The PAs' overall position in the hospital, relationships with coworkers (doctors, nurses, and other medical staff), and ability to perform his or her duties while working with the supervising physician were the major environmental factors that influenced job and communication satisfaction. In addition, the number of working years and marital status were important demographic factors influencing job satisfaction. Demographic and environmental factors influencing job satisfaction are analyzed, and ways in which the roles and responsibilities of PAs can be clarified, strengthened, and improved are discussed in an overall effort to provide management strategies for the current PA system in Taiwan.

  16. Euthanasia and physician-assisted suicide in cases of terminal cancer: the opinions of physicians and nurses in Greece.

    PubMed

    Parpa, Efi; Mystakidou, Kyriaki; Tsilika, Eleni; Sakkas, Pavlos; Patiraki, Elisabeth; Pistevou-Gombaki, Kyriaki; Govina, Ourania; Vlahos, Lambros

    2008-10-01

    The aim of this study was to investigate the opinions of physicians and nurses on euthanasia and physician-assisted suicide in advanced cancer patients in Greece. Two hundred and fifteen physicians and 250 nurses from various hospitals in Greece completed a questionnaire concerning issues on euthanasia and physician-assisted suicide. More physicians (43.3%) than nurses (3.2%, p < 0.0005) reported that in the case of a cardiac or respiratory arrest, they would not attempt to revive a terminally ill cancer patient. Only 1.9% of physicians and 3.6% of nurses agreed on physician-assisted suicide. Forty-seven per cent of physicians and 45.2% of nurses would prefer the legalization of a terminally ill patient's hastened death; in the case of such a request, 64.2% of physicians and 55.2% of nurses (p = 0.06) would consider it if it was legal. The majority of the participants tended to disagree with euthanasia or physician-assisted suicide in terminally ill cancer patients, probably due to the fact that these acts in Greece are illegal.

  17. Euthanasia and medically assisted suicide--the case for legalizing physician assisted suicide.

    PubMed

    Manga, P

    2001-01-01

    Ethical and legal debates over ending life are inescapably emotive, controversial and complex. It is, however, increasingly urgent to resolve the debate over the legalization or continued prohibition of physician assisted suicide for a number of reasons, not least of which is the changing public and professional opinion and the growing concern over what may be actually but quietly and surreptitiously occurring in medical practice. The paper assesses the arguments for and against the legalization of this special case of euthanasia and concludes that with appropriate and well-defined criteria, guidelines, review and reporting requirements, the legalization of physician assisted suicide is not only ethical defensible but practical.

  18. Need for statutory legitimation of the roles of physician's assistants

    PubMed Central

    Barkin, Roger M.

    1974-01-01

    A significant constraint on new categories of health manpower is the absence of statutory legitimation of their roles. Licensure has been evolved as an effort to assure high-quality health care, but recently it has been a barrier to effective and innovative use of manpower. Medical and Nurse Practice Acts generally define the practices of medicine and nursing, but they do not define clearly the scope of these practices. Thus, these acts subject physicians to undue risks in delegating responsibilities and Type A assistants (nurses or non-nurses with special training) to undue risks in accepting those functions. Furthermore, only vague guidelines are provided to protect the public and to assure adequate quality control. To date, 35 States have enacted legislation to provide statutory legitimation of Type A assisants and to permit physicians to delegate appropriate responsibilities to new types of health manpower. It is hoped that this legislation will diminish barriers to effective use of health manpower. PMID:4150002

  19. Physician-assisted suicide-a clean bill of health?

    PubMed

    Preston, Robert

    2017-09-01

    Physician-assisted suicide (PAS) laws have been enacted in five US States and, along with physician-administered euthanasia, in Canada and the Netherlands. Annual reports of the Oregon Health Authority and published research papers. Not all recipients of lethal drugs use them to end their lives. Improvements in palliative care provision. Rising numbers of deaths from PAS. Emergence of 'doctor shopping' and multiple-prescribing. Absence of qualitative scrutiny of assessment process. No re-assessment or oversight when prescribed drugs are ingested. Recent pressures to extend Oregon's PAS law. Reasons given for seeking PAS indicate this is a societal rather than a clinical issue and raise the question whether adjudicating on requests for legalized PAS is an appropriate role for doctors. Research into quality of decision-making in requests for PAS and into potential role of doctors as expert witnesses rather than judges in requests for PAS.

  20. Advance directives, dementia, and physician-assisted death.

    PubMed

    Menzel, Paul T; Steinbock, Bonnie

    2013-01-01

    Physician-assisted suicide laws in Oregon and Washington require the person's current competency and a prognosis of terminal illness. In The Netherlands voluntariness and unbearable suffering are required for euthanasia. Many people are more concerned about the loss of autonomy and independence in years of severe dementia than about pain and suffering in their last months. To address this concern, people could write advance directives for physician-assisted death in dementia. Should such directives be implemented even though, at the time, the person is no longer competent and would not be either terminally ill or suffering unbearably? We argue that in many cases they should be, and that a sliding scale which considers both autonomy and the capacity for enjoyment provides the best justification for determining when: when written by a previously well-informed and competent person, such a directive gains in authority as the later person's capacities to generate new critical interests and to enjoy life decrease. Such an extension of legalized death assistance is grounded in the same central value of voluntariness that undergirds the current more limited legalization. © 2013 American Society of Law, Medicine & Ethics, Inc.

  1. Understanding the motivations of the multigenerational physician assistant workforce.

    PubMed

    Lopes, John E; Delellis, Nailya O

    2013-10-01

    Physician assistants (PAs) are more frequently finding themselves in positions where they are responsible for staff recruitment and retention. Staff turnover is associated with significant financial costs for organizations. Motivational theories focusing on job design indicate that paying attention to a combination of factors related to the work itself, in addition to the environment where the work is performed, increases satisfaction. This study asked a convenience sample of practicing PAs to rate the importance of a number of work-related factors known to influence job satisfaction. The results may be used as a basis for designing an environment to increase job satisfaction and improve recruitment and retention of highly qualified staff.

  2. Life insurance, living benefits, and physician-assisted death.

    PubMed

    Parker, Frederick R; Rubin, Harvey W; Winslade, William J

    2004-01-01

    One of the most significant concerns about the legalization of physician-assisted death in the United States relates to the possibility that a chronically or terminally ill person would choose to end her or his life for financial reasons. Because we believe that the life insurance industry is uniquely poised to help minimize any such incentive, we submit that it has a moral obligation to do so. In particular, we propose that the industry encourage greater flexibility in the payout of policy benefits in the event an insured should be diagnosed with a terminal illness or suffer from intractable pain.

  3. The Interservice Physician Assistant Program: Education quantity and quality.

    PubMed

    Harrison, Randolph Scott; Adamson, Katherine Justen; Kroger, Shan Michael

    2015-12-01

    The Interservice Physician Assistant Program (IPAP) was formed in 1996 by the assimilation of three service programs (Army, Air Force, and Navy). Applicants are selected from each service and upon successful completion of the program become commissioned officers within their respective medical corps. Clinical training takes place within military treatment facilities across the United States. Located in San Antonio, Texas, the program graduates about 169 PAs a year. Graduates are deployed to attend to service personnel, refugees, civilians, and victims of epidemics. The IPAP is unique in that it is the largest PA program in the world and its applicant pool is restricted to military personnel.

  4. A framework for physician assistant intervention for overweight and obesity.

    PubMed

    Herman, Lawrence; McGinnity, John G; Doll, Michael; Peterson, Eric D; Russell, Amanda; Largay, Joseph

    2015-07-01

    Overweight and obesity compose a chronic disease process of epidemic proportions that presents on a continuum, likely affecting nearly two out of every three patients treated by physician assistants (PAs). However, meaningful and actionable definitions, including but not limited to anthropometric and clinical descriptors, are needed. The effective treatment of overweight and obesity requires an efficient and timely process of screening, diagnosis, evaluation of complications, staging, and clear algorithmic management. PAs are trained as primary care providers and can diagnose and treat overweight and obese patients regardless of practice setting and across the spectrum of the disease and patient's age.

  5. New Zealanders' attitudes toward physician-assisted dying.

    PubMed

    Rae, Nicola; Johnson, Malcolm H; Malpas, Phillipa J

    2015-03-01

    Physician-assisted dying (PAD) is legal in several countries in Europe and some states of the United States. Despite regular societal debate in New Zealand about assisted dying, little is known about what the New Zealand public think about this issue. The present study was the first to examine New Zealanders' attitudes toward assisted dying in the context of various parameters of patient suffering, and as a public policy issue. Stratified random sampling techniques were used to elicit 677 participants from the electoral roll. They completed an anonymous questionnaire asking about the most appropriate medical response to patients who explicitly request assistance in dying, as well as their opinions around legalization of PAD. Overall, 78% felt PAD was the most appropriate response in certain situations while 82% felt it should be legalized. When the patient was suffering from loss of dignity, PAD was considered the most appropriate response to patients' requests for assistance in dying by 75% of respondents; when the patient was suffering from intractable pain, 65% of respondents considered PAD the most appropriate response. Almost 65% of those who wanted PAD to be legalized felt it should only be accessible to those suffering unbearably with little hope of recovery, and 46% felt that the presence of mental illness should be an exclusionary factor. The results have highlighted the high value respondents place on patient autonomy with regards to end-of-life choices; however the choice to hasten death is not a 'right' that should be available to all. RESULTS have clearly shown that New Zealanders believe regulation will play a key role in maintaining compliance with any assisted dying legislation, and in restricting access, so that only patients who are suffering intolerably and hopelessly are able to legally gain medical assistance to end their life.

  6. 42 CFR 405.2414 - Nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Nurse practitioner and physician assistant services... Clinic and Federally Qualified Health Center Services § 405.2414 Nurse practitioner and physician... nurse practitioner, physician assistant, nurse midwife, or specialized nurse practitioner who...

  7. 42 CFR 405.2414 - Nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Nurse practitioner and physician assistant services... Clinic and Federally Qualified Health Center Services § 405.2414 Nurse practitioner and physician... nurse practitioner, physician assistant, nurse midwife, or specialized nurse practitioner who...

  8. 42 CFR 405.2414 - Nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Nurse practitioner and physician assistant services... Clinic and Federally Qualified Health Center Services § 405.2414 Nurse practitioner and physician... nurse practitioner, physician assistant, nurse midwife, or specialized nurse practitioner who...

  9. Physician-assisted suicide: the legal slippery slope.

    PubMed

    Walker, R M

    2001-01-01

    In Oregon, physicians can prescribe lethal amounts of medication only if requested by competent, terminally ill patients. However, the possibility of extending the practice to patients who lack decisional capacity exists. This paper examines why the legal extension of physician-assisted suicide (PAS) to incapacitated patients is possible, and perhaps likely. The author reviews several pivotal court cases that have served to define the distinctions and legalities among "right-to-die" cases and the various forms of euthanasia and PAS. Significant public support exists for legalizing PAS and voluntary euthanasia in the United States. The only defenses against sliding from PAS to voluntary euthanasia are adhering to traditional physician morality that stands against it and keeping the issue of voluntary euthanasia legally framed as homicide. However, if voluntary euthanasia evolves euphemistically as a medical choice issue, then the possibility of its legalization exists. If courts allow PAS to be framed as a basic personal right akin to the right to refuse treatment, and if they rely on right-to-die case precedents, then they will likely extend PAS to voluntary euthanasia and nonvoluntary euthanasia. This would be done by extending the right to PAS to incapacitated patients, who may or may not have expressed a choice for PAS prior to incapacity.

  10. Attitudes Toward Academic Dishonesty in Physician Assistant Students.

    PubMed

    Vail, Marianne E; Coleman, Suzanne; Johannsson, Mark B; Wright, Karen A

    2015-12-01

    The purpose of this study was to assess physician assistant (PA) students' attitudes and experiences toward academic dishonesty during training and to determine whether PA students self-report cheating during PA school. An anonymous, quantitative, exploratory, descriptive survey was sent to clinical-year PA students enrolled in PA programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). A sample of 493 self-selected PA students in their clinical year of training responded to the survey. Only 3% of clinical-year PA students self-reported cheating during PA school. Males self-reported significantly higher rates of cheating in PA school than females. The most common cheating behavior that clinical-year PA students reported either observing or hearing about in PA school was receiving information about an exam prior to its administration (70.9%). The attitudinal statement that respondents most strongly agreed with was that "cheaters in PA school just end up hurting themselves in the long run." The strongest predictor for cheating in PA school was a history of cheating as an undergraduate. This study confirmed previous research indicating that academic dishonesty exists in PA education. It also determined that clinical-year PA student attitudes toward and experiences with academic dishonesty vary.

  11. Student mental health implications for physician assistant education.

    PubMed

    Jones, P Eugene; Williams, Jeffrey M

    2014-01-01

    This report examines student mental health and learning disabilities along the continuum from childhood to college by examining diagnosing and prescribing patterns and potential implications for physician assistant (PA) faculty based on the Standards of the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) and the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5, Section 2, Specific Learning Disorders). We reviewed existing data to compare decades of national patterns in diagnosing and prescribing for conditions that have known comorbidities with learning disabilities. By including quantitative and qualitative data from children, adolescents, undergraduate college students, and veterans, we illustrate the potential impact these patterns could have on some current and future applicants to PA educational programs and the requirements for PA faculty to address these needs. Multiple national data sources revealed increasing numbers of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), psychoactive prescriptions written for those under age 18, and self-reported increases in multiple psychological disorders among college students. More recent evidence shows a twofold increase in military veterans returning to college with posttraumatic stress disorder, traumatic brain injury, and depression. The growing numbers of students with conditions described in this report requires academic faculty to be aware of requirements to recognize and address their mental health service needs. PA educators could benefit from supplemental faculty development activities to help prepare them to recognize the pipeline patterns of a growing percentage of postsecondary students with mental health conditions and learning disabilities.

  12. Salary differences of male and female physician assistant educators.

    PubMed

    Coombs, Jennifer; Valentin, Virginia

    2014-01-01

    The Physician Assistant Education Association (PAEA) annual report has shown substantial salary differences between male and female physician assistant (PA) faculty. Despite this published difference between the salaries, very little research has been conducted on the subject. The purpose of this study is to determine if there is a significant difference between male and female PA faculty salaries. The researchers set out to determine if these differences could be further distinguished by education level, rank, or position. In addition, any difference between the percentages of male and female faculty promoted to higher ranks and in leadership positions was also explored. Salary, gender, degree, rank, and position were obtained and deidentified from the 25th PAEA annual report. SPSS Version 20 was used to analyze the data. Statistical analysis included descriptive measures and an independent t test. Data from only those PA educators who reported full-time employment were used. The final analysis included 477 PA faculty salaries. Female PA educators showed statistically significant lower annual incomes than their male counterparts. The income disparity persisted when differentiated by education, rank, and position. Higher percentages of male PA faculty members were found in higher ranks and in leadership positions. This study confirms previous reports that female PA faculty earn less than their male counterparts. With increasing numbers of female PAs entering academia, the lack of women in leadership positions and the wage disparity are concerning.

  13. Predicting physician assistant students' professionalism by personality attributes.

    PubMed

    Moser, Sharon; Dereczyk, Amy

    2012-01-01

    The purpose of this study is to determine whether personality characteristics, both positive and negative, predict the level of professionalism in physician assistant (PA) students. Both the Millon College Counseling Inventory (MCCI) and a physician assistant professionalism scale (PA Professional Scale) were administered to 82 PA students in 5 multiple years at University of Detroit Mercy, a private-university PA program with an end point of a master's degree. Cluster analysis determined natural groupings of healthy and unhealthy personality characteristics, and the two personality clusters were compared to each of 15 professionalism parameters. Significant correlations were determined using a two-tailed Pearson correlation. The "healthy" personality clusters characterized by conscientiousness and outward directedness were significantly predictive for the professionalism attributes of taking full responsibility for self, volunteering for others, dressing professionally, punctuality, participating in class, ability to give and receive criticism, and seeking out new challenges. The "unhealthy" cluster was negatively correlated to taking full responsibility, volunteerism, trustworthiness, dressing professionally, being punctual, giving and receiving criticism, and taking on new challenges. Healthy personality characteristics do predict high levels of self-reported professionalism according to this study. Conversely, unhealthy personality characteristics will predict a low level of self-reported professionalism. Personality profiles can be incorporated into the admission process to select a higher percentage of candidates who value and emulate professionalism, producing better practitioners.

  14. Physician Assistant Job Satisfaction: A Narrative Review of Empirical Research.

    PubMed

    Hooker, Roderick S; Kuilman, Luppo; Everett, Christine M

    2015-12-01

    To examine physician assistant (PA) job satisfaction and identify factors predicting job satisfaction and identify areas of needed research. With a global PA movement underway and a half-century in development, the empirical basis for informing employers of approaches to improve job satisfaction has not received a careful review. A narrative review of empirical research was undertaken to inform stakeholders about PA employment with a goal of improved management. The a priori criteria included published studies that asked PAs about job satisfaction. Articles addressing PA job satisfaction, written in English, were reviewed and categorized according to the Job Characteristics Model. Of 68 publications reviewed, 29 met criteria and were categorized in a Job Characteristics Model. Most studies report a high degree of job satisfaction when autonomy, income, patient responsibility, physician support, and career advancement opportunities are surveyed. Age, sex, specialty, and occupational background are needed to understand the effect on job satisfaction. Quality of studies varies widely. Employers may want to examine their relationships with PAs periodically. The factors of job satisfaction may assist policymakers and health administrators in creating welcoming professional employment environments. The main limitation: no study comprehensively evaluated all the antecedents of job satisfaction. PAs seem to experience job satisfaction supported by low attrition rates and competitive wages. Contributing factors are autonomy, experienced responsibility, pay, and supportive supervising physician. A number of intrinsic rewards derived from the performance of the job within the social environment, along with extrinsic rewards, may contribute to overall job satisfaction. PA job satisfaction research is underdeveloped; investigations should include longitudinal studies, cohort analyses, and economic determinants.

  15. Views of United States physicians and members of the American Medical Association House of Delegates on physician-assisted suicide.

    PubMed

    Whitney, S N; Brown, B W; Brody, H; Alcser, K H; Bachman, J G; Greely, H T

    2001-05-01

    To ascertain the views of physicians and physician leaders toward the legalization of physician-assisted suicide. Confidential mail questionnaire. A nationwide random sample of physicians of all ages and specialties, and all members of the American Medical Association (AMA) House of Delegates as of April 1996. Demographic and practice characteristics and attitude toward legalization of physician-assisted suicide. Usable questionnaires were returned by 658 of 930 eligible physicians in the nationwide random sample (71%) and 315 of 390 eligible physicians in the House of Delegates (81%). In the nationwide random sample, 44.5% favored legalization (16.4% definitely and 28.1% probably), 33.9% opposed legalization (20.4% definitely and 13.5% probably), and 22% were unsure. Opposition to legalization was strongly associated with self-defined politically conservative beliefs, religious affiliation, and the importance of religion to the respondent (P <.001). Among members of the AMA House of Delegates, 23.5% favored legalization (7.3% definitely and 16.2% probably), 61.6% opposed legalization (43.5% definitely and 18.1% probably), and 15% were unsure; their views differed significantly from those of the nationwide random sample (P <.001). Given the choice, a majority of both groups would prefer no law at all, with physician-assisted suicide being neither legal nor illegal. Members of the AMA House of Delegates strongly oppose physician-assisted suicide, but rank-and-file physicians show no consensus either for or against its legalization. Although the debate is sometimes adversarial, most physicians in the United States are uncertain or endorse moderate views on assisted suicide.

  16. Views of United States Physicians and Members of the American Medical Association House of Delegates on Physician-assisted Suicide

    PubMed Central

    Whitney, Simon N; Brown, Byron W; Brody, Howard; Alcser, Kirsten H; Bachman, Jerald G; Greely, Henry T

    2001-01-01

    OBJECTIVE To ascertain the views of physicians and physician leaders toward the legalization of physician-assisted suicide. DESIGN Confidential mail questionnaire. PARTICIPANTS A nationwide random sample of physicians of all ages and specialties, and all members of the American Medical Association (AMA) House of Delegates as of April 1996. MEASUREMENTS Demographic and practice characteristics and attitude toward legalization of physician-assisted suicide. MAIN RESULTS Usable questionnaires were returned by 658 of 930 eligible physicians in the nationwide random sample (71%) and 315 of 390 eligible physicians in the House of Delegates (81%). In the nationwide random sample, 44.5% favored legalization (16.4% definitely and 28.1% probably), 33.9% opposed legalization (20.4% definitely and 13.5% probably), and 22% were unsure. Opposition to legalization was strongly associated with self-defined politically conservative beliefs, religious affiliation, and the importance of religion to the respondent (P < .001). Among members of the AMA House of Delegates, 23.5% favored legalization (7.3% definitely and 16.2% probably), 61.6% opposed legalization (43.5% definitely and 18.1% probably), and 15% were unsure; their views differed significantly from those of the nationwide random sample (P < .001). Given the choice, a majority of both groups would prefer no law at all, with physician-assisted suicide being neither legal nor illegal. CONCLUSIONS Members of the AMA House of Delegates strongly oppose physician-assisted suicide, but rank-and-file physicians show no consensus either for or against its legalization. Although the debate is sometimes adversarial, most physicians in the United States are uncertain or endorse moderate views on assisted suicide. PMID:11359546

  17. Complexities in euthanasia or physician-assisted suicide as perceived by Dutch physicians and patients' relatives.

    PubMed

    Snijdewind, Marianne C; van Tol, Donald G; Onwuteaka-Philipsen, Bregje D; Willems, Dick L

    2014-12-01

    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. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  18. Physician assistants and nurse practitioners: rural-urban settings and reimbursement for services.

    PubMed

    Anderson, D M; Hampton, M B

    1999-01-01

    Evidence based on productivity measures, salaries and costs of medical education indicates that physician assistants and nurse practitioners are cost-effective. Managed care suggests that health maintenance organizations (HMOs) would seek to utilize these professionals. Moreover, underserved rural areas would utilize physician assistants and nurse practitioners to provide access. This study examined the role of payment sources in the utilization of physician assistants and nurse practitioners using the 1994 National Hospital Ambulatory Medical Care Survey (NHAMCS) conducted by the National Center for Health Statistics, U.S. Centers for Disease Control and Prevention. Rural vs. urban results were compared. The study found that significant rural-urban differences exist in the relationships between payment sources and the utilization of physician assistants and nurse practitioners. The study also found that payment source affects varied for physicians, physician assistants and nurse practitioners who saw outpatients in hospital settings. Surprisingly, prepaid and HMO types of reimbursements are shown to have no relationship with physician assistant and nurse practitioner utilization, and this finding is the same for both rural and urban patient visits. After controlling for other influences, the study shows that physicians, physician assistants and nurse practitioners are each as likely as the other to be present at a rural managed care visit. However, physicians are much more likely than physician assistants and nurse practitioners to be present at an urban managed care visit.

  19. Prescribing Exercise for Older Adults: A Needs Assessment Comparing Primary Care Physicians, Nurse Practitioners, and Physician Assistants

    ERIC Educational Resources Information Center

    Dauenhauer, Jason A.; Podgorski, Carol A.; Karuza, Jurgis

    2006-01-01

    To inform the development of educational programming designed to teach providers appropriate methods of exercise prescription for older adults, the authors conducted a survey of 177 physicians, physician assistants, and nurse practitioners (39% response rate). The survey was designed to better understand the prevalence of exercise prescriptions,…

  20. The case for physician assisted suicide: how can it possibly be proven?

    PubMed

    Dahl, E; Levy, N

    2006-06-01

    In her paper, The case for physician assisted suicide: not (yet) proven, Bonnie Steinbock argues that the experience with Oregon's Death with Dignity Act fails to demonstrate that the benefits of legalising physician assisted suicide outweigh its risks. Given that her verdict is based on a small number of highly controversial cases that will most likely occur under any regime of legally implemented safeguards, she renders it virtually impossible to prove the case for physician assisted suicide. In this brief paper, we suggest some ways that may enable us to weigh the risks and benefits of legalisation more fairly and, hopefully, allow us to close the case for physician assisted suicide.

  1. The case for physician assisted suicide: how can it possibly be proven?

    PubMed Central

    Dahl, E; Levy, N

    2006-01-01

    In her paper, The case for physician assisted suicide: not (yet) proven, Bonnie Steinbock argues that the experience with Oregon's Death with Dignity Act fails to demonstrate that the benefits of legalising physician assisted suicide outweigh its risks. Given that her verdict is based on a small number of highly controversial cases that will most likely occur under any regime of legally implemented safeguards, she renders it virtually impossible to prove the case for physician assisted suicide. In this brief paper, we suggest some ways that may enable us to weigh the risks and benefits of legalisation more fairly and, hopefully, allow us to close the case for physician assisted suicide. PMID:16731731

  2. Swiss physicians' attitudes to assisted suicide: A qualitative and quantitative empirical study.

    PubMed

    Brauer, Susanne; Bolliger, Christian; Strub, Jean-Daniel

    2015-01-01

    In Switzerland, assisted suicide is legal as long as it does not involve self-serving motives. Physician-assisted suicide is regulated by specific guidelines issued by the Swiss Academy of Medical Sciences (SAMS). This article summarises the results of an empirical study of physicians' attitudes to assisted suicide in Switzerland, which was commissioned by the SAMS. The study (in German) is available online at: www.samw.ch. Twelve qualitative interviews and a written survey were conducted, involving a disproportional, stratified random sample of Swiss physicians (4,837 contacted, 1,318 respondents, response rate 27%). Due to the response rate and the wide variation of respondents from one professional speciality to another, the findings and interpretations presented should be regarded as applying only to the group of physicians who are interested in or are particularly affected by the issue of assisted suicide. They cannot be generalised to the whole body of physicians in Switzerland. Of the respondents, 77% considered physician-assisted suicide to be justifiable in principle, while 22% were fundamentally opposed to it. Although 43% could imagine situations where they would personally be prepared to perform assisted suicide, it is clear from the study that this potential readiness does not mean that all respondents would automatically be prepared to perform it in practice as soon as the legal criteria are met. The vast majority of respondents emphasised that there should be no obligation to perform physician-assisted suicide. Opinions differed as to whether physician-assisted suicide should remain restricted to cases where the person concerned is approaching the end of life. While a large majority of respondents considered physician-assisted suicide also to be justifiable in principle in non-end-of-life situations, 74% supported the maintenance of the end-of-life criterion in the SAMS Guidelines as a necessary condition for physician-assisted suicide. Over 50% of

  3. The Burmese medic: an international physician assistant analogue.

    PubMed

    Pedersen, Donald M; Pedersen, Kathy J; Santitamrongpan, Verapan

    2012-01-01

    Although there have been recent democratic reforms in Myanmar (formerly known as Burma), for nearly 60 years there has been a consistent history of human rights violations as part of a civil war waged by the Myanmar military, known as the Tatmadaw. Approximately 3,500 villages have been destroyed by the Tatmadaw during the half-century of civil war. Oppression against minority groups, including the Karen, Karenni, Kachin, Mon, Shan, Chin, and Muslims has adversely affected the health outcomes of these vulnerable populations. Since the mid 1990s, medics have been providing care for the ethnic minorities who were displaced from their homes by the civil war and who live in the jungles of eastern Burma as well as in the refugee camps and towns in the border areas of Thailand. This article will look at how these medics are providing care similar to that provided by physician assistants in the United States.

  4. Physician assistant and nurse practitioner utilization in academic medical centers.

    PubMed

    Moote, Marc; Krsek, Cathleen; Kleinpell, Ruth; Todd, Barbara

    2011-01-01

    The purpose of this study was to collect information on the utilization of physician assistants (PAs) and nurse practitioners (NPs) in academic health centers. Data were gathered from a national sample of University HealthSystem Consortium member academic medical centers (AMCs). PAs and NPs have been integrated into most services of respondent AMCs, where they are positively rated for the value they bring to these organizations. The primary reason cited by most AMCs for employing PAs and NPs was Accreditation Council for Graduate Medical Education resident duty hour restrictions (26.9%). Secondary reasons for employing PAs and NPs include increasing patient throughput (88%), increasing patient access (77%), improving patient safety/quality (77%), reducing length of stay (73%), and improving continuity of care (73%). However, 69% of AMCs report they have not successfully documented the financial impact of PA/NP practice or outcomes associated with individual PA or NP care.

  5. Can physician assistants be effective in the UK?

    PubMed

    Stewart, Antony; Catanzaro, Rachel

    2005-01-01

    The National Health Sevice (NHS) faces a serious shortage of medical staff. One solution is to introduce US-style physician assistants (PAs) who train for around two years following previous clinical work or a first degree, and perform duties similar to junior doctors. This paper reviews the history and role of PAs, the quality of their work and their likely impact in the UK. A variety of sources were searched to identify suitable studies. The use of PAs in the UK appears to be an acceptable model that could eventually reduce the current skill shortage and provide high quality patient care. Twelve US-sourced PAs currently work in Sandwell, West Midlands. A recent report suggests they have made a substantial contribution to primary care and have improved patient access. For PAs to be successful in the UK, they must be highly regarded practitioners. High quality educational courses must be established to ensure their credibility.

  6. Snapshot of anatomy teaching in physician assistant education.

    PubMed

    Hegmann, Theresa

    2013-01-01

    Cadaver dissection has been a defining part of the culture of medical education for centuries. Currently there is an active debate regarding the advantages of dissection versus other forms of teaching anatomy. De-identified data from the 2010 Curriculum Survey were obtained from the Physician Assistant Education Association, with 82 PA programs responding to anatomy curriculum questions. SPSS 21 was used for descriptive statistics, t-tests, and Mann-Whitney tests. Programs reported a mean of 102.4 and median of 91 contact hours in anatomy (range 4-270). The "average" PA program anatomy course used 57.4% lecture, 4.6% simulation, 25.9% dissection, and 12.1% prosection. Private programs had significantly fewer total and lab contact-hours than public programs. Teaching anatomy through cadaver dissection poses many challenges for health professions educators. Based on the results presented, PA programs are addressing this challenge in a variety of ways in their curricula.

  7. Nurse practitioner and physician assistant interest in prescribing buprenorphine.

    PubMed

    Roose, Robert J; Kunins, Hillary V; Sohler, Nancy L; Elam, Rashiah T; Cunningham, Chinazo O

    2008-06-01

    Office-based buprenorphine places health care providers in a unique position to combine HIV and drug treatment in the primary care setting. However, federal legislation restricts nurse practitioners (NPs) and physician assistants (PAs) from prescribing buprenorphine, which may limit its potential for uptake and inhibit the role of these nonphysician providers in delivering drug addiction treatment to patients with HIV. This study aimed to examine the level of interest in prescribing buprenorphine among nonphysician providers. We anonymously surveyed providers attending HIV educational conferences in six large U.S. cities about their interest in prescribing buprenorphine. Overall, 48.6% (n = 92) of nonphysician providers were interested in prescribing buprenorphine. Compared to infectious disease specialists, nonphysician providers (adjusted odds ratio [AOR] = 2.89, 95% confidence interval [CI] = 1.22-6.83) and generalist physicians (AOR = 2.04, 95% CI = 1.09-3.84) were significantly more likely to be interested in prescribing buprenorphine. NPs and PAs are interested in prescribing buprenorphine. To improve uptake of buprenorphine in HIV settings, the implications of permitting nonphysician providers to prescribe buprenorphine should be further explored.

  8. Education of military veterans in physician assistant programs.

    PubMed

    Michaud, Edward; Jacques, Paul F; Gianola, F J; Harbert, Ken

    2015-06-01

    To assess the admission policies, experiences, and attitudes of physician assistant (PA) program directors regarding recruiting, admitting, and training military veterans after the announcement of the "Helping Veterans Become Physician Assistants" initiative. A descriptive survey of 22 questions was distributed to all 173 PA program directors in the United States in April 2013. The survey covered years 2011 to 2013, although it was completed in June of 2013. The results of the survey were compared with the results of a similar survey that covered years 2008 through 2010. One hundred and five (60.7%) program directors participated in this survey. Veterans were admitted into 88.1% of responding programs and accounted for an average of 4.0% of all students. One-third of programs (33%) accepted transfer credits for veterans' military training, and 20% accepted credits for off-duty education. One-third (33%) of programs participated in the Yellow Ribbon Program. Almost 60% of programs had military veteran faculty members. Active recruitment of military veteran students occurred in 31.2% of programs. Program directors described multiple benefits of, and barriers to, admitting and educating veterans. For the years 2011 through 2013, as compared to 2008 through 2010, there was an increase in the percentage of PA programs that actively recruited veterans, considered veteran status in the admission process, admitted veterans, and contributed to their financial support. There was also an increased percentage of students with military experience matriculating into PA programs. However, barriers still exist for veterans seeking admission into PA programs, the most significant of which is academic preparedness for a graduate-level PA program.

  9. Rural and urban physicians' perceptions regarding the role and practice of the nurse practitioner, physician assistant, and certified nurse midwife.

    PubMed

    Burgess, Stephanie E; Pruitt, Rosanne H; Maybee, Patricia; Metz, Arnold E; Leuner, Jean

    2003-01-01

    There is a dearth of literature citing the differences in rural and urban physicians' perceptions of the role and practice of nurse practitioners, physician assistants, and certified nurse midwives (nonphysician providers). The purpose of this study was to investigate and compare differences, if any, between rural and urban primary care physicians' perceptions of the role and practice of nonphysician providers. Despite a 15.55% response rate using a mail-out survey in South Carolina, data from 681 rural and urban primary care physicians indicated that they perceived that nonphysician providers possess the necessary skills and knowledge to provide primary care to patients, are an asset to a physician's practice, free the physician's time to handle more critically ill patients, and increase revenue for the practice, but increase the risk of patient care mistakes and a physician's time in administrative duties. Urban physicians' mean scores were higher for perceiving that nonphysician providers are able to see as many patients in a given day as a physician but experience impediments in the delivery of patient care. Results will be used to clarify physicians' perceptions regarding the role and practice of nonphysician providers to reduce impediments to patient care access.

  10. Survey shows consumers open to a greater role for physician assistants and nurse practitioners.

    PubMed

    Dill, Michael J; Pankow, Stacie; Erikson, Clese; Shipman, Scott

    2013-06-01

    Impending physician shortages in the United States will necessitate greater reliance on physician assistants and nurse practitioners, particularly in primary care. But how willing are Americans to accept that change? This study examines provider preferences from patients' perspective, using data from the Association of American Medical Colleges' Consumer Survey. We found that about half of the respondents preferred to have a physician as their primary care provider. However, when presented with scenarios wherein they could see a physician assistant or a nurse practitioner sooner than a physician, most elected to see one of the other health care professionals instead of waiting. Although our findings provide evidence that US consumers are open to the idea of receiving care from physician assistants and nurse practitioners, it is important to consider barriers to more widespread use, such as scope-of-practice regulations. Policy makers should incorporate such evidence into solutions for the physician shortage.

  11. Facing requests for physician-assisted suicide: toward a practical and principled clinical skill set.

    PubMed

    Emanuel, L L

    1998-08-19

    Requests for physician-assisted suicide are not a new phenomenon, and many physicians are likely to face this challenging situation. This article proposes for professionals an 8-step approach to respond to requests for physician-assisted suicide. The approach seeks to identify and treat the root causes of the request and aims to present a plan for consistent application of a set of clinical skills. Justification for the steps requires only 2 noncontentious principles: the patient should be free of unwanted intervention, and the physician is obligated to provide suffering patients with comfort care. Care based on these 2 principles alone does not include physician-assisted suicide. The approach does, however, justify patient refusal of oral intake in specific circumstances. The approach could resolve a majority of requests for physician-assisted suicide and should be tested further for clinical efficacy.

  12. Trends in State Regulation of Nurse Practitioners and Physician Assistants, 2001 to 2010

    PubMed Central

    Gadbois, Emily A.; Miller, Edward Alan; Tyler, Denise; Intrator, Orna

    2016-01-01

    Nurse practitioners and physician assistants can alleviate some of the primary care shortage facing the United States, but their scope-of-practice is limited by state regulation. This study reports both cross-sectional and longitudinal trends in state scope-of-practice regulations for nurse practitioners and physician assistants over a 10-year period. Regulations from 2001 to 2010 were compiled and described with respect to entry-to-practice standards, physician involvement in treatment/diagnosis, prescriptive authority, and controlled substances. Findings indicate that most states loosened regulations, granting greater autonomy to nurse practitioners and physician assistants, particularly with respect to prescriptive authority and physician involvement in treatment and diagnosis. Many states also increased barriers to entry, requiring high levels of education before entering practice. Knowledge of state trends in nurse practitioner and physician assistant regulation should inform current efforts to standardize scope-of-practice nationally. PMID:25542195

  13. Physician Assisted Suicide: Knowledge and Views of Fifth-Year Medical Students in Germany

    ERIC Educational Resources Information Center

    Schildmann, Jan; Herrmann, Eva; Burchardi, Nicole; Schwantes, Ulrich; Vollmann, Jochen

    2006-01-01

    Suicide and assisted suicide are not criminal acts in Germany. However, attempting suicide may create a legal duty for physicians to try to save a patient's life. This study presents data on medical students' legal knowledge and ethical views regarding physician assisted suicide (PAS). The majority of 85 respondents held PAS to be illegal. More…

  14. Defining the Future Characteristics of Physician Assistant Education Proceedings (Alexandria, VA, August 16-17, 1996).

    ERIC Educational Resources Information Center

    Miller, Anthony A., Ed.

    This report summarizes a project that focused on the future of the education of physician assistants. The panel of expert presenters represented physician assistant (PA) educators, educators of other health care professionals, employers of PAs, health care oriented foundations, a health care workforce expert, and members of the PA profession. The…

  15. 42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse...

  16. Physician Assistant Attitude and Expressed Intent to Work with Geriatric Patients

    ERIC Educational Resources Information Center

    Woolsey, Lisa J.

    2007-01-01

    This study evaluated the attitudes of physician assistant students (PAS) and practicing physician assistants (PA) toward geriatric patients and the expressed intent of PAS and practicing PAs toward practicing in the specialized field of geriatric medicine using a cross-sectional study design. The 233 participants each completed a questionnaire…

  17. Moving from Clinical Practice to Academe: An Analysis of Career Change for Physician Assistants

    ERIC Educational Resources Information Center

    Marciano, Gerard Jude

    2013-01-01

    Recruitment of qualified and motivated faculty for physician assistant education programs is difficult. While the causes of the difficulty may be many, the primary one is the physician assistants (PAs) must choose between clinical and academic practice in order to pursue a career in academe. Little if any research has been conducted in this area.…

  18. 42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse...

  19. 42 CFR 405.2415 - Services and supplies incident to nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Services and supplies incident to nurse... Services and supplies incident to nurse practitioner and physician assistant services. (a) Services and supplies incident to a nurse practitioner's or physician assistant's services are reimbursable under...

  20. 42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse...

  1. 42 CFR 405.2415 - Services and supplies incident to nurse practitioner, physician assistant, certified nurse...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Services and supplies incident to nurse practitioner, physician assistant, certified nurse midwife, clinical psychologist, or clinical social worker... nurse practitioner, physician assistant, certified nurse midwife, clinical psychologist, or...

  2. 42 CFR 405.2415 - Services and supplies incident to nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Services and supplies incident to nurse... Services and supplies incident to nurse practitioner and physician assistant services. (a) Services and supplies incident to a nurse practitioner's or physician assistant's services are reimbursable under...

  3. 42 CFR 405.2415 - Services and supplies incident to nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Services and supplies incident to nurse... Services and supplies incident to nurse practitioner and physician assistant services. (a) Services and supplies incident to a nurse practitioner's or physician assistant's services are reimbursable under...

  4. 42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse...

  5. Delivering a Multicultural Curriculum on the Cultural Competence of Physician Assistant Students

    ERIC Educational Resources Information Center

    De Oliveira, Katie

    2014-01-01

    The purpose of this study was to explore the effect the integration of a multicultural curriculum has on the perceived level of cultural competence of physician assistant students. A convergent parallel mixed-methods approach was utilized to collect the necessary data. The physician assistant students participated in focus-group sessions and a…

  6. New Health Practitioners: The Nurse Practitioner and the Physician's Assistant. Extension Studies 80.

    ERIC Educational Resources Information Center

    Woolley, Barbara H.

    Based on the trend toward greater reliance on new health practitioners, this book focuses on the nurse practitioner and the physician's assistant. The first of four sections describes the nurse practitioner and the physician's assistant and what their functions are in the delivery of health care services. Discussing why new health practitioners…

  7. Defining the Future Characteristics of Physician Assistant Education Proceedings (Alexandria, VA, August 16-17, 1996).

    ERIC Educational Resources Information Center

    Miller, Anthony A., Ed.

    This report summarizes a project that focused on the future of the education of physician assistants. The panel of expert presenters represented physician assistant (PA) educators, educators of other health care professionals, employers of PAs, health care oriented foundations, a health care workforce expert, and members of the PA profession. The…

  8. Physician Assisted Suicide: Knowledge and Views of Fifth-Year Medical Students in Germany

    ERIC Educational Resources Information Center

    Schildmann, Jan; Herrmann, Eva; Burchardi, Nicole; Schwantes, Ulrich; Vollmann, Jochen

    2006-01-01

    Suicide and assisted suicide are not criminal acts in Germany. However, attempting suicide may create a legal duty for physicians to try to save a patient's life. This study presents data on medical students' legal knowledge and ethical views regarding physician assisted suicide (PAS). The majority of 85 respondents held PAS to be illegal. More…

  9. Should a Legal Option of Physician-Assisted Death Include Those Who Are "Tired of Life"?

    PubMed

    Miller, Franklin G

    2016-01-01

    Should there be a legal option of physician-assisted death? If so, what criteria should define its scope and limits? Answers to these questions are contested and controversial. In this essay I examine considerations for and against making physician-assisted death available for individuals of advanced age who are not terminally ill but find their lives no longer worth living.

  10. 42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse practitioner's...

  11. Physician Assistants and Nurse Practitioners in Rural Washington Emergency Departments.

    PubMed

    Nelson, Scott C; Hooker, Roderick S

    2016-06-01

    One role of physician assistants (PAs) and nurse practitioners (NPs) is to meet the growing demand for access to rural health care. Critical Access Hospitals, those with less than 25 beds, are usually located in rural communities, often providing continuity of care that clinics cannot deliver. Because little is known about staffing in these small hospital emergency departments, an exploratory study was undertaken using a mixed-methods approach. In Washington State, 18 of the 39 Critical Access Hospitals staff their emergency departments with PAs and NPs. Utilization data were collected through structured interviews by phone or in person on site. Most PAs and NPs lived within the community and staffing tended to be either 24 hours in-house or short notice if they lived or worked nearby. Emergency department visits ranged from 200 to 25,000 per year. All sites were designated level V or IV trauma centers and often managed cardiac events, significant injuries and, in some larger settings, obstetrics. In most instances, PAs were the sole providers in the emergency departments, albeit with physician backup and emergency medical technician support if a surge of emergency cases arose. Two-thirds of the PAs had graduated within the last 5 years. Most preferred the autonomy of the emergency department role and all expressed job satisfaction. Geographically, the more remote a Washington State Critical Access Hospital is, the more likely it will be staffed by PAs/NPs. The diverse utilization of semiautonomous PAs and NPs and their rise in rural hospital employment is a new workforce observation that requires broader investigation.

  12. The role of physician assistants in improving renal care.

    PubMed

    Smith, Garrett O

    2004-04-01

    Currently, nephrology PAs remain a small group. According to 2003 census data from The American Academy of Nephrology Physician Assistants, only 98 of 20,646 survey respondents identified themselves as practicing in nephrology. The future of PAs or nurse practitioners in nephrology is not only very bright, but is also an absolute necessity. We have known for many years that the number of individuals with kidney disease in the United States is increasing at a rate that outpaces our ability to develop and train nephrologists. This has resulted in an ever-increasing ratio of patients to clinical nephrologists. The workload for management of dialysis patients on a daily basis is becoming exhaustive and will not improve. The fastest growing segment of dialysis patients is now people in their 70s and 80s, and they bring with them multiple chronic health problems that are affected by dialysis and the treatment of their renal disease. The result is the need for closer monitoring, not less. The role of physician extenders can have a very positive impact for this patient population. Being the eyes, ears, nose, and fingers of our nephrologists can help in avoiding potential major problems in the outpatient arena. There is not a magic formula in caring for this patient population; it is a matter of spending time and becoming familiar with our patients, a premium most nephrologists do not have at present. It is not a matter of willingness; it is a matter of capability, of being in more than one place, and of having time to make the patient assessments. I think there is a great opportunity for nephrologists to create a new segment of providers to assist them in these endeavors. They can sponsor PAs as preceptors before graduation so that the students can have the opportunity to see what it takes to care for this population, the level of medicine they need to learn, and the responsibility they will need to accept. The nephrologist will benefit from working with a PA that has a

  13. Academic Integrity Across Physician Assistant Programs in the United States.

    PubMed

    Dereczyk, Amy

    2015-09-01

    The purpose of this study was to describe how academic integrity is addressed in physician assistant (PA) programs across the United States. A descriptive survey was developed dividing questions into 2 groups: demographic information and academic integrity questions. The survey tool was distributed to program directors at all PA programs in the United States that were both fully accredited and provisionally accredited. A total of 171 surveys were distributed with a response of 110 surveys. Most institutions have honor codes in place (86.14%), with most having had an honor code for more than 10 years (62.38%). A notable percentage (25.45%) of program directors believes that academic integrity is a problem at their institution. Overall, 45.45% responded that academic integrity is voiced as an issue by faculty in all disciplines at their institution. Yet, when participants were asked to rate their concern about academic integrity at their program, 49.50% had little or no concern, 30.69% were neutral, and 19.80% reported great or extreme concern about academic integrity within their program. This study provided baseline data on how academic integrity is currently addressed in PA programs. Drawing from this baseline data and the review of the literature, the next step is to develop academic integrity recommendations that PA programs can adopt.

  14. Examining intercultural sensitivity and competency of physician assistant students.

    PubMed

    Huckabee, Michael J; Matkin, Gina S

    2012-01-01

    Training in intercultural competency for health care professionals is necessary to bring greater balance to the disparity currently found among those needing health care. The purpose of this study was to determine what, if any, improvements in cultural competency were measurable in physician assistant (PA) students as they matriculated, using the Multicultural Awareness, Knowledge and Skills Survey-Revised as a pretest upon program entry and again as a posttest on the final day of the program. Ninety-three PA students from four successive classes graduating from a private midwest college between 2003 and 2007 participated in the pre and post measurements. All students were enrolled in specific didactic studies and clinical experiences in cultural sensitivity and competency. The results demonstrated significant improvement in knowledge (pretest 2.63, posttest 2.76, p=0.001) and skills (pretest 2.63, posttest 2.93, p<0.001) for all classes combined. The Intercultural Development Inventory was administered to the most recent graduating class to further explore these results. This cohort showed the highest scores (group mean 3.58 on scale of 1-5) in the Minimization developmental stage, which emphasizes cultural commonality over cultural distinctions. Enhanced curricular instruction such as exploring cultural assessment methods and controversies in health care differences, combined with increased clinical experiences with diverse cultures, are recommended to help move students past the minimization stage to gain greater cultural competency.

  15. Physician-assisted suicide in psychiatry and loss of hope.

    PubMed

    Berghmans, Ron; Widdershoven, Guy; Widdershoven-Heerding, Ineke

    2013-01-01

    In the Netherlands, euthanasia and physician-assisted suicide (PAS) are considered acceptable medical practices in specific circumstances. The majority of cases of euthanasia and PAS involve patients suffering from cancer. However, in 1994 the Dutch Supreme Court in the so-called Chabot-case ruled that "the seriousness of the suffering of the patient does not depend on the cause of the suffering", thereby rejecting a distinction between physical (or somatic) and mental suffering. This opened the way for further debate about the acceptability of PAS in cases of serious and refractory mental illness. An important objection against offering PAS to mentally ill patients is that this might reinforce loss of hope, and demoralization. Based on an analysis of a reported case, this argument is evaluated. It is argued that offering PAS to a patient with a mental illness who suffers unbearably, enduringly and without prospect of relief does not necessarily imply taking away hope and can be ethically acceptable. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Physician-Assisted Death and Severe, Treatment-Resistant Depression.

    PubMed

    Steinbock, Bonnie

    2017-09-01

    Should people suffering from untreatable psychiatric conditions be eligible for physician-assisted death? This is possible in Belgium and the Netherlands, where PAD for psychiatric conditions is permitted, though rare, so long as the criteria of due care are met. Those opposed to all instances of PAD point to Belgium and the Netherlands as a dark warning that once PAD is legalized, restricting it will prove impossible because safeguards, such as the requirement that a patient be terminally ill, will inevitably be eroded or discarded. However, some supporters respond that limiting PAD to those suffering from terminal illness, or physical illnesses generally, is arbitrary and illogical. In addition, precisely because such patients are not terminally ill, their suffering may last for years, even the rest of their lives. Finally, severe depression may not be treatable. If PAD is justifiable under some conditions-as I shall assume in this article-then why wouldn't it be justifiable for these patients? Why shouldn't psychiatrists who have nothing else to offer their suffering patients be able to help them to die, if that is what they want? © 2017 The Hastings Center.

  17. British community pharmacists' views of physician-assisted suicide (PAS)

    PubMed Central

    Hanlon, T.; Weiss, M.; Rees, J.

    2000-01-01

    of the pharmaceutical service whilst at the same respecting the personal beliefs of those who object to cooperating in the ending of a life. Key Words: Professional ethics • pharmacy ethics • community pharmacy • bioethics • physician-assisted suicide • euthanasia PMID:11055040

  18. Why do older people oppose physician-assisted dying? A qualitative study.

    PubMed

    Malpas, Phillipa J; Wilson, Maria K R; Rae, Nicola; Johnson, Malcolm

    2014-04-01

    Physician-assisted dying at the end of life has become a significant issue of public discussion. While legally available in a number of countries and jurisdictions, it remains controversial and illegal in New Zealand. The study aimed to explore the reasons some healthy older New Zealanders oppose physician-assisted dying in order to inform current debate. Recorded interviews were transcribed and analysed by the authors after some edits had been made by respondents. In all, 11 older participants (over 65 years) who responded to advertisements placed in Grey Power magazines and a University of Auckland email list were interviewed for around 1 h and asked a number of open-ended questions. Four central themes opposing physician-assisted dying were identified from the interviews: one's personal experience with health care and dying and death, religious reasoning and beliefs, slippery slope worries and concern about potential abuses if physician-assisted dying were legalised. An important finding of the study suggests that how some older individuals think about physician-assisted dying is strongly influenced by their past experiences of dying and death. While some participants had witnessed good, well-managed dying and death experiences which confirmed for them the view that physician-assisted dying was unnecessary, those who had witnessed poor dying and death experiences opposed physician-assisted dying on the grounds that such practices could come to be abused by others.

  19. Division of primary care services between physicians, physician assistants, and nurse practitioners for older patients with diabetes.

    PubMed

    Everett, Christine M; Thorpe, Carolyn T; Palta, Mari; Carayon, Pascale; Gilchrist, Valerie J; Smith, Maureen A

    2013-10-01

    Team-based care involving physician assistants and/or nurse practitioners (PA/NPs) in the patient-centered medical home is one approach to improving care quality. However, little is known about how to incorporate PA/NPs into primary care teams. Using data from a large physician group, we describe the division of patients and services (e.g., acute, chronic, preventive, other) between primary care providers for older diabetes patients on panels with varying levels of PA/NP involvement (i.e., no role, supplemental provider, or usual provider of care). Panels with PA/NP usual providers had higher proportions of patients with Medicaid, disability, and depression. Patients with physician usual providers had similar probabilities of visits with supplemental PA/NPs and physicians for all service types. However, patients with PA/NP usual providers had higher probabilities of visits with a supplemental physician. Understanding how patients and services are divided between PA/NPs and physicians will assist in defining provider roles on primary care teams.

  20. Nurse practitioners and physician assistants in the intensive care unit: an evidence-based review.

    PubMed

    Kleinpell, Ruth M; Ely, E Wesley; Grabenkort, Robert

    2008-10-01

    Advanced practitioners including nurse practitioners and physician assistants are contributing to care for critically ill patients in the intensive care unit through their participation on the multidisciplinary team and in collaborative physician practice roles. However, the impact of nurse practitioners and physician assistants in the intensive care unit setting is not well known. To identify published literature on the role of nurse practitioners and physician assistants in acute and critical care settings; to review the literature using nonquantitative methods and provide a summary of the results to date incorporating studies assessing the impact and outcomes of nurse practitioner and physician assistant providers in the intensive care unit; and to identify implications for critical care practice. We conducted a systematic search of the English-language literature of publications on nurse practitioners and physician assistants utilizing Ovid MEDLINE, PubMed, and the Cumulative Index of Nursing and Allied Health Literature databases from 1996 through August 2007. None. Over 145 articles were reviewed on the role of the nurse practitioner and physician assistant in acute and critical care settings. A total of 31 research studies focused on the role and impact of these practitioners in the care of acute and critically ill patients. Of those, 20 were focused on nurse practitioner care, six focused on both nurse practitioner and physician assistant care, and five were focused on physician assistant care in acute and critical care settings. Fourteen focused on intensive care unit care, and 17 focused on acute care including emergency room, trauma, and management of patients with specific acute care conditions such as stroke, pneumonia, and congestive heart failure. Most studies used retrospective or prospective study designs and nonprobability sampling techniques. Only two randomized control trials were identified. The majority examined the impact of care on patient

  1. Attitudes on euthanasia and physician-assisted suicide among medical students in Athens.

    PubMed

    Kontaxakis, Vp; Paplos, K G; Havaki-Kontaxaki, B J; Ferentinos, P; Kontaxaki, M-I V; Kollias, C T; Lykouras, E

    2009-10-01

    Attitudes towards assisted death activities among medical students, the future health gatekeepers, are scarce and controversial. The aims of this study were to explore attitudes on euthanasia and physician-assisted suicide among final year medical students in Athens, to investigate potential differences in attitudes between male and female medical students and to review worldwide attitudes of medical students regarding assisted death activities. A 20- item questionnaire was used. The total number of participants was 251 (mean age 24.7±1.8 years). 52.0% and 69.7% of the respondents were for the acceptance of euthanasia and physician-assisted suicide, respectively. Women's attitudes were more often influenced by religious convictions as well as by the fact that there is a risk that physician-assisted suicide might be misused with certain disadvantaged groups. On the other hand, men more often believed that a request for physician-assisted suicide from a terminally ill patient is prima-facie evidence of a mental disorder, usually depression. Concerning attitudes towards euthanasia among medical students in various countries there are contradictory results. In USA, the Netherlands, Hungary and Switzerland most of the students supported euthanasia and physician-assisted suicide. However, in many other countries such as Norway, Sweden, Yugoslavia, Italy, Germany, Sudan, Malaysia and Puerto Rico most students expressed negative positions regarding euthanasia and physician assisted suicide.

  2. Predictors of pursuit of physician-assisted death.

    PubMed

    Smith, Kathryn A; Harvath, Theresa A; Goy, Elizabeth R; Ganzini, Linda

    2015-03-01

    Physician-assisted death (PAD) was legalized in 1997 by Oregon's Death with Dignity Act. The States of Washington, Montana, Vermont, and New Mexico have since provided legal sanction for PAD. Through 2013, 1173 Oregonians have received a prescription under the Death with Dignity Act and 752 have died after taking the prescribed medication in Oregon. To determine the predictive value of personal and interpersonal variables in the pursuit of PAD. Fifty-five Oregonians who either requested PAD or contacted a PAD advocacy organization were compared with 39 individuals with advanced disease who did not pursue PAD. We compared the two groups on responses to standardized measures of depression, hopelessness, spirituality, social support, and pain. We also compared the two groups on style of attachment to intimate others and caregivers as understood through attachment theory. We found that PAD requesters had higher levels of depression, hopelessness, and dismissive attachment (attachment to others characterized by independence and self-reliance), and lower levels of spirituality. There were moderate correlations among the variables of spirituality, hopelessness, depression, social support, and dismissive attachment. There was a strong correlation between depression and hopelessness. Low spirituality emerged as the strongest predictor of pursuit of PAD in the regression analysis. Although some factors motivating pursuit of PAD, such as depression, may be ameliorated by medical interventions, other factors, such as style of attachment and sense of spirituality, are long-standing aspects of the individual that should be supported at the end of life. Practitioners must develop respectful awareness and understanding of the interpersonal and spiritual perspectives of their patients to provide such support. Published by Elsevier Inc.

  3. Predictive Modeling the Physician Assistant Supply: 2010–2025

    PubMed Central

    Hooker, Roderick S.; Cawley, James F.; Everett, Christine M.

    2011-01-01

    Objective A component of health-care reform in 2010 identified physician assistants (PAs) as needed to help mitigate the expected doctor shortage. We modeled their number to predict rational estimates for workforce planners. Methods The number of PAs in active clinical practice in 2010 formed the baseline. We used graduation rates and program expansion to project annual growth; attrition estimates offset these amounts. A simulation model incorporated historical trends, current supply, and graduation amounts. Sensitivity analyses were conducted to systematically adjust parameters in the model to determine the effects of such changes. Results As of 2010, there were 74,476 PAs in the active workforce. The mean age was 42 years and 65% were female. There were 154 accredited educational programs; 99% had a graduating class and produced an average of 44 graduates annually (total n=6,776). With a 7% increase in graduate entry rate and a 5% annual attrition rate, the supply of clinically active PAs will grow to 93,099 in 2015, 111,004 in 2020, and 127,821 in 2025. This model holds clinically active PAs in primary care at 34%. Conclusions The number of clinically active PAs is projected to increase by almost 72% in 15 years. Attrition rates, especially retirement patterns, are not well understood for PAs, and variation could affect future supply. While the majority of PAs are in the medical specialties and subspecialties fields, new policy steps funding PA education and promoting primary care may add more PAs in primary care than the model predicts. PMID:21886331

  4. Excellence in physician assistant training through faculty development.

    PubMed

    Glicken, Anita Duhl

    2008-11-01

    Once again, experts predict a shortage of health care providers by 2020. The physician assistant (PA) profession was created in the 1960s to address a similar need. Currently, there are 141 accredited PA training programs in the United States, 75 of them established in the 10 years between 1993 and 2002. Historically, PA education and practice models have been responsive to the ever-changing landscape of health care. It may be the profession's flexibility and adaptability that has enabled it to survive and flourish in a competitive service environment. The growth of new PA programs mandates a need for continuing faculty development, as increasing numbers of educators hail primarily from clinical practice and come equipped with minimal teaching experience. PA faculty development addresses these new recruits' needs to develop model curricula, implement new courses, and enhance instruction-all with the goal of improving both access to and quality of health care.The author describes the impact of Health Resources and Service Administration Title VII, Section 747 (Title VII) contracts in addressing this need. Title VII-funded PA education projects, considered innovative at the time of implementation, included both faculty development workshops that promoted active learning of basic teaching and administrative skills and new curricula designed to enhance faculty teaching in genomics and practice management. These projects and others resulted in enduring professional resources that have not only strengthened the PA community but also enjoyed broad applicability within other health professions groups.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

  5. Physician assisted suicide: knowledge and views of fifth-year medical students in Germany.

    PubMed

    Schildmann, Jan; Herrmann, Eva; Burchardi, Nicole; Schwantes, Ulrich; Vollmann, Jochen

    2006-01-01

    Suicide and assisted suicide are not criminal acts in Germany. However, attempting suicide may create a legal duty for physicians to try to save a patient's life. This study presents data on medical students' legal knowledge and ethical views regarding physician assisted suicide (PAS). The majority of 85 respondents held PAS to be illegal. More than a third of the students viewed PAS in certain situations to be ethically acceptable whereas a smaller proportion thought that it should be legal. Compared with German physicians the medical students taking part in this study were less opposed to PAS. The majority perceived the undergraduate training concerning ethical aspect of assisted death as deficient.

  6. Euthanasia and physician-assisted suicide among patients with amyotrophic lateral sclerosis in the Netherlands.

    PubMed

    Veldink, Jan H; Wokke, John H J; van der Wal, Gerrit; Vianney de Jong, J M B; van den Berg, Leonard H

    2002-05-23

    Amyotrophic lateral sclerosis (ALS) is a disease that causes progressive paralysis leading to respiratory failure. Patients with ALS may consider physician-assisted suicide. However, it is not known how many patients, if given the option, would actually decide to end their lives by physician-assisted suicide or euthanasia nor at what stage of the disease they would choose to do so. We identified physicians of 279 patients in the Netherlands with a diagnosis of ALS who died between 1994 and 1999. Physicians were asked to fill out a validated questionnaire about the end-of-life decisions that were made. Of 241 eligible physicians, 203 returned the questionnaire (84 percent). Of the 203 patients, 35 (17 percent) chose euthanasia and died that way. An additional six patients (3 percent) died as a result of physician-assisted suicide. Patients to whom religion was important were less likely to have died as a result of euthanasia or physician-assisted suicide. The choice of euthanasia or physician-assisted suicide was not associated with any particular characteristics of the disease or of the patient's care, nor was it associated with income or educational level. Disability before death was significantly more severe in patients who died as a result of euthanasia than among those who died in other ways. Physician-assisted suicide appeared to occur somewhat earlier in the course of the disease than did euthanasia. An additional 48 patients (24 percent) received palliative treatment, which probably shortened their lives. In the Netherlands, we found that one in five patients with ALS died as a result of euthanasia or physician-assisted suicide.

  7. Euthanasia or physician-assisted suicide? A survey from the Netherlands.

    PubMed

    Kouwenhoven, Pauline S C; van Thiel, Ghislaine J M W; Raijmakers, Natasja J H; Rietjens, Judith A C; van der Heide, Agnes; van Delden, Johannes J M

    2014-03-01

    Legalizing euthanasia or physician-assisted suicide (PAS) is a current topic of debate in many countries. The Netherlands is the only country where legislation covers both. To study physicians' experiences and attitudes concerning the choice between euthanasia and PAS. A questionnaire including vignettes was sent to a random sample of 1955 Dutch general practitioners, elderly care physicians and medical specialists. In total, 793 physicians (41%) participated. There was no clear preference for euthanasia (36%) or PAS (34%). Two thirds of physicians thought that PAS underlines the autonomy and responsibility of the patient and considered this a reason to choose PAS. Reasons for not choosing PAS were expected practical problems. A minority (22%) discussed the possibility of PAS with their patient in case of a request for assistance in dying. Patients receiving PAS more often experienced psychosocial suffering in comparison with patients receiving euthanasia. In vignettes of patients with a request for assistance in dying due to psychosocial suffering, physicians agreed more often with the performance of PAS than with euthanasia. Dutch physicians perceive a difference between euthanasia and PAS. Although they believe PAS underlines patient autonomy and responsibility, the option of PAS is rarely discussed with the patient. The more psychosocial in nature the patient's suffering, the more physicians choose PAS. In these cases, PAS seems to fulfil physicians' preferences to emphasize patient autonomy and responsibility. Expected technical problems and unfamiliarity with PAS also play a role. Paradoxically, the choice for PAS is predominantly a physician's one.

  8. Physician-Assisted Suicide and Euthanasia in the ICU: A Dialogue on Core Ethical Issues.

    PubMed

    Goligher, Ewan C; Ely, E Wesley; Sulmasy, Daniel P; Bakker, Jan; Raphael, John; Volandes, Angelo E; Patel, Bhavesh M; Payne, Kate; Hosie, Annmarie; Churchill, Larry; White, Douglas B; Downar, James

    2017-02-01

    Many patients are admitted to the ICU at or near the end of their lives. Consequently, the increasingly common debate regarding physician-assisted suicide and euthanasia holds implications for the practice of critical care medicine. The objective of this article is to explore core ethical issues related to physician-assisted suicide and euthanasia from the perspective of healthcare professionals and ethicists on both sides of the debate. We identified four issues highlighting the key areas of ethical tension central to evaluating physician-assisted suicide and euthanasia in medical practice: 1) the benefit or harm of death itself, 2) the relationship between physician-assisted suicide and euthanasia and withholding or withdrawing life support, 3) the morality of a physician deliberately causing death, and 4) the management of conscientious objection related to physician-assisted suicide and euthanasia in the critical care setting. We present areas of common ground and important unresolved differences. We reached differing positions on the first three core ethical questions and achieved unanimity on how critical care clinicians should manage conscientious objections related to physician-assisted suicide and euthanasia. The alternative positions presented in this article may serve to promote open and informed dialogue within the critical care community.

  9. Physician assisted suicide and the Supreme Court: putting the constitutional claim to rest.

    PubMed Central

    Mariner, W K

    1997-01-01

    Like the debate about many controversial questions of ethics and medical care in America, public debate about physician assisted suicide became focused on questions of constitutional law. On June 26, 1997, the United States Supreme Court unanimously rejected any constitutional right of terminally ill patients to physician assisted suicide. An analysis of the Court's reasoning reveals that its decisions resolved only a narrow constitutional question that affects relatively few people--mentally competent, terminally ill patients who wish to hasten their imminent deaths by having a physician prescribe medication that they intend to use to commit suicide. Although suicide is not a crime, states remain free to prohibit assisted suicide. One consequence of the Court's decisions may be renewed debate on state laws. A more productive result would be to address the broader public health concerns that gave rise to support for physician assisted suicide--inadequate care for the terminally ill and prevention of suicide. PMID:9431307

  10. [Each person has to make their own individual decision - arguments for physician assisted suicide].

    PubMed

    Posa, Andreas

    2016-06-01

    Since November 2015, businesslike assisted suicide is punishable in Germany. But who acts businesslike? The majority of the German population prefers to make own decisions about the circumstances of their arriving death, and many of them would also accept (physician) assisted suicide if necessary. Only a minority of physicians plead for prohibiting assisted suicide in general. In the end everyone should be able to take position on his own. No one is obliged to use or execute assisted suicide. © Georg Thieme Verlag KG Stuttgart · New York.

  11. The Role of Physician Assistants in Rural Health Care: A Systematic Review of the Literature

    ERIC Educational Resources Information Center

    Henry, Lisa R.; Hooker, Roderick S.; Yates, Kathryn L.

    2011-01-01

    Purpose: A literature review was performed to assess the role of physician assistants (PAs) in rural health care. Four categories were examined: scope of practice, physician perceptions, community perceptions, and retention/recruitment. Methods: A search of the literature from 1974 to 2008 was undertaken by probing the electronic bibliographic…

  12. EPEC-O Self-Study - Module 14 - Physician-Assisted Suicide

    Cancer.gov

    Module fourteen of the EPEC-O Self-Study Original Version focuses on the skills that the physician can use to respond both compassionately and confidently to a request, not on the merits of arguments for or against legalizing physician-assisted suicide (PAS) or euthanasia.

  13. The Role of Physician Assistants in Rural Health Care: A Systematic Review of the Literature

    ERIC Educational Resources Information Center

    Henry, Lisa R.; Hooker, Roderick S.; Yates, Kathryn L.

    2011-01-01

    Purpose: A literature review was performed to assess the role of physician assistants (PAs) in rural health care. Four categories were examined: scope of practice, physician perceptions, community perceptions, and retention/recruitment. Methods: A search of the literature from 1974 to 2008 was undertaken by probing the electronic bibliographic…

  14. Black/white differences in attitudes toward physician-assisted suicide.

    PubMed Central

    Lichtenstein, R. L.; Alcser, K. H.; Corning, A. D.; Bachman, J. G.; Doukas, D. J.

    1997-01-01

    In 1994, as the Michigan legislature considered whether to continue a law banning physician-assisted suicide, we conducted a series of surveys on this topic. One of these surveys, conducted in Detroit, was designed to measure the attitudes of a largely black population toward physician-assisted suicide. Questionnaires were mailed to 500 residents of Detroit. The questionnaire described a plan for legalizing physician-assisted suicide, called Plan A, that incorporated eligibility standards and safeguards to minimize abuse. Attitudes on three issues were investigated: 1) Should physician-assisted suicide be banned or legalized? 2) Should voluntary euthanasia also be permitted? 3) Might respondents request legalized physician-assisted suicide for themselves? Majorities of both whites and blacks supported Plan A; however, support was much lower among blacks than whites. Blacks were also less likely to support voluntary euthanasia or to envision asking for physician-assisted suicide themselves. Our analysis indicates that when age and sex are held constant, strength of religious commitment may account for much of the black-white difference in attitudes. We also consider alternative explanations based on cultural attitudes and degree of trust in the medical system. PMID:9046766

  15. Black/white differences in attitudes toward physician-assisted suicide.

    PubMed

    Lichtenstein, R L; Alcser, K H; Corning, A D; Bachman, J G; Doukas, D J

    1997-02-01

    In 1994, as the Michigan legislature considered whether to continue a law banning physician-assisted suicide, we conducted a series of surveys on this topic. One of these surveys, conducted in Detroit, was designed to measure the attitudes of a largely black population toward physician-assisted suicide. Questionnaires were mailed to 500 residents of Detroit. The questionnaire described a plan for legalizing physician-assisted suicide, called Plan A, that incorporated eligibility standards and safeguards to minimize abuse. Attitudes on three issues were investigated: 1) Should physician-assisted suicide be banned or legalized? 2) Should voluntary euthanasia also be permitted? 3) Might respondents request legalized physician-assisted suicide for themselves? Majorities of both whites and blacks supported Plan A; however, support was much lower among blacks than whites. Blacks were also less likely to support voluntary euthanasia or to envision asking for physician-assisted suicide themselves. Our analysis indicates that when age and sex are held constant, strength of religious commitment may account for much of the black-white difference in attitudes. We also consider alternative explanations based on cultural attitudes and degree of trust in the medical system.

  16. How California Prepared for Implementation of Physician-Assisted Death: A Primer

    PubMed Central

    Petrillo, Laura A.; Dzeng, Elizabeth; Harrison, Krista L.; Forbes, Lindsay; Scribner, Benjamin; Koenig, Barbara A.

    2017-01-01

    Physician-assisted death is now legal in California, and similar laws are being considered in many other states. The California law includes safeguards, yet health care providers will face practical and ethical issues while implementing physician-assisted death that are not addressed by the law. To help providers and health care facilities in California prepare to provide optimal care to patients who inquire about physician-assisted death, we brought together experts from California, Oregon, and Washington. We convened a conference of 112 stakeholders in December 2015, and herein present their recommendations. Themes of recommendations regarding implementation include (1) institutions should develop and revise physician-assisted death policies; (2) legal physician-assisted death will have implications for California’s culturally and socioeconomically diverse population, and for patients from vulnerable groups; (3) conscientious objection and moral distress for health care providers must be considered; and (4) palliative care is essential to the response to the law. The expert conference participants’ insights are a valuable guide, both for providers and health care facilities in California planning or revising their response, and for other jurisdictions where physician-assisted death laws are being considered or implemented. PMID:28426307

  17. How California Prepared for Implementation of Physician-Assisted Death: A Primer.

    PubMed

    Petrillo, Laura A; Dzeng, Elizabeth; Harrison, Krista L; Forbes, Lindsay; Scribner, Benjamin; Koenig, Barbara A

    2017-06-01

    Physician-assisted death is now legal in California, and similar laws are being considered in many other states. The California law includes safeguards, yet health care providers will face practical and ethical issues while implementing physician-assisted death that are not addressed by the law. To help providers and health care facilities in California prepare to provide optimal care to patients who inquire about physician-assisted death, we brought together experts from California, Oregon, and Washington. We convened a conference of 112 stakeholders in December 2015, and herein present their recommendations. Themes of recommendations regarding implementation include (1) institutions should develop and revise physician-assisted death policies; (2) legal physician-assisted death will have implications for California's culturally and socioeconomically diverse population, and for patients from vulnerable groups; (3) conscientious objection and moral distress for health care providers must be considered; and (4) palliative care is essential to the response to the law. The expert conference participants' insights are a valuable guide, both for providers and health care facilities in California planning or revising their response, and for other jurisdictions where physician-assisted death laws are being considered or implemented.

  18. Clinical problems with the performance of euthanasia and physician-assisted suicide in The Netherlands.

    PubMed

    Groenewoud, J H; van der Heide, A; Onwuteaka-Philipsen, B D; Willems, D L; van der Maas, P J; van der Wal, G

    2000-02-24

    The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in The Netherlands (one conducted in 1990 and 1991 and the other in 1995 and 1996), with a total of 649 cases. We categorized clinical problems as technical problems, such as difficulty inserting an intravenous line; complications, such as myoclonus or vomiting; or problems with completion, such as a longer-than-expected interval between the administration of medications and death. In 114 cases, the physician's intention was to provide assistance with suicide, and in 535, the intention was to perform euthanasia. Problems of any type were more frequent in cases of assisted suicide than in cases of euthanasia. Complications occurred in 7 percent of cases of assisted suicide, and problems with completion (a longer-than-expected time to death, failure to induce coma, or induction of coma followed by awakening of the patient) occurred in 16 percent of the cases; complications and problems with completion occurred in 3 percent and 6 percent of cases of euthanasia, respectively. The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in 12 cases) and the inability of the patient to take all the medications (in 5). There may be clinical problems with the performance of euthanasia and physician-assisted suicide. In The Netherlands, physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves because of the patient's inability to take the medication or because of problems with the completion of physician-assisted suicide.

  19. Assisting Undergraduate Physician Assistant Training in Psychiatry: The Role of Academic Psychiatry Departments.

    PubMed

    Rakofsky, Jeffrey J; Ferguson, Britnay A

    2015-12-01

    Physician assistants (PAs) are medical professionals who practice medicine with the supervision of a physician through delegated autonomy. PA school accreditation standards provide limited guidance for training PAs in psychiatry. As a result, PA students may receive inconsistent and possibly inadequate exposure to psychiatry. Providing broad and in-depth exposure to the field of psychiatry is important to attract PA students to pursue careers in psychiatry and provide a possible solution to the shortage of psychiatrists nationwide. Additionally, this level of exposure will prepare PA students who pursue careers in other fields of medicine to recognize and address their patient's psychiatric symptoms in an appropriate manner. This training can be provided by an academic department of psychiatry invested in the education of PA students. We describe a training model implemented at our university that emphasizes psychiatrist involvement in the preclinical year of PA school and full integration of PA students into the medical student psychiatry clerkship during the clinical years. The benefits and challenges to implementing this model are discussed as well.

  20. Stability of attitudes regarding physician-assisted suicide and euthanasia among oncology patients, physicians, and the general public.

    PubMed

    Wolfe, J; Fairclough, D L; Clarridge, B R; Daniels, E R; Emanuel, E J

    1999-04-01

    Attitudes regarding the ethics of physician-assisted suicide (PAS) and euthanasia have been examined in many cross-sectional studies. Stability of these attitudes has not been studied, and this is important in informing the dialog on PAS in this country. We evaluated the stability of attitudes regarding euthanasia and PAS among three cohorts. Subjects included 593 respondents: 111 oncology patients, 324 oncologists, and 158 members of the general public. We conducted initial and follow-up interviews separated by 6 to 12 months by telephone, regarding acceptance of PAS and euthanasia in four different clinical vignettes. The proportion of respondents with stable responses to vignettes ranged from 69.2% to 94.8%. In comparison to patients and the general public, physicians had less stable responses concerning the PAS pain vignette (69.1% v 80.8%; P =.001) and more stable responses for all euthanasia vignettes (P <.001) except for pain. Over time, physicians were significantly more likely to change toward opposing PAS and euthanasia in all vignettes (P <.05). Characteristics previously associated with attitudes regarding PAS and euthanasia, such as Roman Catholic religion, were not predictive of stability. Up to one third of participants changed their attitudes regarding the ethical acceptability of PAS and euthanasia in their follow-up interview. This lack of consistency mandates careful interpretation of referendums and requests for physician-assisted suicide. Furthermore, in this study, we found that physicians are becoming increasingly opposed to PAS and euthanasia. The growing disparity between physicians and patients regarding the role of these practices is large enough to suggest possible conflicts in the delivery of end-of-life care.

  1. [Requests for assisted reproduction formulated by same-sex couples consulting physicians in France].

    PubMed

    Jouannet, P; Spira, A

    2014-08-01

    In order to determine the characteristic features of requests for assisted reproduction formulated by same-sex couples consulting physicians in France, we conducted a study in collaboration with professional organizations, general practitioners, gynecologists and obstetricians who distributed an email questionnaire among their recruitment. In our sample, 191 physicians (71% of responders) reported that 1040 homosexual couples expressed desire to become parents in 2011-2012. Nearly all of the physicians (94%) reported that the couples sought assistance before participating in an assisted reproduction technology (ART) program in a foreign country, but 35% reported that advice was solicited concerning natural reproduction and 48.5% reported requests for advice concerning inseminations performed by the woman herself. Most of the physicians responded to all or part of the requests and 61% of those who had been consulted reported they had directly participated in preparing an ART program in a foreign country. Among the 270 physicians who participated in this study, 162 (60%) believed that ART should be assessable to homosexual couples in France, but less than half of them were in favor of reimbursement by the national health insurance fund. Although biased and non-representative, this study shows that assisted reproduction, with or without medical intervention, is a real-life phenomenon for many homosexual couples, and for many physicians, even before same-sex marriage became legal. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  2. Scrupulous Monitoring of Physician-Assisted Dying: The Case for Mandatory Reporting to Coroners and Medical Examiners of All Physician-Assisted Deaths in Canada.

    PubMed

    Guichon, Juliet; Alakija, Pauline; Doig, Christopher; Mitchell, Jan; Thibeault, Pascal

    2016-02-01

    Although the practice of physician-assisted dying (hereinafter "PAD") will soon be lawful in Canada, opponents of PAD claim that it might result in involuntary deaths. The Supreme Court of Canada in Carter v. Canada (Attorney General) rejected such arguments holding that involuntary deaths are preventable provided that jurisdictions devise stringent limits to the practice of PAD and that these stringent limits are "scrupulously monitored and enforced". This article examines the question of how best to engage in scrupulous monitoring of physician-assisted dying. At present, the province of Quebec has legislated, and three expert groups have proposed the creation of new administrative offices to monitor the practice of PAD (these groups are the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, the External Panel on Options for a Legislative Response to Carter v. Canada, and the Canadian Medical Association). This article argues that scrupulous monitoring can be better achieved by requiring explicit mandatory notification of all physician-assisted deaths to coroners and medical examiners, rather than by creating new administrative offices. It is more effective, efficient and prudent to use already existing coroner and medical examiner death reporting and investigative frameworks to report physician-assisted deaths than to create new, untried, parallel and potentially more expensive administrative offices. In Canada, almost all provincial and territorial statutes that govern the official actions of coroners and medical examiners currently require the reporting of non-natural deaths, which include those that will be attributable to PAD. To achieve the scrupulous monitoring of PAD required by the Supreme Court, provincial and territorial governments, in collaboration with the federal government, should. 1. review their coroner and fatality statutes to clarify that physician-assisted deaths (as non-natural deaths) are mandatorily notifiable; 2

  3. The contribution of physicians, physician assistants, and nurse practitioners toward rural primary care: findings from a 13-state survey.

    PubMed

    Doescher, Mark P; Andrilla, C Holly A; Skillman, Susan M; Morgan, Perri; Kaplan, Louise

    2014-06-01

    Estimates of the relative contributions of physicians, physician assistants (PAs), and nurse practitioners (NPs) toward rural primary care are needed to inform workforce planning activities aimed at reducing rural primary shortages. For each provider group, this study quantifies the average weekly number of outpatient primary care visits and the types of services provided within and beyond the outpatient setting. A randomly drawn sample of 788 physicians, 601 PAs, and 918 NPs with rural addresses in 13 US states responded to a mailed questionnaire that measured reported weekly outpatient visits and scope of services provided within and beyond the outpatient setting. Analysis of variance and χ(2) testing were used to test for bivariate associations. Multivariate regression was used to model average weekly outpatient volume adjusting for provider sociodemographics and geographical location. Compared with physicians, average weekly outpatient visit quantity was 8% lower for PAs and 25% lower for NPs (P<0.001). After multivariate adjustment, this gap became negligible for PAs (P=0.56) and decreased to 10% for NPs (P<0.001). Compared with PAs and NPs, primary care physicians were more likely to provide services beyond the outpatient setting, including hospital care, emergency care, childbirth attending deliveries, and after-hours call coverage (all P<0.001). Although our findings suggest that a greater reliance on PAs and NPs in rural primary settings would have a minor impact on outpatient practice volume, this shift might reduce the availability of services that have more often been traditionally provided by rural primary care physicians beyond the outpatient clinic setting.

  4. Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study.

    PubMed

    Lovink, Marleen Hermien; Persoon, Anke; van Vught, Anneke Jah; Schoonhoven, Lisette; Koopmans, Raymond Tcm; Laurant, Miranda Gh

    2017-06-08

    In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context-mechanism-outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government. © Article author(s) (or their employer(s) unless otherwise stated

  5. Physician- and nurse-assisted smoking cessation in Harlem.

    PubMed Central

    Royce, J. M.; Ashford, A.; Resnicow, K.; Freeman, H. P.; Caesar, A. A.; Orlandi, M. A.

    1995-01-01

    This study was designed to increase smoking cessation rates, quit attempts, and cutting down among low-income African Americans using brief clinician advice in conjunction with socioculturally appropriate self-help smoking cessation/relapse prevention materials. Physicians and nurses were instructed in the National Cancer Institute's smoking intervention at inservice sessions. Smokers interviewed in a Harlem, New York clinic waiting room were recontacted 7 months later by telephone or mail (77% response). Residents receiving the intervention reported a 21% cessation rate at follow-up. An additional 27% decreased cigarette intake by at least 50%. Those reporting follow-up abstinence were significantly more likely to designate a quit date at baseline. They were also more likely to be men, employed, and have a nonsmoking partner. Smokers who decreased their cigarette intake significantly were older, employed, less nicotine-dependent (eg, delayed their wake-up cigarette), and more likely to use project materials. Physician advice had a significant impact both on patients' cutting down at least 50% and patients' watching the project video. Designation of a quit date and using project materials had a significant impact on making serious quit attempts. Results corroborate large sample, randomized, controlled trials with noninner-city physicians. We conclude that clinician smoking advice for every patient is warranted. PMID:7752283

  6. Physician-assisted suicide, euthanasia, and Christian bioethics: moral controversy in Germany.

    PubMed

    May, Arnd T

    2003-01-01

    Discussions in Germany regarding appropriate end-of-life decision-making have been heavily influenced by the liberalization of access to physician-assisted suicide and voluntary active euthanasia in the Netherlands and Belgium. These discussions disclose conflicting moral views regarding the propriety of physician-assisted suicide and euthanasia, threatening conflicts within not only the medical profession, but also the mainline churches in Germany, whose membership now entertains views regarding end-of-life decision-making at odds with traditional Christian doctrine. On the surface, there appears to be a broad consensus supporting the hospice movement and condemning physician-assisted suicide and euthanasia. The German Supreme Court has held that treatment decisions should, in absence of known patients' wishes, be made in light of commonly shared values, unless these violate the principle of "in dubio pro vita". The Roman Catholic church and the Evangelical Lutheran church in Germany have developed an advance directive for treatment choices at the end of life, while condemning physician-assisted suicide and euthanasia. This stance is in tension with the strong emerging support for physician-assisted suicide and euthanasia, a development that promises to open up foundational disagreements within mainline German Christianity regarding the appropriate approach to intentionally terminating human life.

  7. Non-physician-assisted suicide in The Netherlands: a cross-sectional survey among the general public.

    PubMed

    Schoonman, Merel Kristi; van Thiel, Ghislaine José Madeleine Wilhelmien; van Delden, Johannes Jozef Marten

    2014-12-01

    In The Netherlands, approximately 45% of patients' requests for euthanasia are granted by a physician. After a rejected request, some patients approach non-physicians and ask them for assistance in suicide. Recently, a non-physician who assisted his mother's suicide was declared guilty without punishment. The aim of the current study was to investigate the opinion of the Dutch general public on non-physician-assisted suicide. A cross-sectional survey among the Dutch general public was performed. A total of 1113 respondents were included (response rate 80%). The survey covered two case descriptions in which a patient asks a non-physician for assisted suicide after a non-granted request for physician-assisted dying. In both cases, a son, friend or professional facilitates the suicide by either the provision of information or the purchase of lethal medication. Respondents were invited to give their opinion on these cases and in addition on 10 propositions on non-physician-assisted suicide. When a son provides information on how to acquire lethal medication in case of a patient with a terminal illness, this involvement is accepted by 62% of the respondents. The actual purchase of lethal medication receives less support (38%). If the patient suffers without a serious disease, both forms of assistance are less accepted (46% and 24%, respectively). In addition, only 21% support the legalisation of non-physician-assisted suicide. The Dutch public prefer involvement of a physician in assisted suicide (69%). The Dutch general public consider non-physician-assisted suicide in some specific cases a tolerable alternative for patients with a rejected request for physician-assisted dying if the assistance is limited to the provision of information. However, the majority do not support the legalisation of non-physician-assisted suicide. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Psychiatric consultation with regard to requests for euthanasia or physician-assisted suicide.

    PubMed

    Groenewoud, Johanna H; Van Der Heide, Agnes; Tholen, Alfons J; Schudel, W Joost; Hengeveld, Michiel W; Onwuteaka-Philipsen, Bregje D; Van Der Maas, Paul J; Van Der Wal, Gerrit

    2004-01-01

    The objective of this article is to describe the practice of psychiatric consultation with regard to explicit requests for euthanasia or physician-assisted suicide in the Netherlands. Written questionnaires were sent to an unselected sample of 673 Dutch psychiatrists, about half of all such specialists in the Netherlands. The response rate was 83%. Of the respondents, 36% (199 of 549) had at least once been consulted about a patient's request for physician-assisted death. The annual number of such psychiatric consultations is estimated to be 400 (about 4% of all requests for physician-assisted death). About one in four consultations is initiated by another psychiatrist. Consultants were mainly asked to assess whether the patient had a treatable mental disorder (68%) or whether the patient's request was well considered (66%). Assessment of the influence of transference and countertransference was less frequently sought (24%). Of the 221 consultation cases described, 67 (30%) ended in euthanasia or assisted suicide, whereas another 124 (56%) did not. In most, but not all, cases where the patient's request for physician-assisted death was refused, the respondent had judged that the request was not well considered or that the patient had a treatable mental disorder, or that the decision-making was influenced by transference and countertransference. We conclude that psychiatric consultation for patients requesting physician-assisted death in the Netherlands is rare, as in other countries. The issue of psychiatric consultation with regard to requests for physician-assisted death, especially in patients with a physical disease, needs to be further addressed.

  9. Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study.

    PubMed

    Buiting, Hilde; van Delden, Johannes; Onwuteaka-Philpsen, Bregje; Rietjens, Judith; Rurup, Mette; van Tol, Donald; Gevers, Joseph; van der Maas, Paul; van der Heide, Agnes

    2009-10-27

    An important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention. We examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist. Physicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%). Dutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they

  10. Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study

    PubMed Central

    2009-01-01

    Background An important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention. Methods We examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist. Results Physicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%). Conclusion Dutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on

  11. Levinas and the Hippocratic oath: a discussion of physician-assisted suicide.

    PubMed

    Degnin, F D

    1997-04-01

    At least from the standpoint of contemporary cultural and ethical resources, physicians have argued eloquently and exhaustively both for and against physician-assisted suicide. If one avoids the temptation to ruthlessly simplify either position to immorality or error, then a strange dilemma arises. How is it that well educated and intelligent physicians, committed strongly and compassionately to the care of their patients, argue adamantly for opposing positions? Thus rather than simply rehashing old arguments, this essay attempts to rethink the nature of human morality as both a source and a fracturing of human rationality- and with morality, the question of human nature in the context of violence, oppression, service, and obligation. This interpretation of moral life is laid out roughly along the lines of the Jewish philosopher Emmanuel Levinas, and further clarified through a discussion of the Hippocratic Oath. These resources are then brought to bear on the specific arguments and recommendations concerning physician-assisted suicide.

  12. What the IOM Report on Graduate Medical Education Means for Physician Assistants.

    PubMed

    Cawley, James F

    2015-06-01

    Graduate medical education (GME) is funded by taxpayers through Medicare subsidies that pay for physician residency training, primarily to teaching hospitals. The Institute of Medicine (IOM) recently conducted a study of US GME and issued a series of recommendations for future policy reform. This commentary examines the major elements of proposed reforms for GME and offers analysis of those that may pertain specifically to physician assistant education now and in the future.

  13. Responses to assisted suicide requests: an interview study with Swiss palliative care physicians.

    PubMed

    Gamondi, Claudia; Borasio, Gian Domenico; Oliver, Pam; Preston, Nancy; Payne, Sheila

    2017-08-11

    Assisted suicide in Switzerland is mainly performed by right-to-die societies. Medical involvement is limited to the prescription of the drug and certification of eligibility. Palliative care has traditionally been perceived as generally opposed to assisted suicide, but little is known about palliative care physicians' involvement in assisted suicide practices. This paper aims to describe their perspectives and involvement in assisted suicide practices. A qualitative interview study was conducted with 23 palliative care physicians across Switzerland. Thematic analysis was used to interpret data. Swiss palliative care physicians regularly receive assisted suicide requests while none reported having received specific training in managing these requests. Participants reported being involved in assisted suicide decision making most were not willing to prescribe the lethal drug. After advising patients of the limits on their involvement in assisted suicide, the majority explored the origins of the patient's request and offered alternatives. Many participants struggled to reconcile their understanding of palliative care principles with patients' wishes to exercise their autonomy. The majority of participants had no direct contact with right-to-die societies, many desired better collaboration. A desire was voiced for a more structured debate on assisted suicide availability in hospitals and clearer legal and institutional frameworks. The Swiss model of assisted suicide gives palliative care physicians opportunities to develop roles which are compatible with each practitioner's values, but may not correspond to patients' expectations. Specific education for all palliative care professionals and more structured ways to manage communication about assisted suicide are warranted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Supporting assisted suicide. How do the public and physicians feel about aiding in death?

    PubMed

    Bachman, J G; Brody, H; Alcser, K H; Lichtenstein, R L; Doukas, D J; Corning, A D

    1997-04-01

    In January 1997, the Michigan State Medical Society began a series of interdisciplinary forums to discuss guidelines and safeguards for physician-assisted suicide as part of its ongoing analysis of that vexing issue. The forums derive from the minority statement in the MSMS official position, from physicians who would approve of assisting suicide in a limited number of cases, but only upon the patient's voluntary request and as a last resort. Is it possible to develop guidelines which would succeed in limiting the practice of physician-assisted suicide to that small group of patients? Or, as opponents charge, would guidelines predictably fail to contain the practice and lead to the feared slippery slope?

  15. Attitudes towards euthanasia and assisted suicide: a comparison between psychiatrists and other physicians.

    PubMed

    Levy, Tal Bergman; Azar, Shlomi; Huberfeld, Ronen; Siegel, Andrew M; Strous, Rael D

    2013-09-01

    Euthanasia and physician assisted-suicide are terms used to describe the process in which a doctor of a sick or disabled individual engages in an activity which directly or indirectly leads to their death. This behavior is engaged by the healthcare provider based on their humanistic desire to end suffering and pain. The psychiatrist's involvement may be requested in several distinct situations including evaluation of patient capacity when an appeal for euthanasia is requested on grounds of terminal somatic illness or when the patient is requesting euthanasia due to mental suffering. We compare attitudes of 49 psychiatrists towards euthanasia and assisted suicide with a group of 54 other physicians by means of a questionnaire describing different patients, who either requested physician-assisted suicide or in whom euthanasia as a treatment option was considered, followed by a set of questions relating to euthanasia implementation. When controlled for religious practice, psychiatrists expressed more conservative views regarding euthanasia than did physicians from other medical specialties. Similarly female physicians and orthodox physicians indicated more conservative views. Differences may be due to factors inherent in subspecialty education. We suggest that in light of the unique complexity and context of patient euthanasia requests, based on their training and professional expertise psychiatrists are well suited to take a prominent role in evaluating such requests to die and making a decision as to the relative importance of competing variables.

  16. Non-faith-based arguments against physician-assisted suicide and euthanasia.

    PubMed

    Sulmasy, Daniel P; Travaline, John M; Mitchell, Louise A; Ely, E Wesley

    2016-08-01

    This article is a complement to "A Template for Non-Religious-Based Discussions Against Euthanasia" by Melissa Harintho, Nathaniel Bloodworth, and E. Wesley Ely which appeared in the February 2015 Linacre Quarterly. Herein we build upon Daniel Sulmasy's opening and closing arguments from the 2014 Intelligence Squared debate on legalizing assisted suicide, supplemented by other non-faith-based arguments and thoughts, providing four nontheistic arguments against physician-assisted suicide and euthanasia: (1) "it offends me"; (2) slippery slope; (3) "pain can be alleviated"; (4) physician integrity and patient trust. Lay Summary: Presented here are four non-religious, reasonable arguments against physician-assisted suicide and euthanasia: (1) "it offends me," suicide devalues human life; (2) slippery slope, the limits on euthanasia gradually erode; (3) "pain can be alleviated," palliative care and modern therapeutics more and more adequately manage pain; (4) physician integrity and patient trust, participating in suicide violates the integrity of the physician and undermines the trust patients place in physicians to heal and not to harm.

  17. Non-faith-based arguments against physician-assisted suicide and euthanasia

    PubMed Central

    Sulmasy, Daniel P.; Travaline, John M.; Mitchell, Louise A.; Ely, E. Wesley

    2016-01-01

    This article is a complement to “A Template for Non-Religious-Based Discussions Against Euthanasia” by Melissa Harintho, Nathaniel Bloodworth, and E. Wesley Ely which appeared in the February 2015 Linacre Quarterly. Herein we build upon Daniel Sulmasy's opening and closing arguments from the 2014 Intelligence Squared debate on legalizing assisted suicide, supplemented by other non-faith-based arguments and thoughts, providing four nontheistic arguments against physician-assisted suicide and euthanasia: (1) “it offends me”; (2) slippery slope; (3) “pain can be alleviated”; (4) physician integrity and patient trust. Lay Summary: Presented here are four non-religious, reasonable arguments against physician-assisted suicide and euthanasia: (1) “it offends me,” suicide devalues human life; (2) slippery slope, the limits on euthanasia gradually erode; (3) “pain can be alleviated,” palliative care and modern therapeutics more and more adequately manage pain; (4) physician integrity and patient trust, participating in suicide violates the integrity of the physician and undermines the trust patients place in physicians to heal and not to harm. PMID:27833206

  18. Computer-Assisted Instruction in AIDS Infection Control for Physicians.

    ERIC Educational Resources Information Center

    Garrett, T. J.; And Others

    1990-01-01

    A microcomputer program to provide health care workers with instruction in Acquired Immune Deficiency Syndrome (AIDS) infection control was assessed by medical residents. The experimental group (n=24) acquired more knowledge than controls (n=33). Response to the method was positive, and computer-assisted instruction is seen as useful for AIDS…

  19. Sports physicians, ethics and antidoping governance: between assistance and negligence.

    PubMed

    Dikic, Nenad; McNamee, Michael; Günter, Heinz; Markovic, Snezana Samardzic; Vajgic, Bojan

    2013-07-01

    Recent positive doping cases and a series of mistakes of medical doctors of the International Federation of Basketball have reopened the debate about the role of medical doctor in elite sport. This study shows that some sports physicians involved in recent positive doping cases are insufficiently aware of the nuances of doping regulations and, most importantly, of the list of prohibited substances. Moreover, several team doctors are shown to have exercised poor judgement in relation to these matters with the consequence that athletes are punished for doping offences on the basis of doctors' negligence. In such circumstances, athletes' rights are jeopardised by a failure of the duty of care that (sports) physicians owe their athlete patients. We argue that, with respect to the World Anti Doping Code, antidoping governance fails to define, with sufficient clarity, the role of medical doctors. There is a need for a new approach emphasising urgent educational and training of medical doctors in this domain, which should be considered prior to the revision of the next World Anti Doping Code in 2013 in order to better regulate doctor's conduct especially in relation to professional errors, whether negligent or intentional.

  20. Prevalence of Horizontal Violence Among Emergency Attending Physicians, Residents, and Physician Assistants

    PubMed Central

    Volz, Nico B.; Fringer, Ryan; Walters, Bradford; Kowalenko, Terry

    2017-01-01

    Introduction Horizontal violence (HV) is malicious behavior perpetrated by healthcare workers against each other. These include bullying, verbal or physical threats, purposeful disruptive behavior, and other malicious behaviors. This pilot study investigates the prevalence of HV among emergency department (ED) attending physicians, residents, and mid-level providers (MLPs). Methods We sent an electronic survey to emergency medicine attending physicians (n=67), residents (n=25), and MLPs (n=24) in three unique EDs within a single multi-hospital medical system. The survey consisted of 18 questions that asked participants to indicate with what frequency (never, once, a few times, monthly, weekly, or daily) they have witnessed or experienced a particular behavior in the previous 12 months. Seven additional questions aimed to elicit the impact of HV on the participant, the work environment, or the patient care. Results Of the 122 survey invitations 91 were completed, yielding a response rate of 74.6%. Of the respondents 64.8% were male and 35.2% were female. Attending physicians represented 41.8%, residents 37.4%, and MLPs 19.8% of respondents. Prevalence of reported behaviors ranged from 1.1% (Q18: physical assault) to 34.1% (Q4: been shouted at). Fourteen of these behaviors were most prevalent in the attending cohort, six were most prevalent in the MLP cohort, and three of the behaviors were most prevalent in the resident cohort. Conclusion The HV behaviors investigated in this pilot study were similar to data previously published in nursing cohorts. Furthermore, nearly a quarter of participants (22.2%) indicated that HV has affected care for their patients, suggesting further studies are warranted to assess prevalence and the impact HV has on staff and patients. PMID:28210353

  1. Physician-assisted suicide and the Supreme Court: the Washington and Vacco verdicts.

    PubMed

    Candilis, P J; Appelbaum, K L

    1997-01-01

    In June 1997, the Supreme Court decided that statutes proscribing physicians from providing lethal medication for use by competent, terminally ill patients do not violate the Due Process or Equal Protection Clauses of the Constitution. The Court returned the question of physician-assisted suicide to the states, but did not foreclose future review of state laws that may be too restrictive of care at the end of life. The conceptual distinctions between assisted suicide, refusal of life-sustaining treatment, and administration of pain medication to terminally ill patients were endorsed as important guideposts for future analyses.

  2. The euthanasia and physician-assisted suicide debate: issues for nursing.

    PubMed

    Coyle, N

    1992-08-01

    The role of nursing has yet to be defined in relationship to the controversial issue of euthanasia and physician-assisted suicide. This may be one of the most important issues facing oncology nurses during the next five years. With recent advances in medical technology, patients are fearful that suffering and death will be prolonged. The option of euthanasia and physician-assisted suicide is seen by some to be a right. Oncology nurses, as patient advocates, need to understand the basic issues surrounding this controversy.

  3. [Physician-assisted suicide of a patient suffering from a psycho-organic disorder].

    PubMed

    van der Meer, S; de Veen, R C; Noorthoorn, E O; Kraan, H F

    1999-04-24

    A 71-year-old man suffering from vascular dementia since four years asked for physician-assisted suicide. In the Netherlands physician-assisted suicide, which is forbidden by law, remains an intricate dilemma in medical practice. As far as it concerns untreatable terminal patients who decide to put an end to their lives in agreement with and assisted by their physician, procedures are well defined. The present case may be used as an example in the development of a protocol for physician-assisted suicide in patients who are not terminal in the short term, but who suffer unbearably with no prospect of remission. After the protocol securing various formal and medical consequences was run through, the patient was assisted by handling him a high-dose solution of a barbiturate which he drank himself. The procedure incorporates several second and third opinions. First, the chief psychiatrist of the psychiatric hospital assesses the request. Second, a committee consisting of a number of independent professionals form a second opinion. They have no direct responsibility in the treatment of the patient. The patient also may consult an independent consultant psychiatrist with specific knowledge in the domain of his disorder for a third opinion. This procedure was found legally as well as medically sound, and was approved by the public prosecutor after consultation with the Dutch forum of Procurators-General.

  4. Attitudes of health care professionals, relatives of advanced cancer patients and public towards euthanasia and physician assisted suicide.

    PubMed

    Parpa, Efi; Mystakidou, Kyriaki; Tsilika, Eleni; Sakkas, Pavlos; Patiraki, Elisabeth; Pistevou-Gombaki, Kyriaki; Govina, Ourania; Panagiotou, Irene; Galanos, Antonis; Gouliamos, Athanasios

    2010-10-01

    Nowadays, euthanasia has the meaning of the direct administration of a lethal agent to the patient by another party with a merciful intent after patients' request. Physician assisted suicide refers to the patient intentionally and wilfully ending his or her own life with the assistance of a physician. The objectives of the manuscript were to investigate the opinions of Greek physicians, nurses, lay people and relatives of advanced cancer patients on euthanasia and physician assisted suicide. The final sample consisted of 215 physicians, 250 nurses, 218 relatives and 246 lay people. A survey questionnaire was used concerning issues such as euthanasia and physician assisted suicide. The survey instrument included 13 questions and described issues such as religious and spiritual beliefs, euthanasia, physician assisted suicide and decision-making situations. 43.3% physicians and 41.3% relatives would agree in advance that in case of heart and/or respiratory arrest there would not be an effort to revive a terminally ill cancer patient. 20.5% physicians had a request for euthanasia. Significant associations were found between physicians (9.3%), relatives (1.8%, p=0.001) and lay people (3.7%, p=0.020) on their opinions regarding withdrawing treatment. The majority of the participants were opposed to euthanasia and physician assisted suicide. However many would agree to the legalization of an advanced cancer patient's hastened death. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  5. Physician assisted suicide and clinical vulnerability: a slippery slope.

    PubMed

    Monacelli, F; Martini, M; Odetti, P; Ciliberti, R

    2016-01-01

    The Belgian case of a 24 years' woman affected by resistant depression, who obtained the legal right to assisted suicide rehearsed ethical issues. From the famous Chabot case of the Dutch court in 1994, accumulating legal evidence indicates that the unbearable psychiatric suffering may be equate to the physical struggle of end of life patients. The Belgian law has addressed assisted suicide as an option in case of unbearable psychic suffering with no future prospective. It is unlikely that the practice of euthanasia may be mechanistically reduced to the provision of a suicide as alleviating the burden of suffering in depression is a long life commitment; moreover, the principle of patient's self determination and autonomy is highly debatable: the closure to the future, the hopelessness and the suicidal ideation represent per se core features of depression. Might they be discriminated as non pathological in assessing patients' competence and how? The slippery slopes is even more upsetting when dealing with elderly affected by chronic disability. Some body of evidence justified suicide in elderly as the final auto determination to preserve the person's dignity, and quality of life. The growing scenario of economic shortages in heath care system seems to further legalize the social prejudice and the ageistic discrimination towards elderly with disability. The silver tsunami will face the challenge of true self determination; will it be acted through assisted suicide or through a rebuilding of western heath care policies to fulfill the emergent needs of an aging population?

  6. A national survey of physician-assisted suicide and euthanasia in the United States.

    PubMed

    Meier, D E; Emmons, C A; Wallenstein, S; Quill, T; Morrison, R S; Cassel, C K

    1998-04-23

    Although there have been many studies of physician-assisted suicide and euthanasia in the United States, national data are lacking. In 1996, we mailed questionnaires to a stratified probability sample of 3102 physicians in the 10 specialties in which doctors are most likely to receive requests from patients for assistance with suicide or euthanasia. We weighted the results to obtain nationally representative data. We received 1902 completed questionnaires (response rate, 61 percent). Eleven percent of the physicians said that under current legal constraints, there were circumstances in which they would be willing to hasten a patient's death by prescribing medication, and 7 percent said that they would provide a lethal injection; 36 percent and 24 percent, respectively, said that they would do so if it were legal. Since entering practice, 18.3 percent of the physicians (unweighted number, 320) reported having received a request from a patient for assistance with suicide and 11.1 percent (unweighted number, 196) had received a request for a lethal injection. Sixteen percent of the physicians receiving such requests (unweighted number, 42), or 3.3 percent of the entire sample, reported that they had written at least one prescription to be used to hasten death, and 4.7 percent (unweighted number, 59), said that they had administered at least one lethal injection. A substantial proportion of physicians in the United States report that they receive requests for physician-assisted suicide and euthanasia, and about 7 percent of those who responded to our survey have complied with such requests at least once.

  7. Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe.

    PubMed

    Emanuel, Ezekiel J; Onwuteaka-Philipsen, Bregje D; Urwin, John W; Cohen, Joachim

    2016-07-05

    The increasing legalization of euthanasia and physician-assisted suicide worldwide makes it important to understand related attitudes and practices. To review the legal status of euthanasia and physician-assisted suicide and the available data on attitudes and practices. Polling data and published surveys of the public and physicians, official state and country databases, interview studies with physicians, and death certificate studies (the Netherlands and Belgium) were reviewed for the period 1947 to 2016. Currently, euthanasia or physician-assisted suicide can be legally practiced in the Netherlands, Belgium, Luxembourg, Colombia, and Canada (Quebec since 2014, nationally as of June 2016). Physician-assisted suicide, excluding euthanasia, is legal in 5 US states (Oregon, Washington, Montana, Vermont, and California) and Switzerland. Public support for euthanasia and physician-assisted suicide in the United States has plateaued since the 1990s (range, 47%-69%). In Western Europe, an increasing and strong public support for euthanasia and physician-assisted suicide has been reported; in Central and Eastern Europe, support is decreasing. In the United States, less than 20% of physicians report having received requests for euthanasia or physician-assisted suicide, and 5% or less have complied. In Oregon and Washington state, less than 1% of licensed physicians write prescriptions for physician-assisted suicide per year. In the Netherlands and Belgium, about half or more of physicians reported ever having received a request; 60% of Dutch physicians have ever granted such requests. Between 0.3% to 4.6% of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal. The frequency of these deaths increased after legalization. More than 70% of cases involved patients with cancer. Typical patients are older, white, and well-educated. Pain is mostly not reported as the primary motivation. A large portion of patients receiving

  8. Consultation with another physician on euthanasia and assisted suicide in the Netherlands.

    PubMed

    Onwuteaka-Philipse, B D; van der Wal, G; Kostense, P J; van der Maas, P J

    2000-08-01

    Consultation with another physician is considered to be an important safeguard of the practice of euthanasia and physician-assisted suicide. The objective is to describe the frequency and characteristics of consultation in cases of euthanasia or physician-assisted suicide (EAS) in the Netherlands. Data from two cross-sectional descriptive nationwide surveys, carried out in 1995, were used. Questionnaires were mailed to physicians attending 6060 deaths, identified from death certificates, and a stratified sample of 405 physicians were interviewed. In 1990, a cross-sectional descriptive postal survey of a random sample of 1042 general practitioners took place. Consultation took place in 63% of cases of EAS in the Netherlands, in 99% of the cases reported to the public prosecutor and in approximately 37% of unreported cases. In almost half of the unreported cases the decision had been discussed less formally with at least one colleague. In 1990, 7% of general practitioners met all 8 criteria for good consultation; this increased to 64% in 1995. Of the respondents, 26% had at some time advised against performing euthanasia or assisted suicide when acting as a consultant. This study shows that approximately two thirds of all cases of EAS are safeguarded by consultation. Although in the majority of these cases the consultation is of good quality, there is certainly still room for improvement. The quality of consultation could be improved, for instance, by appointing independent and specifically trained consultants.

  9. Primary Care Physicians', Nurse Practitioners' and Physician Assistants' Knowledge, Attitudes and Beliefs Regarding COPD: 2007 To 2014.

    PubMed

    Yawn, Barbara P; Wollan, Peter C; Textor, Kyle B; Yawn, Roy A

    2016-05-06

    To assess current primary care physicians', nurse practitioners' (NP) and physicians assistants' (PA) knowledge, attitudes and beliefs regarding chronic obstructive pulmonary disease (COPD) and changes from a similar 2007 assessment, we surveyed attendees of 3 regional continuing medical education programs and compared the 2013/2014 responses with responses to a similar survey completed in 2007. Survey data included information on personal demographics, agreement with perceived barriers to COPD diagnosis, awareness, and use of COPD guidelines, and beliefs regarding the value of available COPD therapies. In 2013/2014, 426 primary care clinicians (278 medical doctors [MDs] and doctors of osteopathic medicine [DO] and 148 NPs/PAs) provided useable responses (overall response rate 61%). Overall these physicians were older and more experienced than the NPs/PAs but with few other differences in responses except significantly greater physician reported use of spirometry for COPD diagnosis. About half of the clinicians reported having in-office spirometers but less than two thirds reported using them for all COPD diagnoses. All respondents reported multiple barriers to COPD diagnosis but with fewer than in 2007 reporting lack of knowledge or awareness of COPD guidelines as a major barrier. The most striking difference between 2007 and 2013/2014 responses was the marked increase in beliefs by all clinicians in the ability of COPD treatments to reduce symptoms and numbers of exacerbations. These data affirm that primary care clinicians continue to report multiple barriers to COPD diagnosis including lack of easy access to spirometry and frequent failure to include spirometry in diagnostic confirmation. However, since 2007, the clinicians report a remarkable decline in therapeutic nihilism, which may enhance their interest in learning more about diagnosing and managing COPD.

  10. Euthanasia and physician-assisted suicide policy in The Netherlands and Oregon: a comparative analysis.

    PubMed

    Patel, Kant

    2004-01-01

    This article presents a comparative analysis of euthanasia and physician-assisted suicide policy in The Netherlands and the state of Oregon in the United States. The topics of euthanasia and physician-assisted suicide are discussed in the context of the historical setting of The Netherlands and the United States with special emphasis placed on public opinion, role of the courts and the legislative bodies, and opinions of physicians. Major similarities and differences in the laws of The Netherlands and Oregon are discussed. The article examines whether the passage of the law has led to a slide down the slippery slope in The Netherlands and Oregon as had been suggested by the opponents of the law. The article concludes that the empirical evidence does not support the contention of the opponents. However, the author argues that the potential for this happening is much greater in The Netherlands than in Oregon.

  11. Physician-Assisted Dying: Are Education and Religious Beliefs Related to Nursing Students' Attitudes?

    ERIC Educational Resources Information Center

    Margalith, Ilana; Musgrave, Catherine F.; Goldschmidt, Lydia

    2003-01-01

    A survey of 190 Israeli nursing students found that just over half were opposed to legalization of physician-assisted dying. Exposure to theory about euthanasia or clinical oncology experience had a small effect on these attitudes. Religious beliefs and degree of religiosity were significant determinants of these attitudes. (Contains 23…

  12. Narratives and Values: The Rhetoric of the Physician Assisted Suicide Debate.

    ERIC Educational Resources Information Center

    Dysart, Deborah

    2000-01-01

    Argues that the function of medicine as an art and as a social institution is impeded when the rhetorical nature of its practice is ignored. Offers a case study of two texts widely cited as landmarks in the physician-assisted suicide debate of the 1990s, examining their rhetorical organization and its impact on their reception. (SR)

  13. Ethical Issues in the Social Worker's Role in Physician-Assisted Suicide.

    ERIC Educational Resources Information Center

    Manetta, Ameda A.; Wells, Janice G.

    2001-01-01

    Presents results of an exploratory study of social workers' views on physician-assisted suicide (PAS), situations in which PAS would be favored, and whether there is a difference in education or training on mental health issues, ethics, or suicide between social workers who favor PAS and those who oppose PAS. (BF)

  14. Effectiveness of a Shortened, Clinically Engaged Anatomy Course for Physician Assistant Students

    ERIC Educational Resources Information Center

    Rizzolo, Lawrence J.; Rando, William C.; O'Brien, Michael K.; Garino, Alexandria; Stewart, William B.

    2011-01-01

    There is little consensus among programs that train physician assistants (PAs) regarding how much time should be devoted to the study of anatomy, what should be included, or how it should be taught. Similar concerns led us to redesign anatomy for medical students and introduce clinically engaged anatomy, an approach designed in collaboration with…

  15. Discourse and Occupational Perspective: A Comparison of Nurse Practitioners and Physician Assistants.

    ERIC Educational Resources Information Center

    Drass, Kriss A.

    1988-01-01

    Examines the differences in perspective and training of nurse practitioners and physician assistants, and effects of these on their interactive strategies with patients. Shows how the macro issue of differences in occupational perspective can be incorporated into micro studies of the form and content of talk in social interactions. (SR)

  16. Effectiveness of a Shortened, Clinically Engaged Anatomy Course for Physician Assistant Students

    ERIC Educational Resources Information Center

    Rizzolo, Lawrence J.; Rando, William C.; O'Brien, Michael K.; Garino, Alexandria; Stewart, William B.

    2011-01-01

    There is little consensus among programs that train physician assistants (PAs) regarding how much time should be devoted to the study of anatomy, what should be included, or how it should be taught. Similar concerns led us to redesign anatomy for medical students and introduce clinically engaged anatomy, an approach designed in collaboration with…

  17. The training and utilization of surgical physician assistants. A retrospective study.

    PubMed

    Brandt, L B; Beinfield, M S; Laffaye, H A; Baue, A E

    1989-03-01

    A community hospital's search for qualified surgical house staff in 1975 led to the development of a postgraduate residency program in surgery for physician assistants. Eleven years after its inception, the program's purpose and structure were reviewed, and its alumni, goals, and contributions were evaluated. A 1987 alumni survey provided data to assess the value of residency training to current employment and job satisfaction.

  18. [Medical students' attitudes towards legalisation of euthanasia and physician-assisted suicide].

    PubMed

    Nordstrand, Magnus Andreas; Nordstrand, Sven Jakob; Materstvedt, Lars Johan; Nortvedt, Per; Magelssen, Morten

    2013-11-26

    We wished to investigate prevailing attitudes among future doctors regarding legalisation of euthanasia and physician-assisted suicide. This issue is important, since any legalisation of these practices would confer a completely new role on doctors. Attitudes were identified with the aid of a questionnaire-based survey among medical students in their 5th and 6th year of study in the four Norwegian medical schools. Altogether 531 students responded (59.5% of all students in these cohorts). Of these, 102 (19%) were of the opinion that euthanasia should be legalised in the case of terminal illness, 164 (31%) responded that physician-assisted suicide should be permitted for this indication, while 145 (28%) did not know. A minority of the respondents would permit euthanasia and physician-assisted suicide in other situations. Women and those who reported that religion was important to them were less positive than men to permitting euthanasia or physician-assisted suicide. In most of the situations described, the majority of the students in this survey rejected legalisation. Opinions are more divided in the case of terminal illness, since a larger proportion is in favour of legalisation and more respondents are undecided.

  19. Physician Assistants and Nurse Practitioners as a Usual Source of Care

    ERIC Educational Resources Information Center

    Everett, Christine M.; Schumacher, Jessica R.; Wright, Alexandra; Smith, Maureen A.

    2009-01-01

    Purpose: To identify characteristics and outcomes of patients who use physician assistants and nurse practitioners (PA/NPs) as a usual source of care. Methods: Cross sectional analysis using the telephone and mail surveys of the Wisconsin Longitudinal Study (WLS), a prospective cohort study of Wisconsin high school graduates and selected siblings…

  20. Ethical Issues in the Social Worker's Role in Physician-Assisted Suicide.

    ERIC Educational Resources Information Center

    Manetta, Ameda A.; Wells, Janice G.

    2001-01-01

    Presents results of an exploratory study of social workers' views on physician-assisted suicide (PAS), situations in which PAS would be favored, and whether there is a difference in education or training on mental health issues, ethics, or suicide between social workers who favor PAS and those who oppose PAS. (BF)

  1. Narratives and Values: The Rhetoric of the Physician Assisted Suicide Debate.

    ERIC Educational Resources Information Center

    Dysart, Deborah

    2000-01-01

    Argues that the function of medicine as an art and as a social institution is impeded when the rhetorical nature of its practice is ignored. Offers a case study of two texts widely cited as landmarks in the physician-assisted suicide debate of the 1990s, examining their rhetorical organization and its impact on their reception. (SR)

  2. Physician Assistants and Nurse Practitioners as a Usual Source of Care

    ERIC Educational Resources Information Center

    Everett, Christine M.; Schumacher, Jessica R.; Wright, Alexandra; Smith, Maureen A.

    2009-01-01

    Purpose: To identify characteristics and outcomes of patients who use physician assistants and nurse practitioners (PA/NPs) as a usual source of care. Methods: Cross sectional analysis using the telephone and mail surveys of the Wisconsin Longitudinal Study (WLS), a prospective cohort study of Wisconsin high school graduates and selected siblings…

  3. A Feasibility Study for a Physician's Assistant Program. Occupational Education Research Project. Final Report.

    ERIC Educational Resources Information Center

    Minette, William P.

    This study was conducted to design an educational program for physician's assistant that would conform to the American Medical Association's essential requirements for the occupation and to determine the feasibility of establishing such a program at Pitt Technical Institute in North Carolina. The investigation covered selection procedures,…

  4. 42 CFR 405.2414 - Nurse practitioner, physician assistant, and certified nurse midwife services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Nurse practitioner, physician assistant, and certified nurse midwife services. 405.2414 Section 405.2414 Public Health CENTERS FOR MEDICARE & MEDICAID... AND DISABLED Rural Health Clinic and Federally Qualified Health Center Services § 405.2414...

  5. The Employment of Nurse Practitioners and Physician Assistants in U.S. Nursing Homes

    ERIC Educational Resources Information Center

    Intrator, Orna; Feng, Zhanlian; Mor, Vince; Gifford, David; Bourbonniere, Meg; Zinn, Jacqueline

    2005-01-01

    Purpose: Nursing facilities with nurse practitioners or physician assistants (NPs or PAs) have been reported to provide better care to residents. Assuming that freestanding nursing homes in urban areas that employ these professionals are making an investment in medical infrastructure, we test the hypotheses that facilities in states with higher…

  6. Physician-Assisted Dying: Are Education and Religious Beliefs Related to Nursing Students' Attitudes?

    ERIC Educational Resources Information Center

    Margalith, Ilana; Musgrave, Catherine F.; Goldschmidt, Lydia

    2003-01-01

    A survey of 190 Israeli nursing students found that just over half were opposed to legalization of physician-assisted dying. Exposure to theory about euthanasia or clinical oncology experience had a small effect on these attitudes. Religious beliefs and degree of religiosity were significant determinants of these attitudes. (Contains 23…

  7. Major General Spurgeon Neel and the Army Physician Assistant: A Case Study of Policy Change

    DTIC Science & Technology

    2009-01-01

    1 Major General Spurgeon Neel and the Army Physician Assistant: A Case Study of Policy Change Richard Glade ...a survey, which interestingly, made no attempt to study it. In 2005, Captain John Hughes surveyed every battalion and brigade commander at Fort

  8. Wichita State University Physician's Assistant Program. BHME Contract #72-4199. Final Report.

    ERIC Educational Resources Information Center

    Gladhart, Stephen; Crespo, Merideth

    Wichita State's physician's assistant program, located on the Wichita Veteran's Administration Center campus in Wichita, Kansas, is described in this status report. Established with 12 students in January 1973, the program includes didactic and clinical training for two years and meets the "Essentials of an Approved Educational Program for…

  9. Wichita State University Physician's Assistant Program. BHME Contract #72-4199. Final Report.

    ERIC Educational Resources Information Center

    Gladhart, Stephen; Crespo, Merideth

    Wichita State's physician's assistant program, located on the Wichita Veteran's Administration Center campus in Wichita, Kansas, is described in this status report. Established with 12 students in January 1973, the program includes didactic and clinical training for two years and meets the "Essentials of an Approved Educational Program for…

  10. How Hawaii's doctors feel about physician-assisted suicide and euthanasia: an overview.

    PubMed

    Siaw, L K; Tan, S Y

    1996-12-01

    We polled, by questionnaire, all doctors and medical trainees in Hawaii (n = 3,017) to determine their attitudes towards physician-assisted suicide, euthanasia and other end-of-life medical issues. One thousand and twenty-eight (34.1%) responded. Medical trainees did not differ significantly from practicing physicians. Only a minority of respondents (15.6%) were willing to assist a terminally-ill patient to commit suicide. An even smaller number (9.8) would perform active euthanasia. On the other hand, an overwhelming majority would withhold (97.6%) or withdraw (78.6%) life-support upon request. Most doctors (88.0%) were also willing to administer high doses of narcotics for pain relief, even if such therapy hastened death. About half the doctors felt that physician-assisted suicide and active euthanasia may be justified under some circumstances, although most were unwilling to personally carry out these acts. Catholic, Filipino and Hawaiian/Polynesian doctors were statistically less likely to approve of or perform physician-assisted suicide or active euthanasia.

  11. The Employment of Nurse Practitioners and Physician Assistants in U.S. Nursing Homes

    ERIC Educational Resources Information Center

    Intrator, Orna; Feng, Zhanlian; Mor, Vince; Gifford, David; Bourbonniere, Meg; Zinn, Jacqueline

    2005-01-01

    Purpose: Nursing facilities with nurse practitioners or physician assistants (NPs or PAs) have been reported to provide better care to residents. Assuming that freestanding nursing homes in urban areas that employ these professionals are making an investment in medical infrastructure, we test the hypotheses that facilities in states with higher…

  12. 42 CFR 405.2415 - Services and supplies incident to nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Services and supplies incident to nurse practitioner and physician assistant services. 405.2415 Section 405.2415 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE...

  13. 42 CFR 405.2414 - Nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Nurse practitioner and physician assistant services. 405.2414 Section 405.2414 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Rural...

  14. Advanced Practice Nursing: Is the Physician's Assistant an Accident of History or a Failure to Act?

    ERIC Educational Resources Information Center

    Christman, Luther

    1998-01-01

    The responses of some nursing organizations regarding the establishment of collaborative relationships in the nursing profession may be responsible for the development of the physician assistant profession. The nursing profession should examine these responses while planning strategies to cope with the current chaos in health care. (JOW)

  15. Active euthanasia and physician-assisted suicide: the German discussion.

    PubMed

    Oehmichen, Manfred; Meissner, Christoph

    2003-03-01

    The debate on legalization of active euthanasia in the Netherlands and Belgium and the refused legal right to choose the circumstances of Diana Pretty's own death are the last actual reasons for reconsidering the situation in Germany. Around the world heated debates have broken out on the topic of active euthanasia. Specialists in the field of 'forensic medicine' have taken full part in these discussions. The present survey from the point of view of forensic medicine begins with a look at current terminology and at the laws pertaining to euthanasia in Germany. These laws are then contrasted with actual practice, including a description of the increasing acceptance of active euthanasia by the German population. The main argument against legalization of active euthanasia is that its formal acceptance in law would cause the dam of restraint to burst, culminating in widespread misuse, as already seen in recent serial killings by nurses in hospitals and homes for the elderly around the world. Contrasted with this are the arguments for taking active steps at the end of life, including emotional considerations such as the revulsion against mechanized medicine and the fear of pain and rational arguments such as the necessity to end a 'life unworthy of life', to save medical costs, and obtaining prior consent in 'living wills'. Such considerations have put in jeopardy the moral integrity of the medical profession - and thus the layperson's trust in physicians--around the world. In Germany especially the history of mass killing during the Nazi era constitutes a fundamental argument against active euthanasia. As a consequence, in Germany active euthanasia will not receive legal sanction, although recommendations on rendering dying more bearable are permitted.

  16. Specialty distribution of physician assistants and nurse practitioners in North Carolina.

    PubMed

    Fraher, Erin P; Morgan, Perri; Johnson, Anna

    2016-04-01

    Physician workforce projections often include scenarios that forecast physician shortages under different assumptions about the deployment of physician assistants (PAs) and nurse practitioners (NPs). These scenarios generally assume that PAs and NPs are an interchangeable resource and that their specialty distributions do not change over time. This study investigated changes in PA and NP specialty distribution in North Carolina between 1997 and 2013. The data show that over the study period, PAs and NPs practiced in a wide range of specialties, but each profession had a specific pattern. The proportion of PAs-but not NPs-reporting practice in primary care dropped significantly. PAs were more likely than NPs to report practice in urgent care, emergency medicine, and surgical subspecialties. Physician workforce models need to account for the different and changing specialization trends of NPs and PAs.

  17. Establishing a framework for a physician assistant/bioethics dual degree program.

    PubMed

    Carr, Mark F; Bergman, Brett A

    2014-01-01

    : Numerous medical schools currently offer a master of arts (MA) in bioethics dual degree for physicians. A degree in bioethics enhances the care physicians provide to patients and prepares physicians to serve on ethics committees and consult services. Additionally, they may work on institutional and public policy issues related to ethics. Several physician assistant (PA) programs currently offer a master of public health (MPH) dual degree for PAs. A degree in public health prepares PAs for leadership roles in meeting community health needs. With the success of PA/MPH dual degree programs, we argue here that a PA/bioethics dual degree would be another opportunity to advance the PA profession and consider how such a program might be implemented. The article includes the individual perspectives of the authors, one of whom completed a graduate-level certificate in bioethics concurrently with his 2-year PA program, while the other served as a bioethics program director.

  18. The Rivalry between Simulation and Problem-Based Learning: A Study of Learning Transfer in Physician Assistant Students

    ERIC Educational Resources Information Center

    Meyer, Kimberly E.

    2010-01-01

    The purpose of this dissertation was to evaluate learning transfer achieved by physician assistant students comparing two instructional methods, human patient simulation and electronic clinical case studies. This prospective, randomized, mixed-methods study utilized first and second-year physician assistant student volunteers taking a pretest and…

  19. Common Intra-Cluster Competencies Needed in Selected Occupational Clusters. Final Report. Supplemental Volume XIV: Orthopaedic Physician's Assistant.

    ERIC Educational Resources Information Center

    McClurg, Ronald B.

    An analysis of survey responses from a sample of orthopaedic physician's assistants on competency characteristics for their occupation is presented in this document. (Orthopaedic physician's assistant is one of seventeen occupation groups included in this research.) The competencies are reported in five categories: (1) those competencies selected…

  20. Common Intra-Cluster Competencies Needed in Selected Occupational Clusters. Final Report. Supplemental Volume XIV: Orthopaedic Physician's Assistant.

    ERIC Educational Resources Information Center

    McClurg, Ronald B.

    An analysis of survey responses from a sample of orthopaedic physician's assistants on competency characteristics for their occupation is presented in this document. (Orthopaedic physician's assistant is one of seventeen occupation groups included in this research.) The competencies are reported in five categories: (1) those competencies selected…

  1. Strategies and perceived barriers to recruitment of underrepresented minority students in physician assistant programs.

    PubMed

    DiBaise, Michelle; Salisbury, Helen; Hertelendy, Attila; Muma, Richard D

    2015-03-01

    The purpose of this descriptive cross-sectional study was to identify the characteristics and effectiveness of recruitment strategies for underrepresented minorities (URM) and barriers to URM applicants to physician assistant programs. A 108-question survey was e-mailed to 168 physician assistant programs; 36 partial and 67 fully completed surveys were returned. The fully completed surveys were used in the data analysis. Participants were asked about the use of 20 recruitment strategies and the importance of 34 perceived barriers to enrollment of URM applicants. Of the 20 recruitment strategies, only 4 were used by close to 50% or more of programs: site visits (61.2%), preadmission counseling (58.2%), student loans (57.6%), and presentations targeted to minority students (47.8%). Only 9% of programs used enrichment courses, but this strategy was rated as most effective. Of the 34 barriers, the most frequent was low undergraduate grade point average (GPA) (82.5%). Self-reported success in recruitment was correlated with increased URM matriculation. Higher proportion of African American and Hispanic faculty on admissions committees was correlated with increased rates of URM matriculation. According to a similar survey, compared with medical schools, physician assistant programs use URM recruitment strategies less frequently and perceive financial barriers as a larger problem. The academically competitive physician assistant applicant pool decreases the need for recruitment of all students. Use of GPA and standardized test scores as sole criteria for admission and lack of recruitment of URM students lead to a decrease in diversity. If the physician assistant profession desires to improve student diversity in programs, they should consider using a more holistic approach for the admission process, which may allow for a more flexible and individualized review of applicants.

  2. On the Moral Acceptability of Physician-Assisted Dying for Non-Autonomous Psychiatric Patients.

    PubMed

    Varelius, Jukka

    2016-05-01

    Several authors have recently suggested that the suffering caused by mental illness could provide moral grounds for physician-assisted dying. Yet they typically require that psychiatric-assisted dying could come to question in the cases of autonomous, or rational, psychiatric patients only. Given that also non-autonomous psychiatric patients can sometimes suffer unbearably, this limitation appears questionable. In this article, I maintain that restricting psychiatric-assisted dying to autonomous, or rational, psychiatric patients would not be compatible with endorsing certain end-of-life practices commonly accepted in current medical ethics and law, practices often referred to as 'passive euthanasia'. © 2015 John Wiley & Sons Ltd.

  3. Should Mental Disorders Be a Basis for Physician-Assisted Death?

    PubMed

    Appelbaum, Paul S

    2017-04-01

    Laws permitting physician-assisted death in the United States currently are limited to terminal conditions. Canada is considering whether to extend the practice to encompass intractable suffering caused by mental disorders, and the question inevitably will arise in the United States. Among the problems seen in countries that have legalized assisted death for mental disorders are difficulties in assessing the disorder's intractability and the patient's decisional competence, and the disproportionate involvement of patients with social isolation and personality disorders. Legitimate concern exists that assisted death could serve as a substitute for creating adequate systems of mental health treatment and social support.

  4. British community pharmacists' views of physician-assisted suicide (PAS).

    PubMed

    Hanlon, T R; Weiss, M C; Rees, J

    2000-10-01

    To explore British community pharmacists' views on PAS, including professional responsibility, personal beliefs, changes in law and ethical guidance. Postal questionnaire. Great Britain. A random sample of 320 registered full-time community pharmacists. The survey yielded a response rate of 56%. The results showed that 70% of pharmacists agreed that it was a patient's right to choose to die, with 57% and 45% agreeing that it was the patient's right to involve his/her doctor in the process and to use prescription medicines, respectively. Forty-nine per cent said that they would knowingly dispense a prescription for use in PAS were it to be legalized and 54% believed it correct to refuse to dispense such a prescription. Although 53% believed it to be their right to know when they were being involved in PAS, 28% did not. Most pharmacists (90%) said that they would wish to see the inclusion of a practice protocol for PAS in the code of ethics of the Royal Pharmaceutical Society of Great Britain (CE-RPSGB) in the event of a change in the law on PAS. In addition, 89% would wish to see PAS included in the Conscience Clause of the CE-RPSGB. Males were found to be significantly less likely to favour PAS than females (p < 0.05), as were those declaring an ethnic/religious background of consideration when dealing with ethical issues in practice compared with their counterparts (p < 0.00005). Pharmacists view their professional responsibility in PAS to be more obligatory than a physician's, in having to provide the means for PAS. It is worrying that a proportion of the respondents prefer to remain in ignorance of the true purpose of a prescription for PAS; a finding at odds with current developments within the pharmaceutical profession. A practice protocol for PAS and an extension of the conscience clause should be considered in the event of PAS becoming legal. Such measures would allow the efficient provision of the pharmaceutical service whilst at the same respecting the

  5. Twenty Years of Growth and Innovation: A Reflection on PACKRAT's Impact on Physician Assistant Education.

    PubMed

    Cavanagh, Kim; Lessard, Donovan; Britt, Zach

    2015-12-01

    In its 20th year, the Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) is a student self-assessment that can assist physician assistant (PA) students and PA program faculty in identifying strengths and areas in need of improvement in the didactic and clinical phases of PA education. In this reflection, we provide an overview of the history of PACKRAT and outline some of its benefits for students and PA programs, as well as its generative role in assessment within PA studies. Taking a broader view of PACKRAT's impact on assessment for the PA profession, we outline the research on its benefits and its use to maximize student performance, as well as how it has promoted the development of additional assessment tools.

  6. The education, role, distribution, and compensation of physician assistants in orthopedic surgery.

    PubMed

    Chalupa, Robyn L; Hooker, Roderick S

    2016-05-01

    Physician assistants (PAs) have worked alongside surgeons since the 1970s, yet little is known about their postgraduate education, roles, distribution, and compensation. In 2015, an estimated 8,900 PAs were employed in orthopedics (9.4% of all clinically active PAs in the United States). This study analyzed surveys undertaken by Physician Assistants in Orthopaedic Surgery (PAOS) from 2009 to 2015 and found that most PAs working in orthopedics (85%) reported regularly assisting in surgery. Demand for PAs in orthopedics is expected to grow because of population growth, increasing incidence of musculoskeletal conditions, shortages of surgeons, and changing technology. Improved data acquisition and more detailed analyses are needed to better understand the nature of this specialized workforce.

  7. The reporting rate of euthanasia and physician-assisted suicide: a study of the trends.

    PubMed

    Rurup, Mette L; Buiting, Hilde M; Pasman, H Roeline W; van der Maas, Paul J; van der Heide, Agnes; Onwuteaka-Philipsen, Bregje D

    2008-12-01

    To study trends in reporting rates of euthanasia from 1990 to 2005 in relation to whether recommended or nonrecommended drugs were used, and the most important differences between reported and unreported cases in 2005. Questionnaires were sent to a sample of 6860 physicians who had reported a death in 2005 (response 78%). Previously, 3 similar studies were done at 5-year intervals. The total number of euthanasia and physician-assisted suicide cases was estimated using a "gold standard" definition: death was-according to the physician-the result of the use of drugs at the explicit request of the patient with the explicit goal of hastening death (denominator). The Euthanasia Review Committees provided the number of reported cases (numerator). The reporting rate of euthanasia and physician-assisted suicide increased from 18% in 1990, 41% in 1995, and 54% in 2001 to 80% in 2005. The reporting rate in the subgroup of euthanasia with recommended drugs (barbiturates and muscle relaxants) was 73% in 1995, 71% in 2001, and 99% in 2005. The reporting rate of euthanasia with nonrecommended drugs (eg, opioids) was below 3% in 1995, 2001, and 2005. Unreported euthanasia differed also from reported euthanasia in the fact that physicians less often labeled their act as euthanasia. Euthanasia with nonrecommended drugs is almost never reported. The total reporting rate increased because of an increase in the use of recommended drugs for euthanasia between 1995 and 2001, and an increase in the reporting rate for euthanasia with recommended drugs between 2001 and 2005.

  8. The role of nurses in euthanasia and physician-assisted suicide in The Netherlands.

    PubMed

    van Bruchem-van de Scheur, G G; van der Arend, A J G; Abu-Saad, H Huijer; Spreeuwenberg, C; van Wijmen, F C B; ter Meulen, R H J

    2008-04-01

    Issues concerning legislation and regulation with respect to the role of nurses in euthanasia and physician-assisted suicide gave the Minister for Health reason to commission a study of the role of nurses in medical end-of-life decisions in hospitals, home care and nursing homes. This paper reports the findings of a study of the role of nurses in euthanasia and physician-assisted suicide, conducted as part of a study of the role of nurses in medical end-of-life decisions. The findings for hospitals, home care and nursing homes are described and compared. A questionnaire was sent to 1509 nurses, employed in 73 hospitals, 55 home care organisations and 63 nursing homes. 1179 responses (78.1%) were suitable for analysis. The questionnaire was pilot-tested among 106 nurses, with a response rate of 85%. In 37.0% of cases, the nurse was the first person with whom patients discussed their request for euthanasia or physician-assisted suicide. Consultation between physicians and nurses during the decision-making process took place quite often in hospitals (78.8%) and nursing homes (81.3%) and less frequently in home care situations (41.2%). In some cases (12.2%), nurses administered the euthanatics. The results show substantial differences between the intramural sector (hospitals and nursing homes) and the extramural sector (home care), which are probably linked to the organisational structure of the institutions. Consultation between physicians and nurses during the decision-making process needs improvement, particularly in home care. Some nurses had administered euthanatics, although this task is by law exclusively reserved to physicians.

  9. The Contribution of Nurse Practitioners and Physician Assistants to Generalist Care in Washington State

    PubMed Central

    Larson, Eric H; Palazzo, Lorella; Berkowitz, Bobbi; Pirani, Michael J; Hart, L Gary

    2003-01-01

    Objective To quantify the total contribution to generalist care made by nurse practitioners (NPs) and physician assistants (PAs) in Washington State. Data Sources State professional licensure renewal survey data from 1998–1999. Study Design Cross-sectional. Data on medical specialty, place of practice, and outpatient visits performed were used to estimate productivity of generalist physicians, NPs, and PAs. Provider head counts were adjusted for missing specialty and productivity data and converted into family physician full-time equivalents (FTEs) to facilitate estimation of total contribution to generalist care made by each provider type. Principal Findings Nurse practitioners and physician assistants make up 23.4 percent of the generalist provider population and provide 21.0 percent of the generalist outpatient visits in Washington State. The NP/PA contribution to generalist care is higher in rural areas (24.7 percent of total visits compared to 20.1 percent in urban areas). The PAs and NPs provide 50.3 percent of generalist visits provided by women in rural areas, 36.5 percent in urban areas. When productivity data were converted into family physician FTEs, the productivity adjustments were large. A total of 4,189 generalist physicians produced only 2,760 family physician FTEs (1 FTE=105 outpatient visits per week). The NP and PA productivity adjustments were also quite large. Conclusions Accurate estimates of available generalist care must take into account the contributions of NPs and PAs. Additionally, simple head counts of licensed providers are likely to result in substantial overestimates of available care. Actual productivity data or empirically derived adjustment factors must be used for accurate estimation of provider shortages. PMID:12968815

  10. Prescribing exercise for older adults: A needs assessment comparing primary care physicians, nurse practitioners, and physician assistants.

    PubMed

    Dauenhauer, Jason A; Podgorski, Carol A; Karuza, Jurgis

    2006-01-01

    To inform the development of educational programming designed to teach providers appropriate methods of exercise prescription for older adults, the authors conducted a survey of 177 physicians, physician assistants, and nurse practitioners (39% response rate). The survey was designed to better understand the prevalence of exercise prescriptions, attitudes, barriers, and educational needs of primary care practitioners toward older adults. Forty-seven percent of primary care providers report not prescribing exercise for older adults; 85% of the sample report having no formal training in exercise prescription. Practitioner attitudes were positive toward exercise, but were not predictive of their exercise prescribing behavior, which indicates that education efforts aimed at changing attitudes as a way of increasing exercise-prescribing behaviors would not be sufficient. In order to facilitate and reinforce practice changes to increase exercise-prescribing behaviors of primary care providers, results suggest the need for specific skill training on how to write an exercise prescription and motivate older adults to follow these prescriptions.

  11. To die, to sleep: US physicians' religious and other objections to physician-assisted suicide, terminal sedation, and withdrawal of life support.

    PubMed

    Curlin, Farr A; Nwodim, Chinyere; Vance, Jennifer L; Chin, Marshall H; Lantos, John D

    2008-01-01

    This study analyzes data from a national survey to estimate the proportion of physicians who currently object to physician-assisted suicide (PAS), terminal sedation (TS), and withdrawal of artificial life support (WLS), and to examine associations between such objections and physician ethnicity, religious characteristics, and experience caring for dying patients. Overall, 69% of the US physicians object to PAS, 18% to TS, and 5% to WLS. Highly religious physicians are more likely than those with low religiosity to object to both PAS (84% vs 55%, P < .001) and TS (25% vs 12%, P < .001). Objection to PAS or TS is also associated with being of Asian ethnicity, of Hindu religious affiliation, and having more experience caring for dying patients. These findings suggest that, with respect to morally contested interventions at the end of life, the medical care patients receive will vary based on their physicians' religious characteristics, ethnicity, and experience caring for dying patients.

  12. Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey.

    PubMed

    Chambaere, Kenneth; Bilsen, Johan; Cohen, Joachim; Onwuteaka-Philipsen, Bregje D; Mortier, Freddy; Deliens, Luc

    2010-06-15

    Legalization of euthanasia and physician-assisted suicide has been heavily debated in many countries. To help inform this debate, we describe the practices of euthanasia and assisted suicide, and the use of life-ending drugs without an explicit request from the patient, in Flanders, Belgium, where euthanasia is legal. We mailed a questionnaire regarding the use of life-ending drugs with or without explicit patient request to physicians who certified a representative sample (n = 6927) of death certificates of patients who died in Flanders between June and November 2007. The response rate was 58.4%. Overall, 208 deaths involving the use of life-ending drugs were reported: 142 (weighted prevalence 2.0%) were with an explicit patient request (euthanasia or assisted suicide) and 66 (weighted prevalence 1.8%) were without an explicit request. Euthanasia and assisted suicide mostly involved patients less than 80 years of age, those with cancer and those dying at home. Use of life-ending drugs without an explicit request mostly involved patients 80 years of older, those with a disease other than cancer and those in hospital. Of the deaths without an explicit request, the decision was not discussed with the patient in 77.9% of cases. Compared with assisted deaths with the patient's explicit request, those without an explicit request were more likely to have a shorter length of treatment of the terminal illness, to have cure as a goal of treatment in the last week, to have a shorter estimated time by which life was shortened and to involve the administration of opioids. Physician-assisted deaths with an explicit patient request (euthanasia and assisted suicide) and without an explicit request occurred in different patient groups and under different circumstances. Cases without an explicit request often involved patients whose diseases had unpredictable end-of-life trajectories. Although opioids were used in most of these cases, misconceptions seem to persist about their

  13. Euthanasia and physician-assisted suicide: knowledge, attitudes and experiences of nurses in Andalusia (Spain).

    PubMed

    Tamayo-Velázquez, María-Isabel; Simón-Lorda, Pablo; Cruz-Piqueras, Maite

    2012-09-01

    The aim of this study is to assess the knowledge, attitudes and experiences of Spanish nurses in relation to euthanasia and physician-assisted suicide. In an online questionnaire completed by 390 nurses from Andalusia, 59.1% adequately identified a euthanasia situation and 64.1% a situation involving physician-assisted suicide. Around 69% were aware that both practices were illegal in Spain, while 21.4% had received requests for euthanasia and a further 7.8% for assisted suicide. A total of 22.6% believed that cases of euthanasia had occurred in Spain and 11.4% believed the same for assisted suicide. There was greater support (70%) for legalisation of euthanasia than for assisted suicide (65%), combined with a greater predisposition towards carrying out euthanasia (54%), if it were to be legalised, than participating in assisted suicide (47.3%). Nurses in Andalusia should be offered more education about issues pertaining to the end of life, and extensive research into this area should be undertaken.

  14. Ethical considerations in the regulation of euthanasia and physician-assisted death in Canada.

    PubMed

    Landry, Joshua T; Foreman, Thomas; Kekewich, Michael

    2015-11-01

    On February 6th 2015 the Supreme Court of Canada (SCC) released their decision on Carter v Canada (Attorney General) to uphold a judgment from a lower court which determined that the current prohibition in Canada on physician-assisted dying violated the s. 7 [Charter of Rights and Freedoms] rights of competent adults whose medical condition causes intolerable suffering. The purpose of this piece is to briefly examine current regulations from Oregon (USA), Belgium, and the Netherlands, in which physician-assisted death and/or euthanasia is currently permitted, as well as from the province of Quebec which recently passed Bill-52, "An Act Respecting End-of-Life Care." We present ethical considerations that would be pertinent in the development of policies and regulations across Canada in light of this SCC decision: patient and provider autonomy, determining a relevant decision-making standard for practice, and explicating challenges with the SCC criteria for assisted-death eligibility with special consideration to the provision of assisted-death, and review of assisted-death cases. [It is not the goal of this paper to address all questions related to the regulation and policy development of euthanasia and assisted death in Canada, but rather to stimulate and guide the conversations in these areas for policy makers, professional bodies, and regulators.].

  15. Dignity, death, and dilemmas: a study of Washington hospices and physician-assisted death.

    PubMed

    Campbell, Courtney S; Black, Margaret A

    2014-01-01

    The legalization of physician-assisted death in states such as Washington and Oregon has presented defining ethical issues for hospice programs because up to 90% of terminally ill patients who use the state-regulated procedure to end their lives are enrolled in hospice care. The authors recently partnered with the Washington State Hospice and Palliative Care Organization to examine the policies developed by individual hospice programs on program and staff participation in the Washington Death with Dignity Act. This article sets a national and local context for the discussion of hospice involvement in physician-assisted death, summarizes the content of hospice policies in Washington State, and presents an analysis of these findings. The study reveals meaningful differences among hospice programs about the integrity and identity of hospice and hospice care, leading to different policies, values, understandings of the medical procedure, and caregiving practices. In particular, the authors found differences 1) in the language used by hospices to refer to the Washington statute that reflect differences among national organizations, 2) the values that hospice programs draw on to support their policies, 3) dilemmas created by requests by patients for hospice staff to be present at a patient's death, and 4) five primary levels of noninvolvement and participation by hospice programs in requests from patients for physician-assisted death. This analysis concludes with a framework of questions for developing a comprehensive hospice policy on involvement in physician-assisted death and to assist national, state, local, and personal reflection. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  16. Regional variation in the practice of euthanasia and physician-assisted suicide in the Netherlands.

    PubMed

    Koopman, J J E; Putter, H

    2016-11-01

    The practice of euthanasia and physicianassisted suicide has been compared between countries, but it has not been compared between regions within the Netherlands. This study assesses differences in the frequencies, characteristics, and trends of euthanasia and physician-assisted suicide between five regions in the Netherlands and tries to explain the differences by demographic, socioeconomic, and health-related differences between these regions. Data on the frequencies, characteristics, and trends of euthanasia and physician-assisted suicide for each region and each year from 2002 through 2014 were derived from the annual reports of the Regional Review Committees. Averages and trends were determined using a regression model with the regions and years as independent variables. Demographic, socioeconomic, and health-related variables for each region and each year were derived from the Central Bureau for Statistics and added to the model as covariates. The frequencies, characteristics, and trends of euthanasia and physician-assisted suicide differed between the regions, whereas the frequencies of non-assisted suicide did not differ. Euthanasia and physician-assisted suicide were most frequent and were performed most often by general practitioners, in patients with cancer, in the patient's home, in North Holland. The regional differences remained after adjustment for demographic, socioeconomic, and health-related differences between the regions. More detailed research is needed to specify how and why the practice of euthanasia and physicianassisted suicide differs between regions in the Netherlands and to what extent these differences reflect a deficiency in the quality of care, such as other forms of regional variation in health care practice.

  17. Parental Guidance Required: How Parents Could Help Reduce the Shortage of Minority Physician Assistants.

    PubMed

    Scarbrough, Amanda W; Xie, Yue; Shelton, Steve R

    2017-09-01

    Physician assistants (PAs) are essential to the health care system, and there are not nearly enough of them to meet the needs of our ethnically diverse population. Factors contributing to a lack of minorities in PA schools are related to academic performance, commitments outside work/school, and social and economic deprivation. From 2014 to 2016, the Texas Area Health Education Center East worked with the University of Texas Medical Branch at Galveston to implement Physician Assistant Learner Support programming. This program, targeting minority high school students, promoted and educated both students and parents about PA careers with the objective of alleviating one of the main barriers to minority higher education-lack of understanding of educational and career opportunities. This study found that parental knowledge about PA application requirements, PA degree requirements, financial aid, and career prospects at the high school level is essential to securing parental support of student selection of PA careers.

  18. Physician-assisted dying and two senses of an incurable condition.

    PubMed

    Varelius, Jukka

    2016-09-01

    It is commonly accepted that voluntary active euthanasia and physician-assisted suicide can be allowed, if at all, only in the cases of patients whose conditions are incurable. Yet, there are different understandings of when a patient's condition is incurable. In this article, I consider two understandings of the notion of an incurable condition that can be found in the recent debate on physician-assisted dying. According to one of them, a condition is incurable when it is known that there is no cure for it. According to the other, a condition is incurable when no cure is known to exist for it. I propose two criteria for assessing the conceptions and maintain that, in light of the criteria, the latter is more plausible than the former. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. Health Policy in Physician Assistant Education: Teaching Considerations and a Model Curriculum.

    PubMed

    Kidd, Vasco Deon; Cawley, James F; Kayingo, Gerald

    2016-03-01

    Recognition is growing within the medical academic community that future clinicians will need the tools to understand and influence health policy decisions. With the passage of the Patient Protection and Affordable Care Act of 2010, future clinicians will need not only clinical competence for successful practice but also an understanding of how health systems function. Although the fourth edition of the Accreditation Standards for Physician Assistant Education contains provisions and stipulations for the teaching of health topics in general and health policy specifically, physician assistant (PA) educators retain little consensus regarding either learning objectives or specific rubrics for teaching these important concepts. In this article, we discuss approaches for teaching health policy, delineate useful educational resources for PA faculty, and propose a model curriculum.

  20. The relationship between physician assistant program costs and student tuition and fees.

    PubMed

    Essary, Alison; Wallace, Lisa; Asprey, David

    2014-01-01

    Leaders in medical and physician assistant (PA) education are faced with reduced sources of funding, tuition increases, and enrollment expansion, while students compete for the same pool of federal aid. The amount of research on the cost of education for both PA students and education programs is minimal. This retrospective analysis of Physician Assistant Education Association (PAEA) data, 2008-2011, examined the relationship between PA program costs and student tuition and fees. Statistical analyses included descriptive and parametric testing. Analyses suggest that PA programs rely on student tuition and fees as a significant source of program revenue. Statistical significance was found for mean annual comparisons, 2008-2011. Based on trends in medical education, the burgeoning debt crisis among medical graduates, and rapid changes in the health care environment, it would benefit the PA community to complete additional research on student debt load, cost of education, and allocation of program revenue.

  1. Survey of doctors' opinions of the legalisation of physician assisted suicide

    PubMed Central

    Lee, William; Price, Annabel; Rayner, Lauren; Hotopf, Matthew

    2009-01-01

    Background Assisted dying has wide support among the general population but there is evidence that those providing care for the dying may be less supportive. Senior doctors would be involved in implementing the proposed change in the law. We aimed to measure support for legalising physician assisted dying in a representative sample of senior doctors in England and Wales, and to assess any association between doctors' characteristics and level of support for a change in the law. Methods We conducted a postal survey of 1000 consultants and general practitioners randomly selected from a commercially available database. The main outcome of interest was level of agreement with any change in the law to allow physician assisted suicide. Results The corrected participation rate was 50%. We analysed 372 questionnaires. Respondents' views were divided: 39% were in favour of a change to the law to allow assisted suicide, 49% opposed a change and 12% neither agreed nor disagreed. Doctors who reported caring for the dying were less likely to support a change in the law. Religious belief was also associated with opposition. Gender, specialty and years in post had no significant effect. Conclusion More senior doctors in England and Wales oppose any step towards the legalisation of assisted dying than support this. Doctors who care for the dying were more opposed. This has implications for the ease of implementation of recently proposed legislation. PMID:19261197

  2. The 1965 White House Conference on Health: inspiring the physician assistant movement.

    PubMed

    Hooker, Roderick S; Cawthon, Elisabeth A

    2015-10-01

    The 1965 White House Conference on Health brought together the best minds and the boldest ideas to deal with the nation's pressing health provider needs. The Community Health Clinics Act and the Duke University physician assistant (PA) program were among the many initiatives announced at this conference. The authors explore the conference proceedings, link them with other historical documents and events, and suggest that this conference was a contributing factor to the contemporary PA movement.

  3. Physician-assisted suicide and euthanasia: German Protestantism, conscience, and the limits of purely ethical reflection.

    PubMed

    Bartmann, Peter

    2003-01-01

    In this essay I shall describe and analyse the current debate on physician assisted suicide in contemporary German Protestant church and theology. It will be shown that the Protestant (mainly Lutheran) Church in Germany together with her Roman Catholic sister church has a specific and influential position in the public discussion: The two churches counting the majority of the population in Germany among their members tend to "organize" a social and political consensus on end-of-life questions. This cooperation is until now very successful: Speaking with one voice on end-of-life questions, the two churches function as the guardians of a moral consensus which is appreciated even by many non-believers. Behind this joint service to society the lines of the theological debate have to be ree-discovered. First it will be argued that a Protestant reading of the joint memoranda has to be based on the concept of individual conscience. The crucial questions are then: Whose conscience has the authority to decide? and: Can the physician assisted suicide be desired faithfully? Prominent in the current debate are Ulrich Eibach as a strict defender of the sanctity of life, and on the other side Walter Jens and Hans Kung, who argue for a right to physician assisted suicide under extreme conditions. I shall argue that it will be necessary to go beyond this actual controversy to the works of Gerhard Ebeling and Karl Barth for a clear and instructive account of conscience and a theological analysis of the concepts of life and suicide. On the basis of their considerations, a conscience-related approach to physician assisted suicide is developed.

  4. Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care.

    PubMed

    Radbruch, Lukas; Leget, Carlo; Bahr, Patrick; Müller-Busch, Christof; Ellershaw, John; de Conno, Franco; Vanden Berghe, Paul

    2016-02-01

    In recognition of the ongoing discussion on euthanasia and physician-assisted suicide, the Board of Directors of the European Association for Palliative Care commissioned this white paper from the palliative care perspective. This white paper aims to provide an ethical framework for palliative care professionals on euthanasia and physician-assisted suicide. It also aims to provide an overview on the available evidence as well as a discourse of ethical principles related to these issues. Starting from a 2003 European Association for Palliative Care position paper, 21 statements were drafted and submitted to a five-round Delphi process A panel with 17 experts commented on the paper in round 1. Board members of national palliative care or hospice associations that are collective members of European Association for Palliative Care were invited to an online survey in rounds 2 and 3. The expert panel and the European Association for Palliative Care board members participated in rounds 4 and 5. This final version was adopted as an official position paper of the European Association for Palliative Care in April 2015. Main topics of the white paper are concepts and definitions of palliative care, its values and philosophy, euthanasia and physician-assisted suicide, key issues on the patient and the organizational level. The consensus process confirmed the 2003 European Association for Palliative Care white paper and its position on the relationship between palliative care and euthanasia and physician-assisted suicide. The European Association for Palliative Care feels that it is important to contribute to informed public debates on these issues. Complete consensus seems to be unachievable due to incompatible normative frameworks that clash. © The Author(s) 2015.

  5. Physician-assisted suicide, euthanasia and palliative sedation: attitudes and knowledge of medical students

    PubMed Central

    Anneser, Johanna; Jox, Ralf J.; Thurn, Tamara; Borasio, Gian Domenico

    2016-01-01

    Objectives: In November 2015, the German Federal Parliament voted on a new legal regulation regarding assisted suicide. It was decided to amend the German Criminal Code so that any “regular, repetitive offer” (even on a non-profit basis) of assistance in suicide would now be considered a punishable offense. On July 2, 2015, a date which happened to be accompanied by great media interest in that it was the day that the first draft of said law was presented to Parliament, we surveyed 4th year medical students at the Technical University Munich on “physician-assisted suicide,” “euthanasia” and “palliative sedation,” based on a fictitious case vignette study. Method: The vignette study described two versions of a case in which a patient suffered from a nasopharyngeal carcinoma (physical suffering subjectively perceived as being unbearable vs. emotional suffering). The students were asked about the current legal norms for each respective course of action as well as their attitudes towards the ethical acceptability of these measures. Results: Out of 301 students in total, 241 (80%) participated in the survey; 109 answered the version 1 questionnaire (physical suffering) and 132 answered the version 2 questionnaire (emotional suffering). The majority of students were able to assess the currently prevailing legal norms on palliative sedation (legal) and euthanasia (illegal) correctly (81.2% and 93.7%, respectively), while only a few students knew that physician-assisted suicide, at that point in time, did not constitute a criminal offense. In the case study that was presented, 83.3% of the participants considered palliative sedation and the simultaneous withholding of artificial nutrition and hydration as ethically acceptable, 51.2% considered physician-assisted suicide ethically legitimate, and 19.2% considered euthanasia ethically permissible. When comparing the results of versions 1 and 2, a significant difference could only be seen in the assessment of

  6. Physician-assisted Suicide and Euthanasia in Indian Context: Sooner or Later the Need to Ponder!

    PubMed

    Khan, Farooq; Tadros, George

    2013-01-01

    Physician-assisted suicide (PAS) is a controversial subject which has recently captured the interest of media, public, politicians, and medical profession. Although active euthanasia and PAS are illegal in most parts of the world, with the exception of Switzerland and the Netherlands, there is pressure from some politicians and patient support groups to legalize this practice in and around Europe that could possibly affect many parts of the world. The legal status of PAS and euthanasia in India lies in the Indian Penal Code, which deals with the issues of euthanasia, both active and passive, and also PAS. According to Penal Code 1860, active euthanasia is an offence under Section 302 (punishment for murder) or at least under Section 304 (punishment for culpable homicide not amounting to murder). The difference between euthanasia and physician assisted death lies in who administers the lethal dose; in euthanasia, this is done by a doctor or by a third person, whereas in physician-assisted death, this is done by the patient himself. Various religions and their aspects on suicide, PAS, and euthanasia are discussed. People argue that hospitals do not pay attention to patients' wishes, especially when they are suffering from terminally ill, crippling, and non-responding medical conditions. This is bound to change with the new laws, which might be implemented if PAS is legalized. This issue is becoming relevant to psychiatrists as they need to deal with mental capacity issues all the time.

  7. Physician-assisted Suicide and Euthanasia in Indian Context: Sooner or Later the Need to Ponder!

    PubMed Central

    Khan, Farooq; Tadros, George

    2013-01-01

    Physician-assisted suicide (PAS) is a controversial subject which has recently captured the interest of media, public, politicians, and medical profession. Although active euthanasia and PAS are illegal in most parts of the world, with the exception of Switzerland and the Netherlands, there is pressure from some politicians and patient support groups to legalize this practice in and around Europe that could possibly affect many parts of the world. The legal status of PAS and euthanasia in India lies in the Indian Penal Code, which deals with the issues of euthanasia, both active and passive, and also PAS. According to Penal Code 1860, active euthanasia is an offence under Section 302 (punishment for murder) or at least under Section 304 (punishment for culpable homicide not amounting to murder). The difference between euthanasia and physician assisted death lies in who administers the lethal dose; in euthanasia, this is done by a doctor or by a third person, whereas in physician-assisted death, this is done by the patient himself. Various religions and their aspects on suicide, PAS, and euthanasia are discussed. People argue that hospitals do not pay attention to patients’ wishes, especially when they are suffering from terminally ill, crippling, and non-responding medical conditions. This is bound to change with the new laws, which might be implemented if PAS is legalized. This issue is becoming relevant to psychiatrists as they need to deal with mental capacity issues all the time. PMID:23833354

  8. Continuous sedation until death as physician-assisted suicide/euthanasia: a conceptual analysis.

    PubMed

    Lipuma, Samuel H

    2013-04-01

    A distinction is commonly drawn between continuous sedation until death and physician-assisted suicide/euthanasia. Only the latter is found to involve killing, whereas the former eludes such characterization. I argue that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia in that both involve killing. This is established by first defining and clarifying palliative sedation therapies in general and continuous sedation until death in particular. A case study analysis and a look at current practices are provided. This is followed by a defense of arguments in favor of definitions of death centering on higher brain (neocortical) functioning rather than on whole brain or cardiopulmonary functioning. It is then shown that continuous sedation until death simulates higher brain definitions of death by eliminating consciousness. Appeals to reversibility and double effect fail to establish any distinguishing characteristics between the simulation of death that occurs in continuous sedation until death and the death that occurs as a result of physician-assisted suicide/euthanasia. Concluding remarks clarify the moral ramifications of these findings.

  9. Physician-assisted suicide: a review of the literature concerning practical and clinical implications for UK doctors

    PubMed Central

    Hicks, Madelyn Hsiao-Rei

    2006-01-01

    Background A bill to legalize physician-assisted suicide in the UK recently made significant progress in the British House of Lords and will be reintroduced in the future. Until now there has been little discussion of the clinical implications of physician-assisted suicide for the UK. This paper describes problematical issues that became apparent from a review of the medical and psychiatric literature as to the potential effects of legalized physician-assisted suicide. Discussion Most deaths by physician-assisted suicide are likely to occur for the illness of cancer and in the elderly. GPs will deal with most requests for assisted suicide. The UK is likely to have proportionately more PAS deaths than Oregon due to the bill's wider application to individuals with more severe physical disabilities. Evidence from other countries has shown that coercion and unconscious motivations on the part of patients and doctors in the form of transference and countertransference contribute to the misapplication of physician-assisted suicide. Depression influences requests for hastened death in terminally ill patients, but is often under-recognized or dismissed by doctors, some of whom proceed with assisted death anyway. Psychiatric evaluations, though helpful, do not solve these problems. Safeguards that are incorporated into physician-assisted suicide criteria probably decrease but do not prevent its misapplication. Summary The UK is likely to face significant clinical problems arising from physician-assisted suicide if it is legalized. Terminally ill patients with mental illness, especially depression, are particularly vulnerable to the misapplication of physician-assisted suicide despite guidelines and safeguards. PMID:16792812

  10. Physician Assistants

    MedlinePlus

    ... More Sources of Data Publications Latest Publications » The Economics Daily Monthly Labor Review Beyond the Numbers Spotlight ... of Methods Research Papers Copyright Information Contact & Help Economic Releases Latest Releases » Major Economic Indicators » Schedules for ...

  11. Comparing oncologist, nurse, and physician assistant attitudes toward discussions of negative emotions with patients.

    PubMed

    Morgan, Perri A; de Oliveira, Justine Strand; Alexander, Stewart C; Pollak, Kathryn I; Jeffreys, Amy S; Olsen, Maren K; Olson, Maren K; Arnold, Robert M; Abernethy, Amy P; Rodriguez, Keri L; Rodrigues, Keri L; Tulsky, James A

    2010-01-01

    Although research shows that empathic communication improves patient outcomes, physicians often fail to respond empathically to patients. Nurses and physician assistants (PAs) may be able to help fill the need for empathic communication. Our study compares the attitudes of oncologists, nurses, and PAs toward communication with patients who demonstrate negative emotions. We analyzed surveys from 48 oncologists, 26 PAs, and 22 nurses who participated in the Studying Communication in Oncologist-Patient Encounters trial. Surveys included previously validated items that examined attitudes toward communication with patients about emotion. The mean age of oncology physicians was higher (49 years) than that of PAs (40 years) or nurses (43 years), and 19% of physicians, 81% of PAs, and 100% of nurses were female. Race, years of oncology experience, and previous communication training were similar across provider types. Most nurses (82%) and PAs (68%) described themselves as having a socioemotional orientation, while most oncologists (70%) reported a technological/scientific orientation (p < .0001). PAs and nurses indicated more comfort with psychosocial talk than did oncologists (p < .0001). Discomfort with disclosing uncertainty and provider confidence and expectations when addressing patient concerns were similar across provider types. PAs and nurses were more oriented toward socioemotional aspects of medicine and were more comfortable with psychosocial talk than were oncologists. Future studies should examine whether these differences are attributable to other factors, including gender, and whether nurses and PAs are more likely than physicians to demonstrate empathic behaviors when patients express negative emotions.

  12. Continuous deep sedation, physician-assisted suicide, and euthanasia in Huntington's disorder.

    PubMed

    Lindblad, Anna; Juth, Niklas; Fürst, Carl Johan; Lynöe, Niels

    2010-11-01

    To investigate the attitudes among Swedish physicians and the general public towards continuous deep sedation (CDS) as an alternative treatment for a competent, not imminently dying patient with Huntington's disorder requesting physician-assisted suicide (PAS) and euthanasia. A questionnaire was distributed to 1200 physicians in Sweden and 1201 individuals in Stockholm. It consisted of three parts: 1) A vignette about a competent patient with Huntington's disease requesting PAS. When no longer competent, relatives request euthanasia on behalf of the patient. Responders were asked about their attitudes towards these requests and whether CDS would be an acceptable alternative. 2) General questions about PAS and euthanasia. 3) Background variables. The response rate was 56% (physicians) and 52% (general public). The majority of the general public and a fairly large proportion of physicians reported more liberal views on CDS than are expressed in current Swedish and international recommendations. In light of the results, we suggest that there is a need for a broader discussion about the recommendations for CDS, with a special focus on the needs of patients with progressive neurodegenerative disorders.

  13. Granted, undecided, withdrawn, and refused requests for euthanasia and physician-assisted suicide.

    PubMed

    Jansen-van der Weide, Marijke C; Onwuteaka-Philipsen, Bregje D; van der Wal, Gerrit

    The aims of this study were to obtain information about the characteristics of requests for euthanasia and physician-assisted suicide (EAS) and to distinguish among different types of situations that can arise between the request and the physician's decision. All general practitioners in 18 of the 23 Dutch general practitioner districts received a written questionnaire in which they were asked to describe the most recent request for EAS they received. A total of 3614 general practitioners responded to the questionnaire (response rate, 60%). Of all explicit requests for EAS, 44% resulted in EAS. In the other cases the patient died before the performance (13%) or finalization of the decision making (13%), the patient withdrew the request (13%), or the physician refused the request (12%). Patients' most prominent symptoms were "feeling bad," "tiredness," and "lack of appetite." The most frequently mentioned reasons for requesting EAS were "pointless suffering," "loss of dignity," and "weakness." The patients' situation met the official requirements for accepted practice best in requests that resulted in EAS and least in refused requests. A lesser degree of competence and less unbearable and hopeless suffering had the strongest associations with the refusal of a request. The complexity of EAS decision making is reflected in the fact that besides granting and refusing a request, 3 other situations could be distinguished. The decisions physicians make, the reasons they have for their decisions, and the way they arrived at their decisions seem to be based on patient evaluations. Physicians report compliance with the official requirements for accepted practice.

  14. Physicians', Nurses', and Medical Assistants' Perceptions of the Human Papillomavirus Vaccine in a Large Integrated Health Care System.

    PubMed

    Mills, Jordan; Van Winkle, Patrick; Shen, Macy; Hong, Christina; Hudson, Sharon

    2016-01-01

    Vaccination against the human papillomavirus (HPV) decreases risks of cancer and genital warts and the need for gynecologic procedures, yet nationwide vaccination rates are low. Previous surveys exploring this phenomenon have not included input from nurses and medical assistants, who play integral roles in HPV vaccine delivery. To understand perceptions of HPV vaccine delivery among physicians, nurses, and medical assistants in a large integrated health care system in Southern California. Online surveys were sent to 13 nurse administrators and 75 physicians. Physicians were instructed to forward the survey to nurses and medical assistants with whom they work. A total of 76 surveys were completed, consisting of 52 physicians, 16 clinical nurses and medical assistants, and 8 nurse administrators. Physicians' perceptions of vaccine safety or strength of recommendation did not differ by specialty department. Physicians reportedly perceived the HPV vaccine as safer than did clinical nurses and medical assistants (p < 0.001), who indicated they wanted more education on the safety and efficacy of the vaccine before being comfortable strongly recommending it. Respondents advised that all clinicians could improve in their roles as HPV vaccine advocates through patient counseling and providing informational literature and that workflow standardization was needed to minimize missed vaccination opportunities. Physicians reportedly perceive the HPV vaccine as safer compared with nurses and medical assistants. Both groups think that more education of nonphysician staff is needed. Having proper systems in place is also vital to improving vaccination compliance.

  15. Interdisciplinary communication and collaboration among physicians, nurses, and unlicensed assistive personnel.

    PubMed

    Lancaster, Gwendolyn; Kolakowsky-Hayner, Stephanie; Kovacich, Joann; Greer-Williams, Nancy

    2015-05-01

    Historically, health care has primarily focused on physician, nurse, and allied healthcare provider triads. Using a phenomenological approach, this study explores the potential for hospital-based interdisciplinary care provided by physicians, nurses, and unlicensed assistive personnel (UAPs). This phenomenological study used a purposive nonprobability, criterion-based, convenience sample from a metropolitan hospital. Malhotra's (1981) Schutzian lifeworld phenomenological orchestra study provided the theoretical basis for the conductorless orchestra model, which guided this study. In an orchestra, each member sees and hears the musical score from a different vantage point or perspective and has a different stock of knowledge or talent; however, members work together to produce a cohesive performance. Like the orchestra, individual talents and perspectives of physicians, nurses, and UAPs can be collaboratively blended to create a symphony: enhanced patient-centered care. Qualitative semistructured face-to-face, individual interviews were carefully transcribed and coded with the aid of NVivo 9, a qualitative data analysis software program, to discover emergent patterns and themes. The study suggests that most of the time physicians, nurses, and UAPs operate as separate healthcare providers who barely speak to each other. Physicians see themselves as the primary patient care decision makers. Many physicians acknowledge the importance of nurses' knowledge and expertise. On the other hand, the study indicates a hierarchical, subservient relationship among nurses and UAPs. Physicians and nurses tend to work together or consult each other at times, but UAPs are rarely included in any type of meaningful patient discussion. Since physicians, nurses, and UAPs each provide portions of patient care, coordination of the various treatments and interventions provided is critical to prevent errors and fragmentation of care. Tensions, misunderstandings, and conflicts caused by

  16. A "suicide pill" for older people: attitudes of physicians, the general population, and relatives of patients who died after euthanasia or physician-assisted suicide in The Netherlands.

    PubMed

    Rurup, Mette L; Onwuteaka-Philipsen, Bregje D; Van Der Wal, Gerrit

    2005-01-01

    In the Netherlands there has been ongoing debate in the past 10 years about the availability of a hypothetical "suicide pill", with which older people could end their life in a dignified way if they so wished. Data on attitudes to the suicide pill were collected in the Netherlands from 410 physicians, 1,379 members of the general population, and 87 relatives of patients who died after euthanasia or physician-assisted suicide. The general population and relatives were more in favor than physicians. Fifteen percent of the general population and 36% of the relatives thought a suicide pill should be made available.

  17. Attitudes of consultation-liaison psychiatrists toward physician-assisted death practices.

    PubMed

    Roberts, L W; Muskin, P R; Warner, T D; McCarty, T; Roberts, B B; Fidler, D C

    1997-01-01

    The objective of this study was to investigate the views of consultation-liaison (C-L) psychiatrists on assisted-death practices. A 33-question anonymous survey was distributed at the Academy of Psychosomatic Medicine Annual Meeting in November 1995. The instrument explored perceptions of acceptability of assisted death in six hypothetical patient situations as performed by four possible agents. The response rate was 48% (184 conference attendees participated, i.e., completed and returned the surveys). With little variability, the respondents were unwilling to perform assisted death personally and also did not support assisted death as performed by nonphysicians. The respondents were somewhat more accepting of referral or other physicians' involvement in such practices. Assisted death was viewed differently than withdrawal of life support. Several variables were analyzed for their influences on the views expressed. The C-L psychiatrists in this study expressed opposition to assisted death practices. Their views varied somewhat depending on the patient vignette and the agent of death assistance. The authors conclude that C-L psychiatrists may wish to develop their present therapeutic and evaluative role in patient care to alleviate suffering, without hastening patient death.

  18. What Do Physician Assistant Students Know About Nutrition? A Survey of Attitudes, Self-Perceived Proficiency, and Knowledge During Three Stages of Physician Assistant Education.

    PubMed

    Favia, Megan; Moore, Amy; Kelly, Patrick; Werner, Christine

    2016-08-03

    This study applied a cross-sectional design and analyzed the nutrition knowledge and attitudes of physician assistant (PA) students during 3 stages of PA education. The PA students from the class of 2014, 2015, and 2016 attending a midwestern university were surveyed using Qualtrics. Descriptive statistics and analysis of variance tests were performed to determine the difference between the 3 cohorts on "previous nutrition knowledge," "attitudes," and "knowledge" subscores and total scores. A post hoc analysis was performed to determine the differences between groups. A statistically significant difference was found in the mean total score between classes, with the class of 2014 scoring 17 points higher on average than the class of 2016. These results suggest that positive nutrition attitudes and knowledge among PA students from this sample were lacking. This study suggests a possible need for revision of nutrition education provided by PA programs.

  19. [Physician Assisted Suicide - Survey on § 217 StGB in Germany].

    PubMed

    Zenz, Julia; Rissing-van Saan, Ruth; Zenz, Michael

    2017-03-01

    Background In late 2015, Germany passed a law (§ 217 StGB) prohibiting persons from aiding others in committing suicide on a regular, repetitive basis. Despite intensive societal debate and surveys about assisted dying, the present study was the first to examine attitudes towards the new legal regulation among professionals. Methods In early 2016, all participants of a congress on palliative care received a one-page anonymous questionnaire to complete until the end of the conference. The questionnaire consisted of questions regarding assisted suicide and the new law. The participants were asked to express their agreement or disagreement on a 4 to 5-point Likert scale. Results 457 questionnaires (48 %) were completed, 138 from physicians, 318 from nurses, 1 non specified. More than 80 % knew about the new law. Only half of the respondents supported it. 54 % felt that the law did not sufficiently differentiate between an illegal form of assisted suicide and a form exempt from prosecution. For more than 40 % the new law made no sense. Conclusion Professionals engaged in terminal care were reluctant to support a criminal liability of "business-like" physician-assisted suicide and suspected greater uncertainty among professionals in end of life care.

  20. [Terminal sedation: consultation with a second physician as is the case in euthanasia and assisted suicide].

    PubMed

    Ponsioen, B P; Schuurman, W H A Elink; van den Hurk, A J P M; van der Poel, B N M; Runia, E H

    2005-02-26

    In terminally-ill patients in the Netherlands deep sedation by means of a continuous subcutaneous infusion with midazolam occurs more frequently than euthanasia and assisted suicide. Deep terminal sedation is applied to relieve symptoms during the phase of dying, but in contrast to euthanasia and assisted suicide, does not hasten death. In three terminally-ill patients, a 65-year-old man suffering from pulmonary carcinoma, a 94-year-old woman with general malaise, nausea and anorexia, and a 79-year-old woman in the final stage of ovarian carcinoma, a general-practitioner advisor was consulted about an end-of-life decision--deep terminal sedation versus euthanasia or assisted suicide. The first two patients were given deep sedation until death, in both cases a day and a half later. The third patient's request for euthanasia was considered to meet the legal criteria for euthanasia. Compliance with the Dutch statutory criteria for due care in euthanasia and assisted suicide might also be helpful when deciding about terminal deep sedation, but the role and responsibility of the attending physician may differ. However, the radical effects of sedation on the terminally-ill patient and the rapid changes in the clinical situation of the patient when the decision to sedate is taken, both emphasize the need for consultation with another physician.

  1. Durability of Expanded Physician Assistant Training Positions Following the End of Health Resources and Services Administration Expansion of Physician Assistant Training Funding.

    PubMed

    Rolls, Joanne; Keahey, David

    2016-09-01

    The purpose of this study was to assess the number of Health Resources and Services Administration Expansion of Physician Assistant Training (EPAT)-funded physician assistant (PA) programs planning to maintain class size at expanded levels after grant funds expire and to report proposed financing methods. The 5-year EPAT grant expired in 2015, and the effect of this funding on creating a durable expansion of PA training seats has not yet been investigated. The study used an anonymous, 9-question, Web-based survey sent to the program directors at each of the PA programs that received EPAT funding. Data were analyzed in Excel and using SAS statistical analysis software for both simple percentages and for Fisher's exact test. The survey response rate was 81.48%. Eighty-two percent of responding programs indicated that they planned to maintain all expanded positions. Fourteen percent will revert to their previous student class size, and 4% will maintain a portion of the expanded positions. A majority of the 18 programs (66%) maintaining all EPAT seats will be funded by tuition pass-through, and one program (6%) will increase tuition. There was no statistical association between the program type and the decision to maintain expanded positions (P = .820). This study demonstrates that the one-time EPAT PA grant funding opportunity created a durable expansion in PA training seats. Future research should focus on the effectiveness of the program in increasing the number of graduates choosing to practice in primary care and the durability of expansion several years after funding expiration.

  2. Depression and suicide are natural kinds: implications for physician-assisted suicide.

    PubMed

    Tsou, Jonathan Y

    2013-01-01

    In this article, I argue that depression and suicide are natural kinds insofar as they are classes of abnormal behavior underwritten by sets of stable biological mechanisms. In particular, depression and suicide are neurobiological kinds characterized by disturbances in serotonin functioning that affect various brain areas (i.e., the amygdala, anterior cingulate, prefrontal cortex, and hippocampus). The significance of this argument is that the natural (biological) basis of depression and suicide allows for reliable projectable inferences (i.e., predictions) to be made about individual members of a kind. In the context of assisted suicide, inferences about the decision-making capacity of depressed individuals seeking physician-assisted suicide are of special interest. I examine evidence that depression can hamper the decision-making capacity of individuals seeking assisted suicide and discuss some implications.

  3. Legalisation of euthanasia or physician-assisted suicide: survey of doctors' attitudes.

    PubMed

    Seale, C

    2009-04-01

    This study reports UK doctors' opinions about legalisation of medically assisted dying (euthanasia and physician-assisted suicide), comparing this with the UK general public. A postal survey of 3733 UK medical practitioners was done. The majority of UK doctors are opposed to legalisation, contrasting with the UK general public. Palliative medicine specialists are particularly opposed. A strong religious belief is independently associated with opposition to assisted dying. Frequency of treating patients who die is not independently associated with attitudes. Many doctors supporting legalisation also express reservations and advocate safeguards; many doctors opposing legalisation believe and accept that treatment and nontreatment decisions may shorten life. It is hoped that future debates about legalisation can proceed with this evidence in mind.

  4. Physician assistants and nurse practitioners perform effective roles on teams caring for Medicare patients with diabetes.

    PubMed

    Everett, Christine; Thorpe, Carolyn; Palta, Mari; Carayon, Pascale; Bartels, Christie; Smith, Maureen A

    2013-11-01

    One approach to the patient-centered medical home, particularly for patients with chronic illnesses, is to include physician assistants (PAs) and nurse practitioners (NPs) on primary care teams. Using Medicare claims and electronic health record data from a large physician group, we compared outcomes for two groups of adult Medicare patients with diabetes whose conditions were at various levels of complexity: those whose care teams included PAs or NPs in various roles, and those who received care from physicians only. Outcomes were generally equivalent in thirteen comparisons. In four comparisons, outcomes were superior for the patients receiving care from PAs or NPs, but in three other comparisons the outcomes were superior for patients receiving care from physicians only. Specific roles performed by PAs and NPs were associated with different patterns in the measure of the quality of diabetes care and use of health care services. No role was best for all outcomes. Our findings suggest that patient characteristics, as well as patients' and organizations' goals, should be considered when determining when and how to deploy PAs and NPs on primary care teams. Accordingly, training and policy should continue to support role flexibility for these health professionals.

  5. Physician-assisted death: A Canada-wide survey of ALS health care providers.

    PubMed

    Abrahao, Agessandro; Downar, James; Pinto, Hanika; Dupré, Nicolas; Izenberg, Aaron; Kingston, William; Korngut, Lawrence; O'Connell, Colleen; Petrescu, Nicolae; Shoesmith, Christen; Tandon, Anu; Vargas-Santos, Ana Beatriz; Zinman, Lorne

    2016-09-13

    To survey amyotrophic lateral sclerosis (ALS) health care providers to determine attitudes regarding physician-assisted death (PAD) after the Supreme Court of Canada (SCC) invalidated the Criminal Code provisions that prohibit PAD in February 2015. We conducted a Canada-wide survey of physicians and allied health professionals (AHP) involved in the care of patients with ALS on their opinions regarding (1) the SCC ruling, (2) their willingness to participate in PAD, and (3) the PAD implementation process for patients with ALS. We received 231 responses from ALS health care providers representing all 15 academic ALS centers in Canada, with an overall response rate for invited participants of 74%. The majority of physicians and AHP agreed with the SCC ruling and believed that patients with moderate and severe stage ALS should have access to PAD; however, most physicians would not provide a lethal prescription or injection to an eligible patient. They preferred the patient obtain a second opinion to confirm eligibility, have a psychiatric assessment, and then be referred to a third party to administer PAD. The majority of respondents felt unprepared for the initiation of this program and favored the development of PAD training modules and guidelines. ALS health care providers support the SCC decision and the majority believe PAD should be available to patients with moderate to severe ALS with physical or emotional suffering. However, few clinicians are willing to directly provide PAD and additional training and guidelines are required before implementation in Canada. © 2016 American Academy of Neurology.

  6. The economic benefit for family/general medicine practices employing physician assistants.

    PubMed

    Grzybicki, Dana M; Sullivan, Paul J; Oppy, J Miller; Bethke, Anne-Marie; Raab, Stephen S

    2002-07-01

    To measure the economic benefit of a family/general medicine physician assistant (PA) practice. Qualitative description of a model PA practice in a family/general medicine practice office setting, and comparison of the financial productivity of a PA practice with that of a non-PA (physician-only) practice. The study site was a family/general medicine practice office in southwestern Pennsylvania. The description of PA practice was obtained through direct observation and semistructured interviews during site visits in 1998. Comparison of site practice characteristics with published national statistics was performed to confirm the site's usefulness as a model practice. Data used for PA productivity analyses were obtained from site visits, interviews, office billing records, office appointment logs, and national organizations. The PA in the model practice had a same-task substitution ratio of 0.86 compared with the supervising physician. The PA was economically beneficial for the practice, with a compensation-to-production ratio of 0.36. Compared with a practice employing a full-time physician, the annual financial differential of a practice employing a full-time PA was $52,592. Sensitivity analyses illustrated the economic benefit of a PA practice in a variety of theoretical family/general medicine practice office settings. Family/general medicine PAs are of significant economic benefit to practices that employ them.

  7. The last phase of life: who requests and who receives euthanasia or physician-assisted suicide?

    PubMed

    Onwuteaka-Philipsen, Bregje D; Rurup, Mette L; Pasman, H Roeline W; van der Heide, Agnes

    2010-07-01

    When suffering becomes unbearable for patients they might request for euthanasia. To study which patients request for euthanasia and which requests actually resulted in euthanasia in relation with diagnosis, care setting at the end of life, and patient demographics. A cross-sectional study covering all Dutch health care settings. In 2005, of death certificates of deceased persons, a stratified sample was derived from the Netherlands central death registry. The attending physician received a written questionnaire (n = 6860; response 78%). If deaths were reported to have been nonsudden, the attending physician filled in a 4-page questionnaire on end-of-life decision-making. Data regarding the deceased person's age, sex, marital status, and cause of death were derived from the death certificate. Of patients whose death was nonsudden, 7% explicitly requested for euthanasia. In about two thirds, the request did not lead to euthanasia or physician-assisted suicide being performed, in 39% because the patient died before the request could be granted and in 38% because the physician thought the criteria for due care were not met. Factors positively associated with a patient requesting for euthanasia are (young) age, diagnosis (cancer, nervous system), place of death (home), and involvement of palliative teams and psychiatrist in care. Diagnosis and place of death are also associated with requests resulting in euthanasia. Only a minority of patients request euthanasia at the end of life and of these requests a majority is not granted. Careful decision-making is necessary in all requests for euthanasia.

  8. Veterinary surgeons' attitudes towards physician-assisted suicide: an empirical study of Swedish experts on euthanasia.

    PubMed

    Lerner, Henrik; Lindblad, Anna; Algers, Bo; Lynöe, Niels

    2011-05-01

    To examine the hypothesis that knowledge about physician-assisted suicide (PAS) and euthanasia is associated with a more restrictive attitude towards PAS. A questionnaire about attitudes towards PAS, including prioritization of arguments pro and contra, was sent to Swedish veterinary surgeons. The results were compared with those from similar surveys of attitudes among the general public and physicians. All veterinary surgeons who were members of the Swedish Veterinary Association and had provided an email address (n=2421). Similarities or differences in response pattern between veterinary surgeons, physicians and the general public. The response pattern among veterinary surgeons and the general public was almost similar in all relevant aspects. Of the veterinarians 75% (95% CI 72% to 78%) were in favour of PAS, compared with 73% (95% CI 69% to 77%) among the general public. Only 10% (95% CI 5% to 15%) of the veterinary surgeons were against PAS, compared with 12% (95% CI 5% to 19%) among the general public. Finally, 15% (95% CI 10% to 21%) of veterinarians were undecided, compared with 15% (95% CI 8% to 22%) among the general public. Physicians had a more restrictive attitude to PAS than the general public. Since veterinary surgeons have frequent practical experience of euthanasia in animals, they do have knowledge about what euthanasia really is. Veterinary surgeons and the general public had an almost similar response pattern. Accordingly it seems difficult to maintain that knowledge about euthanasia is unambiguously associated with a restrictive attitude towards PAS.

  9. Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey

    PubMed Central

    Chambaere, Kenneth; Bilsen, Johan; Cohen, Joachim; Onwuteaka-Philipsen, Bregje D.; Mortier, Freddy; Deliens, Luc

    2010-01-01

    Background Legalization of euthanasia and physician-assisted suicide has been heavily debated in many countries. To help inform this debate, we describe the practices of euthanasia and assisted suicide, and the use of life-ending drugs without an explicit request from the patient, in Flanders, Belgium, where euthanasia is legal. Methods We mailed a questionnaire regarding the use of life-ending drugs with or without explicit patient request to physicians who certified a representative sample (n = 6927) of death certificates of patients who died in Flanders between June and November 2007. Results The response rate was 58.4%. Overall, 208 deaths involving the use of life-ending drugs were reported: 142 (weighted prevalence 2.0%) were with an explicit patient request (euthanasia or assisted suicide) and 66 (weighted prevalence 1.8%) were without an explicit request. Euthanasia and assisted suicide mostly involved patients less than 80 years of age, those with cancer and those dying at home. Use of life-ending drugs without an explicit request mostly involved patients 80 years of older, those with a disease other than cancer and those in hospital. Of the deaths without an explicit request, the decision was not discussed with the patient in 77.9% of cases. Compared with assisted deaths with the patient’s explicit request, those without an explicit request were more likely to have a shorter length of treatment of the terminal illness, to have cure as a goal of treatment in the last week, to have a shorter estimated time by which life was shortened and to involve the administration of opioids. Interpretation Physician-assisted deaths with an explicit patient request (euthanasia and assisted suicide) and without an explicit request occurred in different patient groups and under different circumstances. Cases without an explicit request often involved patients whose diseases had unpredictable end-of-life trajectories. Although opioids were used in most of these cases

  10. [Granted, undecided, withdrawn and refused requests for euthanasia and physician-assisted suicide in the Netherlands; 2000-2002].

    PubMed

    Onwuteaka-Philipsen, B D; Jansen-Van der Weide, M C; Van der Wal, G

    2006-02-04

    To determine the characteristics of patients who request euthanasia or physician-assisted suicide and whether these characteristics differ among those whose request is granted, those who die before the procedure, those who die before completion of the approval process, those who withdraw their request, and lastly, those whose request is refused by the physician. Questionnaire study. All general practitioners in 18 of the 23 Dutch general practitioner districts received a written questionnaire in which they were asked to describe the most recent request for euthanasia or physician-assisted suicide that they had received (response 60%, n=3614). Of all explicit requests, 44% resulted in euthanasia or physician-assisted suicide. Thirteen percent of patients died before the procedure, 13% died before completion of the approval process, 13% withdrew their request and 12% were refused by the physician. The most prominent symptoms were 'feeling bad', 'tiredness', and 'lack of appetite'. The most frequently mentioned reasons for requesting euthanasia or physician-assisted suicide were 'pointless suffering', 'loss of dignity', and 'general weakness'. The patients' situation met the official requirements for accepted practice best in the group of requests that resulted in euthanasia or physician-assisted suicide and least in the group of refused requests. A lesser degree of competence and less unbearable and hopeless suffering had the strongest associations with the refusal of a request. The complexity of euthanasia or physician-assisted suicide decision-making is reflected in the fact that, besides granting and refusing a request, 3 other situations could be distinguished. The decisions physicians made, the reasons for their decisions and the way they arrived at their decisions appeared to be based on patient evaluations and on the official requirements for accepted practice.

  11. Palliative care professionals' willingness to perform euthanasia or physician assisted suicide.

    PubMed

    Zenz, Julia; Tryba, Michael; Zenz, Michael

    2015-11-14

    Euthanasia and physician assisted suicide (PAS) are highly debated upon particularly in the light of medical advancement and an aging society. Little is known about the professionals' willingness to perform these practices particularly among those engaged in the field of palliative care and pain management. Thus a study was performed among those professionals. An anonymous questionnaire was handed out to all participants of a palliative care congress and a pain symposium in 2013. The questionnaire consisted of 8 questions regarding end of life decisions. Proposed patient vignettes were used. A total of 470 eligible questionnaires were returned, 198 by physicians, 272 by nurses. The response rate was 64 %. The majority of professionals were reluctant to perform euthanasia or PAS: 5.3 % of the respondents would be willing to perform euthanasia on a patient with a terminal illness if asked to do so. The reluctance grew in case of a patient with a non-terminal illness. The respondents were more willing to perform PAS than euthanasia. Nurses were more reluctant to take action as opposed to the physicians. The majority of the respondents would attempt to treat the patient's symptoms first before considering life-ending measures. As regards any decision making process the majority would consult with a colleague. This is the first German study to ask about the willingness of professionals to take action as regards euthanasia and PAS without biased phrasing. As opposed to the general acceptance that is respectively high, the actual willingness to perform life-ending measures is low. The German debate on physician assisted suicide and its possible legalization should also incorporate clarifications regarding the responsibility who should eventually perform these acts.

  12. Suffering and medicalization at the end of life: The case of physician-assisted dying.

    PubMed

    Karsoho, Hadi; Fishman, Jennifer R; Wright, David Kenneth; Macdonald, Mary Ellen

    2016-12-01

    'Suffering' is a central discursive trope for the right-to-die movement. In this article, we ask how proponents of physician-assisted dying (PAD) articulate suffering with the role of medicine at the end of life within the context of a decriminalization and legalization debate. We draw upon empirical data from our study of Carter v. Canada, the landmark court case that decriminalized PAD in Canada in 2015. We conducted in-depth interviews with 42 key participants of the case and collected over 4000 pages of legal documents generated by the case. In our analysis of the data, we show the different ways proponents construct relationships between suffering, mainstream curative medicine, palliative care, and assisted dying. Proponents see curative medicine as complicit in the production of suffering at the end of life; they lament a cultural context wherein life-prolongation is the moral imperative of physicians who are paternalistic and death-denying. Proponents further limit palliative care's ability to alleviate suffering at the end of life and even go so far as to claim that in some instances, palliative care produces suffering. Proponents' articulation of suffering with both mainstream medicine and palliative care might suggest an outright rejection of a place for medicine at the end of life. We further find, however, that proponents insist on the involvement of physicians in assisted dying. Proponents emphasize how a request for PAD can set in motion an interactive therapeutic process that alleviates suffering at the end of life. We argue that the proponents' articulation of suffering with the role of medicine at the end of life should be understood as a discourse through which one configuration of end-of-life care comes to be accepted and another rejected, a discourse that ultimately does not challenge, but makes productive use of the larger framework of the medicalization of dying. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  13. Patient, Physician, Medical Assistant, and Office Visit Factors Associated With Medication List Agreement.

    PubMed

    Reedy, Alexis Benavides; Yeh, Jun Yun; Nowacki, Amy S; Hickner, John

    2016-03-01

    Despite its importance for patient safety, there have been few studies of medication reconciliation in primary care. Our goal was to identify potential patient, physician, medical assistant (MA), and office visit factors associated with accurate medication lists in Cleveland Clinic primary care practices. Physician and MA medication reconciliation activities were directly observed during office visits. The primary outcome was agreement between the electronic medical record medication list at the conclusion of the office visit and what the patients said they were actually taking, assessed by structured telephone interview within 2 weeks of the office visit. Medication list agreement was defined as the absence of any discrepancies in name, dose, frequency, route, and as-needed status. Associations between patient, physician, MA, and office visit factors and medication list accuracy were assessed using χ2 tests and logistic regression. Twenty-four physicians and 33 MAs were observed during 231 patient encounters. Nineteen patients (8%) could not be contacted for the telephone interview and were excluded from the analysis. Thirty-two patients (15%) had perfect medication list agreement for prescription and nonprescription medications, and 66 patients (31%) had medication list agreement for prescription medications only. Of the 14 patient, physician, and MA medication reconciliation behaviors examined, only 1, in which the MA begins the medication review with an open-ended question, was significantly associated with a medication list in agreement (odds ratio, 2.96; confidence interval, 1.43-6.09) for prescription and nonprescription medications. This association was not significant when only prescription medications were included (odds ratio, 0.90; confidence interval, 0.43-1.91). No behaviors we observed significantly influenced prescription medication list agreement. Having MAs begin their medication review with an open-ended question may be a simple, inexpensive

  14. The role of and challenges for psychologists in physician assisted suicide.

    PubMed

    Johnson, Shara M; Cramer, Robert J; Conroy, Mary Alice; Gardner, Brett O

    2014-01-01

    Physician assisted suicide (PAS) poses complex legal and ethical dilemmas for practicing psychologists. Since the passage of the Oregon Death with Dignity Act in 1997, Montana and Washington have passed similar legislation. Despite the law requiring competence evaluations by medical and psychological professionals, existing psycholegal literature inadequately addresses the role of psychologists in the PAS process. This article reviews legal statutes and analyzes ethical dilemmas psychologists may face if involved. We consider competence both generally and in the context of PAS. Suggestions are made for psychologists completing competence assessments and future directions to improve competence assessments for PAS are provided.

  15. Kansas physician assistants' attitudes and beliefs regarding spirituality and religiosity in patient care.

    PubMed

    Berg, Gina M; Crowe, Robin E; Budke, Ginny; Norman, Jennifer; Swick, Valerie; Nyberg, Sue; Lee, Felecia

    2013-09-01

    Research indicates patients want to discuss spirituality/religious (S/R) beliefs with their healthcare provider. This was a cross-sectional study of Kansas physician assistants (PA) regarding S/R in patient care. Surveys included questions about personal S/R beliefs and attitudes about S/R in patient care. Self-reported religious respondents agreed (92%) they should be aware of patient S/R; 82% agreed they should address it. Agreement with incorporating S/R increased significantly based on patient acuity. This research indicates Kansas PAs' personal S/R beliefs influence their attitudes toward awareness and addressing patient S/R.

  16. Integrating cultural competency throughout a first-year physician assistant curriculum steadily improves cultural awareness.

    PubMed

    Beck, Barbra; Scheel, Matthew H; De Oliveira, Kathleen; Hopp, Jane

    2013-01-01

    This study tracked student self-assessments of cultural awareness at regular intervals during the first year of a master's of science physician assistant (PA) program to test effectiveness of a cultural competency component in the curriculum. Students completed a cultural awareness survey at the beginning of the program and retook the survey at approximately 4-month intervals throughout the first year. Regression analyses confirmed positive linear relationships between survey number and score on 31 of 31 items. Cultural awareness among PA students benefits from repeated exposures to lessons on cultural competency. Schools attempting to develop or expand cultural awareness among students should consider presenting material in multiple courses across terms.

  17. Radical or routine? Nurse practitioners, nurse-midwives, and physician assistants as abortion providers.

    PubMed

    Freedman, Lori; Battistelli, Molly Frances; Gerdts, Caitlin; McLemore, Monica

    2015-05-01

    In 2013 California passed legislation that expanded the pool of eligible aspiration abortion providers to include advanced practice nurses, nurse-midwives, and physician-assistants. This law, enacted in 2014, is based on evidence generated by the Health Workforce Pilot Project #171, which examined the safety and effectiveness of aspiration abortion care provided by these clinicians as well as patient acceptability and satisfaction. This evidence and the resulting policy change build on international research and established workforce strategies used to expand access to safe abortion services for women worldwide, representing a radical departure from the legislative trend of constricting access in the United States. Copyright © 2015. Published by Elsevier Ltd.

  18. The rising agenda of physician-assisted suicide: explaining the growth and content of morality policy.

    PubMed

    Glick, H R; Hutchinson, A

    1999-01-01

    Employing theories and methods of agenda-setting analysis, this article explains the rapid rise of physician-assisted suicide (PAS) on the national political agenda based on its status as a morality policy. PAS reached the mass agenda before the professional agenda, probably because PAS is an outgrowth of previous right-to-die policies and Dr. Jack Kevorkian's assisted suicides provided major focusing events. As in other morality policies, competing groups fight for the last word, but PAS has been blocked on most governmental agendas because its image and media tone has been mostly negative and public opinion is divided. Groups in a few generally liberal states have tried to enact policy through referenda when legislators failed to address the issue. We speculate that competing interest groups will become more active and that state courts will become a venue of choice in the future.

  19. Family matters: a social system perspective on physician-assisted suicide and the older adult.

    PubMed

    King, D A; Kim, S Y H; Conwell, Y

    2000-06-01

    Physician-assisted suicide is one of the most controversial issues facing health care providers today, provoking contentious debate that spans medical, psychological, legal, religious, and moral realms. Despite the wealth of theories and opinions proffered, most of this work focuses on concepts of individual competence and autonomy, with little or no attention paid to the dynamics of family or other psychosocial systems likely to affect an individual's decision to ask for assistance in ending his or her life. Moreover, concepts such as "autonomy" typically are examined from a legal perspective without consideration of the late-life developmental themes confronting older adults and their families, that is, the stages of life cycle transition and the predictable family stresses that typically accompany serious illness.

  20. Advising vaccinations for the elderly: a cross-sectional survey on differences between general practitioners and physician assistants in Germany.

    PubMed

    Klett-Tammen, Carolina Judith; Krause, Gérard; von Lengerke, Thomas; Castell, Stefanie

    2016-07-29

    In Germany, the coverage of officially recommended vaccinations for the elderly is below a desirable level. It is known that advice provided by General Practitioners and Physician Assistants influences the uptake in patients ≥60 years. Therefore, the predictors of advice-giving behavior by these professions should be investigated to develop recommendations for possible actions for improvement. We conducted a postal cross-sectional survey on knowledge, attitudes and advice - giving behavior regarding vaccinations in the elderly among General Practitioners and Physician Assistants in 4995 practices in Germany. To find specific predictors, we performed logistic regressions with non-advising on any officially recommended vaccination or on three specific vaccinations as four separate outcomes, first using all participants, then only General Practitioners and lastly only Physician Assistants as our study population. Participants consisted of 774 General Practitioners and 563 Physician Assistants, of whom overall 21 % stated to have not advised an officially recommended vaccination in elderly patients. The most frequent explanation was having forgotten about it. The habit of not counselling on vaccinations at regular intervals was associated with not advising any vaccination (OR: 2.8), influenza vaccination (OR: 2.3), and pneumococcal vaccination (OR: 3.1). While more General Practitioners than Physician Assistants felt sufficiently informed (90 % vs. 79 %, p < 0.001), General Practitioners displayed higher odds to not advise specific vaccinations (ORs: 1.8-2.8). To reduce the high risk of forgetting to advice on vaccinations, we recommend improving and promoting standing recall-systems, encouraging General Practitioners and Physician Assistants to counsel routinely at regular intervals regarding vaccinations, and providing Physician Assistants with better, tailor-made information on official recommendations and their changes.

  1. Determinants of the sustained employment of physician assistants in hospitals: a qualitative study.

    PubMed

    Timmermans, Marijke J C; van Vught, Anneke J A H; Maassen, Irma T H M; Draaijer, Lisette; Hoofwijk, Anton G M; Spanier, Marcel; van Unen, Wijnand; Wensing, Michel; Laurant, Miranda G H

    2016-11-18

    To identify determinants of the initial employment of physician assistants (PAs) for inpatient care as well as of the sustainability of their employment. We conducted a qualitative study with semistructured interviews with care providers. Interviews continued until data saturation was achieved. All interviews were transcribed verbatim. A framework approach was used for data analysis. Codes were sorted by the themes, bringing similar concepts together. This study was conducted between June 2014 and May 2015 within 11 different hospital wards in the Netherlands. The wards varied in medical speciality, as well as in hospital type and the organisational model for inpatient care. Participant included staff physicians, residents, PAs and nurses. The following themes emerged to be important for the initial employment of PAs and the sustainability of their employment: the innovation, individual factors, professional interactions, incentives and resources, capacity for organisational change and social, political and legal factors. 10 years after the introduction of PAs, there was little discussion among the adopters about the added value of PAs, but organisational and financial uncertainties played an important role in the decision to employ and continue employment of PAs. Barriers to employ and continue PA employment were mostly a consequence of locally arranged restrictions by hospital management and staff physicians, as barriers regarding national laws, PA education and competencies seemed absent. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  2. Determinants of the sustained employment of physician assistants in hospitals: a qualitative study

    PubMed Central

    Timmermans, Marijke J C; van Vught, Anneke J A H; Maassen, Irma T H M; Draaijer, Lisette; Hoofwijk, Anton G M; Spanier, Marcel; van Unen, Wijnand; Wensing, Michel; Laurant, Miranda G H

    2016-01-01

    Objectives To identify determinants of the initial employment of physician assistants (PAs) for inpatient care as well as of the sustainability of their employment. Design We conducted a qualitative study with semistructured interviews with care providers. Interviews continued until data saturation was achieved. All interviews were transcribed verbatim. A framework approach was used for data analysis. Codes were sorted by the themes, bringing similar concepts together. Setting This study was conducted between June 2014 and May 2015 within 11 different hospital wards in the Netherlands. The wards varied in medical speciality, as well as in hospital type and the organisational model for inpatient care. Participants Participant included staff physicians, residents, PAs and nurses. Results The following themes emerged to be important for the initial employment of PAs and the sustainability of their employment: the innovation, individual factors, professional interactions, incentives and resources, capacity for organisational change and social, political and legal factors. Conclusions 10 years after the introduction of PAs, there was little discussion among the adopters about the added value of PAs, but organisational and financial uncertainties played an important role in the decision to employ and continue employment of PAs. Barriers to employ and continue PA employment were mostly a consequence of locally arranged restrictions by hospital management and staff physicians, as barriers regarding national laws, PA education and competencies seemed absent. PMID:27864243

  3. Factors influencing the satisfaction of rural physician assistants: a cross-sectional study.

    PubMed

    Filipova, Anna A

    2014-01-01

    The purpose of the study was to determine factors that attract physician assistants (PAs) to rural settings, and what they found satisfying about their practice and community. A cross-sectional survey design was used. All PAs who were practicing in both nonmetropolitan counties and rural communities in metropolitan counties, in a single midwestern US state, served as the population for the study. A total of 414 usable questionnaires were returned of the 1,072 distributed, a 39% response rate. Factor analysis, descriptive statistics, Pearson's correlation analysis, and robust regression analyses were used. Statistical models were tested to identify antecedents of four job satisfaction factors (satisfaction with professional respect, satisfaction with supervising physician, satisfaction with authority/ autonomy, and satisfaction with workload/salary). The strongest predictor of all four job satisfaction factors was community satisfaction, followed by importance of job practice. Additionally, the four job satisfaction factors had some significant associations with importance of socialization, community importance, practice attributes (years of practice, years in current location, specialty, and facility type), job responsibilities (percentage of patient load not discussed with physician, weekly hours as PA, inpatient visits), and demographics (marital status, race, age, education).

  4. Titrating Guidance: A Model to Guide Physicians Assisting Patients and Families Facing Complex Decisions

    PubMed Central

    Goldstein, Nathan E.; Back, Anthony L.; Morrison, R. Sean

    2009-01-01

    Over the last century, developments in new medical treatments have led to an exponential increase in longevity, but as a consequence, patients may be left with chronic illness associated with long-term severe functional and cognitive disability. Patients and their families are often forced to make a difficult and complex choices between death and long-term debility, neither of which are acceptable outcomes. Traditional models of medical decision making, however, do not fully address how clinicians should best assist with these decisions. In this manuscript, we present a new paradigm which demonstrates how the role of the physician changes over time in response to the curved relationship between the predictability of a patient's outcome and the chance of returning to an acceptable quality of life. To translate this model into clinical practice, we present a five step model for physicians where they: 1) determine where the patient is on the curve; 2) identify the cognitive factors and preferences for outcomes which affect the patient/family's decision-making process; 3) reflect on their own reaction to the decision at hand; 4) acknowledge how these factors can be addressed in conversation; and 5) guide the patient/family in creation of plan of care. This model can help improve patient-physician communication and decision making so that complex and difficult decisions can be turned into ones that yield to medical expertise, good communication, and personal caring. PMID:18779459

  5. Physician-assisted death. Opinions of Mexican medical students and residents.

    PubMed

    Loria, Alvar; Villarreal-Garza, Cynthia; Sifuentes, Erika; Lisker, Ruben

    2013-08-01

    To explore opinions of young residents and medical students on physician-assisted death (PAD). A questionnaire was answered by 140 residents at the beginning of their residency and 99 third- or fourth-year medical students (46 attended religiously administered medical schools [RAMS] and 53 lay-administered medical schools [LAMS]). Main questions were agreement with PAD, therapy withdrawal (TW) and personalized PAD (PPAD) on whether participants themselves would seek help to die. There were no differences of acceptance between residents and students but LAMS students had significantly higher agreement than RAMS students for PAD (68 vs. 33%), TW (79 vs. 39%) and PPAD (57 vs. 48%). LAMS students were also more willing to agree to a physician prescribe/inject a lethal drug, even if PAD were not legalized. However, legality was also an important issue, i.e., 25-58% of those unsure or opposed to PAD would reverse the decision if PAD were legalized, and 42-54% of those unwilling to TW would also reverse if written consent of the patient existed. Overall acceptance of residents and students was significantly higher than our previous study in nearly 1,000 older physicians (50 vs. 39% for PAD and 58 vs. 48% for TW). PAD and TW acceptability seems to be increasing in Mexico, probably as a result of evolving social attitudes that appeared to be counteracted by a more conservative upbringing at home in our young RAMS students. Copyright © 2013 IMSS. Published by Elsevier Inc. All rights reserved.

  6. Autonomy-based arguments against physician-assisted suicide and euthanasia: a critique.

    PubMed

    Sjöstrand, Manne; Helgesson, Gert; Eriksson, Stefan; Juth, Niklas

    2013-05-01

    Respect for autonomy is typically considered a key reason for allowing physician assisted suicide and euthanasia. However, several recent papers have claimed this to be grounded in a misconception of the normative relevance of autonomy. It has been argued that autonomy is properly conceived of as a value, and that this makes assisted suicide as well as euthanasia wrong, since they destroy the autonomy of the patient. This paper evaluates this line of reasoning by investigating the conception of valuable autonomy. Starting off from the current debate in end-of-life care, two different interpretations of how autonomy is valuable is discussed. According to one interpretation, autonomy is a personal prudential value, which may provide a reason why euthanasia and assisted suicide might be against a patient's best interests. According to a second interpretation, inspired by Kantian ethics, being autonomous is unconditionally valuable, which may imply a duty to preserve autonomy. We argue that both lines of reasoning have limitations when it comes to situations relevant for end-of life care. It is concluded that neither way of reasoning can be used to show that assisted suicide or euthanasia always is impermissible.

  7. Working effectively with interpreters: a model curriculum for physician assistant students.

    PubMed

    Marion, Gail S; Hildebrandt, Carol A; Davis, Stephen W; Marín, Antonio J; Crandall, Sonia J

    2008-01-01

    Effective patient-provider communication is crucial to achieving good health care outcomes. To accomplish this with patients of limited English proficiency, learning to work effectively with interpreters is essential. The primary goal of this study was to determine if physician assistant students could effectively use interpreters to communicate with Spanish speaking patients after implementation of a cultural competency and Medical Spanish curriculum. In year one of a three year implementation process, a module for teaching students to work effectively with interpreters was developed and implemented in the Wake Forest University School of Medicine Department of Physician Assistant Studies. After four hours of orientation, practice and role play, students were observed and recorded during a standardized patient assessment and evaluated by clinicians as well as by trained, bi-lingual evaluators. In the Class of 2007, 94% (43 students) and in the Class of 2008, 96% (47 students) demonstrated competence. Our findings highlight the feasibility and usefulness of training students to work effectively with interpreters. Evaluation and feedback from students and faculty have been positive. Cost for this curriculum enhancement was reasonable, making it feasible to introduce the training into a wide variety of medical and allied health programs.

  8. Observations on the rejection of physician-assisted suicide: a Roman Catholic perspective.

    PubMed

    Bresnahan, James F

    1995-12-01

    Roman Catholic moral theology follows a centuries-old tradition of moral reflection. Contemporary Roman Catholic moral theory applies these traditional arguments to the realm of medical ethics, including the issues of active euthanasia and physician-assisted suicide. Unavoidable moral limits on licit medical intervention sometimes require that the moral duty to treat cede to the duty to cease treatment when measures become more harmful than beneficial to the patient. This does not reduce the need for the compassionate use of palliative care in response to suffering. However, it does mean that rather than being excessively committed to maintaining mere biological human life, or actively seeking death, that we learn a sober realism about the limits of human life. Catholic moral analysis examines an act objectively, both in its relation to the agent and as a material event in the world. This allows both the virtuous or vicious intentions of the agent and the effects of the action to be included in its moral evaluation. Thus, Catholic moral analysis is both quasi-deontological and quasi-consequentialist. Objectively, active euthanasia and physician-assisted suicide, as acts of deliberate killing, are seen as repugnant, in that they fail to incarnate a benign inner intention or to form an agent in virtue. Catholic moral theology is extremely skeptical that an act of intending death directly can be consonant with a sincere compassion for the dying, suffering person and views it as a direct negation of the precious gift of human life.

  9. Longitudinal integration of cultural components into a physician assistant program's clinical year may improve cultural competency.

    PubMed

    Bahrke, Barbara; De Oliveira, Kathleen; Scheel, Matthew H; Beck, Barbra; Hopp, Jane

    2014-01-01

    This study assessed the efficacy of longitudinal integration of cultural components into the clinical year of a 2-year master of science in physician assistant studies (MSPAS) program. Students submitted cultural reflection papers, gave a medical case/cultural presentation, and participated in cultural awareness discussion groups throughout the clinical year. Students completed the same cultural awareness survey at the conclusion of their clinical year that they had completed at benchmarked intervals during their didactic year. Additionally, cultural competency was assessed during the students' summative objective structured clinical examination (OSCE) using a combination of the program's objectives and established professional standards. Qualitative data suggested that students recognized the importance of cultural competency in providing quality patient care and recognized that remaining culturally competent is an ongoing process. Linear trend analyses revealed significant positive relationships between survey response scores and time in the program. The OSCE's cultural assessment scores indicated cultural competency in broad, general categories, but scores declined as cultural categories narrowed and became more detailed. Continued integration of cultural awareness training and assessment throughout the clinical year of a physician assistant (PA) program may have a positive impact on improving cultural competency. PA programs seeking to improve cultural competency in their students should consider continued integration of cultural components throughout the clinical year.

  10. Physician-assisted suicide and/or euthanasia: Pragmatic implications for palliative care [corrected].

    PubMed

    Hudson, Peter; Hudson, Rosalie; Philip, Jennifer; Boughey, Mark; Kelly, Brian; Hertogh, Cees

    2015-10-01

    Despite the availability of palliative care in many countries, legalization of euthanasia and physician-assisted suicide (EAS) continues to be debated-particularly around ethical and legal issues--and the surrounding controversy shows no signs of abating. Responding to EAS requests is considered one of the most difficult healthcare responsibilities. In the present paper, we highlight some of the less frequently discussed practical implications for palliative care provision if EAS were to be legalized. Our aim was not to take an explicit anti-EAS stance or expand on findings from systematic reviews or philosophical and ethico-legal treatises, but rather to offer clinical perspectives and the potential pragmatic implications of legalized EAS for palliative care provision, patients and families, healthcare professionals, and the broader community. We provide insights from our multidisciplinary clinical experience, coupled with those from various jurisdictions where EAS is, or has been, legalized. We believe that these issues, many of which are encountered at the bedside, must be considered in detail so that the pragmatic implications of EAS can be comprehensively considered. Increased resources and effort must be directed toward training, research, community engagement, and ensuring adequate resourcing for palliative care before further consideration is given to allocating resources for legalizing euthanasia and physician-assisted suicide.

  11. Physician-assisted dying and psychiatry: recent developments in The Netherlands.

    PubMed

    Pols, Hans; Oak, Stephanie

    2013-01-01

    The Netherlands was one of the first countries in the world to establish a legal framework for physician-assisted dying (PAD). In this article, we provide an overview of the public, political, legal, and medical debates on physician-assisted dying in The Netherlands, focusing on the role of psychiatry and mental illness. The number of individuals with chronic mental illness requesting PAD has been relatively small (although the number can be expected to increase because of the activities of various civic organizations advocating the right to die) and Dutch psychiatrists have been extremely reluctant to respond to such requests. Nevertheless, mental conditions have been central to the public debate on PAD by helping to define the nature and limits of current legislation and professional practice. Although a few Dutch psychiatrists have campaigned to increase the involvement of psychiatrists and many support PAD in principle, the majority has been hesitant to engage in PAD despite increasing public pressure. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Facilitating Research in Physician Assistant Programs: Creating a Student-Level Longitudinal Database.

    PubMed

    Morgan, Perri; Humeniuk, Katherine M; Everett, Christine M

    2015-09-01

    As physician assistant (PA) roles expand and diversify in the United States and around the world, there is a pressing need for research that illuminates how PAs may best be selected, educated, and used in health systems to maximize their potential contributions to health. Physician assistant education programs are well positioned to advance this research by collecting and organizing data on applicants, students, and graduates. Our PA program is creating a permanent longitudinal education database for research that contains extensive student-level data. This database will allow us to conduct research on all phases of PA education, from admission processes through the professional practice of our graduates. In this article, we describe our approach to constructing a longitudinal student-level research database and discuss the strengths and limitations of longitudinal databases for research on education and the practice of PAs. We hope to encourage other PA programs to initiate similar projects so that, in the future, data can be combined for use in multi-institutional research that can contribute to improved education for PA students across programs.

  13. The Texas health workforce benefit of military physician assistant program veterans.

    PubMed

    Jones, P Eugene; Hooker, Roderick S

    2013-01-01

    Little is known about the benefits to society of the educational development of health personnel in the military who return to civilian life and continue their careers. The U.S. Department of Defense has produced physician assistants (PAs) since the early 1970s, and PA training is now consolidated into one location in Texas as the Interservice Physician Assistant Program (IPAP). We studied redistribution of PAs upon service departure to determine if IPAP attendance had an effect on the Texas PA workforce. The Texas Medical Board dataset of licensed PAs was examined to identify program attended, practice specialty by supervising physician designation, practice location, and primary care or specialty care practice designation. Primary care was defined as family medicine, general pediatrics, or general internal medicine. All other designations were classified as specialty practice. Of 6016 licensed Texas PAs, 425 (7.0%) reported attending a military PA training program. Of the 254 PAs in full-time civilian clinical practice, 148 (58.3%) reported practice in primary care settings, and 106 (41.7%) reported specialty clinical practice settings. With the average military officer retirement age of 47 years and the 2010 average U.S. retirement age of 64 years for men and 62 for women, an estimated 16 years of community workforce productivity is provided per veteran PA following completion of military service. We estimated over 47,000 outpatient visits are provided per PA following military service. The care provided can be measured as a positive return-on-investment of taxpayer-provided education.

  14. Primary care physician assistant and advance practice nurses roles: Patient healthcare utilization, unmet need, and satisfaction.

    PubMed

    Everett, Christine M; Morgan, Perri; Jackson, George L

    2016-12-01

    Team-based care involving physician assistants (PAs) and advance practice nurses (APNs) is one strategy for improving access and quality of care. PA/APNs perform a variety of roles on primary care teams. However, limited research describes the relationship between PA/APN role and patient outcomes. We examined multiple outcomes associated with primary care PA/APN roles. In this cross-sectional survey analysis, we studied adult respondents to the 2010 Health Tracking Household Survey. Outcomes included primary care and emergency department visits, hospitalizations, unmet need, and satisfaction. PA/APN role was categorized as physician only (no PA/APN visits; reference), usual provider (PA/APN provide majority of primary care visits) or supplemental provider (physician as usual provider, PA/APN provide a subset of visits). Multivariable logistic and multinomial logistic regressions were performed. Compared to people with physician only care, patients with PA/APNs as usual providers [5-9 visits RRR=2.4 (CI 1.8-3.4), 10+ visits RRR=3.0 (CI 2.0-4.5): reference 2-4 visits] and supplemental providers had increased risk of having 5 or more primary care visits [5-9 visits RRR=1.3 (CI 1.0-1.6)]. Patients reporting PA/APN as supplemental providers had increased risk of emergency department utilization [2+ visits: RRR 1.8 (CI 1.3, 2.5)], and lower satisfaction [very dissatisfied: RRR 1.8 (CI 1.03-3.0)]. No differences were seen for hospitalizations or unmet need. Healthcare utilization patterns and satisfaction varied between adults with PA/APN in different roles, but reported unmet need did not. These findings suggest a wide range of outcomes should be considered when identifying the best PA/APN role on primary care teams. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Cross-sectional research into counselling for non-physician assisted suicide: who asks for it and what happens?

    PubMed

    Hagens, Martijn; Pasman, H Roeline W; Onwuteaka-Philipsen, Bregje D

    2014-10-02

    In the Netherlands, people with a wish to die can request physician assistance in dying. However, almost two thirds of the explicit requests do not result in physician assistance in dying. Some people with a wish to end life seek counselling outside the medical context to end their own life. The aim of this cross-sectional research was to obtain information about clients receiving counselling for non-physician assisted suicide, and the characteristics and outcome of the counselling itself. All counsellors working with foundation De Einder (an organisation that offers professional counselling for people with a wish to end life) (N=12) filled in registration forms about all clients they counselled in 2011 and/or 2012. Only client registration data forms with at least one face-to-face contact with the counsellor were selected for analysis (n=595). More than half of the clients were over 65 years old. More than one third of the clients had no wish to end life and 16% had an urgent wish to end life. Almost two thirds of the clients had not requested physician assistance in dying. Half of the clients had others involved in the counselling. More than half of the clients received explicit practical information concerning non-physician assisted suicide, while 13% of all clients actually ended their own life through non-physician assisted suicide. Clients without a (severe) disease were older than clients with a severe disease. They also had more problems of old age and existential suffering and more often wanted to be prepared for self-determination. The clients without a (severe) disease more often had no wish to end life and requested physician assistance in dying less often than clients with a severe disease. While some of the clients receiving counselling for non-physician assisted suicide seem to be looking for a peaceful death to escape from current suffering, others have no wish to end life and seem to be looking for reassurance in anticipation of prospective

  16. Replacing an academic internal medicine residency program with a physician assistant--hospitalist model: a comparative analysis study.

    PubMed

    Dhuper, Sunil; Choksi, Sonia

    2009-01-01

    This study describes a comparative analysis of replacing medical residents with physician assistants and hospitalists on patient outcomes in a community hospital. Prospective data during the physician assistants-hospitalists service for 2 years was compared with 2 years of retrospective data of the medical residents model. Outcome measures included mortality, adverse events, readmissions, and patient satisfaction. For physician assistants- hospitalists versus medical residents models, all-cause and case mix index-adjusted mortality was 107/5508 (1.94%) and 0.019 versus 156/5458 (2.85%) and 0.029, respectively (P < or = .001). The adverse event cases were 9 versus 5 ( P = .29), and the readmission rate within 30 days was 64 versus 69 (P = .34). Patient satisfaction was 95% versus 96% (P = .33). Quality of care provided by the physician assistants-hospitalists model was equivalent. All-cause and case mix index- adjusted mortality was significantly lower during the physician assistants-hospitalists period.Although the application of these findings to other institutions requires further study, the authors found no intrinsic barriers that would impede implementation elsewhere.

  17. A comparison of physicians and medical assistants in interpreting verbal autopsy interviews for allocating cause of neonatal death in Matlab, Bangladesh: can medical assistants be considered an alternative to physicians?

    PubMed Central

    2010-01-01

    Objective This study assessed the agreement between medical physicians in their interpretation of verbal autopsy (VA) interview data for identifying causes of neonatal deaths in rural Bangladesh. Methods The study was carried out in Matlab, a rural sub-district in eastern Bangladesh. Trained persons conducted the VA interview with the mother or another family member at the home of the deceased. Three physicians and a medical assistant independently reviewed the VA interviews to assign causes of death using the International Classification of Diseases - Tenth Revision (ICD-10) codes. A physician assigned cause was decided when at least two physicians agreed on a cause of death. Cause-specific mortality fraction (CSMF), kappa (k) statistic, sensitivity, specificity, and positive predictive values were applied to compare agreement between the reviewers. Results Of the 365 neonatal deaths reviewed, agreement on a direct cause of death was reached by at least two physicians in 339 (93%) of cases. Physician and medical assistant reviews of causes of death demonstrated the following levels of diagnostic agreement for the main causes of deaths: for birth asphyxia the sensitivity was 84%, specificity 93%, and kappa 0.77. For prematurity/low birth weight, the sensitivity, specificity, and kappa statistics were, respectively, 53%, 96%, and 0.55, for sepsis/meningitis they were 48%, 98%, and 0.53, and for pneumonia they were 75%, 94%, and 0.51. Conclusion This study revealed a moderate to strong agreement between physician- assigned and medical assistant- assigned major causes of neonatal death. A well-trained medical assistant could be considered an alternative for assigning major causes of neonatal deaths in rural Bangladesh and in similar settings where physicians are scarce and their time costs more. A validation study with medically confirmed diagnosis will improve the performance of VA for assigning cause of neonatal death. PMID:20712906

  18. Determinants of Public Attitudes towards Euthanasia in Adults and Physician-Assisted Death in Neonates in Austria: A National Survey

    PubMed Central

    Stolz, Erwin; Burkert, Nathalie; Großschädl, Franziska; Rásky, Éva; Stronegger, Willibald J.; Freidl, Wolfgang

    2015-01-01

    Background Euthanasia remains a controversial topic in both public discourses and legislation. Although some determinants of acceptance of euthanasia and physician-assisted death have been identified in previous studies, there is still a shortage of information whether different forms of euthanasia are supported by the same or different sub-populations and whether authoritarian personality dispositions are linked to attitudes towards euthanasia. Methods A large, representative face-to-face survey was conducted in Austria in 2014 (n = 1,971). Respondents faced three scenarios of euthanasia and one of physician assisted death differing regarding the level of specificity, voluntariness and subject, requiring either approval or rejection: (1) abstract description of euthanasia, (2) abstract description of physician-assisted suicide, (3) the case of euthanasia of a terminally-ill 79-year old cancer patient, and (4) the case of non-voluntary, physician assisted death of a severely disabled or ill neonate. A number of potential determinants for rejection ordered in three categories (socio-demographic, personal experience, orientations) including authoritarianism were tested via multiple logistic regression analyses. Results Rejection was highest in the case of the neonate (69%) and lowest for the case of the older cancer patient (35%). A consistent negative impact of religiosity on the acceptance across all scenarios and differential effects for socio-economic status, area of residence, religious confession, liberalism, and authoritarianism were found. Individuals with a stronger authoritarian personality disposition were more likely to reject physician-assisted suicide for adults but at the same time also more likely to approve of physician-assisted death of a disabled neonate. Conclusion Euthanasia in adults was supported by a partially different sub-population than assisted death of disabled neonates. PMID:25906265

  19. Determinants of Public Attitudes towards Euthanasia in Adults and Physician-Assisted Death in Neonates in Austria: A National Survey.

    PubMed

    Stolz, Erwin; Burkert, Nathalie; Großschädl, Franziska; Rásky, Éva; Stronegger, Willibald J; Freidl, Wolfgang

    2015-01-01

    Euthanasia remains a controversial topic in both public discourses and legislation. Although some determinants of acceptance of euthanasia and physician-assisted death have been identified in previous studies, there is still a shortage of information whether different forms of euthanasia are supported by the same or different sub-populations and whether authoritarian personality dispositions are linked to attitudes towards euthanasia. A large, representative face-to-face survey was conducted in Austria in 2014 (n = 1,971). Respondents faced three scenarios of euthanasia and one of physician assisted death differing regarding the level of specificity, voluntariness and subject, requiring either approval or rejection: (1) abstract description of euthanasia, (2) abstract description of physician-assisted suicide, (3) the case of euthanasia of a terminally-ill 79-year old cancer patient, and (4) the case of non-voluntary, physician assisted death of a severely disabled or ill neonate. A number of potential determinants for rejection ordered in three categories (socio-demographic, personal experience, orientations) including authoritarianism were tested via multiple logistic regression analyses. Rejection was highest in the case of the neonate (69%) and lowest for the case of the older cancer patient (35%). A consistent negative impact of religiosity on the acceptance across all scenarios and differential effects for socio-economic status, area of residence, religious confession, liberalism, and authoritarianism were found. Individuals with a stronger authoritarian personality disposition were more likely to reject physician-assisted suicide for adults but at the same time also more likely to approve of physician-assisted death of a disabled neonate. Euthanasia in adults was supported by a partially different sub-population than assisted death of disabled neonates.

  20. Abortion education in nurse practitioner, physician assistant and certified nurse-midwifery programs: a national survey.

    PubMed

    Foster, Angel M; Polis, Chelsea; Allee, Mary Kate; Simmonds, Katherine; Zurek, Melanie; Brown, Ann

    2006-04-01

    This study was undertaken to examine the inclusion and extent of abortion education in accredited nurse practitioner (NP), physician assistant (PA) and certified nurse-midwifery (CNM) programs in the United States. In January 2000, a confidential survey requesting information about the curricular inclusion of eight reproductive health topics was mailed to program directors at all 486 accredited NP, PA and CNM programs in the United States. Two hundred two surveys were returned, with a response rate of 42%. Overall, 53% of programs reported didactic instruction on surgical abortion, manual vacuum aspiration or medication abortion and 21% reported including at least one of these three procedures in their routine clinical curriculum. Abortion education is deficient in NP, PA and CNM programs in the United States. As integral components of women's health care, abortion, pregnancy options counseling and family planning merit incorporation into routine didactic and clinical education.

  1. A study of Canadian hospice palliative care volunteers' attitudes toward physician-assisted suicide.

    PubMed

    Claxton-Oldfield, Stephen; Miller, Kathryn

    2015-05-01

    The purpose of this study was to examine the attitudes of hospice palliative care (HPC) volunteers who provide in-home support (n = 47) and members of the community (n = 58) toward the issue of physician-assisted suicide (PAS). On the first part of the survey, participants responded to 15 items designed to assess their attitudes toward PAS. An examination of individual items revealed differences in opinions among members of both the groups. Responses to additional questions revealed that the majority of volunteers and community members (1) support legalizing PAS; (2) would choose HPC over PAS for themselves if they were terminally ill; and (3) think Canadians should place more priority on developing HPC rather than on legalizing PAS. The implications of these findings are discussed.

  2. The role of religion in the debate about physician-assisted dying.

    PubMed

    Stempsey, William E

    2010-11-01

    This paper explores the role of religious belief in public debate about physician-assisted dying and argues that the role is essential because any discussion about the way we die raises the deepest questions about the meaning of human life and death. For religious people, such questions are essentially religious ones, even when the religious elements are framed in secular political or philosophical language. The paper begins by reviewing some of the empirical data about religious belief and practice in the United States and Europe. It then explores the question of the proper role of religion in public policy debate and concludes with a discussion of the importance of religion and religious practices in considerations of how we die.

  3. Voluntary euthanasia, physician-assisted suicide, and the right to do wrong.

    PubMed

    Varelius, Jukka

    2013-09-01

    It has been argued that voluntary euthanasia (VE) and physician-assisted suicide (PAS) are morally wrong. Yet, a gravely suffering patient might insist that he has a moral right to the procedures even if they were morally wrong. There are also philosophers who maintain that an agent can have a moral right to do something that is morally wrong. In this article, I assess the view that a suffering patient can have a moral right to VE and PAS despite the moral wrongness of the procedures in light of the main argument for a moral right to do wrong found in recent philosophical literature. I maintain that the argument does not provide adequate support for such a right to VE and PAS.

  4. Does the experience of interpersonal predictors of suicidal desire predict positive attitudes toward Physician Assisted Suicide?

    PubMed

    Tucker, Raymond P; Buchanan, Carmen A; O'Keefe, Victoria M; Wingate, Laricka R

    2014-01-01

    The current study examined the relationship between Physician Assisted Suicide (PAS) attitudes and interpersonal risk factors of suicidal desire as outlined by the interpersonal-psychological theory of suicidal behavior (Joiner, 2005). It was hypothesized that both thwarted belongingness and perceived burdensomeness would be positively related to PAS acceptance. Results indicated that thwarted belongingness and perceived burdensomeness predicted significance of favorable attitudes toward PAS in a college sample. Results suggest that attitudes toward PAS may be influenced by the experience of thwarted belongingness and perceived burdensomeness and provide a clear rationale for the study of these variables in populations more apt to consider hastened death. Future work regarding the application of the interpersonal-psychological theory of suicidal behavior in hastened death research is discussed.

  5. Musculoskeletal Workforce Needs: Are Physician Assistants and Nurse Practitioners the Solution? AOA Critical Issues.

    PubMed

    Day, Charles S; Boden, Scott D; Knott, Patrick T; O'Rourke, Nancy C; Yang, Brian W

    2016-06-01

    Growth estimates and demographic shifts of the population of the United States foreshadow a future heightened demand for musculoskeletal care. Although many articles have discussed this growing demand on the musculoskeletal workforce, few address the inevitable need for more musculoskeletal care providers. As we are unable to increase the number of orthopaedic surgeons because of restrictions on graduate medical education slots, physician assistants (PAs) and nurse practitioners (NPs) represent one potential solution to the impending musculoskeletal care supply shortage. This American Orthopaedic Association (AOA) symposium report investigates models for advanced practice provider integration, considers key issues affecting PAs and NPs, and proposes guidelines to help to assess the logistical and educational possibilities of further incorporating NPs and PAs into the orthopaedic workforce in order to address future musculoskeletal care needs.

  6. Ethical issues in the social worker's role in physician-assisted suicide.

    PubMed

    Manetta, A A; Wells, J G

    2001-08-01

    This article presents the results of an exploratory study of social workers' views on physician-assisted suicide (PAS), situations in which PAS would be favored, and whether there is a difference in education or training on mental health issues, ethics, or suicide between social workers who favor PAS and those who oppose PAS. A questionnaire was administered to a convenience sample of 66 social workers in South Carolina. The authors raise questions about the training in mental health issues, ethics, and suicide that social workers have received to prepare them to work with clients making this end-of-life decision. Implications for social work practice and suggestions for future research are presented.

  7. Satisfaction, Burnout, and Turnover Among Nurse Practitioners and Physician Assistants: A Review of the Empirical Literature.

    PubMed

    Hoff, Timothy; Carabetta, Shannon; Collinson, Grace E

    2017-09-01

    Examining the work-related psychological states of nurse practitioners and physician assistants is important, given their increased role expansion. The current PRISMA-guided review examined studies published between 2000 and 2016 for both these groups. The review also examined features of the research to draw conclusions about overall quality. Applying theories in job enrichment and job demands, 32 articles were identified that contained analyses of satisfaction, burnout, stress, and turnover. Key findings include the lack of robust research designs, overemphasis on job satisfaction, lower levels of satisfaction across both groups, and higher intrinsic versus extrinsic satisfaction levels generally. The literature can develop by using larger, more representative samples, including subgroup analyses that incorporate everyday work contexts, and more predictive modeling. The results suggest that both occupations experience role expansion in both positive and negative ways that may require additional policy or managerial interventions.

  8. Physician assistants and nurse practitioners in the National Health Service Corps.

    PubMed

    Pathman, Donald E; Konrad, Thomas R; Hooker, Roderick S

    2014-12-01

    This study describes the experiences of physician assistants (PAs) and nurse practitioners (NPs) in the National Health Service Corps' (NHSC) loan repayment program in 2010. In 2011, a stratified random sample of NHSC clinicians was surveyed. Data from the 148 PA and 137 NP respondents were analyzed (52.4% response rate). PAs were younger than NPs (mean age 31 versus 35 years), less often female (68% versus 91%), and more often carried educational debt over $100,000 (56% versus 24%). Both groups were serving in states familiar to them and within communities where they felt accepted. The groups were generally satisfied on most measures of work, with PAs more satisfied than NPs on some measures. The NHSC's PAs and NPs are well matched to communities and satisfied with their work. Maximizing their NHSC experiences and retention requires recognizing their differences in demographics, debt, and areas of job satisfaction.

  9. Take some time to look inside their hearts: hospice social workers contemplate physician assisted suicide.

    PubMed

    Miller, Pamela J; Mesler, Mark A; Eggman, Susan T

    2002-01-01

    This article presents a subset of data from a larger study that explored the impact of the legal choice of physician assisted suicide (PAS) on hospice providers. Eight social workers shared their personal and professional voices about a very controversial and difficult issue. Oregon is the only place in the country where PAS is legal and these social workers practice in an environment where the choice of PAS has been an option for two years. Three overarching themes emerged from the data: (1) the dilemmas that arise from the hospice philosophy; (2) the conflicts that emerge between the choice of PAS and social works' cardinal values and practice principles; and (3) the struggles with personal values and PAS.

  10. [The desire to depart from life with dignity--an approach to physician-assisted suicide].

    PubMed

    Petermann, Heike

    2008-01-01

    "Sentenced to life". In German newspaper and journal articles as well as on television a controversial debate has emerged about the right-to-die. In history and many Western countries people have always been discussing assisted suicide. Under Oregon's Death with Dignity Act, terminally ill adult Oregonians are allowed to obtain and use prescriptions from their physicians for self-administered, lethal medications. The Oregon Public Health Division is required by the Act to collect information on compliance and to issue an annual report. This has been made public. According to these data, there was no slippery slope. In addition, no philosophical arguments can be put forward for the absolute prohibition against suicide of the terminally ill. This should give impetus to efforts to find solutions for the patients in all Western countries.

  11. Communicating with cancer patients: what areas do physician assistants find most challenging?

    PubMed

    Parker, Patricia A; Ross, Alicia C; Polansky, Maura N; Palmer, J Lynn; Rodriguez, M Alma; Baile, Walter F

    2010-12-01

    Physician assistants (PAs) and other midlevel practitioners have been taking on increasing clinical roles in oncology settings. Little is known about the communication needs and skills of oncology PAs. PAs working in oncology (n = 301) completed an online survey that included questions about their perceived skill and difficulty on several key communication tasks. Overall, PAs rated these communication tasks as "somewhat" to "moderately" difficult and their skill level in these areas as "average" to "good." Areas of most perceived difficulty were intervening with angry patients or those in denial and breaking bad news. Highest perceived skills were in communicating with patients from cultures and religions different than your own and telling patient he/she has cancer or disease has progressed, and the lowest perceived skills were in discussing do not resuscitate orders. There are areas in which enhancement of communication skills may be needed, and educational opportunities should be developed for PAs working in oncology.

  12. The Supreme Court of Canada Ruling on Physician-Assisted Death: Implications for Psychiatry in Canada.

    PubMed

    Duffy, Olivia Anne

    2015-12-01

    On February 6, 2015, the Supreme Court of Canada ruled that the prohibition of physician-assisted death (PAD) was unconstitutional for a competent adult person who "clearly consents to the termination of life" and has a "grievous and irremediable (including an illness, disease, or disability) condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." The radically subjective nature of this ruling raises important questions about who will be involved and how this practice might be regulated. This paper aims to stimulate discussion about psychiatry's role in this heretofore illegal practice and to explore how psychiatry might become involved in end-of-life care in a meaningful, patient-centred way. First, I will review existing international legislation and professional regulatory standards regarding psychiatry and PAD. Second, I will discuss important challenges psychiatry might face regarding capacity assessment, the notion of rational suicide, and the assessment of suffering.

  13. The position of the New York Academy of Medicine on physician-assisted suicide.

    PubMed Central

    Barondess, J. A.

    1997-01-01

    In January 1997, after a lengthy, careful, and difficult process, an ad hoc group, chaired by Dr. Alan R. Fleischman, a Senior Vice President of the New York Academy of Medicine (NYAM), with representation from clinical medicine, biomedical ethics, law, and the clergy, developed a position on the difficult and contentious issue of physician-assisted suicide. After substantial debate, the Board of Trustees of NYAM authorized a letter from the President of the Academy to the Justices of the United States Supreme Court and to the attorneys on both sides of the cases about to be argued before the Court. The text of that letter, which summarizes the views of the New York Academy of Medicine, is reproduced here. PMID:9211005

  14. The problem of the possible rationality of suicide and the ethics of physician-assisted suicide.

    PubMed

    Wittwer, Héctor

    2013-01-01

    Opponents of the legalization of physician assisted suicide (PAS) often claim that physicians must not give a helping hand to suicidal patients because (i) it is morally forbidden to help somebody to carry out an action which is inherently irrational and which will probably cause him severe harm, and (ii) the act of self-killing is necessarily irrational and self-harming. The article focuses on the second premise of this paternalistic argument against the moral permissibility of PAS and its legalization. First, it is shown that this premise can be understood in two ways, depending on whether the predicate "irrational" is taken to refer to a human being's lack of the capacity to decide and act rationally or irrationally, or to the property of the decision to end one's life. Whereas the first variant of the premise stating that all suicidal individuals lack the capacity to act rationally can only be verified or falsified by empirical studies, the second assumption is a normative one which only philosophy can deal with. Restated in another way, it says that is always rationally forbidden to kill oneself because the decision to end one's own life is necessarily irrational. The five arguments which have been brought forward to justify this claim are analyzed and criticized. It is argued that there is no valid argument for the necessary irrationality of suicide. Hence, the claim that PAS is morally forbidden and, therefore, ought not to be legalized cannot rest on that premise.

  15. Is physician-assisted death only for developed countries? Latin America as a case study.

    PubMed

    Luna, Florencia; Van Delden, Johannes J M

    2004-01-01

    The achievements of modern medicine are manifold and impressive. However, there is a broad recognition of the fact that continuing medical treatment is not always beneficial to the patient, nor is it always what the patient wants. This has led to a debate about the way physicians may or may not be involved in the end of life of patients. Could there be a justification for the active ending of a patient's life? This debate has a global character. In this article we will explore this debate for developing countries; we will focus on physician-assisted death (PAD) in Latin American countries. At stake is the moral relevance of differences, not the moral justification of PAD per se. We argue that arguments for PAD apply equally in affluent and in developing countries. Some of the counterarguments, however, would seem to hold more in developing countries than in affluent countries. Yet, under certain conditions, a policy tolerating PAD would be as acceptable in developing countries as in developed countries.

  16. Oregon versus Ashcroft: pain relief, physician-assisted suicide, and the Controlled Substances Act.

    PubMed

    Rich, Ben A

    2002-12-01

    Late in 2001, the State of Oregon filed suit against Attorney General John Ashcroft, seeking to halt his recent directive that physicians who comply with the Oregon Death with Dignity Act by writing a lethal prescription for a controlled substance should be prosecuted for violating the federal Controlled Substances Act (CSA). This special article reviews the history of the series of challenges to the Oregon Act since its initial adoption in 1994, with particular consideration of the arguments on both sides of Oregon v. Ashcroft and the disposition of the case by the district court. The article utilizes an historical review of the Oregon Act, including legal and political challenges to it, as well as discussion of the 3 years of data on the experience with legalized physician-assisted suicide in Oregon, and analysis of the legal issues in the current litigation. The federal district court concluded that the Attorney General's interpretation of certain provisions of the CSA so as to preclude the writing of a lethal prescription where otherwise permitted by state law as a legitimate medical practice was inconsistent with the CSA and, therefore, beyond the scope of his authority. The Oregon Act will continue in force while the Attorney General's appeal of the district court ruling is considered by the Ninth Circuit Court of Appeals.

  17. Physician-Assisted Suicide: Considering the Evidence, Existential Distress, and an Emerging Role for Psychiatry.

    PubMed

    Gopal, Abilash A

    2015-06-01

    Physician-assisted suicide (PAS) is one of the most provocative topics facing society today. Given the great responsibility conferred on physicians by recent laws allowing PAS, a careful examination of this subject is warranted by psychiatrists and other specialists who may be consulted during a patient's request for PAS. In this article, recent evidence regarding the implementation of PAS in the United States and The Netherlands is reviewed. Support is found for some concerns about PAS, such as the possibility that mental illness occurs at higher rates in patients requesting PAS, but not for other concerns, such as the fear that PAS will be practiced more frequently on vulnerable populations (the slippery-slope argument). These data and common arguments for and against PAS are discussed with an emphasis on the tension between values, such as maximizing patient autonomy and adhering to professional obligations, as well as the need for additional research that focuses more directly on the patient-centered perspective. Implications of the available evidence are discussed and lead to a consideration of mental anguish in terminally ill patients including aspects of existential distress and an acknowledgment of the importance of tailoring end-of-life care to the distinct set of values and experiences that shape each patient's perspective. The article concludes with a discussion of an expanding role for psychiatrists in evaluating patients who request PAS. © 2015 American Academy of Psychiatry and the Law.

  18. Necessity and benefits of physician assistants' participation in international clinical experiences.

    PubMed

    Kibe, Lucy Wachera

    2012-01-01

    Several consultation stations have been set up in an unfinished stone building. My team is made up of a Kenyan physician assistant (called clinical officer), a Kenyan medical student, and me, a US physician assistant student. We are huddled around a small worn-out square table. A middle-aged woman and her two children, ages 2 and 6, approach the table. They have traveled 2 miles to the medical camp. The children, covered in dust, are emaciated with protruding abdomens, dry skin, and congested noses. The clinical officer (CO) conducts a brief interview in Swahili, the Kenyan national language. The mother explains that they have been coughing up thick yellow sputum for a week and have no appetite. They've also had diarrhea for a couple of weeks. I examine the children, who are obviously scared. Hot, moist skin. They are both running a fever. I listen to the lungs: reduced lung sounds. The protruding abdomens are rock hard. I report the findings to the team. The CO turns to the Kenyan medical student and me and quizzes us on differential diagnoses with rationale for each. We come up with malaria, pneumonia, TB, and worm infestation. Due to limited resources, medical diagnosis in Kenya relies heavily on history and physical exam. The CO explains that comorbid conditions are probable. Luckily, we have malaria-testing kits at the camp. They test negative for malaria. We decide to treat them for pneumonia. We also offer them a free hot meal, toothbrushes, T-shirts, coloring paper, and crayons. The children manage to smile. The mother is so grateful, she cries.

  19. Self-assessment of cancer competencies and physician assistant cancer education: instrument development and baseline testing.

    PubMed

    Spence, Laurel R; Fasser, Carl E; McLaughlin, Robert J; Holcomb, J David

    2010-01-01

    Although the benefits of primary and secondary prevention of cancer are well recognized among health care providers, insufficient knowledge or skill often leads to inadequate assessment and management, particularly in the primary care setting. The scant literature on physician assistant (PA) cancer-related competencies suggests that PAs may not be well-prepared in this arena. Thus, curriculum reform in PA education is paramount for improving PAs' abilities to provide cancer risk assessment and management services. The Physician Assistant Cancer Education (PACE) project was designed for such a purpose. Following instrument development, baseline measurement of perceived abilities for cancer-related core competencies was assessed in a representative cohort of PA students. Literature search strategies, expert review, and a nationwide survey of PA program directors yielded the 26-item Competencies in Cancer Assessment and Management (C-CAM) instrument. Baseline self-efficacy data were gathered from students across eight PACE-affiliated PA programs. Statistical analysis focused upon instrument quality and comparisons of reported self-efficacy among respondent cohorts. Data were collected from 544 PA students. Overall instrument reliability was excellent (Chronbach's alpha 0.97). Exploratory factor analysis identified three factors explaining 72.83% of response variance. Mean values varied somewhat across institutional cohorts. Clinical students demonstrated higher self-efficacy than preclinical students. The C-CAM is an effective instrument to assess PA student self-efficacy in cancer prevention, risk assessment, and risk management competencies. Although a trend toward higher self-efficacy was observed among clinical students, further research is required to assess the extent to which reported self-efficacy may be expected to change over time.

  20. Attitudes of young neurosurgeons and neurosurgical residents towards euthanasia and physician-assisted suicide.

    PubMed

    Broekman, M L D; Verlooy, J S A

    2013-11-01

    Euthanasia and physician assisted suicide (PAS) are two controversial topics in neurosurgical practice. Personal attitudes and opinions on these important issues may vary between professionals, and may also depend on their location since current legislation differs between European countries. As these issues may have significant impact on clinical practice, the goal of the present study was to survey the opinions of neurosurgical residents and young neurosurgeons across Europe with respect to euthanasia and physician assisted suicide. We performed a survey among the participants of the European Association of Neurosurgical Societies (EANS) training courses (2011-2012), asking residents and young neurosurgeons nine questions on euthanasia and PAS. For the analysis of this survey, we divided all 295 participants into four European regions (North, South, East, West). We found that even though most residents are aware of regulations about euthanasia or PAS in their country or hospital, a substantial number were not aware of the regulations. We observed no significant differences in terms of their opinions on euthanasia and PAS among the four European regions. While most are actually in favor of euthanasia or PAS, if legally allowed, under appropriate circumstances, very few neurosurgeons would be willing to actively participate in these end-of-life practices. The results of this first survey on neurosurgical residents' attitudes towards euthanasia and PAS show that a significant number of residents is not familiar with national and/or local regulations regarding euthanasia and PAS. If legally allowed, most residents would be in favor of euthanasia and PAS, but only a minority would be willing to actively participate in these practices. We did not observe a difference in stances on euthanasia and PAS among residents from different regions in Europe.

  1. The military veteran to physician assistant pathway: building the primary care workforce.

    PubMed

    Brock, Douglas; Bolon, Shannon; Wick, Keren; Harbert, Kenneth; Jacques, Paul; Evans, Timothy; Abdullah, Athena; Gianola, F J

    2013-12-01

    The physician assistant (PA) profession emerged to utilize the skills of returning Vietnam-era military medics and corpsmen to fortify deficits in the health care workforce. Today, the nation again faces projected health care workforce shortages and a significant armed forces drawdown. The authors describe national efforts to address both issues by facilitating veterans' entrance into civilian PA careers and leveraging their skills.More than 50,000 service personnel with military health care training were discharged between 2006 and 2010. These veterans' health care experience and maturity make them ideal candidates for civilian training as primary care providers. They trained and practiced in teams and functioned under minimal supervision to care for a broad range of patients. Military health care personnel are experienced in emergency medicine, urgent care, primary care, public health, and disaster medicine. However, the PA profession scarcely taps this valuable resource. Fewer than 4% of veterans with health care experience may ever apply for civilian PA training.The Health Resources and Services Administration (HRSA) implements two strategies to help prepare and graduate veterans from PA education programs. First, Primary Care Training and Enhancement (PCTE) grants help develop the primary care workforce. In 2012, HRSA introduced reserved review points for PCTE: Physician Assistant Training in Primary Care applicants with veteran-targeted activities, increasing their likelihood of receiving funding. Second, HRSA leads civilian and military stakeholder workgroups that are identifying recruitment and retention activities and curricula adaptations that maximize veterans' potential as PAs. Both strategies are described, and early outcomes are presented.

  2. Doctor-cared dying instead of physician-assisted suicide: a perspective from Germany.

    PubMed

    Oduncu, Fuat S; Sahm, Stephan

    2010-11-01

    The current article deals with the ethics and practice of physician-assisted suicide (PAS) and dying. The debate about PAS must take the important legal and ethical context of medical acts at the end of life into consideration, and cannot be examined independently from physicians' duties with respect to care for the terminally ill and dying. The discussion in Germany about active euthanasia, limiting medical intervention at the end of life, patient autonomy, advanced directives, and PAS is not fundamentally different in content and arguments from discussions led in other European countries and the United States. This must be emphasized, since it is occasionally claimed that in Germany a thorough discussion could not be held with the same openness as in other countries due to Germany's recent history. Still, it is worthwhile to portray the debate, which has been held intensively both among experts and the German public, from the German perspective. In general, it can be stated that in Germany debates about questions of medical ethics and bioethics are taking place with relatively large participation of an interested public, as shown, for instance, by the intense recent discussions about the legalisation of advanced directives on June 18 2009, the generation and use of embryonic stem cells in research or the highly difficult challenges for the prioritizing and rationing of scarce resources within the German health care system. Hence, the current article provides some insights into central medical and legal documents and the controversial public debate on the regulation of end-of-life medical care. In conclusion, euthanasia and PAS as practices of direct medical killing or medically assisted killing of vulnerable persons as "due care" is to be strictly rejected. Instead, we propose a more holistically-oriented palliative concept of a compassionate and virtuous doctor-cared dying that is embedded in an ethics of care.

  3. Precautionary practices for administering anesthetic gases: A survey of physician anesthesiologists, nurse anesthetists and anesthesiologist assistants.

    PubMed

    Boiano, James M; Steege, Andrea L

    2016-10-02

    Scavenging systems and administrative and work practice controls for minimizing occupational exposure to waste anesthetic gases have been recommended for many years. Anesthetic gases and vapors that are released or leak out during medical procedures are considered waste anesthetic gases. To better understand the extent recommended practices are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted in 2011 among members of professional practice organizations representing anesthesia care providers including physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants. This national survey is the first to examine self-reported use of controls to minimize exposure to waste anesthetic gases among anesthesia care providers. The survey was completed by 1,783 nurse anesthetists, 1,104 physician anesthesiologists, and 100 anesthesiologist assistants who administered inhaled anesthetics in the seven days prior to the survey. Working in hospitals and outpatient surgical centers, respondents most often administered sevoflurane and, to a lesser extent desflurane and isoflurane, in combination with nitrous oxide. Use of scavenging systems was nearly universal, reported by 97% of respondents. However, adherence to other recommended practices was lacking to varying degrees and differed among those administering anesthetics to pediatric (P) or adult (A) patients. Examples of practices which increase exposure risk, expressed as percent of respondents, included: using high (fresh gas) flow anesthesia only (17% P, 6% A), starting anesthetic gas flow before delivery mask or airway mask was applied to patient (35% P; 14% A); not routinely checking anesthesia equipment for leaks (4% P, 5% A), and using a funnel-fill system to fill vaporizers (16%). Respondents also reported that facilities lacked safe handling procedures (19%) and hazard awareness training (18%). Adherence to precautionary work practices was generally highest among

  4. GPs' views on the practice of physician-assisted suicide and their role in proposed UK legalisation: a qualitative study.

    PubMed

    Hussain, Tariq; White, Patrick

    2009-11-01

    A bill to legalise assisted dying in the UK has been proposed in Parliament's House of Lords three times since 2003. The House of Lords Select Committee concluded in 2005 that 'the few attempts to understand the basis of doctors' views have shown equivocal data varying over time'. Fresh research was recommended to gain a fuller understanding of health sector views. To examine GPs' views of the practice of physician-assisted suicide as defined by the 2005/2006 House of Lords (Joffe) Bill and views of their role in the proposed legislation; and to explore the influences determining GPs' views on physician-assisted suicide. Qualitative interview study. Primary care in South London, England. Semi-structured interviews with GPs were conducted by a lead interviewer and analysed in a search for themes, using the framework approach. Thirteen GPs were interviewed. GPs who had not personally witnessed terminal suffering that could justify assisted dying were against the legislation. Some GPs felt their personal religious views, which regarded assisted dying as morally wrong, could not be the basis of a generalisable medical ethic for others. GPs who had witnessed a person's suffering that, in their opinion, justified physician-assisted suicide were in favour of legislative change. Some GPs felt a specialist referral pathway to provide assisted dying would help to ensure proper standards were met. GPs' views on physician-assisted suicide ranged from support to opposition, depending principally on their interpretation of their experience of patients' suffering at the end of life. The goal to lessen suffering of the terminally ill, and apprehensions about patients being harmed, were common to both groups. Respect for autonomy and the right of self-determination versus the need to protect vulnerable people from the potential for harm from social coercion were the dominant themes.

  5. GPs' views on the practice of physician-assisted suicide and their role in proposed UK legalisation: a qualitative study

    PubMed Central

    Hussain, Tariq; White, Patrick

    2009-01-01

    Background A bill to legalise assisted dying in the UK has been proposed in Parliament's House of Lords three times since 2003. The House of Lords Select Committee concluded in 2005 that ‘the few attempts to understand the basis of doctors' views have shown equivocal data varying over time’. Fresh research was recommended to gain a fuller understanding of health sector views. Aim To examine GPs' views of the practice of physician-assisted suicide as defined by the 2005/2006 House of Lords (Joffe) Bill and views of their role in the proposed legislation; and to explore the influences determining GPs' views on physician-assisted suicide. Design of study Qualitative interview study. Setting Primary care in South London, England. Method Semi-structured interviews with GPs were conducted by a lead interviewer and analysed in a search for themes, using the framework approach. Results Thirteen GPs were interviewed. GPs who had not personally witnessed terminal suffering that could justify assisted dying were against the legislation. Some GPs felt their personal religious views, which regarded assisted dying as morally wrong, could not be the basis of a generalisable medical ethic for others. GPs who had witnessed a person's suffering that, in their opinion, justified physician-assisted suicide were in favour of legislative change. Some GPs felt a specialist referral pathway to provide assisted dying would help to ensure proper standards were met. Conclusion GPs' views on physician-assisted suicide ranged from support to opposition, depending principally on their interpretation of their experience of patients' suffering at the end of life. The goal to lessen suffering of the terminally ill, and apprehensions about patients being harmed, were common to both groups. Respect for autonomy and the right of self-determination versus the need to protect vulnerable people from the potential for harm from social coercion were the dominant themes. PMID:19861029

  6. Physician-assisted suicide reconsidered: dying as a Christian in a post-Christian age.

    PubMed

    Engelhardt, H Tristram

    1998-08-01

    The traditional Christian focus concerning dying is on repentance, not dignity. The goal of a traditional Christian death is not a pleasing, final chapter to life, but union with God: holiness. The pursuit of holiness requires putting on Christ and accepting His cross. In contrast, post-traditional Christian and secular concerns with self-determination, control, dignity, and self-esteem make physician-assisted suicide and voluntary active euthanasia plausible moral choices. Such is not the case within the context of the traditional Christian experience of God, which throughout its 2000 years has sternly condemned suicide and assisted suicide. The wrongness of such actions cannot adequately be appreciated outside the experience of that Christian life. Traditional Christian appreciations of death involve an epistemology and metaphysics of values in discordance with those of secular morality. This difference in the appreciation of the meaning of dying and death, as well as in the appreciation of the moral significance of suicide, discloses a new battle in the culture wars separating traditional Christian morality from that of the surrounding society.

  7. Nutrition education in health professions programs: a survey of dental, physician assistant, nurse practitioner, and nurse midwifery programs.

    PubMed

    Touger-Decker, R; Barracato, J M; O'Sullivan-Maillet, J

    2001-01-01

    This study determined the perceived needs and curriculum recommendations for nutrition education, and expected competencies in nutrition of graduates, of predoctoral dental, physician assistant, nurse practitioner, and midwifery programs. Surveys were mailed to all dental schools (n = 54) and physician assistant (n = 95), nurse practitioner (n = 150), and certified nurse midwifery programs (n = 42) in the United States. Surveys were addressed to the program directors of physician assistant, nurse practitioner, and certified nurse midwifery programs and the associate or assistant dean of academic affairs of dental schools. A 4-page survey was designed and pilot-tested. The survey included questions on respondents perceptions of and recommendations for their programs in nutrition education and expected nutrition competence level of their graduates. A reminder postcard was mailed 2 weeks after the initial mailing to nonrespondents; a second survey was mailed to nonrespondents 1 month after the postcard mailing. Data were analyzed using JMP-IN software. Frequencies, and chi 2 analyses, Wilcoxon rank sum test, Pearson chi 2 test. The overall response rate was 80.7% (n = 276). Perceived needs for competence in nutrition varied by respondents. Most of the physician assistant nurse midwifery, and nurse practitioner program directors had similar perceptions of graduates' competence in nutrition. Dental school academic administrators differed significantly from the program directors about the perceived need for knowing how to counsel on a modified diet and how and when to refer to a registered dietitian. Time was the most important factor that would enhance provision of nutrition education in the programs. Computer-based programs were the most frequently requested education tool to enhance nutrition education. The disciplines agreed that graduates of dental schools and physician assistant, nurse practitioner, and nurse midwifery programs need some level of competence in

  8. How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide?

    PubMed

    Jones, David Albert; Paton, David

    2015-10-01

    Several US states have legalized or decriminalized physician-assisted suicide (PAS) while others are considering permitting PAS. Although it has been suggested that legalization could lead to a reduction in total suicides and to a delay in those suicides that do occur, to date no research has tested whether these effects can be identified in practice. The aim of this study was to fill this gap by examining the association between the legalization of PAS and state-level suicide rates in the United States between 1990 and 2013. We used regression analysis to test the change in rates of nonassisted suicides and total suicides (including assisted suicides) before and after the legalization of PAS. Controlling for various socioeconomic factors, unobservable state and year effects, and state-specific linear trends, we found that legalizing PAS was associated with a 6.3% (95% confidence interval 2.70%-9.9%) increase in total suicides (including assisted suicides). This effect was larger in the individuals older than 65 years (14.5%, CI 6.4%-22.7%). Introduction of PAS was neither associated with a reduction in nonassisted suicide rates nor with an increase in the mean age of nonassisted suicide. Legalizing PAS has been associated with an increased rate of total suicides relative to other states and no decrease in nonassisted suicides. This suggests either that PAS does not inhibit (nor acts as an alternative to) nonassisted suicide, or that it acts in this way in some individuals but is associated with an increased inclination to suicide in other individuals.

  9. Nurse Practitioners, Physician Assistants, and Certified Nurse-Midwives: A Policy Analysis. Health Technology Case Study 37.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. Office of Technology Assessment.

    This case study was conducted to analyze the cost-effectiveness of nurse practitioners (NPs), physicians' assistants (PAs), and certified nurse midwives (CNMs) by examining (1) the contributions of each group in meeting health-care needs; (2) the effect of changing the method of payment for their services on the health-care delivery system; and…

  10. Just How Important Is the Messenger versus the Message? The Case of Framing Physician-Assisted Suicide

    ERIC Educational Resources Information Center

    Haider-Markel, Donald P.; Joslyn, Mark R.

    2004-01-01

    As a political issue, death and dying topics only sometimes reach the political agenda. However, some issues, such as physician-assisted suicide (PAS) have been highly salient. This article explores attitudes toward PAS by examining the malleability of opinion when respondents are exposed to issue frames and when specific messengers present those…

  11. Amicus Curiae Brief for the United States Supreme Court on Mental Health Issues Associated with "Physician-Assisted Suicide"

    ERIC Educational Resources Information Center

    Werth, James L., Jr.; Gordon, Judith R.

    2002-01-01

    After providing background material related to the Supreme Court cases on "physician-assisted suicide" (Washington v. Glucksberg, 1997, and Vacco v. Quill, 1997), this article presents the amicus curiae brief that was submitted to the United States Supreme Court by 2 national mental health organizations, a state psychological association, and an…

  12. An Analysis of Department of Defense Medical Corpsmen Training Programs and Possible Contributions to Civilian Physician's Assistant Programs.

    ERIC Educational Resources Information Center

    Cabral, William R.; Stewart, Wendell L.

    The general Medical Corpsmen Training Programs of the Army, Navy, and Air Force are presented and analyzed. These programs are compared with the Civilian Physician's Assistant Programs at Duke University and the University of Washington Medex Program. The purpose was to determine whether additional academic credit could be granted for Military…

  13. A Comparison of Osteopathic, Pharmacy, Physical Therapy, Physician Assistant and Occupational Therapy Students' Personality Styles: Implications for Education and Practice.

    ERIC Educational Resources Information Center

    Hardigan, Patrick C.; Cohen, Stanley R.

    This study compared personality traits of students in five health professions. The Myers-Briggs Type Indicator was completed by 1,508 osteopathic students, 654 pharmacy students, 165 physical therapy students, 211 physician assistant students, and 70 occupational therapy students. Comparing the extrovert/introvert dimension revealed that pharmacy…

  14. Amicus Curiae Brief for the United States Supreme Court on Mental Health Issues Associated with "Physician-Assisted Suicide"

    ERIC Educational Resources Information Center

    Werth, James L., Jr.; Gordon, Judith R.

    2002-01-01

    After providing background material related to the Supreme Court cases on "physician-assisted suicide" (Washington v. Glucksberg, 1997, and Vacco v. Quill, 1997), this article presents the amicus curiae brief that was submitted to the United States Supreme Court by 2 national mental health organizations, a state psychological association, and an…

  15. Just How Important Is the Messenger versus the Message? The Case of Framing Physician-Assisted Suicide

    ERIC Educational Resources Information Center

    Haider-Markel, Donald P.; Joslyn, Mark R.

    2004-01-01

    As a political issue, death and dying topics only sometimes reach the political agenda. However, some issues, such as physician-assisted suicide (PAS) have been highly salient. This article explores attitudes toward PAS by examining the malleability of opinion when respondents are exposed to issue frames and when specific messengers present those…

  16. Evaluating newly acquired authority of nurse practitioners and physician assistants for reserved medical procedures in the Netherlands: a study protocol

    PubMed Central

    De Bruijn-Geraets, Daisy P; Van Eijk-Hustings, Yvonne JL; Vrijhoef, Hubertus JM

    2014-01-01

    Aim The study protocol is designed to evaluate the effects of granting independent authorization for medical procedures to nurse practitioners and physician assistants on processes and outcomes of health care. Background Recent (temporarily) enacted legislation in Dutch health care authorizes nurse practitioners and physician assistants to indicate and perform specified medical procedures, i.e. catheterization, cardioversion, defibrillation, endoscopy, injection, puncture, prescribing and simple surgical procedures, independently. Formerly, these procedures were exclusively reserved to physicians, dentists and midwives. Design A triangulation mixed method design is used to collect quantitative (surveys) and qualitative (interviews) data. Methods Outcomes are selected from evidence-based frameworks and models for assessing the impact of advanced nursing on quality of health care. Data are collected in various manners. Surveys are structured around the domains: (i) quality of care; (ii) costs; (iii) healthcare resource use; and (iv) patient centredness. Focus group and expert interviews aim to ascertain facilitators and barriers to the implementation process. Data are collected before the amendment of the law, 1 and 2·5 years thereafter. Groups of patients, nurse practitioners, physician assistants, supervising physicians and policy makers all participate in this national study. The study is supported by a grant from the Dutch Ministry of Health, Welfare and Sport in March 2011. Research Ethics Committee approval was obtained in July 2011. Conclusion This study will provide information about the effects of granting independent authorization for medical procedures to nurse practitioners and physician assistants on processes and outcomes of health care. Study findings aim to support policy makers and other stakeholders in making related decisions. The study design enables a cross-national comparative analysis. PMID:24684631

  17. Institutional sponsorship, student debt, and specialty choice in physician assistant education.

    PubMed

    Cawley, James F; Jones, P Eugene

    2013-01-01

    Physician assistant (PA) educational programs emerged in the mid 1960s in response to health workforce shortages and decreasing access to care and, specifically, the decline of generalist physicians. There is wide diversity in the institutional sponsorship of PA programs, and sponsorship has trended of late to private institutions. We analyzed trends in sponsorship of PA educational programs and found that, in the past 15 years, there were 25 publicly sponsored and 96 privately sponsored programs that gained accreditation, a 3.84:1 private-to-public ratio. Of the 96 privately sponsored programs, only seven (7.3%) were located within institutions reporting membership in the Association of Academic Health Centers, compared to eight of the 25 publicly sponsored programs (32%). In 1978, a large majority (estimated 43 of the 48 then-existing PA programs) received their start-up or continuing funding through the US Public Health Service, Section 747 Title VII program, whereas in 2012 there were far fewer (39 of 173). The finding of a preponderance of private institutions may correlate with the trend of PAs selecting specialty practice (65%) over primary care. Specialty choice of graduating PA students may or may not be related to the disproportionate debt burden associated with attending privately sponsored programs, where the public-to-private tuition difference is significant. Moreover, the waning number of programs participating in the Title VII grant process may also have contributed to the overall rise in tuition rates among PA educational programs due to the loss of supplemental funding.

  18. Nurse practitioner and physician assistant scope of practice in 118 acute care hospitals.

    PubMed

    Kartha, Anand; Restuccia, Joseph D; Burgess, James F; Benzer, Justin; Glasgow, Justin; Hockenberry, Jason; Mohr, David C; Kaboli, Peter J

    2014-10-01

    Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs) are cost-effective substitutes for physicians, with similar outcomes in primary care and surgery. However, little is understood about APP roles in inpatient medicine. Describe APPs role in inpatient medicine. Observational cross-sectional cohort study. One hundred twenty-four Veterans Health Administration (VHA) hospitals. Chiefs of medicine (COMs) and nurse managers. Surveys included inpatient medicine scope of practice for APPs and perceived healthcare quality. We conducted bivariate unadjusted and multivariable adjusted analyses. One hundred eighteen COMs (95.2%) and 198 nurse managers (75.0%) completed surveys. Of 118 medicine services, 56 (47.5%) employed APPs; 27 (48.2%) used NPs only, 15 (26.8%) PAs only, and 14 (25.0%) used both. Full-time equivalents for NPs was 0.5 to 7 (mean = 2.22) and PAs was 1 to 9 (mean = 2.23). Daily caseload was similar at 4 to 10 patients (mean = 6.5 patients). There were few significant differences between tasks. The presence of APPs was not associated with patient or nurse manager satisfaction. Presence of NPs was associated with greater overall inpatient and discharge coordination ratings by COMs and nurse managers, respectively; the presence of PAs was associated with lower overall inpatient coordination ratings by nurse managers. NPs and PAs work on half of VHA inpatient medicine services with broad, yet similar, scopes of practice. There were few differences between their roles and perceptions of care. Given their very different background, regulation, and reimbursement, this has implications for inpatient medicine services that plan to hire NPs or PAs. © 2014 Society of Hospital Medicine.

  19. An educational strategy for using physician assistant students to provide health promotion education to community adolescents.

    PubMed

    Ruff, Cathy C

    2012-01-01

    The "Competencies for the Physician Assistant Profession" identify core competencies that physician assistants (PAs) are expected to acquire and maintain throughout their career (see http://www.nccpa.net/pdfs/Definition%20of%20PA%20Competencies% 203.5%20for%20Publication.pdf). Two categories of competencies relate to patient care and interpersonal and communication skills and articulate the need for PAs to be effective communicators and patient educators. The value of a health education curriculum for the adolescent population has been recognized since the early 1900s. PA student-designed health promotion presentations aimed at the adolescent population are an innovative educational strategy involving students in community education. PA student-designed presentations based upon previously identified topics were presented in the community. Students presented topics including Smoking Cessation, The Effects of Drugs and Alcohol, Self-Esteem, and others to adolescents. Community audiences were varied and included alternative high schools and teens within the Department of Youth Corrections facilities. PA students created 17 portable presentations for community adolescents. Two hundred sixty-eight students gave presentations to more than 700 adolescents ranging from 11-22 years of age between the years 2005-2010. Eighty-two percent (646/791) of adolescent participants either strongly agreed or agreed that they learned at least one new piece of information from the presentations. Sixty percent (12/20) of community leaders requested that the PA students return to give additional health promotion presentations. Analysis of comments by PA students revealed that 98% of students found the experience beneficial. Students identified the experience as helping them better understand how to design presentations to meet the needs of their audience, feel more comfortable with adolescents, and gain confidence in communicating. Seventy-five percent stated they would continue to be

  20. Precautionary Practices for Administering Anesthetic Gases: A Survey of Physician Anesthesiologists, Nurse Anesthetists and Anesthesiologist Assistants

    PubMed Central

    Boiano, James M.; Steege, Andrea L.

    2016-01-01

    Scavenging systems and administrative and work practice controls for minimizing occupational exposure to waste anesthetic gases have been available and recommended for many years. Anesthetic gases and vapors that are released or leak out during medical procedures are considered waste anesthetic gases. To better understand the extent recommended practices are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted in 2011 among members of professional practice organizations representing anesthesia care providers (ACPs) including physician anesthesiologists, nurse anesthetists and anesthesiologist assistants. This national survey is the first to examine self-reported use of controls to minimize exposure to waste anesthetic gases among ACPs. The survey was completed by 1,783 nurse anesthetists, 1,104 physician anesthesiologists and 100 anesthesiologist assistants who administered inhaled anesthetics in the seven days prior to the survey. Working in hospitals and outpatient surgical centers, respondents reported that they most often administered sevoflurane and, to a lesser extent desflurane and isoflurane, in combination with nitrous oxide. Use of scavenging systems was nearly universal, reported by 97% of respondents. However, adherence to recommended administrative and work practice controls were lacking to varying degrees and differed among those administering anesthetics to pediatric (P) or adult (A) patients. Examples of practices which increase exposure risk, expressed as percent of respondents, included: using high (fresh gas) flow anesthesia only (17% P, 6% A), starting anesthetic gas flow before delivery mask or airway mask was applied to patient (35% P; 14% A); not routinely checking anesthesia equipment and components for leaks (4% P, 5% A), and using a funnel-fill system to fill vaporizers (16%). Respondents also reported that facilities lacked safe handling procedures (19%) and hazard awareness training (18%). Adherence to

  1. When being 'tired of living' plays an important role in a request for euthanasia or physician-assisted suicide: patient characteristics and the physician's decision.

    PubMed

    Rurup, Mette L; Onwuteaka-Philipsen, Bregje D; Jansen-van der Weide, Marijke C; van der Wal, Gerrit

    2005-10-01

    In the Netherlands physicians are allowed to grant requests for euthanasia or physician-assisted suicide (EAS) if they meet several requirements of due care. According to jurisprudence, a physician is not allowed to end the life of a patient whose request for EAS is based on being 'tired of living', because such a request falls outside the medical domain. Our previous studies have shown that in spite of this, such requests are made approximately 400 times a year. To learn more about patients who request EAS because they are tired of living, and about factors that influence the decision of the physician. Questionnaires (n=4842) completed by general practitioners (n=3994). According to the physicians, 17% of patients who requested EAS were 'tired of living'. Of 139 patients in whose request for EAS being tired of living played a major role, 47% suffered from cancer, 25% suffered from another severe disease and 28% had no severe disease. In all three groups the same three symptoms occurred most frequently, 'feeling bad', 'tired', and 'not active'. Each of these symptoms occurred in more than half of the patients in each group. Most of the requests from patients with cancer were granted, but those from patients who had some other severe disease, or no severe disease at all, were refused. Factors that were related to granting a request were: the presence of unbearable and hopeless suffering, the absence of alternatives, and the absence of depressive symptoms. Being tired of living can play a major role in requests for EAS, both in the absence and the presence of a severe disease. The high occurrence of symptoms in the absence of a classifiable severe disease implies that physical symptoms are prevalent in this group of patients, leaving the legal requirement for EAS of 'a medical cause' open to interpretation in the more complex medical practice.

  2. Physician-Assisted Suicide and Euthanasia: Can You Even Imagine Teaching Medical Students How to End Their Patients' Lives?

    PubMed Central

    Boudreau, J Donald

    2011-01-01

    The peer-reviewed literature includes numerous well-informed opinions on the topics of euthanasia and physician-assisted suicide. However, there is a paucity of commentary on the interface of these issues with medical education. This is surprising, given the universal assumption that in the event of the legalization of euthanasia, the individuals on whom society expects to confer the primary responsibility for carrying out these acts are members of the medical profession. Medical students and residents would inevitably and necessarily be implicated. It is my perspective that everyone in the profession, including those charged with educating future generations of physicians, has a critical interest in participating in this ongoing debate. I explore potential implications for medical education of a widespread sanctioning of physician-inflicted and physician-assisted death. My analysis, which uses a consequential-basis approach, leads me to conclude that euthanasia, when understood to include physician aid in hastening death, is incommensurate with humanism and the practice of medicine that considers healing as its overriding mandate. I ask readers to imagine the consequences of being required to teach students how to end their patients' lives and urge medical educators to remain cognizant of their responsibility in upholding long-entrenched and foundational professional values. PMID:22319424

  3. Patterns of relating between physicians and medical assistants in small family medicine offices.

    PubMed

    Elder, Nancy C; Jacobson, C Jeffrey; Bolon, Shannon K; Fixler, Joseph; Pallerla, Harini; Busick, Christina; Gerrety, Erica; Kinney, Dee; Regan, Saundra; Pugnale, Michael

    2014-01-01

    The clinician-colleague relationship is a cornerstone of relationship-centered care (RCC); in small family medicine offices, the clinician-medical assistant (MA) relationship is especially important. We sought to better understand the relationship between MA roles and the clinician-MA relationship within the RCC framework. We conducted an ethnographic study of 5 small family medicine offices (having <5 clinicians) in the Cincinnati Area Research and Improvement Group (CARInG) Network using interviews, surveys, and observations. We interviewed 19 MAs and supervisors and 11 clinicians (9 family physicians and 2 nurse practitioners) and observed 15 MAs in practice. Qualitative analysis used the editing style. MAs' roles in small family medicine offices were determined by MA career motivations and clinician-MA relationships. MA career motivations comprised interest in health care, easy training/workload, and customer service orientation. Clinician-MA relationships were influenced by how MAs and clinicians respond to their perceptions of MA clinical competence (illustrated predominantly by comparing MAs with nurses) and organizational structure. We propose a model, trust and verify, to describe the structure of the clinician-MA relationship. This model is informed by clinicians' roles in hiring and managing MAs and the social familiarity of MAs and clinicians. Within the RCC framework, these findings can be seen as previously undefined constraints and freedoms in what is known as the Complex Responsive Process of Relating between clinicians and MAs. Improved understanding of clinician-MA relationships will allow a better appreciation of how clinicians and MAs function in family medicine teams. Our findings may assist small offices undergoing practice transformation and guide future research to improve the education, training, and use of MAs in the family medicine setting.

  4. Nurse practitioner and physician assistant students' knowledge, attitudes, and perspectives of chiropractic

    PubMed Central

    Bowden, Briana S.; Ball, Lisa

    2016-01-01

    Objective: The purpose of this study was to assess nurse practitioner (NP) and physician assistant (PA) students' views of chiropractic. As the role of these providers progresses in primary care settings, providers' views and knowledge of chiropractic will impact interprofessional collaboration and patient outcomes. Understanding how NP and PA students perceive chiropractic may be beneficial in building integrative health care systems. Methods: This descriptive quantitative pilot study utilized a 56-item survey to examine attitudes, knowledge, and perspectives of NP and PA students in their 2nd year of graduate studies. Frequencies and binomial and multinomial logistic regression models were used to examine responses to survey totals. Results: Ninety-two (97%) students completed the survey. There were conflicting results as to whether participants viewed chiropractic as mainstream or alternative. The majority of participants indicated lack of awareness regarding current scientific evidence for chiropractic and indicated a positive interest in learning more about the profession. Students who reported prior experience with chiropractic had higher attitude-positive responses compared to those without experience. Participants were found to have substantial knowledge deficits in relation to chiropractic treatments and scope of practice. Conclusion: The results of this study emphasize the need for increased integrative initiatives and chiropractic exposure in NP and PA education to enhance future interprofessional collaboration in health care. PMID:26771903

  5. Physician-Assisted Suicide and Other Forms of Euthanasia in Islamic Spiritual Care.

    PubMed

    Isgandarova, Nazila

    2015-12-01

    The muteness in the Qur'an about suicide due to intolerable pain and a firm opposition to suicide in the hadith literature formed a strong opinion among Muslims that neither repentance nor the suffering of the person can remove the sin of suicide or mercy 'killing' (al-qatl al-rahim), even if these acts are committed with the purpose of relieving suffering and pain. Some interpretations of the Islamic sources even give advantage to murderers as opposed to people who commit suicide because the murderers, at least, may have opportunity to repent for their sin. However, people who commit suicide are 'labeled' for losing faith in the afterlife without a chance to repent for their act. This paper claims that Islamic spiritual care can help people make decisions that may impact patients, family members, health care givers and the whole community by responding to questions such as 'What is the Islamic view on death?', 'What is the Islamic response to physician-assisted suicide and other forms of euthanasia?', 'What are the religious and moral underpinnings of these responses in Islam?'

  6. The relationship between faculty characteristics and the implementation of cultural competency training in physician assistant education.

    PubMed

    Kelly, Patricia J

    2012-01-01

    Cultural competency training has been present in academic medicine for many years, but interest resurfaced when the Institute of Medicine released a report on health care disparity and called for curricular improvement in medical education to eliminate this disparity. Unfortunately, many limitations in the implementation and assessment of the training have emerged, and it has been demonstrated that cultural competency training has not been uniform across medical education or physician assistant education. A national online survey of faculty members at 141 accredited PA programs was conducted. The study addressed the relationship of specific faculty characteristics with the implementation of cultural elements in cultural competency training in the didactic phase of PA programs. Results of the study demonstrated that disability was excluded most frequently in the implementation process. In addition, a significant relationship between a lack of previous cultural competency training by faculty members and the implementation of less cultural elements was demonstrated. These findings support the need for a standardized definition of culture and greater emphasis on cultural competency training for faculty.

  7. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia

    PubMed Central

    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-01-01

    Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively ‘dead’. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma’s position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. PMID:27211055

  8. The Supreme Court of Canada Ruling on Physician-Assisted Death: Implications for Psychiatry in Canada

    PubMed Central

    Duffy, Olivia Anne

    2015-01-01

    On February 6, 2015, the Supreme Court of Canada ruled that the prohibition of physician-assisted death (PAD) was unconstitutional for a competent adult person who “clearly consents to the termination of life” and has a “grievous and irremediable (including an illness, disease, or disability) condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”1 The radically subjective nature of this ruling raises important questions about who will be involved and how this practice might be regulated. This paper aims to stimulate discussion about psychiatry’s role in this heretofore illegal practice and to explore how psychiatry might become involved in end-of-life care in a meaningful, patient-centred way. First, I will review existing international legislation and professional regulatory standards regarding psychiatry and PAD. Second, I will discuss important challenges psychiatry might face regarding capacity assessment, the notion of rational suicide, and the assessment of suffering. PMID:26720829

  9. Adoption of oral health curriculum by physician assistant education programs in 2014.

    PubMed

    Langelier, Margaret H; Glicken, Anita Duhl; Surdu, Simona

    2015-06-01

    The purpose of the study was to describe inclusion of didactic and clinical instruction in oral health in physician assistant (PA) education programs in 2014. A previous study in 2008 found that PA education program directors generally understood the importance of teaching about the linkage of oral health with systemic health; yet, few programs had actually integrated oral health instruction into the PA curriculum. This study was undertaken to ascertain the number of PA programs teaching oral health topics and to evaluate the content of instruction and implementation strategies. The study used a Web-based survey using a skip logic design that branched respondents based on inclusion or the absence of an oral health curriculum in the PA education program. The questions included predefined response options with the opportunity for narrative responses and comments. Analysis of survey data was completed using SPSS (IBM) and SAS (SAS Institute, Inc) and consisted mainly of frequencies and cross tabulations. There was greater inclusion of oral health curriculum in 2014 than in 2008 with most PA programs now providing didactic and clinical training in oral health. Stakeholders' efforts to engage PA program faculty with integration of oral health subject matter into core curriculum have resulted in wider availability of training for PA students in oral health promotion and prevention services. Efforts to equip PA faculty to teach oral health topics and clinical skills should continue as past efforts have resulted in wider integration of oral health subject matter into core PA curriculum.

  10. Physician assistants in medical ward care: a descriptive study of the situation in the Netherlands.

    PubMed

    Timmermans, Marijke J C; van Vught, Anneke J A H; Van den Berg, Michiel; Ponfoort, Erik D; Riemens, Frank; van Unen, Jacco; Wobbes, Theo; Wensing, Michel; Laurant, Miranda G H

    2016-06-01

    Medical ward care has been increasingly reallocated from medical doctors (MDs) to physician assistants (PAs). Insight into their roles and tasks is limited. This study aims to provide insight into different organizational models of medical ward care, focusing on the position, tasks and responsibilities of the involved PAs and MDs. In this cross-sectional descriptive study 34 hospital wards were included. Characteristics of the organizational models were collected from the heads of departments. We documented provider continuity by examination of work schedules. MDs and PAs in charge for medical ward care (n = 179) were asked to complete a questionnaire to measure workload, supervision and tasks performed. We distinguished four different organizational models for ward care: medical specialists in charge of admitted patients (100% MS), medical residents in charge (100% MR), PAs in charge (100% PA), both MRs and PAs in charge (mixed PA/MR). The wards with PAs had the highest provider continuity. PAs spend relatively more time on direct patient care; MDs spend relatively more time on indirect patient care. PAs spend more hours on quality projects (P = 0.000), while MDs spend more time on scientific research (P = 0.030). Across different organizational models for medical ward care, we found variations in time per task, time per bed and provider continuity. Further research should focus on the impact of these differences on outcomes and efficiency of medical ward care. © 2015 John Wiley & Sons, Ltd.

  11. Young Kuwaitis' views of the acceptability of physician-assisted suicide.

    PubMed

    Ahmed, Ramadan A; Sorum, Paul C; Mullet, Etienne

    2010-11-01

    To study the views of people in a largely Muslim country, Kuwait, of the acceptability of a life-ending action such as physician-assisted suicide (PAS). 330 Kuwaiti university students judged the acceptability of PAS in 36 scenarios composed of all combinations of four factors: the patient's age (35, 60 or 85 years); the level of incurability of the illness (completely incurable vs extremely difficult to cure); the type of suffering (extreme physical pain or complete dependence) and the extent to which the patient requests a life-ending procedure, euthanasia or PAS (no request, some form of request, repeated requests). In all scenarios, the patients were women who were receiving the best possible care. The ratings were subjected to cluster analysis and analyses of variance. Five clusters were found. For 44%, PAS was always very unacceptable, no matter what the circumstances. For 23%, it was unacceptable, but less so if the patient was older or requested it repeatedly. For 16%, it was unacceptable if the patient was young but was acceptable if the patient was elderly. For 5%, it was unacceptable if the patient had extreme pain but was acceptable if completely dependent. For 11%, it was unacceptable if the patient did not request it but acceptable if she did. The majority of the Kuwaiti university students opposed PAS either categorically or with a slight variation according to circumstances. Nonetheless, a minority approved of PAS in some cases, particularly when the patient was elderly.

  12. Imperfect physician assistant and physical therapist admissions processes in the United States

    PubMed Central

    2014-01-01

    We compared and contrasted physician assistant and physical therapy profession admissions processes based on the similar number of accredited programs in the United States and the co-existence of many programs in the same school of health professions, because both professions conduct similar centralized application procedures administered by the same organization. Many studies are critical of the fallibility and inadequate scientific rigor of the high-stakes nature of health professions admissions decisions, yet typical admission processes remain very similar. Cognitive variables, most notably undergraduate grade point averages, have been shown to be the best predictors of academic achievement in the health professions. The variability of non-cognitive attributes assessed and the methods used to measure them have come under increasing scrutiny in the literature. The variance in health professions students’ performance in the classroom and on certifying examinations remains unexplained, and cognitive considerations vary considerably between and among programs that describe them. One uncertainty resulting from this review is whether or not desired candidate attributes highly sought after by individual programs are more student-centered or graduate-centered. Based on the findings from the literature, we suggest that student success in the classroom versus the clinic is based on a different set of variables. Given the range of positions and general lack of reliability and validity in studies of non-cognitive admissions attributes, we think that health professions admissions processes remain imperfect works in progress. PMID:24810020

  13. Click it: assessment of classroom response systems in physician assistant education.

    PubMed

    Graeff, Evelyn C; Vail, Marianne; Maldonado, Ana; Lund, Maha; Galante, Steve; Tataronis, Gary

    2011-01-01

    The effect that classroom response systems, or clickers, have on knowledge retention and student satisfaction was studied in a physician assistant program. A clicker, a device similar to a remote control, was used by students to answer questions during lectures. This new technology has been marketed to educators as beneficial in keeping students actively involved and increasing their attentiveness in the classroom. To date, the results of studies on knowledge retention with the use of clickers have been mixed. For this pilot study, the students were divided into two groups with a pre- and post-test given in order to evaluate knowledge retention. One group received lectures in a traditional format, while the other group received the lectures incorporating clicker response questions. After the test scores from four lectures were analyzed, the incorporation of clickers did not alter knowledge retention. Retention of knowledge from both groups was similar and no statistical difference was found. However, student satisfaction regarding the use of clickers was positive. Students reported that clickers kept them more actively involved, increased attentiveness, and made lectures more enjoyable. Although the pilot study did not show a greater improvement in knowledge retention with the use of clickers, further research is needed to assess their effectiveness.

  14. Attitudes of UK doctors towards euthanasia and physician-assisted suicide: a systematic literature review.

    PubMed

    McCormack, Ruaidhri; Clifford, Margaret; Conroy, Marian

    2012-01-01

    To review studies over a 20-year period that assess the attitudes of UK doctors concerning active, voluntary euthanasia (AVE) and physician-assisted suicide (PAS), assess efforts to minimise bias in included studies, determine the effect of subgroup variables (e.g. age, gender) on doctors' attitudes, and make recommendations for future research. Three electronic databases, four pertinent journals, reference lists of included studies. Literature search of English articles between January 1990 and April 2010. Studies were excluded if they did not present independent data (e.g. commentaries) or if they related to doctors outside the UK, patients younger than 18 years old, terminal sedation, withdrawing or withholding treatment, or double-effect. Quantitative and qualitative data were extracted. Following study selection and data extraction, 15 studies were included. UK doctors oppose the introduction of both AVE and PAS in the majority of studies. Degree of religiosity appeared as a statistically significant factor in influencing doctors' attitudes. The top three themes in the qualitative analysis were the provision of palliative care, adequate safeguards in the event of AVE or PAS being introduced, and a profession to facilitate AVE or PAS that does not include doctors. UK doctors appear to oppose the introduction of AVE and PAS, even when one considers the methodological limitations of included studies. Attempts to minimise bias in included studies varied. Further studies are necessary to establish if subgroup variables other than degree of religiosity influence attitudes, and to thoroughly explore the qualitative themes that appeared.

  15. Trends in Nurse Practitioner and Physician Assistant Practice in Nursing Homes, 2000-2010.

    PubMed

    Intrator, Orna; Miller, Edward Alan; Gadbois, Emily; Acquah, Joseph Kofi; Makineni, Rajesh; Tyler, Denise

    2015-12-01

    To examine nurse practitioner (NP) and physician assistant (PA) practice in nursing homes (NHs) during 2000-2010. Data were derived from the Online Survey Certification and Reporting system and Medicare Part B claims (20 percent sample). NP/PA state average employment, visit per bed year (VPBY), and providers per NH were examined. State fixed-effect models examined the association between state regulations and NP/PA use. NHs using any NPs/PAs increased from 20.4 to 35.0 percent during 2000-2010. Average NP/PA VPBY increased from 1.0/0.3 to 3.0/0.6 during 2000-2010. Average number of NPs/PAs per NH increased from 0.2/0.09 to 0.5/0.14 during 2000-2010. The impact of state scope-of-practice regulations was mixed. NP and PA scope-of-practice regulations impact their practice in NHs, not always as intended. © Health Research and Educational Trust.

  16. Euthanasia and physician-assisted suicide in amyotrophic lateral sclerosis: a prospective study.

    PubMed

    Maessen, Maud; Veldink, Jan H; Onwuteaka-Philipsen, Bregje D; Hendricks, Henk T; Schelhaas, Helenius J; Grupstra, Hepke F; van der Wal, Gerrit; van den Berg, Leonard H

    2014-10-01

    The objective of this study is to determine if quality of care, symptoms of depression, disease characteristics and quality of life of patients with amyotrophic lateral sclerosis (ALS) are related to requesting euthanasia or physician-assisted suicide (EAS) and dying due to EAS. Therefore, 102 ALS patients filled out structured questionnaires every 3 months until death and the results were correlated with EAS. Thirty-one percent of the patients requested EAS, 69% of whom eventually died as a result of EAS (22% of all patients). Ten percent died during continuous deep sedation; only one of them had explicitly requested death to be hastened. Of the patients who requested EAS, 86% considered the health care to be good or excellent, 16% felt depressed, 45% experienced loss of dignity and 42% feared choking. These percentages do not differ from the number of patients who did not explicitly request EAS. The frequency of consultations of professional caregivers and availability of appliances was similar in both groups. Our findings do not support continuous deep sedation being used as a substitute for EAS. In this prospective study, no evidence was found for a relation between EAS and the quality and quantity of care received, quality of life and symptoms of depression in patients with ALS. Our study does not support the notion that unmet palliative care needs are related to EAS.

  17. Physician-assisted suicide and euthanasia: disproportionate prevalence of women among Kevorkian's patients.

    PubMed

    Solomon, Louis M; Noll, Rebekka C

    2008-06-01

    End-of-life decisions are among the most difficult to make or study. When we examined these decisions made under the auspices and protection of stringent state laws, we found no gender bias among patients who chose to end their lives in the face of documented debilitating and terminal diseases. However, in the case of euthanasia as practiced by Jack Kevorkian, we found significant statistical bias against women. Moreover, other data have questioned whether all of Kevorkian's patients did, in fact, have debilitating and terminal illnesses. In this article, we explore why a gender disparity exists in end-of-life decision making. We conclude that if physician-assisted suicide and euthanasia are to be integrated into any end-of-life medical care policy, stringent legal and medical safeguards will be required. Institution of these safeguards should prevent selection bias in a vulnerable population hastening death for reasons other than medically justifiable conditions or issues of individual autonomy, and should ensure that end-of-life decisions are truly reflective of competent personal choice, free from economic considerations or societal pressure.

  18. A protocol for consultation of another physician in cases of euthanasia and assisted suicide

    PubMed Central

    van der

    2001-01-01

    Objective—Consultation of another physician is an important method of review of the practice of euthanasia. For the project "support and consultation in euthanasia in Amsterdam" which is aimed at professionalising consultation, a protocol for consultation was developed to support the general practitioners who were going to work as consultants and to ensure uniformity. Participants—Ten experts (including general practitioners who were experienced in euthanasia and consultation, a psychiatrist, a social geriatrician, a professor in health law and a public prosecutor) and the general practitioners who were going to use the protocol. Evidence—There is limited literature on consultation: discursive articles and empirical studies describing the practice of euthanasia. Consensus—An initial draft on the basis of the literature was commented on by the experts and general practitioners in two rounds. Finally, the protocol was amended after it had been used during the training of consultants. Conclusions—The protocol differentiates between steps that are necessary in a consultation and steps that are recommended. Guidelines about four important aspects of consultation were given: independence, expertise, tasks and judgment of the consultant. In 97% of 109 consultations in which the protocol was used the consultant considered the protocol to be useful to a greater or lesser extent. Although this protocol was developed locally, it also employs universal principles. Therefore it can be of use in the development of consultation elsewhere. Key Words: Euthanasia • assisted suicide • consultation • quality assurance • protocol PMID:11579191

  19. The medical care practitioner: developing a physician assistant equivalent for the United Kingdom.

    PubMed

    Parle, Jim V; Ross, Nick M; Doe, William F

    2006-07-03

    A range of demographic, social and other factors are creating a crisis in the provision of clinical care in the United Kingdom for which the physician assistant (PA) model developed in the United States appears to offer a partial solution. Local and national moves are underway to develop a similar cadre of registered health care professionals in England, with the current title of medical care practitioners (MCPs). A competence and curriculum framework document produced by a national steering group has formed the basis for a recent consultation process. A limited evaluation of US-trained PAs working in the West Midlands region of England in both primary care and acute secondary care suggests that PA activity is similar to that of doctors working in primary care and to primary care doctors working in the accident and emergency setting. The planned introduction of MCPs in England appears to offer, first, an effective strategy for increasing medical capacity, without jeopardising quality in frontline clinical services; and, second, the prospect of increased flexibility and stability in the medical workforce. The deployment of MCPs may offer advantages over increasing the number of doctors or taking nurses out of nursing roles. The introduction of MCPs may also enhance service effectiveness and efficiency.

  20. Physician-assisted suicide in Oregon: what are the key factors?

    PubMed

    Wineberg, Howard; Werth, James L

    2003-07-01

    Oregon's Death with Dignity Act has been operative since late 1997. The substantial national and international interest in Oregon's law makes it important to document any possible trends in the characteristics of persons who use the law. To do this, the present article examines previously reported data from various sources and places them within the context of the end-of-life decisions more generally. The Oregon data demonstrate that, regardless of the care received, a very small percentage of terminally ill Oregonians seem determined to request a lethal medication so that they may control the manner and timing of their death. College graduates and divorced persons are substantially more likely to use physician-assisted suicide to end their lives than are other persons. Control and autonomy appear to be the primary issues associated with taking legally prescribed medication to hasten one's death. A better understanding of the influence that a patient's marital status, education level, and desire for control may have on her or his ability to cope with, and make decisions related to, a terminal illness may allow health care professionals to better care for dying patients.

  1. Use of Harvey® the Cardiopulmonary Patient Simulator in Physician Assistant Training.

    PubMed

    Loftin, Camille; Garner, Kristen; Eames, Jennifer; West, Holly

    2016-03-01

    The purpose of this study was to evaluate physician assistant students' confidence levels in detection of heart murmurs following instruction with Harvey(R) the Cardiopulmonary Patient Simulator compared with a classroom heart sounds activity. Cohort 1 (n = 33) participated in the classroom heart sounds activity and then participated in the Harvey simulation exercise. Cohort 2 (n = 34) first participated in the Harvey simulation activity and then in the classroom heart sounds activity. All students completed preintervention and postintervention surveys to assess confidence in detecting heart sounds. A multiple-choice quiz was distributed to each group after participation in the first heart sounds activity. Sixty-seven students completed all surveys. Before either activity, 6% of students in Cohort 1 and 3% in Cohort 2 reported confidence in detecting abnormal heart sounds. After completing the first activity, 85% of the classroom heart sounds activity group (Cohort 1) and 53% of the Harvey simulation group (Cohort 2) reported confidence in detecting abnormal heart sounds. The mean score on the multiple-choice quiz was 62% in Cohort 1 and 24% in Cohort 2. Both cohorts reported confidence in learning abnormal heart sounds after participation in the Harvey simulation compared with baseline confidence. Students who participated in the classroom heart sounds activity before the Harvey simulation activity performed higher on the murmur identification multiple-choice quiz. The University of Texas Medical Branch PA faculty should consider continued use of both the classroom heart sounds activity and Harvey simulation.

  2. Assessment of physician-assisted death by members of the public prosecution in The Netherlands.

    PubMed Central

    Cuperus-Bosma, J M; van der Wal, G; Looman, C W; van der Maas, P J

    1999-01-01

    OBJECTIVES: To identify the factors that influence the assessment of reported cases of physician-assisted death by members of the public prosecution. DESIGN/SETTING: At the beginning of 1996, during verbal interviews, 12 short case-descriptions were presented to a representative group of 47 members of the public prosecution in the Netherlands. RESULTS: Assessment varied considerably between respondents. Some respondents made more "lenient" assessments than others. Characteristics of the respondents, such as function, personal-life philosophy and age, were not related to the assessment. Case characteristics, i.e. the presence of an explicit request, life expectancy and the type of suffering, strongly influenced the assessment. Of these characteristics, the presence or absence of an explicit request was the most important determinant of the decision whether or not to hold an inquest. CONCLUSIONS: Although the presence of an explicit request, life expectancy and the type of suffering each influenced the assessment, each individual assessment was dependent on the assessor. The resulting danger of legal inequality and legal uncertainty, particularly in complicated cases, should be kept to a minimum by the introduction of some form of protocol and consultation in doubtful or boundary cases. The notification procedure already promotes a certain degree of uniformity in the prosecution policy. PMID:10070632

  3. A rural-urban comparison of patterns of physician assistant practice.

    PubMed

    Martin, K E

    2000-07-01

    Access to primary care continues to be a concern in rural areas. The deficit of primary care providers in rural environments has the potential to increase the role of physician assistants (PAs) in the system of rural health care delivery. Little is known about the conditions, sites, and patterns of practice of PAs and their distribution in Pennsylvania, the state with the largest rural population. To learn more about these providers in rural and urban settings and their willingness to practice in underserved areas, the author conducted a census of all PAs who hold a Pennsylvania license. Survey results revealed significant rural-urban differences in socioeconomic, demographic, and practice profile parameters. Providers in rural areas are more likely than urban counterparts to practice primary care in a primary care practice setting; see more patients per week; and are the principal provider of care for a higher percentage of their patients. Experience with managed care is greater for urban PAs. A rural PA is more likely than an urban PA to practice in an underserved area. For both rural and urban PAs who practice primary care, significant differences were noted in their willingness to practice in a rural underserved area, compared to PAs who do not practice primary care.

  4. Nurse practitioners and physician assistants employed by general and subspecialty pediatricians.

    PubMed

    Freed, Gary L; Dunham, Kelly M; Loveland-Cherry, Carol; Martyn, Kristy K; Moote, Marc J

    2011-10-01

    There is little nationally representative information describing the current manner in which nurse practitioners (NPs) and physician assistants (PAs) work in pediatric practices and their professional activities. To understand better the current NP and PA workforce in pediatric primary and subspecialty care, we conducted a national survey of pediatricians. A survey study of a random national sample of 498 pediatric generalists and 1696 subspecialists in the United States was performed by using a structured questionnaire administered by mail. The survey focused on practice settings, employment, and scope of work of NPs and PAs. Response rates were 72% for generalists and 77% for subspecialists. More than one-half (55%) of generalists reported that they do not currently work with NPs or PAs, compared with only one-third of subspecialists who do not. Many generalists and subspecialists intend to increase the number of NPs and PAs in their practices in the next 5 years. More generalist and subspecialty practices work with NPs than with PAs. There was great variability between generalists and subspecialists and among different subspecialties in the proportions that worked with NPs and PAs. The scope of work of NPs and PAs also varied between generalists and subspecialists. Planned increases in the number of NPs hired and expansion of their scope of work might put subspecialists and general pediatricians in competition with regard to recruitment and hiring of a limited pool of new pediatric NPs. Similar issues might arise with PAs.

  5. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia.

    PubMed

    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-05-01

    Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. Copyright: © Singapore Medical Association.

  6. Quality of death and dying in patients who request physician-assisted death.

    PubMed

    Smith, Kathryn A; Goy, Elizabeth R; Harvath, Theresa A; Ganzini, Linda

    2011-04-01

    Physician-assisted death (PAD) was legalized in 1997 by Oregon's Death with Dignity Act (ODDA). Through 2009, 460 Oregonians have died by lethal prescription under the ODDA. To determine whether there was a difference in the quality of the dying experience, from the perspective of family members, between 52 Oregonians who received lethal prescriptions, 34 who requested but did not receive lethal prescriptions, and 63 who did not pursue PAD. Cross-sectional survey. Family members retrospectively rated the dying experience of their loved one with the 33 item Quality of Death and Dying Questionnaire (QODD). There were differences reported in 9 of the 33 quality item indicators. Few significant differences were noted in items that measured domains of connectedness, transcendence, and overall quality of death. Those receiving PAD prescriptions had higher quality ratings on items measuring symptom control (e.g., control over surroundings and control of bowels/bladder) and higher ratings on items related to preparedness for death (saying goodbye to loved ones, and possession of a means to end life if desired) than those who did not pursue PAD or, in some cases, those who requested but did not receive a lethal prescription. The quality of death experienced by those who received lethal prescriptions is no worse than those not pursuing PAD, and in some areas it is rated by family members as better.

  7. The productivity of physician assistants and nurse practitioners and health work force policy in the era of managed health care.

    PubMed

    Scheffler, R M; Waitzman, N J; Hillman, J M

    1996-01-01

    Managed care is spreading rapidly in the United States and creating incentives for physician practices to find the most efficient combination of health professionals to deliver care to an enrolled population. Given these trends, it is appropriate to reexamine the roles of physician assistants (PAs) and nurse practitioners (NPs) in the health care workforce. This paper briefly reviews the literature on PA and NP productivity, managed care plans' use of PAs and NPs, and the potential impact of PAs and NPs on the size and composition of the future physician workforce. In general, the literature supports the idea that PAs and NPs could have a major impact on the future health care workforce. Studies show significant opportunities for increased physician substitution and even conservative assumptions about physician task delegation imply a large increase in the number of PAs and NPs that can be effectively deployed. However, the current literature has certain limitations that make it difficult to quantify the future impact of PAs and NPs. Among these limitations is the fact that virtually all formal productivity studies were conducted in fee-for-service settings during the 1970s, rather than managed care settings. In addition, the vast majority of PA and NP productivity studies have viewed PAs and NPs as physician substitutes rather than as members of interdisciplinary health care teams, which may become the dominant health care delivery model over the next 10-20 years.

  8. Factors associated with the use of advanced practice nurses/physician assistants in a fee-for-service nursing home practice: a comparison with primary care physicians.

    PubMed

    Bakerjian, Debra; Harrington, Charlene

    2012-07-01

    The purpose of this research was to examine factors associated with the use of advanced practice nurse and physician assistant (APN/PA) visits to nursing home (NH) patients compared with those by primary care physicians (PCPs). This was a secondary analysis using Medicare claims data. General estimation equations were used to determine the odds of NH residents receiving APN/PA visits. Ordinary least squares analyses were used to examine factors associated with these visits. A total of 5,436 APN/PAs provided care to 27% of 129,812 residents and were responsible for 16% of the 1.1 million Medicare NH fee-for-service visits in 2004. APN/PAs made an average of 33 visits annually compared with PCPs (21 visits). Neuropsychiatric and acute diagnoses and patients with a long-stay status were associated with more APN/PA visits. APN/PAs provide a substantial amount of care, but regional variations occur, and Medicare regulations constrain the ability of APN/PAs to substitute for physician visits.

  9. Exploring the interface between 'physician-assisted death' and palliative care: cross-sectional data from Australasian palliative care specialists.

    PubMed

    Sheahan, L

    2016-04-01

    Legalisation of physician-assisted dying (PAD) remains a highly contested issue. In the Australasian context, the opinion and perspective of palliative care specialists have not been captured empirically, and are required to inform better the debate around this issue, moving forward. To identify current attitudes and experiences of palliative care specialists in Australasia regarding requests for physician-assisted suicide and voluntary euthanasia, and to capture the opinion of palliative care specialists on the legalisation of these practices in the Australasian context. An anonymous, cross-sectional, online survey of Australasian specialists in palliative care, addressing the following six areas: (i) demographics; (ii) frequency of requests, and response given; (iii) understanding of the term 'voluntary euthanasia'; (iv) opinion regarding legalisation of physician-assisted suicide and voluntary euthanasia in Australasia, and willingness to participate if legal; (v) identification of the most important values guiding this opinion; and (vi) anticipated impact that legalisation of assisted death would have on palliative care practice. Important findings include: (i) palliative care specialists are largely opposed to the legalisation of PAD; (ii) the proportional titration of opioids is not understood by any palliative care specialist studied to be 'voluntary euthanasia'; and (iii) there is a wide variation in frequency of requests, and one-third of palliative care specialists express discomfort in dealing with requests for assisted suicide or euthanasia. Key areas for future research at the interface between PAD and best practice end-of-life care are identified, including exploration into why palliative care specialists are largely opposed to PAD, and consideration of the impact 'the opioid misconception' may have on the literature informing this debate. © 2016 Royal Australasian College of Physicians.

  10. Strengthening hospital preparedness for chemical, biological, radiological, nuclear, and explosive events: clinicians' opinions regarding physician/physician assistant response and training.

    PubMed

    McInerney, Joan E; Richter, Anke

    2011-01-01

    This research explores the attitudes of physicians and physician assistants (PA) regarding response roles and responsibilities as well as training opinions to understand how best to partner with emergency department physicians and to effectively apply scarce healthcare dollars to ensure successful emergency preparedness. Physicians and PAs representing 21 specialties in two level I trauma public hospitals were surveyed. Participants scored statements within four categories regarding roles and responsibilities of clinicians in a disaster; barriers to participation; implementation of chemical, biological, radiological, nuclear, and explosive training; and training preferences on a Likert scale of 1 (strongly agree) to 5 (strongly disagree). Additional open-ended questions were asked. Respondents strongly feel that they have an ethical responsibility to respond in a disaster situation and that other clinicians would be receptive to their assistance. They feel that they have clinical skills that could be useful in a catastrophic response effort. They are very receptive to additional training to enable them to respond. Respondents are neutral to slightly positive about whether this training should be mandated, yet requiring training as a condition for licensure, board certification, or credentialing was slightly negative. Therefore, it is unclear how the mandate would be encouraged or enforced. Barriers to training include mild concerns about risk and malpractice, the cost of training, the time involved in training, and the cost for the time in training (eg, lost revenue and continuing medical education time). Respondents are not concerned about whether they can learn and retain these skills. Across all questions, there was no statistically significant difference in responses between the medical and surgical subspecialties. Improving healthcare preparedness to respond to a terrorist or natural disaster requires increased efforts at organization, education and training

  11. The contribution of physician assistants in primary care: a systematic review.

    PubMed

    Halter, Mary; Drennan, Vari; Chattopadhyay, Kaushik; Carneiro, Wilfred; Yiallouros, Jennifer; de Lusignan, Simon; Gage, Heather; Gabe, Jonathan; Grant, Robert

    2013-06-18

    Primary care provision is important in the delivery of health care but many countries face primary care workforce challenges. Increasing demand, enlarged workloads, and current and anticipated physician shortages in many countries have led to the introduction of mid-level professionals, such as Physician Assistants (PAs). This systematic review aimed to appraise the evidence of the contribution of PAs within primary care, defined for this study as general practice, relevant to the UK or similar systems. Medline, CINAHL, PsycINFO, BNI, SSCI and SCOPUS databases were searched from 1950 to 2010. PAs with a recognised PA qualification, general practice/family medicine included and the findings relevant to it presented separately and an English language journal publication. Two reviewers independently identified relevant publications, assessed quality using Critical Appraisal Skills Programme tools and extracted findings. Findings were classified and synthesised narratively as factors related to structure, process or outcome of care. 2167 publications were identified, of which 49 met our inclusion criteria, with 46 from the United States of America (USA). Structure: approximately half of PAs are reported to work in primary care in the USA with good support and a willingness to employ amongst doctors. the majority of PAs' workload is the management of patients with acute presentations. PAs tend to see younger patients and a different caseload to doctors, and require supervision. Studies of costs provide mixed results. acceptability to patients and potential patients is consistently found to be high, and studies of appropriateness report positively. Overall the evidence was appraised as of weak to moderate quality, with little comparative data presented and little change in research questions over time. identification of a broad range of studies examining 'contribution' made meta analysis or meta synthesis untenable. The research evidence of the contribution of PAs to

  12. The contribution of Physician Assistants in primary care: a systematic review

    PubMed Central

    2013-01-01

    Background Primary care provision is important in the delivery of health care but many countries face primary care workforce challenges. Increasing demand, enlarged workloads, and current and anticipated physician shortages in many countries have led to the introduction of mid-level professionals, such as Physician Assistants (PAs). Objective: This systematic review aimed to appraise the evidence of the contribution of PAs within primary care, defined for this study as general practice, relevant to the UK or similar systems. Methods Medline, CINAHL, PsycINFO, BNI, SSCI and SCOPUS databases were searched from 1950 to 2010. Eligibility criteria: PAs with a recognised PA qualification, general practice/family medicine included and the findings relevant to it presented separately and an English language journal publication. Two reviewers independently identified relevant publications, assessed quality using Critical Appraisal Skills Programme tools and extracted findings. Findings were classified and synthesised narratively as factors related to structure, process or outcome of care. Results 2167 publications were identified, of which 49 met our inclusion criteria, with 46 from the United States of America (USA). Structure: approximately half of PAs are reported to work in primary care in the USA with good support and a willingness to employ amongst doctors. Process: the majority of PAs’ workload is the management of patients with acute presentations. PAs tend to see younger patients and a different caseload to doctors, and require supervision. Studies of costs provide mixed results. Outcomes: acceptability to patients and potential patients is consistently found to be high, and studies of appropriateness report positively. Overall the evidence was appraised as of weak to moderate quality, with little comparative data presented and little change in research questions over time. Limitations: identification of a broad range of studies examining ‘contribution’ made

  13. The effects of expanded nurse practitioner and physician assistant scope of practice on the cost of Medicaid patient care.

    PubMed

    Timmons, Edward Joseph

    2017-02-01

    The provision of health care to low-income Americans remains an ongoing policy challenge. In this paper, I examine how important changes to occupational licensing laws for nurse practitioners and physician assistants have affected cost and intensity of health care for Medicaid patients. The results suggest that allowing physician assistants to prescribe controlled substances is associated with a substantial (more than 11%) reduction in the dollar amount of outpatient claims per Medicaid recipient. I find little evidence that expanded scope of practice has affected proxies for care intensity such as total claims and total care days. Relaxing occupational licensing requirements by broadening the scope of practice for healthcare providers may represent a low-cost alternative to providing quality care to America's poor. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. Pilot Survey of Physician Assistants Regarding Lesbian, Gay, Bisexual, and Transgender Providers Suggests Role for Workplace Nondiscrimination Policies.

    PubMed

    Ewton, Tiffany A; Lingas, Elena O

    2015-12-01

    Lesbian, gay, bisexual, and transgender (LGBT) medical providers in the United States have historically faced discrimination from their peers. To assess current workplace culture and attitudes, and to evaluate awareness of workplace and professional policies regarding LGBT discrimination, we sent a cross-sectional survey to 163 PAs (Physician Assistants). Respondents had an overall positive attitude towards LGBT providers, yet the majority was not aware of relevant policy statements (>60%). A significant association existed between policy awareness and LGBT inclusivity (P<.025) and confidence reporting anti-gay harassment (P=.017). Despite improved societal attitudes toward LGBT providers, non-discriminatory work environments for LGBT physician assistants may relate to greater awareness of specific workplace policy standards.

  15. Would physician-assisted suicide jeopardize trust in the medical services? An empirical study of attitudes among the general public in Sweden.

    PubMed

    Lindblad, Anna; Löfmark, Rurik; Lynöe, Niels

    2009-05-01

    To investigate the attitudes among the Swedish population towards physician-assisted suicide, with special regard to the possible effects on trust in the medical services of physician-assisted suicide being allowed. A postal questionnaire about physician-assisted suicide under certain conditions and its possible influence on trust in the medical services was distributed to 1206 randomly selected individuals living in the county of Stockholm. Two reminders were distributed, followed by a short version of the questionnaire containing only the question about the attitude towards physician-assisted suicide. The total response rate was 51%, a short-version reminder adding another 7%. Of all participants, 73% were in favour of physician-assisted suicide, 12% were against, and 15% were undecided. They believed that their trust in the medical services would increase (38%) or not be influenced at all (45%) if physician-assisted suicide were to be allowed. However, 75% of those who were against physician-assisted suicide believed that their trust would decrease. As compared to those reporting high trust in medical services (n = 492), those with low trust (n = 97) stated that their trust would increase, 36% (confidence interval (CI) = 35-37%) vs. 49% (95% CI = 39-59%). Thirty-three per cent (95% CI = 28-38%) of the younger respondents (<50 years), and 43% (95% CI = 37-49%) of the older respondents believed that their trust would increase. We found no evidence for the assumption that trust in the medical services would be unambiguously jeopardized if physician-assisted suicide were to be legalized. Only among the minority who opposed physician-assisted suicide did a majority of respondents report that their trust would decrease.

  16. [Legal issues of physician-assisted euthanasia. Part II--Help in the dying process, direct and indirect active euthanasia].

    PubMed

    Laux, Johannes; Röbel, Andreas; Parzeller, Markus

    2013-01-01

    In Germany, physician-assisted euthanasia involves numerous risks for the attending physician under criminal and professional law. In the absence of clear legal provisions, four different categories of euthanasia have been developed in legal practice and the relevant literature: help in the dying process, direct active euthanasia, indirect active euthanasia and passive euthanasia. The so-called "help during the dying process" by administering medically indicated analgesic drugs without a life-shortening effect is exempt from punishment if it corresponds to the will of the patient. If the physician omits to give such analgesic drugs although the patient demands them, this is deemed a punishable act of bodily injury. The same applies if the physician administers analgesics against the will of the patient. Medically indicated pain treatment which has a potential or certain life-shortening effect (indirect active euthanasia) is permitted under certain conditions: if there are no alternative and equally suitable treatment options without the risk of shortening the patient's life, if the patient has given his consent to the treatment and if the physician does not act with the intention to kill. The deliberate killing of a dying or terminally ill patient for the purpose of ending his suffering (direct active euthanasia) is prohibited. This includes both deliberately killing a patient against or without his will (by so-called "angels of death") and the killing of a patient who expressly and earnestly demands such an act from his physician (killing on request/on demand). Physician-assisted suicide is generally not liable to punishment in Germany. Nevertheless, the action may be subject to punishment if the physician omits to rescue the life of an unconscious suicide victim. "Palliative sedation" is regarded as a special case. It may become necessary if certain symptoms in the terminal stage of a fatal disease unbearable for the patient cannot be controlled by any other

  17. International Association for Hospice and Palliative Care Position Statement: Euthanasia and Physician-Assisted Suicide.

    PubMed

    De Lima, Liliana; Woodruff, Roger; Pettus, Katherine; Downing, Julia; Buitrago, Rosa; Munyoro, Esther; Venkateswaran, Chitra; Bhatnagar, Sushma; Radbruch, Lukas

    2017-01-01

    Reports about regulations and laws on Euthanasia and Physician Assisted Suicide (PAS) are becoming increasingly common in the media. Many groups have expressed opposition to euthanasia and PAS while those in favor argue that severely chronically ill and debilitated patients have a right to control the timing and manner of their death. Others argue that both PAS and euthanasia are ethically legitimate in rare and exceptional cases. Given that these discussions as well as the new and proposed laws and regulations may have a powerful impact on patients, caregivers, and health care providers, the International Association for Hospice and Palliative Care (IAHPC) has prepared this statement. To describe the position of the IAHPC regarding Euthanasia and PAS. The IAHPC formed a working group (WG) of seven board members and two staff officers who volunteered to participate in this process. An online search was performed using the terms "position statement", "euthanasia" "assisted suicide" "PAS" to identify existing position statements from health professional organizations. Only statements from national or pan-national associations were included. Statements from seven general medical and nursing associations and statements from seven palliative care organizations were identified. A working document including a summary of the different position statements was prepared and based on these, an initial draft was prepared. Online discussions among the members of the WG took place for a period of three months. The differences were reconciled by email discussions. The resulting draft was shared with the full board. Additional comments and suggestions were incorporated. This document represents the final version approved by the IAHPC Board of Directors. IAHPC believes that no country or state should consider the legalization of euthanasia or PAS until it ensures universal access to palliative care services and to appropriate medications, including opioids for pain and dyspnea. In

  18. International Association for Hospice and Palliative Care Position Statement: Euthanasia and Physician-Assisted Suicide

    PubMed Central

    Woodruff, Roger; Pettus, Katherine; Downing, Julia; Buitrago, Rosa; Munyoro, Esther; Venkateswaran, Chitra; Bhatnagar, Sushma; Radbruch, Lukas

    2017-01-01

    Abstract Background: Reports about regulations and laws on Euthanasia and Physician Assisted Suicide (PAS) are becoming increasingly common in the media. Many groups have expressed opposition to euthanasia and PAS while those in favor argue that severely chronically ill and debilitated patients have a right to control the timing and manner of their death. Others argue that both PAS and euthanasia are ethically legitimate in rare and exceptional cases. Given that these discussions as well as the new and proposed laws and regulations may have a powerful impact on patients, caregivers, and health care providers, the International Association for Hospice and Palliative Care (IAHPC) has prepared this statement. Purpose: To describe the position of the IAHPC regarding Euthanasia and PAS. Method: The IAHPC formed a working group (WG) of seven board members and two staff officers who volunteered to participate in this process. An online search was performed using the terms “position statement”, “euthanasia” “assisted suicide” “PAS” to identify existing position statements from health professional organizations. Only statements from national or pan-national associations were included. Statements from seven general medical and nursing associations and statements from seven palliative care organizations were identified. A working document including a summary of the different position statements was prepared and based on these, an initial draft was prepared. Online discussions among the members of the WG took place for a period of three months. The differences were reconciled by email discussions. The resulting draft was shared with the full board. Additional comments and suggestions were incorporated. This document represents the final version approved by the IAHPC Board of Directors. Result: IAHPC believes that no country or state should consider the legalization of euthanasia or PAS until it ensures universal access to palliative care services and to

  19. Advanced registered nurse practitioners and physician assistants in the practice of pediatric neurosurgery: a clinical report.

    PubMed

    James, Hector E; MacGregor, Teresa L; Postlethwait, Richard A; Hofrichter, Paul B; Aldana, Phillip R

    2011-01-01

    This report addresses the clinical experience of the Division of Pediatric Neurosurgery with dedicated nurse practitioners and a physician assistant (PA) in outpatient and inpatient health care delivery, including surgical activities, as well as participation with the neurosurgery call schedule, quality improvement, teaching, and clinical research activities. We report on the activities of allied health personnel in the Division of Pediatric Neurosurgery for the purpose of identifying the current and future role for health care delivery, related to the care of the child with a neurosurgical condition. This addresses the participation of 2 advanced registered nurse practitioners (ARNPs) and a PA in the outpatient and inpatient setting, call schedule, interventions in and out of the operating room, quality improvement sessions, continuing medical education, clinical research, clinical databases, presentations in meetings, teaching, and scientific publications. This report covers the period from September 2003 (when the division was initiated) to February 2011. The division currently consists of 3 pediatric neurosurgeons, 2 ARNPs and 1 PA. The ARNPs/PA have participated in the pediatric neurosurgery clinic held 5 half-days per week, the monthly multidisciplinary clinics (Spinal Defects Clinic, Pediatric Neurosciences Clinic, and the Fetal Diagnosis and Therapy Center working group), and inpatient care, as well as assisting in operative interventions. They participated in the on-call schedule and attended the monthly quality improvement sessions of the division in addition to presenting papers and topics in the monthly continuing medical education session. The PA maintained a computerized database of operative interventions, coding, morbidities, and outcomes. All were involved in teaching activities. They prepared preoperative and postoperative orders and practice guidelines, and they were also involved in the preparation of the database of institutional clinical

  20. The Roles of Nurse Practitioners and Physician Assistants in Rheumatology Practices in the US

    PubMed Central

    Solomon, Daniel H.; Bitton, Asaf; Fraenkel, Liana; Brown, Erika; Tsao, Peter; Katz, Jeffrey N.

    2014-01-01

    Background A recent workforce study of rheumatology in the US suggests that during the next several decades the demand for rheumatology services will outstrip the supply of rheumatologists. Mid-level providers such as nurse practitioners (NPs) and physician assistants (PAs) may be able to alleviate projected shortages. Methods We administered a nation-wide survey of mid-level providers during 2012. Invitations with the survey were sent with one follow-up reminder. The survey contained questions regarding demographics, training, level of practice independence, responsibilities, drug prescribing, use of objective outcome measures, and knowledge and use of treat to target (TTT) strategies. Results The invitation was sent to 482 eligible mid-level providers via e-mail and 90 via US mail. We received a total of 174 (30%) responses. The mean age was 46 years and 83% were female. Nearly 75% had ≤10 years of experience, 53% had received formal training in rheumatology. Almost two-thirds reported having their own panel of patients. The top three practice responsibilities described were performing patient education (98%), adjusting medication dosages (97%), and conducting physical exams (96%). Over 90% felt very or somewhat comfortable diagnosing rheumatoid arthritis (RA) and a similar percentage prescribed DMARDs. Three-quarters reported using disease activity measures for RA and 56% reported that their practices used TTT strategies. Conclusion Most respondents reported they they had substantial patient care responsibilities, used disease activity measures for RA, and incorporated TTT in their practice. These data suggest mid-level providers may help to reduce shortages in the rheumatology workforce and conform with recommendations to employ TTT strategies in RA treatment. PMID:24339154

  1. Assessment of admissions policies for veteran corpsmen and medics applying to physician assistant educational programs.

    PubMed

    Michaud, Ed; Jacques, Paul F; Gianola, F J; Harbert, Ken

    2012-01-01

    The purpose of this study was to assess the admission policies, experiences, and attitudes of physician assistant (PA) program directors with regard to recruiting, admitting, and training veteran corpsmen and medics. A descriptive survey consisting of 18 questions was distributed to all 154 PA program directors in the United States. One hundred ten (71.4%) program directors participated in the survey. Veterans were admitted into 83.6% of programs in the years 2008-2010, and accounted for an average of 2.6% of all students. A minority of PA programs accepted college credits earned by veterans for their military training (45.3%) or for their off-duty education (28.4%). Few PA programs participated in the Yellow Ribbon Program (16%) or actively recruited veterans (16%). Over half of PA programs (56.7%) would be more likely to give special consideration to the admission of veteran corpsmen and medics if it was easier to equate their military education and experience to the program's admission prerequisites. The most frequently reported benefits for educating veteran corpsmen and medics in PA programs are their health care and life experiences, maturity, and motivation. Barriers for educating veterans include veterans' lack of academic preparedness for graduate education, a lack of time/access for recruiting, and the cost of PA school. Most PA program directors cited multiple benefits for educating veteran corpsmen and medics, but veterans face barriers for admission into PA programs. Approaches are discussed for facilitating the transition of corpsmen and medics from the military to careers as PAs.

  2. National trends in the United States of America physician assistant workforce from 1980 to 2007

    PubMed Central

    2009-01-01

    Background The physician assistant (PA) profession is a nationally recognized medical profession in the United States of America (USA). However, relatively little is known regarding national trends of the PA workforce. Methods We examined the 1980-2007 USA Census data to determine the demographic distribution of the PA workforce and PA-to-population relationships. Maps were developed to provide graphical display of the data. All analyses were adjusted for the complex census design and analytical weights provided by the Census Bureau. Results In 1980 there were about 29 120 PAs, 64% of which were males. By contrast, in 2007 there were approximately 97 721 PAs with more than 66% of females. In 1980, Nevada had the highest estimated rate of 40 PAs per 100 000 persons, and North Dakota had the lowest rate (three). The corresponding rates in 2007 were about 85 in New Hampshire and ten in Mississippi. The levels of PA education have increased from less than 21% of PAs with four or more years of college in 1980, to more than 65% in 2007. While less than 17% of PAs were of minority groups in 1980, this figure rose to 23% in 2007. Although nearly 70% of PAs were younger than 35 years old in 1980, this percentage fell to 38% in 2007. Conclusion The trends of sustained increase and geographic variation in the PA workforce were identified. Educational level, percentage of minority, and age of the PA workforce have increased over time. Major causes of the changes in the PA workforce include educational factors and federal legislation or state regulation. PMID:19941662

  3. Attitudes of elderly patients and their families toward physician-assisted suicide.

    PubMed

    Koenig, H G; Wildman-Hanlon, D; Schmader, K

    1996-10-28

    To examine and compare attitudes of elderly outpatients and their families toward physician-assisted suicide (PAS), explore sociodemographic and health correlates of these attitudes, assess family members' ability to predict patients' attitudes toward PAS, and determine family members' ability to agree on these predictions. Elderly patients with medical and psychiatric problems (n = 168; mean age, 75.8 years) who were attending a geriatrics specialty clinic, along with accompanying family members (n = 146), were systematically surveyed on their attitudes toward PAS in case of terminal illness, chronic illness, and mental incompetence. Relatives were also asked to predict patients' responses to items on the questionnaire. Patients and relatives were blinded to each others' responses. Favorable attitudes toward PAS were reported by 39.9% of the patients and 59.3% of the relatives (P < .001) in case of terminal illness, 18.2% and 25.3%, respectively, in case of chronic illness, 13.5% and 15.4%, respectively, in case of mental incompetence, and 34.0% and 55.6% (P < .001), respectively, for legalization of PAS. Family members showed a marginal ability to predict patients' attitudes toward PAS with kappa values of agreement that ranged from 0.09 to 0.41. Family members also had difficulty agreeing with each other on how they thought patients would respond (range of kappa values, 0.18-0.47). Patients who opposed PAS were women, black individuals, and those with less education, low incomes, and dementia or cognitive impairment. While many frail elderly patients favored PAS in cases of terminal illness, the proportion that opposed it was significantly higher than that among relatives; relatives, in turn, displayed only a marginal ability either to predict patients' attitudes or to agree among themselves. Patients who oppose PAS represent a particularly vulnerable element of society (elderly persons, women, black individuals, and poor, uneducated, and demented persons), and

  4. Physician Assistants Improve Efficiency and Decrease Costs in Outpatient Oral and Maxillofacial Surgery.

    PubMed

    Resnick, Cory M; Daniels, Kimberly M; Flath-Sporn, Susan J; Doyle, Michael; Heald, Ronald; Padwa, Bonnie L

    2016-11-01

    To determine the effects on time, cost, and complication rates of integrating physician assistants (PAs) into the procedural components of an outpatient oral and maxillofacial surgery practice. This is a prospective cohort study of patients from the Department of Plastic and Oral Surgery at Boston Children's Hospital who underwent removal of 4 impacted third molars with intravenous sedation in our outpatient facility. Patients were separated into the "no PA group" and PA group. Process maps were created to capture all activities from room preparation to patient discharge, and all activities were timed for each case. A time-driven activity-based costing method was used to calculate the average times and costs from the provider's perspective for each group. Complication rates were calculated during the periods for both groups. Descriptive statistics were calculated, and significance was set at P < .05. The total process time did not differ significantly between groups, but the average total procedure cost decreased by $75.08 after the introduction of PAs (P < .001). The time that the oral and maxillofacial surgeon was directly involved in the procedure decreased by an average of 19.2 minutes after the introduction of PAs (P < .001). No significant differences in postoperative complications were found. The addition of PAs into the procedural components of an outpatient oral and maxillofacial surgery practice resulted in decreased costs whereas complication rates remained constant. The increased availability of the oral and maxillofacial surgeon after the incorporation of PAs allows for more patients to be seen during a clinic session, which has the potential to further increase efficiency and revenue. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Utilizing the physician assistant role: case study in an upper-extremity orthopedic surgical program

    PubMed Central

    Hepp, Shelanne L.; Suter, Esther; Nagy, Dwayne; Knorren, Tanya; Bergman, Joseph W.

    2017-01-01

    Background Shortages with resources and inefficiencies with orthopedic services in Canada create opportunities for alternative staffing models and ways to use existing resources. Physician assistants (PAs) are a common provider used in specialty orthopedic services in the United States; however, Canada has limited experience with PAs. As part of a larger demonstration project, Alberta Health Services (AHS) implemented 1 PA position in an upper-extremity surgical program in Alberta, Canada, to demonstrate the role in 4 areas: preoperative, operative, postoperative and follow-up care. Methods A mixed-methods evaluation was conducted using semi-structured interviews (n = 38), health care provider (n = 28) and patient surveys (n = 47), and 2 years of clinic data on new patients. Data from a double operating room experiment detailed expected versus actual times for 3 phases of surgery (pre, during, post). Results Preoperatively, the PA prioritizes patient referrals for surgery and redirects patients to alternative care. In the second year with the PA in place, there was an increase in total new patients seen (113%). Postoperatively, the PA attended rounds on 5 surgeons’ patients and handled follow-up care activities. Health care providers and patients reported that the PA provided excellent care. Findings from the operating room showed that the preparation time was greater than expected (38.6%), whereas the surgeon time (20.6%) and postsurgery time (37.2%) was less than expected. Conclusion After 24 months the PA has become a valuable member of the health care team and works across the continuum of orthopedic care. The PA delivers quality care and improves system efficiencies. PMID:28234216

  6. [Legal issues of physician-assisted euthanasia part I--terminology and historical overview].

    PubMed

    Laux, Johannes; Röbel, Andreas; Parzeller, Markus

    2012-01-01

    Under German criminal law, euthanasia assisted by the attending physician involves the risk of criminal prosecution. However, in the absence of clear legal provisions, the law concerning euthanasia has been primarily developed by court rulings and jurisprudential literature in the last 30 years. According to a traditional classification there are four categories of euthanasia: help in the dying process, direct active euthanasia, indirect active euthanasia and passive euthanasia. However, there is still no generally accepted definition for the general term "euthanasia". The development of the law on the permissibility of euthanasia was strongly influenced by the conflict between the right of self-determination of every human being guaranteed by the Constitution and the constitutional mandate of the state to protect and maintain human life. The decisions of the German Federal Court of Justice on euthanasia in the criminal trials "Wittig" (1984), "Kempten" (1994) and "Putz" (2010) as well as the ruling of the 12th Division for Civil Matters of the Federal Court of Justice (2003) are of special importance. Some of these decisions were significantly influenced by the discussions in the jurisprudential literature. However, the German Bundestag became active for the first time as late as in 2009 when it adopted the 3rd Guardianship Amendment Act, which also contains provisions on the legal validity of a living will independent of the nature and stage of an illness. In spite of the new law, an analysis of the "Putz" case makes it especially clear that the criminal aspects of legal issues at the end of a person's life still remain controversial. It is to be expected that this issue will remain the subject of intensive discussion also in the next few years.

  7. The irony of supporting physician-assisted suicide: a personal account.

    PubMed

    Battin, Margaret Pabst

    2010-11-01

    Under other circumstances, I would have written an academic paper rehearsing the arguments for and against legalization of physician-assisted suicide: autonomy and the avoidance of pain and suffering on the pro side, the wrongness of killing, the integrity of the medical profession, and the risk of abuse, the "slippery slope," on the con side. I've always supported the pro side. What this paper is, however, is a highly personal account of the challenges to my thinking about right-to-die issues. In November 2008, my husband suffered a C2/C3 spinal cord injury in a bicycle collision, leaving him ventilator-dependent, almost completely paralyzed, and in the hospital--but fully alert and profoundly self-reflective. What if he wanted to die? This paper draws from two multimedia presentations--file:///Users/margaretbattin/Documents/BROOKE'S%20ACCIDENT/The%20Salt%20Lake%20Tribune%20%7C%20Multimedia:%20Metamorphosis.webarchive and file:///Users/margaretbattin/Documents/BROOKE'S%20ACCIDENT/The%20Salt%20Lake%20Tribune%20%7C%20Multimedia:%20Learning%20to%20live%20again.webarchive--and personal material concerning quality of life (he'd rank at the bottom on the SF-36 and similar scales) and concerning autonomy (his own accounts, verbatim). This is a detailed portrait of a man whose life involves extraordinary suffering but also luminous experience some of the time. It only makes the question harder: What if he wanted to die?

  8. High hypothetical interest in physician-assisted death in multiple sclerosis.

    PubMed

    Marrie, Ruth Ann; Salter, Amber; Tyry, Tuula; Cutter, Gary R; Cofield, Stacey; Fox, Robert J

    2017-04-18

    To assess the opinions of persons with multiple sclerosis (MS) regarding physician-assisted death (PAD). We surveyed participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry regarding PAD. For each of 5 hypothetical situations, respondents indicated whether they definitely would, probably would, probably would not, or definitely would not consider PAD. They also reported their sociodemographics, disability status using Patient-Determined Disease Steps, depression status, pain status, religiosity, and degree of social support. Using multivariable logistic regression models, we evaluated the factors associated with an individual reporting that he or she would definitely or probably consider PAD in each situation. Of 7,534 respondents, 6,011 (79.8%) were female, and 6,884 (92.9%) were white. Their mean (SD) age was 59.9 (10.2) years. Fifty percent of respondents reported at least moderate disability. Of the 6,792 respondents who responded to any of the PAD questions, 6,400 responded to all questions. Of these, 458 (7.1%) indicated that they would definitely consider PAD in all of the situations listed, while 1,275 (19.9%) indicated that they definitely would not consider PAD in any of the situations listed. If experiencing unbearable pain, 4,383 (65.3%) of respondents would definitely or probably consider PAD. On multivariable analysis, religiosity, social support, depression, pain, disability, sex, and race were associated with considering PAD in some or all of the situations presented. Depending upon the situation, a large proportion of persons with MS would consider PAD. The association of depression with considering PAD emphasizes the importance of diagnosing and treating depression. © 2017 American Academy of Neurology.

  9. Multi-Ethnic Attitudes Toward Physician-Assisted Death in California and Hawaii

    PubMed Central

    Kraemer, Helena; Neri, Eric

    2016-01-01

    Abstract Background: As aid-in-dying laws are gaining more public acceptance and support, it is important to understand diverse perceptions toward physician-assisted death (PAD). We compare attitudes of residents from California and Hawaii to identify variables that may predict attitudes toward PAD. Methods: A cross-sectional online survey of 1095 participants (a 75.8% survey completion rate) from California and 819 from Hawaii (a 78.4% survey completion rate). Data were collected between July through October 2015. Results: Majority of study participants in California (72.5%) and Hawaii (76.5%) were supportive of PAD. Only 36.8% of participants in Hawaii and 34.8% of participants in California reported completing advance directives. To better understand which subgroups were most in favor of PAD, data were analyzed using both recursive partitioning and stepwise logistic regression. Older participants were more supportive of PAD in both states. Also, all ethnic groups were equally supportive of PAD. Completion of advance directives was not a significant predictor of attitudes toward PAD. Persons who reported that faith/religion/spirituality was less important to them were more likely to support PAD in both states. Thus, the major influences on the attitudes to PAD were religious/spiritual views and age, not ethnicity and gender. Even in the subgroups least supportive of PAD, the majority supported PAD. Conclusions: This study shows that in the ethnically diverse states of California and Hawaii, faith/religion/spirituality and age are major influencers of attitudes toward PAD and not ethnicity and gender. Even in the subgroups least supportive of PAD, the majority supports PAD. PMID:27276445

  10. Multi-Ethnic Attitudes Toward Physician-Assisted Death in California and Hawaii.

    PubMed

    Periyakoil, Vyjeyanthi S; Kraemer, Helena; Neri, Eric

    2016-10-01

    As aid-in-dying laws are gaining more public acceptance and support, it is important to understand diverse perceptions toward physician-assisted death (PAD). We compare attitudes of residents from California and Hawaii to identify variables that may predict attitudes toward PAD. A cross-sectional online survey of 1095 participants (a 75.8% survey completion rate) from California and 819 from Hawaii (a 78.4% survey completion rate). Data were collected between July through October 2015. Majority of study participants in California (72.5%) and Hawaii (76.5%) were supportive of PAD. Only 36.8% of participants in Hawaii and 34.8% of participants in California reported completing advance directives. To better understand which subgroups were most in favor of PAD, data were analyzed using both recursive partitioning and stepwise logistic regression. Older participants were more supportive of PAD in both states. Also, all ethnic groups were equally supportive of PAD. Completion of advance directives was not a significant predictor of attitudes toward PAD. Persons who reported that faith/religion/spirituality was less important to them were more likely to support PAD in both states. Thus, the major influences on the attitudes to PAD were religious/spiritual views and age, not ethnicity and gender. Even in the subgroups least supportive of PAD, the majority supported PAD. This study shows that in the ethnically diverse states of California and Hawaii, faith/religion/spirituality and age are major influencers of attitudes toward PAD and not ethnicity and gender. Even in the subgroups least supportive of PAD, the majority supports PAD.

  11. Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in "vulnerable" groups.

    PubMed

    Battin, Margaret P; van der Heide, Agnes; Ganzini, Linda; van der Wal, Gerrit; Onwuteaka-Philipsen, Bregje D

    2007-10-01

    Debates over legalisation of physician-assisted suicide (PAS) or euthanasia often warn of a "slippery slope", predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period. The data from Oregon (where PAS, now called death under the Oregon Death with Dignity Act, is legal) comprised all annual and cumulative Department of Human Services reports 1998-2006 and three independent studies; the data from the Netherlands (where both PAS and euthanasia are now legal) comprised all four government-commissioned nationwide studies of end-of-life decision making (1990, 1995, 2001 and 2005) and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought. Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups. Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges.

  12. Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995.

    PubMed

    van der Maas, P J; van der Wal, G; Haverkate, I; de Graaff, C L; Kester, J G; Onwuteaka-Philipsen, B D; van der Heide, A; Bosma, J M; Willems, D L

    1996-11-28

    In 1991 a new procedure for reporting physician-assisted deaths was introduced in the Netherlands that led to a tripling in the number of reported cases. In 1995, as part of an evaluation of this procedure, a nationwide study of euthanasia and other medical practices concerning the end of life was begun that was identical to a study conducted in 1990. We conducted two studies, the first involving interviews with 405 physicians (general practitioners, nursing home physicians, and clinical specialists) and the second involving questionnaires mailed to the physicians attending 6060 deaths that were identified from death certificates. The response rates were 89 percent and 77 percent, respectively. Among the deaths studied, 2.3 percent of those in the interview study and 2.4 percent of those in the death-certificate study were estimated to have resulted from euthanasia, and 0.4 percent and 0.2 percent, respectively, resulted from physician-assisted suicide. In 0.7 percent of cases, life was ended without the explicit, concurrent request of the patient. Pain and symptoms were alleviated with doses of opioids that may have shortened life in 14.7 to 19.1 percent of cases, and decisions to withhold or withdraw life-prolonging treatment were made in 20.2 percent. Euthanasia seems to have increased in incidence since 1990, and ending of life without the patient's explicit request to have decreased slightly. For each type of medical decision except those in which life-prolonging treatment was withheld or withdrawn, cancer was the most frequently reported diagnosis. Since the notification procedure was introduced, end-of-life decision making in the Netherlands has changed only slightly, in an anticipated direction. Close monitoring of such decisions is possible, and we found no signs of an unacceptable increase in the number of decisions or of less careful decision making.

  13. A contemporary analysis of medicolegal concerns for physician assistants and nurse practitioners.

    PubMed

    Gilliam, J W

    1994-01-01

    The utilization of-PAs and NPs to expand the supply of traditional physician services to the public, at reduced costs, as proposed by President Nixon in 1971, has in 1994 become a national mandate. There is an increasing demand for the "traditional" physician services, which can be efficiently and cost effectively performed by nonphysician practitioners, such as PAs and NPs. Statutory changes permitting physicians "to delegate medical acts in an innovative manner" have been, at times, agonizingly slow. However, when compared to the NP statutes, the PA statutes have evolved at a rapid rate. It is postulated that this may be due to the fact that PAs who are totally dependent on physician supervision are more controllable and hence more acceptable to organized medicine than NPs who are currently flexing their political muscles in a quest for greater independence in their performance of traditional physician services. The reimbursability of the two professions is yet another important consideration. Nurse practitioners are "directly" reimbursed by third-party payors, such as Medicare and Medicade, for the traditional physician services they perform, while PA third-party reimbursement is, by law, paid directly to the employing physician or medical facility. Unlike NPs, PAs were conceived by organized medicine, the AMA, to provide a mechanism for physicians to expand their capability to treat increasing numbers of patients. Accordingly, PAs are tied to their supervising physician by the same governmental agencies that regulate physician licensure. Conversely, NPs, who derive their authority to practice from the various state nurse practice acts, have been, at times, impeded in their quest for an enlargement of their scope of practice, including independent prescriptive privileges. The NP bid for greater independence and enlargement of their scope of practice, on a national level, is viewed by organized medicine as an encroachment into the "independent" practice of

  14. Active-Duty Physicians' Perceptions and Satisfaction with Humanitarian Assistance and Disaster Relief Missions: Implications for the Field

    PubMed Central

    Oravec, Geoffrey J.; Artino, Anthony R.; Hickey, Patrick W.

    2013-01-01

    Background The United States Department of Defense participates in more than 500 missions every year, including humanitarian assistance and disaster relief, as part of medical stability operations. This study assessed perceptions of active-duty physicians regarding these activities and related these findings to the retention and overall satisfaction of healthcare professionals. Methods and Findings An Internet-based survey was developed and validated. Of the 667 physicians who responded to the survey, 47% had participated in at least one mission. On a 7-point, Likert-type response scale, physicians reported favorable overall satisfaction with their participation in these missions (mean  = 5.74). Perceived benefit was greatest for the United States (mean  = 5.56) and self (mean  = 5.39) compared to the target population (mean  = 4.82). These perceptions were related to participants' intentions to extend their military medical service (total model R2  = .37), with the strongest predictors being perceived benefit to self (β = .21, p<.01), the U.S. (β = .19, p<.01), and satisfaction (β = .18, p<.05). In addition, Air Force physicians reported higher levels of satisfaction (mean  = 6.10) than either Army (mean  = 5.27, Cohen's d = 0.75, p<.001) or Navy (mean  = 5.60, Cohen's d  = 0.46, p<.01) physicians. Conclusions Military physicians are largely satisfied with humanitarian missions, reporting the greatest benefit of such activities for themselves and the United States. Elucidation of factors that may increase the perceived benefit to the target populations is warranted. Satisfaction and perceived benefits of humanitarian missions were positively correlated with intentions to extend time in service. These findings could inform the larger humanitarian community as well as military medical practices for both recruiting and retaining medical professionals. PMID:23555564

  15. The Impact of Adding a Physician Assistant to a Critical Care Outreach Team.

    PubMed

    Gershengorn, Hayley B; Xu, Yunchao; Chan, Carri W; Armony, Mor; Gong, Michelle N

    2016-01-01

    Hospitals are increasingly using critical care outreach teams (CCOTs) to respond to patients deteriorating outside intensive care units (ICUs). CCOT staffing is variable across hospitals and optimal team composition is unknown. To assess whether adding a critical care medicine trained physician assistant (CCM-PA) to a critical care outreach team (CCOT) impacts clinical and process outcomes. We performed a retrospective study of two cohorts-one with a CCM-PA added to the CCOT (intervention hospital) and one with no staffing change (control hospital)-at two facilities in the same system. All adults in the emergency department and hospital for whom CCOT consultation was requested from October 1, 2012-March 16, 2013 (pre-intervention) and January 5-March 31, 2014 (post-intervention) were included. We performed difference-in-differences analyses comparing pre- to post-intervention periods in the intervention versus control hospitals to assess the impact of adding the CCM-PA to the CCOT. Our cohort consisted of 3,099 patients (control hospital: 792 pre- and 595 post-intervention; intervention hospital: 1114 pre- and 839 post-intervention). Intervention hospital patients tended to be younger, with fewer comorbidities, but with similar severity of acute illness. Across both periods, hospital mortality (p = 0.26) and hospital length of stay (p = 0.64) for the intervention vs control hospitals were similar, but time-to-transfer to the ICU was longer for the intervention hospital (13.3-17.0 vs 11.5-11.6 hours, p = 0.006). Using the difference-in-differences approach, we found a 19.2% reduction (95 confidence interval: 6.7%-31.6%, p = 0.002) in the time-to-transfer to the ICU associated with adding the CCM-PA to the CCOT; we found no difference in hospital mortality (p = 0.20) or length of stay (p = 0.52). Adding a CCM-PA to the CCOT was associated with a notable reduction in time-to-transfer to the ICU; hospital mortality and length of stay were not impacted.

  16. The Impact of Adding a Physician Assistant to a Critical Care Outreach Team

    PubMed Central

    Xu, Yunchao; Chan, Carri W.; Armony, Mor; Gong, Michelle N.

    2016-01-01

    Rationale Hospitals are increasingly using critical care outreach teams (CCOTs) to respond to patients deteriorating outside intensive care units (ICUs). CCOT staffing is variable across hospitals and optimal team composition is unknown. Objectives To assess whether adding a critical care medicine trained physician assistant (CCM-PA) to a critical care outreach team (CCOT) impacts clinical and process outcomes. Methods We performed a retrospective study of two cohorts—one with a CCM-PA added to the CCOT (intervention hospital) and one with no staffing change (control hospital)—at two facilities in the same system. All adults in the emergency department and hospital for whom CCOT consultation was requested from October 1, 2012-March 16, 2013 (pre-intervention) and January 5-March 31, 2014 (post-intervention) were included. We performed difference-in-differences analyses comparing pre- to post-intervention periods in the intervention versus control hospitals to assess the impact of adding the CCM-PA to the CCOT. Measurements and Main Results Our cohort consisted of 3,099 patients (control hospital: 792 pre- and 595 post-intervention; intervention hospital: 1114 pre- and 839 post-intervention). Intervention hospital patients tended to be younger, with fewer comorbidities, but with similar severity of acute illness. Across both periods, hospital mortality (p = 0.26) and hospital length of stay (p = 0.64) for the intervention vs control hospitals were similar, but time-to-transfer to the ICU was longer for the intervention hospital (13.3–17.0 vs 11.5–11.6 hours, p = 0.006). Using the difference-in-differences approach, we found a 19.2% reduction (95 confidence interval: 6.7%-31.6%, p = 0.002) in the time-to-transfer to the ICU associated with adding the CCM-PA to the CCOT; we found no difference in hospital mortality (p = 0.20) or length of stay (p = 0.52). Conclusions Adding a CCM-PA to the CCOT was associated with a notable reduction in time-to-transfer to the

  17. Nurse practitioner and physician assistant practices in three HMOs: implications for future US health manpower needs.

    PubMed Central

    Weiner, J P; Steinwachs, D M; Williamson, J W

    1986-01-01

    This study empirically examines the practices of non-physician providers (NPPs) within three large competitive health maintenance organizations (HMOs), as well as the physicians' and NPPs' views regarding the ideal role of NPPs. These roles are compared with NPP delegation patterns incorporated in the modeling methodology developed by the Graduate Medical Education National Advisory Committee (GMENAC). GMENAC recommended relatively high levels of delegation by physicians to NPPs. One of the HMO sites made use of NPPs at rates even higher than GMENAC's national ideals, while the rates at the other two were lower. The normative ideals for pediatric NPPs developed at each HMO were consistently higher than their actual roles. Concerns with acceptance and the role of NPPs are clearly no longer issues. Instead, the limits on NPP involvement appear to relate to considerations of costs, availability, and the increasing numbers of physicians competing for similar opportunities. PMID:3515977

  18. Nurse practitioner and physician assistant practices in three HMOs: implications for future US health manpower needs.

    PubMed

    Weiner, J P; Steinwachs, D M; Williamson, J W

    1986-05-01

    This study empirically examines the practices of non-physician providers (NPPs) within three large competitive health maintenance organizations (HMOs), as well as the physicians' and NPPs' views regarding the ideal role of NPPs. These roles are compared with NPP delegation patterns incorporated in the modeling methodology developed by the Graduate Medical Education National Advisory Committee (GMENAC). GMENAC recommended relatively high levels of delegation by physicians to NPPs. One of the HMO sites made use of NPPs at rates even higher than GMENAC's national ideals, while the rates at the other two were lower. The normative ideals for pediatric NPPs developed at each HMO were consistently higher than their actual roles. Concerns with acceptance and the role of NPPs are clearly no longer issues. Instead, the limits on NPP involvement appear to relate to considerations of costs, availability, and the increasing numbers of physicians competing for similar opportunities.

  19. Moral and Legal Issues Surrounding Terminal Sedation and Physician Assisted Suicide

    DTIC Science & Technology

    2002-09-23

    and laws such as the Oregon Death With Dignity Act, it is no wonder that the assisted suicide debate is at the forefront of biomedical issues. Death ...Task Force on Life and the Law, When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context 108 (1994) ("[Professional organizations...treatment and allowing assisted suicide or euthanasia have radically different consequences and meanings for public policy.’ When Death is Sought: Assisted

  20. [Attitudes and experiences regarding physician assisted suicide : A survey among members of the German Association for Palliative Medicine].

    PubMed

    Jansky, Maximiliane; Jaspers, Birgit; Radbruch, Lukas; Nauck, Friedemann

    2017-01-01

    The need to regulate physician-assisted suicide (PAS) and organizations offering assisted suicide has been controversially debated in Germany. Before the German parliament voted on various drafts in November 2015, the German Association for Palliative Medicine surveyed its members on their attitudes and experiences regarding PAS. Items for the survey were derived from the literature and consented in a focus group. 2005-2015 - PubMed: PAS [Title/Abstract] UND survey (all countries), grey literature. We invited 5152 members of the DGP to participate in the online/paper survey. Descriptive quantitative and content analytic qualitative analysis of data using SPSS and MaxQDA. We obtained 1811 valid data sets (response rate 36.9%). 33.7% of the participants were male, 43.6% were female, and 0.4% identifed as other. Physicians accounted for 48.5% of the respondents, 17.8% nurses, other professions 14.3%, and about 20% of the data was missing socio-demographic information. More than 90% agreed that "wishes for PAS may be ambivalent" and "are rather a wish to end an unbearable situation". Of the 833 participating physicians, 56% refused participating in PAS and 74.2% had been asked to perform PAS. PAS was actually performed by 3%. Of all participating members, 56% approved of a legal ban of organizations offering assisted suicide. More than 60% of all professions agreed that PAS is not a part of palliative care. The respondents show a broad spectrum of attitudes, only partly supporting statements of relevant bodies, such as DGP. Because many are confronted with the issue, PAS is relevant to professionals in palliative care.

  1. [Physician assistance in dying or help to die--a line of legal demarcation (from the lawyer's perspective)].

    PubMed

    Ulsenheimer, Klaus

    2008-01-01

    The definition of the legal prerequisites for the permissible withholding/withdrawal of medical treatment, the limits to a physician's obligation to provide medical care as well as the differentiation between the aiding with suicide, which is exempt from punishment, and the punishable termination of life upon request or failure to render assistance is actually one of the most difficult medico-legal, professional-ethical, human, ideological and moral problems. The numerous views and opinions expressed are varying accordingly so that the call for legislative action comes as no surprise. Nonetheless, legal practice has provided clarity for a large number of aspects. The life of a human being scores the highest on the value scale of the Basic Law (GG) of the Federal Republic of Germany; the right to self-determination is of particular significance. It does not imply the "right to suicide", though, but suicide--and the participation in it--is not subject to punishment. But if the physician exercises control over the act ("Tatherrschaft") he is required to provide all necessary and reasonable life-saving assistance. There is general consent that assistance with dying by way of intentional killing (active direct euthanasia) is a crime whereas palliative treatment of the terminally ill while accepting the unintentional and inevitable side effect of hastening the patient's death is justified (so-called indirect euthanasia). The so-called passive euthanasia which is characterised by withholding/withdrawing treatment measures is associated with the most difficult problems. In this context the permissible ,,assistance in dying", i.e., the actual euthanasia, has to be distinguished from ,,help to die", that is, euthanasia in a broader sense, as the Federal Supreme Court (BGH) correctly pointed out in its leading decision (BGHSt 40, 257 et sqq.). Within this differentiation the advance directive is of particular importance since only subsidiary reference may be made to the

  2. Full Intelligent Cancer Classification of Thermal Breast Images to Assist Physician in Clinical Diagnostic Applications

    PubMed Central

    Lashkari, AmirEhsan; Pak, Fatemeh; Firouzmand, Mohammad

    2016-01-01

    Breast cancer is the most common type of cancer among women. The important key to treat the breast cancer is early detection of it because according to many pathological studies more than 75% – 80% of all abnormalities are still benign at primary stages; so in recent years, many studies and extensive research done to early detection of breast cancer with higher precision and accuracy. Infra-red breast thermography is an imaging technique based on recording temperature distribution patterns of breast tissue. Compared with breast mammography technique, thermography is more suitable technique because it is noninvasive, non-contact, passive and free ionizing radiation. In this paper, a full automatic high accuracy technique for classification of suspicious areas in thermogram images with the aim of assisting physicians in early detection of breast cancer has been presented. Proposed algorithm consists of four main steps: pre-processing & segmentation, feature extraction, feature selection and classification. At the first step, using full automatic operation, region of interest (ROI) determined and the quality of image improved. Using thresholding and edge detection techniques, both right and left breasts separated from each other. Then relative suspected areas become segmented and image matrix normalized due to the uniqueness of each person's body temperature. At feature extraction stage, 23 features, including statistical, morphological, frequency domain, histogram and Gray Level Co-occurrence Matrix (GLCM) based features are extracted from segmented right and left breast obtained from step 1. To achieve the best features, feature selection methods such as minimum Redundancy and Maximum Relevance (mRMR), Sequential Forward Selection (SFS), Sequential Backward Selection (SBS), Sequential Floating Forward Selection (SFFS), Sequential Floating Backward Selection (SFBS) and Genetic Algorithm (GA) have been used at step 3. Finally to classify and TH labeling procedures

  3. Full Intelligent Cancer Classification of Thermal Breast Images to Assist Physician in Clinical Diagnostic Applications.

    PubMed

    Lashkari, AmirEhsan; Pak, Fatemeh; Firouzmand, Mohammad

    2016-01-01

    Breast cancer is the most common type of cancer among women. The important key to treat the breast cancer is early detection of it because according to many pathological studies more than 75% - 80% of all abnormalities are still benign at primary stages; so in recent years, many studies and extensive research done to early detection of breast cancer with higher precision and accuracy. Infra-red breast thermography is an imaging technique based on recording temperature distribution patterns of breast tissue. Compared with breast mammography technique, thermography is more suitable technique because it is noninvasive, non-contact, passive and free ionizing radiation. In this paper, a full automatic high accuracy technique for classification of suspicious areas in thermogram images with the aim of assisting physicians in early detection of breast cancer has been presented. Proposed algorithm consists of four main steps: pre-processing & segmentation, feature extraction, feature selection and classification. At the first step, using full automatic operation, region of interest (ROI) determined and the quality of image improved. Using thresholding and edge detection techniques, both right and left breasts separated from each other. Then relative suspected areas become segmented and image matrix normalized due to the uniqueness of each person's body temperature. At feature extraction stage, 23 features, including statistical, morphological, frequency domain, histogram and Gray Level Co-occurrence Matrix (GLCM) based features are extracted from segmented right and left breast obtained from step 1. To achieve the best features, feature selection methods such as minimum Redundancy and Maximum Relevance (mRMR), Sequential Forward Selection (SFS), Sequential Backward Selection (SBS), Sequential Floating Forward Selection (SFFS), Sequential Floating Backward Selection (SFBS) and Genetic Algorithm (GA) have been used at step 3. Finally to classify and TH labeling procedures

  4. Identifying and Assisting the Gifted Child: [Six Guides for the] Clinical Social Worker; School Counselor; School Social Worker; Nurse; Physician; [and] Psychologist.

    ERIC Educational Resources Information Center

    Michigan State Board of Education, Lansing.

    These six guides on identifying and assisting the gifted school-age child are specifically addressed to either clinical social workers, school social workers, school counselors, nurses, physicians, and psychologists. Each leaflet examines the role of the target professional in providing assistance to gifted children. For example, the social…

  5. The influence of death attitudes and knowledge of end of life options on attitudes toward physician-assisted suicide.

    PubMed

    Kopp, Steven W

    End of life decisions, such as physician-assisted suicide (PAS), have continued to be controversial as health care policy, moral, and individual health care issues. This study considers knowledge of end of life options and death attitudes as predictors of attitudes toward PAS. Data were gathered from approximately 300 adults through a mailing sent to a household research panel. Validated measures of attitudes toward PAS, knowledge about that state's assisted suicide laws, demographics, and attitudes toward death as measured through the Death Attitude Profile-Revised (DAP-R) were collected and analyzed. The data indicate that attitudes toward PAS are a function of knowledge of end of life options as well as death attitudinal factors.

  6. Effectiveness of an Intervention to Teach Physicians How to Assist Patients to Quit Smoking in Argentina.

    PubMed

    Mejia, Raul; Pérez Stable, Eliseo J; Kaplan, Celia P; Gregorich, Steven E; Livaudais-Toman, Jennifer; Peña, Lorena; Alderete, Mariela; Schoj, Veronica; Alderete, Ethel

    2016-05-01

    We evaluated an intervention to teach physicians how to help their smoking patients quit compared to usual care in Argentina. Physicians were recruited from six clinical systems and randomized to intervention (didactic curriculum in two 3-hour sessions) or usual care. Smoking patients who saw participating physicians within 30 days of the intervention (index clinical visit) were randomly sampled and interviewed by telephone with follow-up surveys at months 6 and 12 after the index clinical visit. Outcomes were tobacco abstinence (main), quit attempt in the past month, use of medications to quit smoking, and cigarettes per day. Repeated measures on the same participants were accommodated via generalized linear mixed models. Two hundred fifty-four physicians were randomized; average age 44.5 years, 53% women and 12% smoked. Of 1378 smoking patients surveyed, 81% were women and 45% had more than 12 years of education. At 1 month, most patients (77%) reported daily smoking, 20% smoked some days and 3% had quit. Mean cigarettes smoked per day was 12.9 (SD = 8.8) and 49% were ready to quit within the year. Intention-to-treat analyses did not show significant group differences in quit rates at 12 months when assuming outcome response was missing at random (23% vs. 24.1%, P = .435). Using missing=smoking imputation rule, quit rates were not different at 12 months (15.6% vs. 16.4% P = .729). Motivated smokers were more likely to quit at 6 months (17.7% vs. 9.6%, P = .03). Training in tobacco cessation for physicians did not improve abstinence among their unselected smoking patients. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Practice environment and the employment of nurse practitioners, physician assistants, and certified nurse midwives by community health centers.

    PubMed

    Shi, L; Samuels, M E

    1997-01-01

    This report examines the relation between state variations in the regulation of nurse practitioners (NPs), physician assistants (PAs), and certified nurse midwives (CNMs), and the employment of these nonphysician providers (NPPs) by community health centers (CHCs). Data for this report came from a 1991-92 survey of CHCs assessing the employment of NPPs, and secondary available data. The dependent variables examined were the numbers of NPPs currently employed by CHCs. Independent variables included 1992 practice environment scores, CHC location, number of CHC physicians, and NPP-to-population ratios. The number of NPs and PAs employed by CHCs was significantly associated with practice environment for these practitioners. NPP-to-population ratios and the number of CHC physicians are also significantly associated with NPP employment by CHCs. State decision makers may reduce legislative and regulatory barriers to practice as a way to improve the practice environment for nonphysician primary care providers, particularly NPs and PAs. Thus, community health centers can employ adequate number of NPPs to fulfill their mission of serving the poor and underserved population.

  8. Quality, efficiency, and cost of a physician-assistant-protocol system for managment of diabetes and hypertension.

    PubMed

    Komaroff, A L; Flatley, M; Browne, C; Sherman, H; Fineberg, S E; Knopp, R H

    1976-04-01

    Briefly trained physicians assistants using protocols (clinical algorithms) for diabetes, hypertension, and related chronic arteriosclerotic and hypertensive heart disease abstrated information from the medical record and obtained history and physical examination data on every patient-visit to a city hospital chronic disease clinic over a 18-month period. The care rendered by the protocol system was compared with care rendered by a "traditional" system in the same clinic in which physicians delegated few clinical tasks. Increased thoroughness in collecting clinical data in the protocol system led to an increase in the recognition of new pathology. Outcome criteria reflected equivalent quality of care in both groups. Efficiency time-motion studies demonstrated a 20 per cent saving in physician time with the protocol system. Coct estimates, based on the time spent with patients by various providers and on the laboratory-test-ordering patterns, demonstrated equivalent costs of the two systems, given optimal staffing patterns. Laboratory tests were a major element of the cost of patient care,and the clinical yield per unit cost of different tests varied widely.

  9. Enhancing Physician Assistant Student Clinical Rotation Evaluations With the RIME Scoring Format: A Retrospective 3-Year Analysis.

    PubMed

    Klocko, David J

    2016-11-03

    This article describes a 3-year retrospective analysis of student clinical rotation evaluations using the Reporter-Interpreter-Manager-Educator (RIME) scoring format. The intent of the analysis was to assess scoring trends to determine whether students with high scores on the Physician Assistant National Certifying Exam (PANCE) also achieved high RIME scores on clinical rotations. The top and bottom quartiles of PANCE scores were identified for the University of Texas (UT) Southwestern Medical Center's physician assistant (PA) classes of 2010-2012 (n = 106). RIME scores for the top and bottom quartiles of students (n = 54) also were identified. RIME scores for the same cohort of students were analyzed using the top and bottom quartiles of students' PANCE scores. The Wilcoxon matched-pairs signed rank test revealed that students with top quartile PANCE scores received a higher aggregate RIME score of 557 compared with the lower quartile of PANCE performers' score of 520 (P < .03). Results for RIME scoring trends, PANCE scores, and end-of-rotation examination scores are presented. Students from the UT Southwestern Medical Center's PA classes of 2010-2012 obtained a Manager classification most often (52%), and students with higher PANCE scores also received higher RIME scores on clinical rotations.

  10. Suboptimal reporting of adverse medical events to the FDA Adverse Events Reporting System by nurse practitioners and physician assistants.

    PubMed

    Ehrenpreis, Eli D; Sifuentes, Humberto; Ehrenpreis, Jamie E; Smith, Zachary L; Marshall, Mike L

    2012-03-01

    The Adverse Events Reporting System (AERS) of the FDA is used to identify toxicities of drugs that are on the market. Nurse practitioners (NP) and physician assistants (PA), having an increasing role in the delivery of medical care, are also needed to participate in post-marketing pharmacovigilance. This study was performed to assess awareness and use of the AERS in voluntary reporting of drug toxicities by NPs and PAs. A cluster sample survey was issued at the Principles of Gastroenterology for the Nurse Practitioner and Physician Assistant course in August 2010. The survey assessed familiarity with the AERS, the number of adverse events seen and the frequency of reports sent to the AERS. NP and PA responses were compared using the two-tailed Fisher's exact. Of the 92 respondents, 67 (72%) were NPs and 24 (26%) PAs. Of the 50 (54%) respondents that reported being familiar with the AERS system, 20 (40%) incorrectly identified the methods to report using the AERS. Overall reporting of adverse events was low, particularly in respondents seeing 5-12 adverse events per year. The study suggests that improved education regarding the importance of using AERS for pharmacovigilance is suggested for NPs and PAs. Due to the small size of the study, these data should be viewed as preliminary, pending a larger confirmatory study.

  11. The death of Loving: maternal identity as moral constraint in a narrative testimonial advocating physician assisted suicide.

    PubMed

    Kenny, Robert Wade

    2002-01-01

    This article considers the narrative testimonial as a rhetorical form in the service of public judgment, with particular attention to the witness's credibility and communicative competence. The author argues that a narrator and witness, as a participant-observer of the events recounted, must generate a story that does not compromise her credibility as a moral agent within the text, and that the capacity to do so is largely a function of communicative competence. Carol Loving's recent book concerning her son's physician assisted suicide is critically assessed to illustrate the primary argument. The critique attempts to show that she neither creates a substantial argument for physician assisted suicide, nor does she warrant her role as a spokesperson for the issue because her narrative violates formative features of maternal identity. Loving's narrative also unintentionally reveals motivational clusters that conflict with and compromise the primary argument, thereby subverting the process of persuasive appeal. Whereas mothers are often mediators for their children in health matters ranging from colds, to psychiatric issues, to matters of death and dying, the failure of Carol Loving in this text, as well as its analysis, should be instructive and cautionary to health professionals who rely on maternal discourse in handling patients, as well as audiences who rely on narrative testimonials as content in their deliberation of public issues.

  12. Attitudes and Usage of the Food and Drug Administration Adverse Event Reporting System Among Gastroenterology Nurse Practitioners and Physician Assistants.

    PubMed

    Salk, Allison; Ehrenpreis, Eli D

    2016-01-01

    The Food and Drug Administration Adverse Event Reporting System (FAERS) is used for postmarketing pharmacovigilance. Our study sought to assess attitudes and usage of the FAERS among gastroenterology nurse practitioners (NPs) and physician assistants (PAs). A survey was administered at the August 2012 Principles of Gastroenterology for the Nurse Practitioner and Physician Assistant course, held in Chicago, IL. Of the 128 respondents, 123 (96%) reported a specialty in gastroenterology or hepatology and were included in analysis. Eighty-nine participants were NPs and 32 PAs, whereas 2 did not report their profession. Although 119 (98%) agreed or strongly agreed with the statement that accurately reporting adverse drug reactions is an important process to optimize patient safety, the majority of participants (54% NPs and 81% PAs) were unfamiliar with the FAERS. In addition, only 20% of NPs and 9% of PAs reported learning about the FAERS in NP or PA schooling. Our study shows enthusiasm among gastroenterology NPs and PAs for the reporting of adverse drug reactions, coupled with a lack of familiarity with the FAERS. This presents an opportunity for enhanced education about reporting of adverse drug reactions for gastroenterology NPs and PAs.

  13. Advanced Practice Registered Nurses and Physician Assistants in Sleep Centers and Clinics: A Survey of Current Roles and Educational Background

    PubMed Central

    Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E.; Rogers, Ann E.

    2014-01-01

    Study Objectives: To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Methods: Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Results: Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through “on the job” training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. Conclusions: APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap. Citation: Colvin L, Cartwright Ann, Collop N, Freedman N, McLeod D, Weaver TE, Rogers AE. Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background. J Clin Sleep Med 2014;10(5):581-587. PMID:24812545

  14. Recognizing a fundamental liberty interest protecting the right to die: an analysis of statutes which criminalize or legalize physician-assisted suicide.

    PubMed

    Tarnow, W J

    1996-01-01

    Physician-assisted suicide is one of the most controversial issues in society today. We live in an age where medical technology has developed so fast and so far that those who would have swiftly succumbed to deadly diseases in the not too distant past are now living, or, rather, being kept alive long past the point of meaningful existence. Although everyone sympathizes with the painful plight of the terminally ill, the specter of physician-assisted suicide gives many pause, and rightfully so: one need only think of the carbon monoxide contraption in the back of Dr. Death's infamous van to realize that society must address the issue of the right to die. Is there any solution to this great debate? In this note, Mr. William Tarnow passionately answers in the affirmative. Mr. Tarnow analyzes the constitutionality of state statutes which either criminalize or legalize physician-assisted suicide under both the Due Process and Equal Protection Clauses of the Constitution of the United States. The note also considers the case law, largely from the federal Ninth Circuit Court of Appeals, invalidating and upholding such statutes under the Constitution. Arguing that there is indeed a constitutional liberty interest in physician-assisted suicide, Mr. Tarnow concludes by suggesting that state legislatures can and must create legislation that legalizes physician-assisted suicide and passes constitutional muster.

  15. [Physician-assisted suicide and advance care planning--ethical considerations on the autonomy of dementia patients at their end of life].

    PubMed

    Gather, Jakov; Vollmann, Jochen

    2014-10-01

    Physician-assisted suicide (PAS), which is currently the subject of intense and controversial discussion in medical ethics, is barely discussed in psychiatry, albeit there are already dementia patients in Germany and other European countries who end their own lives with the assistance of physicians. Based on the finding that patients who ask for medical assistance in suicide often have in mind the loss of their mental capacity, we submit PAS to an ethical analysis and put it into a broader context of patient autonomy at the end of life. In doing so, we point to advance care planning, through which the patient autonomy of the person concerned can be supported as well as respected in later stages of the disease. If patients adhere to their autonomous wish for PAS, physicians find themselves in an ethical dilemma. A further tabooing of the topic, however, does not provide a solution; rather, an open societal and professional ethical discussion and regulation are essential.

  16. To Die, to Sleep: US Physicians’ Religious and Other Objections to Physician-Assisted Suicide, Terminal Sedation, and Withdrawal of Life Support

    PubMed Central

    Curlin, Farr A.; Nwodim, Chinyere; Vance, Jennifer L.; Chin, Marshall H.; Lantos, John D.

    2010-01-01

    This study analyzes data from a national survey to estimate the proportion of physicians who currently object to physician-assisted suicide (PAS), terminal sedation (TS), and withdrawal of artificial life support (WLS), and to examine associations between such objections and physician ethnicity, religious characteristics, and experience caring for dying patients. Overall, 69% of the US physicians object to PAS, 18% to TS, and 5% to WLS. Highly religious physicians are more likely than those with low religiosity to object to both PAS (84% vs 55%, P < .001) and TS (25% vs 12%, P < .001). Objection to PAS or TS is also associated with being of Asian ethnicity, of Hindu religious affiliation, and having more experience caring for dying patients. These findings suggest that, with respect to morally contested interventions at the end of life, the medical care patients receive will vary based on their physicians’ religious characteristics, ethnicity, and experience caring for dying patients. PMID:18198363

  17. Report 59 of the AMA Board of Trustees (A-96). Physician-assisted suicide. Reference Committee on Amendments to Constitution and Bylaws.

    PubMed

    1996-08-01

    This Board of Trustees report calls for reaffirmation of the position of the American Medical Association (AMA) in opposition to physicians assisting their patients in committing suicide. The AMA maintains that the appropriate step for physicians is not to assist a patient in death but to provide compassion and palliative care. In providing end-of-life care, the option of allowing physicians to intentionally cause the death of patients is a line that should not be crossed. This position is based on the historical role of physicians as advocates for healing. The report discusses AMA activity to design and implement a comprehensive physician education plan on end-of-life care in response to the House of Delegates' action in adopting Board of Trustees Report 48-I-95, "Quality Care at the End of Life." This plan will further the AMA's commitment that patients should receive high quality care during every stage of life, including the end of life. The goal of this educational campaign is to advance the medical culture by making palliative treatment and care directions based on values-based advance care planning the standard of care for meeting the needs of patients at the end of life. The basis for this activity will be the acknowledgment that physicians, while unable to always provide a cure, should always be able to relieve suffering, address the psychological needs of patients at the end of life, add value to remaining life, and help patients die with dignity. The report presents information on state legislative activities and judicial actions relating to physician-assisted suicide. The report also presents a discussion on the ethical under-pinnings against physician participation in patients' suicides. This report recommends that: the AMA reaffirm current policies 140.952 and 140.966 (AMA Policy Compendium), in accordance with Council on Ethical and Judicial Affairs Opinion 2.211 (opposition to physician-assisted suicide); the AMA initiate an educational campaign to

  18. Patients’ Acceptance of Physician’s Assistants in Air Force Primary Medicine Clinics

    DTIC Science & Technology

    1980-09-01

    assistants and primary care nurse practitioners-in primary medicine outpatient clinics. This report, one in a series presenting Rand’s eva !u- ation of the...ACTION Tim BY Mh’CAL PERON ON LADY VISIT (Regular uers of boew; percent) Chanute Pres Fairchild Nellos Response 1976 1977 1976 1977 1976 1977 1976 197

  19. Physicians' willingness to grant requests for assistance in dying for children: a study of hypothetical cases.

    PubMed

    Vrakking, Astrid M; van der Heide, Agnes; Looman, Caspar W N; van Delden, Johannes J M; Onwuteaka-Philipsen, Bregje D; van der Maas, Paul J; van der Wal, Gerrit

    2005-05-01

    To study the willingness of Dutch physicians to use potentially life-shortening or lethal drugs for severely ill children. We asked 63 pediatricians about their approach to 10 hypothetical cases of children with cancer. The age of the child (15, 11, or 6 years), the child's (explicit) request, and the opinion of the parents varied. Two hypothetical cases were also presented to 125 general practitioners and 208 clinical specialists. Most pediatricians were willing to increase morphine in all cases. A total of 48% to 60% of pediatricians were willing to use lethal drugs in children at the child's request, when the parents agreed; when parents requested ending of life of their unconscious child, 37% to 42% of pediatricians were willing; 13% to 28% of pediatricians were willing when parents did not agree with their child's request. General practitioners and clinical specialists were as willing as pediatricians to use lethal drugs at the child's request, but less willing to grant a request of parents for their unconscious child. Many Dutch pediatricians are willing to use potentially life-shortening or lethal drugs for children. The legal limit of 12 years, as the age under which voluntary euthanasia is forbidden, is not fully supported by Dutch physicians.

  20. The emerging role of physician assistants in the delivery of dermatologic health care.

    PubMed

    Clark, A R; Monroe, J R; Feldman, S R; Fleischer, A B; Hauser, D A; Hinds, M A

    2000-04-01

    with new conditions without the physician being on site, opening up the possibility for satellite offices in remote areas. Just as dermatologists may move toward specialization in surgery, cosmetics, or medical dermatology, PAs may do the same, filling a niche in a particular practice. As in other specialties, patient acceptance of seeing dermatology PAs has not been a significant problem. Continued access to the dermatologist remains unfettered, but, over time, many patients become willing to see either. Are PAs likely to become future competitors of dermatologists? Genuinely concerned dermatologists worry that a dermatology-trained PA will become part of a gatekeeper system that impedes patient access to dermatologists. This is not happening and is not at all likely to become a trend, for a number of reasons. First, primary care cannot compete with dermatology practices in remuneration for PAs. Just as financial benefits in high-production specialty practices entice physicians, the same benefits entice PAs as well. Second, according to member surveys of the SDPA, virtually 100% of fellow members work with dermatologists. Although PAs can work in any type of practice and evaluate dermatologic symptoms just as a general practitioner would, PAs who specialize in dermatology primarily practice with dermatologists, a collegial association most PAs seek out. PAs have steadfastly maintained their dependent, noncompetitive relationship with physicians and would not have it any other way. Although PAs see a good number of patients (2.8 million) with dermatologic symptoms, the NAMCS data indicate that most (72%) of these patients are also seen by a physician. Third, physicians are ultimately responsible for the actions of their PA employee. A general practitioner not trained to perform excisions or manage certain dermatologic conditions should not allow a PA to perform such duties. Similar to much of medicine, the PA profession continues to evolve, with many members moving awa

  1. GPs' views on changing the law on physician-assisted suicide and euthanasia, and willingness to prescribe or inject lethal drugs: a survey from Wales.

    PubMed

    Pasterfield, Diana; Wilkinson, Clare; Finlay, Ilora G; Neal, Richard D; Hulbert, Nicholas J

    2006-06-01

    If physician-assisted suicide/euthanasia is legalised in the UK, this may be the work of GPs. In the absence of recent or comprehensive evidence about GPs' views on either legalisation or willingness to take part, a questionnaire survey of all Welsh GPs was conducted of whom 1202 (65%) responded. Seven hundred and fifty (62.4% of responders) and 671 (55.8% of responders) said that they did not favour a change in the law to allow physician-assisted suicide/voluntary euthanasia respectively. These data provide a rational basis for determining the position of primary care on this contentious issue.

  2. GPs' views on changing the law on physician-assisted suicide and euthanasia, and willingness to prescribe or inject lethal drugs: a survey from Wales

    PubMed Central

    Pasterfield, Diana; Wilkinson, Clare; Finlay, Ilora G; Neal, Richard D; Hulbert, Nicholas J

    2006-01-01

    If physician-assisted suicide/euthanasia is legalised in the UK, this may be the work of GPs. In the absence of recent or comprehensive evidence about GPs' views on either legalisation or willingness to take part, a questionnaire survey of all Welsh GPs was conducted of whom 1202 (65%) responded. Seven hundred and fifty (62.4% of responders) and 671 (55.8% of responders) said that they did not favour a change in the law to allow physician-assisted suicide/voluntary euthanasia respectively. These data provide a rational basis for determining the position of primary care on this contentious issue. PMID:16762127

  3. The debate about physician assistance in dying: 40 years of unrivalled progress in medical ethics?

    PubMed

    Holm, Søren

    2015-01-01

    Some issues in medical ethics have been present throughout the history of medicine, and thus provide us with an opportunity to ascertain: (1) whether there is progress in medical ethics; and (2) what it means to do good medical ethics. One such perennial issue is physician assistance in dying (PAD). This paper provides an account of the PAD debate in this journal over the last 40 years. It concludes that there is some (but limited) progress in the debate. The distinctions, analogies and hypothetical examples have proliferated, as have empirical studies, but very little has changed in terms of the basic arguments. The paper further argues that many of the contributions to the debate fail to engage fully with the concerns people have about the legal introduction of PAD in the healthcare system, perhaps because many of the contributions sit on the borderline between academic analysis and social activism.

  4. Effect of a long-term care geriatrics rotation on physician assistant students' knowledge and attitudes towards the elderly.

    PubMed

    Bell-Dzide, Dodzi; Gokula, Murthy; Gaspar, Phyllis

    2014-01-01

    Physician assistants (PAs) have the opportunity to contribute to the high demand of providing health care to the growing older adult population. It is essential they have the knowledge to meet this need. The purpose of this study was to determine the difference in knowledge of and attitudes towards the elderly among a group of PA students before and after a required four-week geriatric rotation. PA students' knowledge of geriatrics was significantly improved following the long-term care rotation. Attitude did not change following the rotation but reflected a positive attitude at baseline. It is recommended that PA programs incorporate a rotation in geriatrics/long-term care to help increase PA students' geriatrics-specific knowledge and to better prepare them to provide care to their elderly patients.

  5. [Task shifting and quality of care in practice; physician assistants compared with anaesthesiology residents in the preoperative anaesthesiology outpatient clinic].

    PubMed

    Tromp Meesters, Reinier C; Hettinga, Aggie M; van den Brink, Geert; Postma, Cornelis T; Scheffer, Gertjan

    2013-01-01

    To compare the clinical competencies of second-year anaesthesiology residents and physician assistants (PA) in the preoperative anaesthesiology outpatient clinic. Comparative qualitative observational study. The two study groups were compared using 5 test stations representing 5 different cases of varying degrees of complexity with standardized patients. For each case, the patients and two anaesthesiologists assessed the results of the PAs and the residents using a quantitative scoring system for 4 clinical skills relevant to the preoperative anaesthesiology outpatient clinic. These skills were history-taking, physical examination, communication, and reporting. At each station, a score was calculated for each skill. The groups' scores were subsequently compared. 9 PAs and 11 residents carried out the station tests. There were no significant differences between the two groups of participants. In this study in a preoperative anaesthesiology outpatient clinic no difference in clinical competencies was found between PAs and second-year anaesthesiology residents.

  6. Impact of a personal CYP2D6 testing workshop on physician assistant student attitudes toward pharmacogenetics.

    PubMed

    O'Brien, Travis J; LeLacheur, Susan; Ward, Caitlin; Lee, Norman H; Callier, Shawneequa; Harralson, Arthur F

    2016-03-01

    We assessed the impact of personal CYP2D6 testing on physician assistant student competency in, and attitudes toward, pharmacogenetics (PGx). Buccal samples were genotyped for CYP2D6 polymorphisms. Results were discussed during a 3-h PGx workshop. PGx knowledge was assessed by pre- and post-tests. Focus groups assessed the impact of the workshop on attitudes toward the clinical utility of PGx. Both student knowledge of PGx, and its perceived clinical utility, increased immediately following the workshop. However, exposure to PGx on clinical rotations following the workshop seemed to influence student attitudes toward PGx utility. Personal CYP2D6 testing improves both knowledge and comfort with PGx. Continued exposure to PGx concepts is important for transfer of learning.

  7. Impact of physician assistants on the outcomes of patients with acute myelogenous leukemia receiving chemotherapy in an academic medical center.

    PubMed

    Glotzbecker, Brett E; Yolin-Raley, Deborah S; DeAngelo, Daniel J; Stone, Richard M; Soiffer, Robert J; Alyea, Edwin P

    2013-09-01

    Inpatient academic medical center care historically has been delivered by faculty physicians in conjunction with physicians in training (house officers [HOs]). Alternative staffing models have emerged secondary to American Counsel for Graduate Medical Education work-hour restrictions. The purpose of this study was to assess the quality of acute myelogenous leukemia (AML) care provided by a physician assistant (PA) service compared with a traditional model. Data were retrospectively collected on patients admitted with AML for reinduction chemotherapy from 2008 to 2012. Primary outcome measures were inpatient mortality and length of stay (LOS). Secondary measures included readmissions, intensive care unit (ICU) transfers, consults requested, and radiologic studies ordered. Ninety-five patients with AML were reviewed. Forty-seven patients (49.5%) were admitted to the HO service, and 48 patients (50.5%) were admitted to the PA service. Demographic data were similar between services. LOS was significantly different between the services, with a mean of 36.8 days with the HO model compared with 30.9 days with the PA service (P=.03). The 14-day readmission rate also differed significantly; it was 10.6% (five of 47 patients) and zero for the HO and PA models, respectively (P=.03). The mean number of consults with the HO model was 2.11 (range, zero to five) versus 1.47 (range, zero to four) with the PA service (P=.03). Mortality and ICU transfers were not significantly different. The data demonstrate equivalent mortality and ICU transfers, with a decrease in LOS, readmission rates, and consults for patients cared for in the PA service. This suggests that the PA service is associated with increased operational efficiency and decreased health service use without compromising health care outcomes.

  8. Financial and organizational factors affecting the employment of nurse practitioners and physician assistants in medical group practices.

    PubMed

    Kaissi, Amer; Kralewski, John; Dowd, Bryan

    2003-01-01

    This study examines the financial and organizational factors that are associated with the employment of nurse practitioners (NPs) and physician assistants (PAs) in medical group practices. The source of the data is a survey of 128 medical group practices in Minnesota. The findings suggest that the employment of NPs and PAs and their ratios to primary care physicians (PCPs) in practices that employ them are influenced by the organizational characteristics of the group practice but not by the degree of financial risk sharing for patient care. Although neither the number of years of experience in financial risk sharing nor more revenue from capitation payment contracts were related to employment of these midlevel practitioners (MLPs), large practices, those located in rural locations, not-for-profit practices, and those that scored low on cohesive cultural traits were more likely to employ MLPs. The data provide insights into the market for MLPs and the potential for these clinicians in the future health care system. As medical group practices become larger and have more organizational capacity, they can likely be expected to increase the employment of MLPs and integrate them into their organizations.

  9. Nurse practitioner and physician assistant staffing in the patient-centered medical homes in New York State.

    PubMed

    Park, Jeongyoung

    2015-01-01

    A cornerstone of patient-centered medical homes (PCMHs) is team-based care; however, there is little information about the composition of staff who deliver direct primary care in PCMHs. The purpose of this study was to examine the number and distribution of primary care physicians (PCPs), nurse practitioners (NPs), and physician assistants (PAs) in PCMH and non-PCMH practices located in New York State (N = 7,431). Practice based ratios of primary care NPs and PAs to PCP were calculated and compared by PCMH designations. Designated PCMHs had more NPs and PAs per PCP relative to non-PCMHs. The ratios of NPs to PCPs were almost twice as high in PCMHs compared with non-PCMHs (0.20 and 0.11), and ratios were similarly different for PAs to PCPs (0.16 and 0.09, respectively). The multivariate analyses also support that higher NP and PA staffing was associated with PCMH designation (i.e., there was one additional NP and/or PA for every 25 PCPs). The growth of PCMHs may require more NPs and PAs to meet the anticipated growth in demand for health care. Policy- and practice-level changes are necessary to use them in the most effective ways. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. An implementation program targeted at non-physician, anaesthesia assistants improves the quality of laryngeal mask anaesthesia

    PubMed Central

    Reed, Isabelle; Walker, Ellie; Oliver Rose, Bernd

    2014-01-01

    The laryngeal mask airway (LMA) is used to facilitate adequate ventilation in the majority of procedures requiring general anaesthesia in the UK. Excessive LMA cuff pressure and/or volume, generated by injection of air to form an adequate seal within the upper airway, has been associated with pharyngolaryngeal morbidity, an indicator of quality in anaesthetic practice. However, measurement of LMA cuff pressure to limit excessive cuff pressure is not routine practice, despite trial data showing this reduces adverse outcomes. Our aim was to reduce morbidity from the LMA through the implementation of an educational and interventional program targeted at anaesthetic nurses and operating department assistants (ODA), to alter their physician colleagues’ practice. LMA cuff pressure measurements were made, and postoperative outcomes recorded, in an observational cohort of surgical patients over an initial 2-month period. These results, including patient morbidity and the evidence for LMA cuff pressure measurement, were presented to anaesthesia providers and their assistants. An implementation plan to adjust pressures within recommended levels was then undertaken by anaesthesia assistants. In 90 patients, >95% of LMA pressures were beyond the recommended level; higher volumes of injected air correlated with excess pressure (r=0.58; p<0.0001) and were associated with pharyngolaryngeal morbidity in 28% patients (P=0.04). There was no association with difficulty in LMA insertion, duration or type of surgical procedure. In the implementation cohort (102 patients), pharyngolaryngeal morbidity was reduced to 11% (P=0.001) in the 45 patients where LMA cuff pressure was reduced to within normal limits (absolute risk reduction: 38% (95% CI: 22-54%). LMA manometry in three patients (95% CI: 2-5) was required to prevent an episode of postoperative pharyngolaryngeal morbidity. A systematic educational and interventional program targeted at the entire perioperative anaesthesia team

  11. Reflections on the state of current debate over physician-assisted suicide and euthanasia.

    PubMed

    Winkler, Earl

    1995-07-01

    This paper is part of a larger project. My overall aim is to argue that the evolution of familiar forms of termination of life sustaining treatment, constituting so called passive euthanasia, has severely undercut the logic of every form of reasoning that has traditionally been used to oppose active euthanasia and assistance in suicide. Basically, there are two such forms of traditional opposition, each represented in a range of different versions. There is the inevitable argument concerning social utilities -- that permitting euthanasia and assisted suicide will have bad social consequences. But more fundamentally, the idea persists that killing is intrinsically worse than letting-die in some sense that justifies the current practice of prohibiting the first while allowing the latter. In this paper, I first consider this latter claim. My ultimate strategy, as I have said, is to show that the nature of certain things we have all come to approve regarding termination of treatment makes it next to impossible to convincingly explain, in either of these ways, what is wrong with certain forms of assistance in suicide and euthanasia. In the second part of this paper I take another step in this direction by discussing, in a preliminary way, a special case of the argument from social risks.

  12. Assisted suicide and the killing of people? Maybe. Physician-assisted suicide and the killing of patients? No: the rejection of Shaw's new perspective on euthanasia.

    PubMed

    McLachlan, Hugh V

    2010-05-01

    David Shaw presents a new argument to support the old claim that there is not a significant moral difference between killing and letting die and, by implication, between active and passive euthanasia. He concludes that doctors should not make a distinction between them. However, whether or not killing and letting die are morally equivalent is not as important a question as he suggests. One can justify legal distinctions on non-moral grounds. One might oppose physician-assisted suicide and active euthanasia when performed by doctors on patients whether or not one is in favour of the legalisation of assisted suicide and active euthanasia. Furthermore, one can consider particular actions to be contrary to appropriate professional conduct even in the absence of legal and ethical objections to them. Someone who wants to die might want only a doctor to kill him or to help him to kill himself. However, we are not entitled to everything that we want in life or death. A doctor cannot always fittingly provide all that a patient wants or needs. It is appropriate that doctors provide their expert advice with regard to the performance of active euthanasia but they can and should do so while, qua doctors, they remain hors de combat.

  13. Physician-assisted suicide of patients with dementia. A medical ethical analysis with a special focus on patient autonomy.

    PubMed

    Gather, Jakov; Vollmann, Jochen

    2013-01-01

    For many years there has been a controversial international debate on physician-assisted suicide (PAS). While proponents of PAS regularly refer to the unbearable suffering and the right of self-determination of incurably ill patients, critics often warn about the diverse risks of abuse. In our article, we aim to present ethical arguments for and against PAS for patients in an early stage of dementia. Our focus shall be on ethical questions of autonomy, conceptual and empirical findings on competence and the assessment of mental capacity to make health care decisions. While the capacity to make health care decisions represents an ethically significant precondition for PAS, it becomes more and more impaired in the course of the dementia process. We present conditions that should be met in order to ethically justify PAS for patients with dementia. From both a psychiatric and an ethical perspective, a thorough differential diagnosis and an adequate medical and psychosocial support for patients with dementia considering PAS and their relatives should be guaranteed. If, after due deliberation, the patient still wishes assistance with suicide, a transparent and documented assessment of competence should be conducted by a professional psychiatrist.

  14. Life shortening and physician assistance in dying: euthanasia from the viewpoint of German legal medicine.

    PubMed

    Oehmichen, M; Meissner, C

    2000-01-01

    Around the world heated debates have broken out on the topic of active euthanasia. Specialists in the field of 'forensic medicine' have taken full part in these discussions. The present survey from the point of view of forensic medicine begins with a look at current terminology and at the laws pertaining to euthanasia in Germany. These laws are then contrasted with actual practice, including a description of the increasing acceptance of active euthanasia by the German population and its legalization in Holland. The main argument against active euthanasia is that its formal acceptance in law would cause the dam of restraint to burst, culminating in widespread misuse, as already seen in recent serial killings by nurses in hospitals and homes for the elderly around the world. Contrasted to this are the arguments for taking active steps at the end of life, including emotional considerations such as the revulsion against mechanized medicine and the fear of pain and rational arguments such as the necessity to end a 'life unworthy of life', to save medical costs, and obtaining prior consent in 'living wills'. Such considerations have put in jeopardy the moral integrity of the medical profession - and thus the layperson's trust in physicians - around the world. In Germany especially the history of mass killing during the Nazi era constitutes a fundamental argument against active euthanasia. As a consequence, in Germany active euthanasia will not receive legal sanction, although recommendations on rendering dying more bearable are permitted. Copyright 2000 S. Karger AG, Basel

  15. Barriers to the provision of smoking cessation assistance: a qualitative study among Romanian family physicians

    PubMed Central

    Panaitescu, Catalina; Moffat, Mandy A; Williams, Siân; Pinnock, Hilary; Boros, Melinda; Oana, Cristian Sever; Alexiu, Sandra; Tsiligianni, Ioanna

    2014-01-01

    Background: Smoking cessation is the most effective intervention to prevent and slow down the progression of several respiratory and other diseases and improve patient outcomes. Romania has legislation and a national tobacco control programme in line with the World Health Organization Framework for Tobacco Control. However, few smokers are advised to quit by their family physicians (FPs). Aim: To identify and explore the perceived barriers that prevent Romanian FPs from engaging in smoking cessation with patients. Methods: A qualitative study was undertaken. A total of 41 FPs were recruited purposively from Bucharest and rural areas within 600 km of the city. Ten FPs took part in a focus group and 31 participated in semistructured interviews. Analysis was descriptive, inductive and themed, according to the barriers experienced. Results: Five main barriers were identified: limited perceived role for FPs; lack of time during consultations; past experience and presence of disincentives; patients’ inability to afford medication; and lack of training in smoking cessation skills. Overarching these specific barriers were key themes of a medical and societal hierarchy, which undermined the FP role, stretched resources and constrained care. Conclusions: Many of the barriers described by the Romanian FPs reflected universally recognised challenges to the provision of smoking cessation advice. The context of a relatively hierarchical health-care system and limitations of time and resources exacerbated many of the problems and created new barriers that will need to be addressed if Romania is to achieve the aims of its National Programme Against Tobacco Consumption. PMID:25010432

  16. Canadian Medical Education Journal Survey evaluations of University of British Columbia residents' education and attitudes regarding palliative care and physician assisted death.

    PubMed

    Spicer, David; Paul, Sonia; Tang, Tom; Chen, Charlie; Chase, Jocelyn

    2017-02-01

    Little prior research has been conducted regarding resident physicians' opinions on the subject of Physician Assisted Death (PAD), despite past surveys ascertaining the attitudes of practicing physicians towards PAD in Canada. We solicited British Columbia residents' opinions on the amount of education they receive about palliative care and physician assisted death, and their attitudes towards the implementation of PAD. We conducted a cross sectional, anonymous online survey with the resident physicians of British Columbia, Canada. Questions included: close-ended questions, graded Likert scale questions, and comments. Among the respondents (n=299, response rate 24%), 44% received ≥5 hours of education in palliative care, 40% received between zero and four hours of education, and 16% reported zero hours. Of all respondents, 75% had received no education about PAD and the majority agreed that there should be more education about palliative care (74%) and PAD (85%). Only 35% of residents felt their program provided them with enough education to make an informed decision about PAD, yet 59% would provide a consenting patient with PAD. Half of the respondents believed PAD would ultimately be provided by palliative care physicians. Residents desire further education about palliative care and PAD. Training programs should consider conducting a thorough needs assessment and implementing structured education to meet this need.

  17. A Study of the First Year of the End-of-Life Clinic for Physician-Assisted Dying in the Netherlands.

    PubMed

    Snijdewind, Marianne C; Willems, Dick L; Deliens, Luc; Onwuteaka-Philipsen, Bregje D; Chambaere, Kenneth

    2015-10-01

    Right to Die NL, an organization in the Netherlands that advocates for the option of euthanasia, founded the End-of-Life Clinic in 2012 to provide euthanasia or physician-assisted suicide for patients who meet all legal requirements but whose regular physicians rejected their request. Many patients whose requests are rejected have less common situations, such as a psychiatric or psychological condition, dementia, or being tired of living. To study outcomes of requests for euthanasia or physician-assisted suicide received by the clinic and factors associated with granting or rejecting requests. Analysis of application forms and registration files from March 1, 2012, to March 1, 2013, the clinic's first year of operation, for 645 patients who applied to the clinic with a request for euthanasia or physician-assisted suicide and whose cases were concluded during the study period. A request could be granted, rejected, or withdrawn or the patient could have died before a final decision was reached. We analyzed bivariate and multivariate associations with medical conditions, type of suffering, and sociodemographic variables. Of the 645 requests made by patients, 162 requests (25.1%) were granted, 300 requests (46.5%) were refused, 124 patients (19.2%) died before the request could be assessed, and 59 patients (9.1%) withdrew their requests. Patients with a somatic condition (113 of 344 [32.8%]) or with cognitive decline (21 of 56 [37.5%]) had the highest percentage of granted requests. Patients with a psychological condition had the smallest percentage of granted requests. Six (5.0%) of 121 requests from patients with a psychological condition were granted, as were 11 (27.5%) of 40 requests from patients who were tired of living. Physicians in the Netherlands have more reservations about less common reasons that patients request euthanasia and physician-assisted suicide, such as psychological conditions and being tired of living, than the medical staff working for the End

  18. The Development of Standards to Ensure the Competency of Physician Assistants. Volume I of V: Summary Report. Final Report, July 1, 1976-August 14, 1979.

    ERIC Educational Resources Information Center

    Fisher, Donald W.; And Others

    This report, volume 1 of 5 that were produced by a study, summarizes the study to address the further refinement of the physician assistant (PA) role and continuing medical education (CME) for PAs by developing standards to ensure PA competence. Methods and results of the study are discussed independently for each objective by providing a summary…

  19. Relatives' Perspective on the Terminally Ill Patients Who Died after Euthanasia or Physician-Assisted Suicide: A Retrospective Cross-Sectional Interview Study in the Netherlands

    ERIC Educational Resources Information Center

    Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D.; Muller, Martien T.; van der Wal, Gerrit; van der Heide, Agnes; van der Maas, Paul J.

    2007-01-01

    This study used retrospective interviews with 87 relatives to describe the experiences of patients who died by euthanasia or physician-assisted suicide (EAS) in the Netherlands. Most of the patients suffered from cancer (85%). The relatives were most often a partner (63%) or a child (28%) of the patient. Before explicitly requesting EAS most…

  20. Relatives' Perspective on the Terminally Ill Patients Who Died after Euthanasia or Physician-Assisted Suicide: A Retrospective Cross-Sectional Interview Study in the Netherlands

    ERIC Educational Resources Information Center

    Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D.; Muller, Martien T.; van der Wal, Gerrit; van der Heide, Agnes; van der Maas, Paul J.

    2007-01-01

    This study used retrospective interviews with 87 relatives to describe the experiences of patients who died by euthanasia or physician-assisted suicide (EAS) in the Netherlands. Most of the patients suffered from cancer (85%). The relatives were most often a partner (63%) or a child (28%) of the patient. Before explicitly requesting EAS most…

  1. Effect of a physician assistant as triage liaison provider on patient throughput in an academic emergency department.

    PubMed

    Nestler, David M; Fratzke, Alesia R; Church, Christopher J; Scanlan-Hanson, Lori; Sadosty, Annie T; Halasy, Michael P; Finley, Janet L; Boggust, Andy; Hess, Erik P

    2012-11-01

    Overcapacity issues plague emergency departments (EDs). Studies suggest that triage liaison providers (TLPs) may shorten patient length of stay (LOS) and reduce the proportion of patients who leave without being seen (LWBS), but these results are not universal. Previous studies used physicians as TLPs. We evaluated whether a physician assistant (PA), acting as a TLP, would shorten LOS and decrease LWBS rates. The authors used an observational cohort controlled before-and-after study design with predefined outcome measures, comparing 8 pilot days to 8 control days. The TLP evaluated all Emergency Severity Index (ESI) level 3, 4, and 5 patients, excluding pediatric and behavioral health patients. A total of 353 patients were included on pilot days and 371 on control days. LOS was shorter on pilot days than control days (median [interquartile range {IQR}] = 229 [168 to 303] minutes vs. 270 [187 to 372] minutes, p < 0.001). Waiting room times were similar between pilot and control days (median [IQR] = 69 [20 to 119] minutes vs. 70 [19 to 137] minutes, p = 0.408), but treatment room times were shorter (median [IQR] = 151 [92 to 223] minutes vs. 187 [110 to 254] minutes, p < 0.001). Finally, a lower proportion of patients LWBS on pilot days (1.4% vs. 9.7%, p < 0.001). The addition of a PA as a TLP was associated with a 41-minute decrease in median total LOS and a lower proportion of patients who LWBS. The decrease in total LOS is likely attributable to the addition of the TLP, with patients having shorter duration in treatment rooms on pilot days compared to control days. © 2012 by the Society for Academic Emergency Medicine.

  2. Effect of a Physician Assistant as Triage Liaison Provider on Patient Throughput in an Academic Emergency Department

    PubMed Central

    Nestler, David M.; Fratzke, Alesia R.; Church, Christopher J.; Scanlan-Hanson, Lori; Sadosty, Annie T.; Halasy, Michael P.; Finley, Janet L.; Boggust, Andy; Hess, Erik P.

    2012-01-01

    Objectives Overcapacity issues plague emergency departments (EDs). Studies suggest triage liaison providers (TLPs) may shorten patient length of stay (LOS) and reduce the proportion of patients who leave without being seen (LWBS), but these results are not universal. Previous studies used physicians as TLPs. We evaluated whether a physician assistant (PA), acting as a TLP, would shorten LOS and decrease LWBS rates. Methods The authors used an observational cohort controlled before-and-after study design with predefined outcome measures, comparing eight pilot days to eight control days. The TLP evaluated all Emergency Severity Index (ESI) level 3, 4, and 5 patients, excluding pediatric and behavioral health patients. Results Three hundred fifty-three patients were included on pilot days, and 371 on control days. LOS was shorter on pilot days than control days (median 229 minutes [IQR 168 to 303 minutes] vs. 270 minutes [IQR 187 to 372 minutes], p < 0.001). Waiting room times were similar between pilot and control days (median 69 minutes [IQR 20 to 119 minutes] vs. 70 minutes [IQR 19 to 137 minutes], p = 0.408), but treatment room times were shorter (median 151 minutes [IQR 92 to 223 minutes] vs. 187 minutes [IQR 110 to 254 minutes], p < 0.001). Finally, a lower proportion of patients LWBS on pilot days (1.4% vs. 9.7%, p < 0.001). Conclusions The addition of a PA as a TLP was associated with a 41 minute decrease in median total LOS, and a lower proportion of patients who LWBS. The decrease in total LOS is likely attributable to the addition of the TLP, with patients having shorter duration in treatment rooms on pilot days compared to control days. PMID:23167853

  3. Brain death, states of impaired consciousness, and physician-assisted death for end-of-life organ donation and transplantation.

    PubMed

    Verheijde, Joseph L; Rady, Mohamed Y; McGregor, Joan L

    2009-11-01

    -heart-beating organ procurement from patients with impaired consciousness is de facto a concealed practice of physician-assisted death, and therefore, violates both criminal law and the central tenet of medicine not to do harm to patients. Society must decide if physician-assisted death is permissible and desirable to resolve the conflict about procuring organs from patients with impaired consciousness within the context of the perceived need to enhance the supply of transplantable organs.

  4. Canadian Medical Education Journal Survey evaluations of University of British Columbia residents’ education and attitudes regarding palliative care and physician assisted death

    PubMed Central

    Spicer, David; Paul, Sonia; Tang, Tom; Chen, Charlie; Chase, Jocelyn

    2017-01-01

    Background Little prior research has been conducted regarding resident physicians’ opinions on the subject of Physician Assisted Death (PAD), despite past surveys ascertaining the attitudes of practicing physicians towards PAD in Canada. We solicited British Columbia residents’ opinions on the amount of education they receive about palliative care and physician assisted death, and their attitudes towards the implementation of PAD. Methods We conducted a cross sectional, anonymous online survey with the resident physicians of British Columbia, Canada. Questions included: close-ended questions, graded Likert scale questions, and comments. Results Among the respondents (n=299, response rate 24%), 44% received ≥5 hours of education in palliative care, 40% received between zero and four hours of education, and 16% reported zero hours. Of all respondents, 75% had received no education about PAD and the majority agreed that there should be more education about palliative care (74%) and PAD (85%). Only 35% of residents felt their program provided them with enough education to make an informed decision about PAD, yet 59% would provide a consenting patient with PAD. Half of the respondents believed PAD would ultimately be provided by palliative care physicians. Interpretation Residents desire further education about palliative care and PAD. Training programs should consider conducting a thorough needs assessment and implementing structured education to meet this need. PMID:28344712

  5. Improving mammography screening using best practices and practice enhancement assistants: an Oklahoma Physicians Resource/Research Network (OKPRN) study.

    PubMed

    Aspy, Cheryl B; Enright, Margaret; Halstead, Lawanna; Mold, James W

    2008-01-01

    In 2004 only 68% of women in Oklahoma over the age of 40 reported having a mammogram in the past 2 years, compared with 75% nationally. Strategies to improve mammography rates have been numerous but have generally included single strategies, such as physician education, practice audit and feedback, and reminders; flow sheets and results have been mixed. The purpose of this randomized controlled trial was to determine the impact of a practice facilitator and "best practice" interventions on mammography rates in a practice-based research network. A total of 16 practices participated; 8 were assigned to intervention and 8 to usual care. Pre- and post-audits of mammography rates were conducted. Intervention practices received feedback with benchmarking, academic detailing, and the assistance of a practice enhancement assistant to help with practice redesign over a 9-month period. The groups differed significantly for both the proportion of mammograms offered to eligible patients (P = .043) and for the proportion of patients with current mammograms (P < .015). For the control group, 38% of eligible women were offered a mammogram and 202 (35% of those eligible) actually did have documentation that a mammogram had been performed. Fifty-three percent of the eligible patients in the intervention group were offered a mammogram and 52% of those eligible (n = 332) did have documentation in the chart that the mammogram had been completed. The results suggest that these interventions can improve mammography rates in a range of practice settings. These findings are consistent with other studies that have tested multicomponent interventions.

  6. Effectiveness of educational strategies preparing physician assistants, nurse practitioners, and certified nurse-midwives for underserved areas.

    PubMed

    Fowkes, V K; Gamel, N N; Wilson, S R; Garcia, R D

    1994-01-01

    A study of physician assistant, nurse practitioner, and certified nurse midwifery programs was undertaken to identify and assess the effectiveness of recruitment, educational, and deployment strategies that programs use to prepare practitioners for medically underserved areas. The 51 programs studied were those having mission statements or known track records relating to this goal. A total of 170 interviews were conducted with faculty, students, graduates, and employers from 9 programs visited on-site and 42 programs surveyed by telephone. All programs had some recruitment and training activities in underserved sites. Only about half of the programs were able to submit data on their graduates' practice settings and specialties. These data suggest that older students who have backgrounds in underserved areas and clearly identified practice goals are more likely to practice in underserved areas. Programs that actively promote service to the underserved do so through publicly stated missions and recruitment and educational strategies that complement these missions. Such programs also are more likely to evaluate and document their success than programs that lack strategies.

  7. Nurse practitioner, nurse midwife and physician assistant attitudes and care practices related to persons with HIV/AIDS.

    PubMed

    Martin, J E; Bedimo, A L

    2000-02-01

    Although multiple studies of nurses' attitudes toward people living with HIV/AIDS (PLWAs) can be found in the literature, little is known about the attitudes, beliefs and practices of nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs). A survey including a 21-item AIDS Attitude Scale measuring the constructs of Avoidance and Empathy was sent to 1,291 NPs, CNMs and PAs in Louisiana, Arkansas and Mississippi to describe their attitudes and care practices related to PLWAs. Respondents who were more comfortable treating PLWAs had significantly lower avoidance scores and significantly higher empathy scores than respondents with lower comfort levels in providing care. Greater than 80% of respondents indicated that they would provide health care to HIV-infected individuals. Respondents who referred HIV/AIDS patients for all care did so primarily due to lack of experience with HIV and the availability of more experienced providers. Avoidance and empathy scores were not found to be significantly associated with referral for care. This study suggests that this group of providers has relatively low avoidance and high empathy toward PLWAs and is willing to care for HIV-infected individuals.

  8. Effectiveness of educational strategies preparing physician assistants, nurse practitioners, and certified nurse-midwives for underserved areas.

    PubMed Central

    Fowkes, V K; Gamel, N N; Wilson, S R; Garcia, R D

    1994-01-01

    A study of physician assistant, nurse practitioner, and certified nurse midwifery programs was undertaken to identify and assess the effectiveness of recruitment, educational, and deployment strategies that programs use to prepare practitioners for medically underserved areas. The 51 programs studied were those having mission statements or known track records relating to this goal. A total of 170 interviews were conducted with faculty, students, graduates, and employers from 9 programs visited on-site and 42 programs surveyed by telephone. All programs had some recruitment and training activities in underserved sites. Only about half of the programs were able to submit data on their graduates' practice settings and specialties. These data suggest that older students who have backgrounds in underserved areas and clearly identified practice goals are more likely to practice in underserved areas. Programs that actively promote service to the underserved do so through publicly stated missions and recruitment and educational strategies that complement these missions. Such programs also are more likely to evaluate and document their success than programs that lack strategies. PMID:7938389

  9. Educational Needs Assessment Highlights Several Areas of Emphasis in Teaching Evidence-Based Medicine Skills to Physician Assistant Students.

    PubMed

    Kuntz, Susan; Ali, Syed Haris; Hahn, Emily

    2016-08-03

    An assessment of educational needs is essential for curricular reform in medical education. Using the conceptual framework of needs assessment, this study aimed to determine which content should be emphasized in teaching evidence-based medicine (EBM) skills to physician assistant (PA) students. Key content areas were identified from the published literature and objectives for previous courses. A questionnaire-type needs assessment instrument was created and given to a graduating class of PA students (n = 21) at the University of North Dakota. The response format had two 5-option scales, one to assess current skill levels and the other to assess ideal skill levels. Means for each category were calculated, and a mean difference analysis was performed. An average mean difference of 0.5 was noted in 3 domains (information retrieval skills, writing skills, and overall gains), and a mean difference of 0.7 was noted in one domain (statistical skills). Items with a mean difference of ≥ 0.7 were identified for prioritization for curricular reform. Open-ended input from respondents substantiated the need for greater emphasis on these content areas. Several content areas related to EBM skills can be identified and prioritized through a systematically conducted educational needs assessment. This method can be used to identify discrepancies between the existing and ideal states of affairs in PA education.

  10. Knowledge and attitude change in physician assistant students after an interprofessional geriatric care experience: a mixed methods study.

    PubMed

    Segal-Gidan, Freddi; Walsh, Anne; Lie, Désirée; Fung, Cha Chi; Lohenry, Kevin

    2014-01-01

    To examine changes in physician assistant (PA) student attitudes and knowledge about interprofessional education (IPE) after participation in a longitudinal community-based curriculum. Second-year PA students participated in an interprofessional geriatrics curriculum. Faculty-facilitated IPE teams met three times and assessed one adult patient longitudinally over 8 months. Attitudes of student participants and their nonparticipating peers (comparison group) were assessed pre- and postcurriculum using the validated Readiness for Interprofessional Learning Scale (RIPLS). Reflections submitted by participants after each session were analyzed thematically. No significant differences in RIPLS scores were found compared with baseline for either group; participating students had significantly higher baseline scores compared with nonparticipating students. Qualitative analysis of participant reflections revealed two major themes: "roles and scope of practice of other health professions"; and "applicability of team-based care to practice" with a temporal change in theme pattern over one year. Volunteer student participants had a more positive attitude toward interprofessional learning than nonparticipants. Primary learning occurred about roles of other professions and the value of team-based care. The mixed evaluation methodology allowed examination of attitudes, knowledge, and underlying ("informal" or "hidden") learning.

  11. Questions elderly patients have about on-going therapy: a pilot study to assist in communication with physicians.

    PubMed

    Kimberlin, C; Assa, M; Rubin, D; Zaenger, P

    2001-12-01

    This pilot study examined the prevalence and types of questions elderly patients have about their current drug therapy. It also evaluated the effectiveness of a brief intervention to prepare patients to ask questions about drug therapy during medical visits. The research used a posttest-only experimental design. Forty-five elderly patients seen at a primary care clinic during a one-month period consented to participate and completed the study. After consent, subjects were randomly assigned to intervention and control conditions. A brief interview with intervention group subjects conducted by a medical student assigned to the clinic as part of a summer research experience helped subjects formulate questions they had about current therapy before they went into medical visits. Patient-physician visits were audiotaped and patient questions about medications and health care were tallied. Subjects in the intervention group were significantly more likely to ask questions of providers than were subjects in the control group. Intervention group subjects were found to ask a wider variety of medication-related questions than were control group subjects, including questions related to proper use, problems perceived with medications, and effectiveness of treatment. Assisting patients to formulate questions before medical visits results in an increased likelihood that patients will ask questions and will ask a wider variety of questions during the medical visit.

  12. Practice characteristics and lifestyle choices of men and women physician assistants and the relationship to career satisfaction.

    PubMed

    Biscardi, Carol A; Mitchell, John; Simpkins, Susan; Pinto Zipp, Genevieve

    2013-01-01

    With 60% of practicing physician assistants (PAs) being women, it is critical to identify any gender-related differences in career satisfaction. The purpose of this study was to identify practice characteristics and lifestyle choices of men and women practicing PAs, determine any gender-related differences, and identify whether a relationship exists between gender and career satisfaction. This descriptive study used a survey addressing career satisfaction, lifestyle choices, professional practice characteristics, and gender concerns. Randomly selected PAs completed an on-line survey. Nonparametric testing was used to analyze the data. Analyses included 85 men and 97 women respondents. More men (82.4%) than women (59.8%) were married; a significant association between gender and domestic status was found (p=0.009). The way that men rated career satisfaction was not significantly different than the way women did (p=0.47). Sixty-five percent of men and women completely agreed that they are satisfied with their career. Eighty-three percent of men and women PAs believed that they can balance their personal and professional responsibilities. While the sample was small, it does represent the demographics of PAs currently in practice and thus supports the assumption that the PA profession affords the ability to balance responsibilities and promotes career satisfaction.

  13. Flexibility in individualized, competency-based workplace curricula with EPAs: Analyzing four cohorts of physician assistants in training.

    PubMed

    Wiersma, Fraukje; Berkvens, Josephine; Ten Cate, Olle

    2017-05-01

    Entrustable professional activities (EPAs) were introduced as a principle for individualized physician assistant (PA) workplace curricula at the University of Applied Sciences (UAS) Utrecht in 2008. We studied how the focus on EPAs served the competency-based flexibility intention of the program. We analyzed data of those 119 students who enrolled in the program 2010 through 2013, and completed the program before April 2016. We analyzed the number of EPAs per student at start and end of the program, number changed during training and the reasons for change. Data of 101 students were suitable for evaluation. Excluded were 16 students ending the program prematurely and two with study delay. Mean number of EPAs per student at the start was 6.8 (range 4-12) and at the end 6.6 (range 3-13). On average 1.5 EPAs were altered (range 0-13). Reasons included extension of the EPA package during training (n = 10), lack of proficiency at planned moments of summative entrustment decisions (n = 9) and procedures not being suitable for PAs at closer look (n = 6). All changes resulted in a curriculum meeting the school's standards for graduation. The flexibility of the EPA concept enabled changes in the individualized curriculum of students, according to the intended competency-based nature of the educational program.

  14. Building a competency-based workplace curriculum around entrustable professional activities: The case of physician assistant training.

    PubMed

    Mulder, Hanneke; Ten Cate, Olle; Daalder, Rieneke; Berkvens, Josephine

    2010-01-01

    Competency-based medical education (CBME) is increasingly dominating clinical training, but also poses questions as to its practical implementation. There is a need for practical guidelines to translate CBME to the clinical work floor. This article aims to provide a practical model, based on the concept of entrustable professional activities (EPAs) to make this translation, derived from curriculum building for physician assistants (PAs). For the training of PAs at the Utrecht University of Applied Sciences, a three-step model was developed to guide competency-based curriculum development, teaching and assessment. It includes specific guidelines for the identification, systematic description and planning of EPAs. The EPA concept appeared to be a useful tool to build competency-based clinical workplace curricula. Implementation of the curriculum requires use of trainee portfolios and progress interviews, statements of rewarded responsibility and training of supervisors. The individualised approach and flexibility that true CBME implies is brought into practice with this model. The model may also be transferred to other domains of clinical training, among which postgraduate training for medical specialties.

  15. Medical teacher and his pedagogical training (experience with Bratislavian system of training the assistants for pedagogical activity in postgraduate education of physicians and pharmacists).

    PubMed

    Badalík, L; Paniaková, M

    1984-01-01

    System of training the medical teachers for pedagogical activity, used in the Institute for Postgraduate Education of Physicians and Pharmacists (IPEPP) in Bratislava, have not had long tradition as yet. We do not want this training to be understood as universal instruction to prepare the assistants for pedagogical activity, which is in a final consequence always dependent on the concrete conditions and social needs. It should serve as information on one of the possibilities to secure the systematic training of medical teachers for pedagogical activity in postgraduate education of physicians and pharmacists.

  16. A "Suicide Pill" for Older People: Attitudes of Physicians, the General Population, and Relatives of Patients Who Died after Euthanasia or Physician-Assisted Suicide in the Netherlands

    ERIC Educational Resources Information Center

    Rurup, Mette L.; Onwuteaka-Philipsen, Bregje D.; van der Wal, Gerrit; van der Heide, Agnes; van Der Maas, Paul J.

    2005-01-01

    In the Netherlands there has been ongoing debate in the past 10 years about the availability of a hypothetical "suicide pill", with which older people could end their life in a dignified way if they so wished. Data on attitudes to the suicide pill were collected in the Netherlands from 410 physicians, 1,379 members of the general…

  17. A "Suicide Pill" for Older People: Attitudes of Physicians, the General Population, and Relatives of Patients Who Died after Euthanasia or Physician-Assisted Suicide in the Netherlands

    ERIC Educational Resources Information Center

    Rurup, Mette L.; Onwuteaka-Philipsen, Bregje D.; van der Wal, Gerrit; van der Heide, Agnes; van Der Maas, Paul J.

    2005-01-01

    In the Netherlands there has been ongoing debate in the past 10 years about the availability of a hypothetical "suicide pill", with which older people could end their life in a dignified way if they so wished. Data on attitudes to the suicide pill were collected in the Netherlands from 410 physicians, 1,379 members of the general…

  18. Requests for euthanasia or physician-assisted suicide from older persons who do not have a severe disease: an interview study.

    PubMed

    Rurup, Mette L; Muller, Martien T; Onwuteaka-Philipsen, Bregje D; van der Heide, Agnes; van der Wal, Gerrit; van der Maas, Paul J

    2005-05-01

    To determine how often requests are made for euthanasia and physician-assisted suicide (EAS) in the absence of severe disease and how such requests are dealt with in medical practice in The Netherlands. Retrospective interview study. 125 general practitioners (GPs), 77 nursing home physicians (NHPs), and 208 clinical specialists. In The Netherlands, each year approximately 400 people request EAS, because they are 'weary of life'. Thirty per cent of all physicians have at some time received an explicit request for EAS in the absence of severe disease; 3% of all physicians had granted a request for EAS in such a case. Most requests for EAS to GPs in the absence of severe disease (n = 29) were made by single people aged 80 years and over. While their problems were most frequently of a social nature, 79% had one or more non-severe illnesses. Most GPs refused the request; half of them proposed an alternative treatment, which the patient often refused. Nineteen people who did not receive any treatment persisted in their wish to die; the request for EAS from 5 out of 10 patients who received one or more types of treatment was withdrawn or became less explicit. Most physicians in The Netherlands refuse requests for EAS in the absence of severe disease. Most patients persist in their request. In an ageing population more research is needed to provide physicians with practical interventions to prevent suicide and to make life bearable and satisfactory for elderly people who wish to die.

  19. Impact of Hospital-Employed Physician Assistants on a Level II Community-Based Orthopaedic Trauma System.

    PubMed

    Althausen, Peter L; Shannon, Steven; Owens, Brianne; Coll, Daniel; Cvitash, Michael; Lu, Minggen; O'Mara, Timothy J; Bray, Timothy J

    2016-12-01

    The American Academy of Orthopedic Surgeons and the Orthopedic Trauma Association have released guidelines for the provision of orthopedic trauma services such as adequate stipends, designated operating rooms, ancillary staff, and guaranteed reimbursement for indigent care. One recommendation included a provision for hospital-based physician assistants (PAs). Given current reimbursement arrangements, PA collections for billable services may not meet their salary and benefit expenses. However, their actions may indirectly affect emergency room, operating room, and hospital reimbursement and patient care itself. The purpose of our study is to define the true impact of hospitalbased PAs on orthopaedic trauma care at a level II community hospital. Retrospective case series. Level II trauma center. One thousand one hundred four trauma patients with orthopaedic injuries. PA involvement. Emergency room data such as triage time, time until seen by the orthopedic service, and total emergency room time was recorded. Operating room data such as time to surgery, set-up time, total operating time, and out of room time was entered as well. Charts were reviewed to determine if patients were given postoperative antibiotics and Deep Venous Thrombosis (DVT) prophylaxis. Intraoperative and postoperative complications were noted, and lengths of stay were calculated for all patients. At our institution, PA collections from patient care cover only 50% of their costs for salary and benefits. However, with PA involvement, trauma patients with orthopedic injuries were seen 205 minutes faster (P = 0.006), total Emergency Room (ER) time decreased 175 minutes (P = 0.0001), and time to surgery improved 360 minutes (P . 0.03). Operating room parameters were minimally improved, but postoperative DVT prophylaxis increased by a mean of 6.73% (P = 0.0084), postoperative antibiotic administration increased by 2.88% (P = 0.0302), and there was a 4.67% decrease in postoperative complications (P = 0

  20. Will the S.C.C.'s Decision on Physician-Assisted Death Apply to Persons Suffering from Severe Mental Illness?

    PubMed

    Walker-Renshaw, Barbara; Finley, Margot

    2016-02-01

    In this article, the authors address the question of whether the Supreme Court of Canada's decision in Carter v. Canada leaves open the possibility that persons with severe, treatment-refractory mental illness may lawfully seek a physician-assisted death. If so, how will health care providers distinguish between suicidal ideation and intent that is a symptom of the pathology of a treatable mental illness, on the one hand; and suicidal ideation and intent that is, perhaps, a capable and thoughtful response to a "grievous and irremediable" condition, on the other hand? Mental illness is the most common risk factor for suicide. If physician-assisted death becomes an accepted practice in mental health care, how will that be reconciled with the well-established impetus in mental health care to prevent suicide? The authors consider the competing ethical values of beneficence and promoting patient autonomy, in the context of the recovery movement in mental health care.