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Introduction: Chronic diseases are increasing, and have multiple consequences that at a certain time, over the years, can reach a terminal state of the disease. It is important to know the vision of these patients on medically assisted death.


Objective: To know and analyze the discourse of chronically ill patients on death with dignity, euthanasia and physician-assisted suicide in order to make visible the need to regulate death whit dignity.


Method: A qualitative research was carried out that is inserted within the paradigm of social constructionism. Interviews were conducted using a semi-structured guide. Discourse analysis was extracted to find convergences and differences in the discourses.


Results: Seven participants who suffered from a chronic disease were interviewed. The discourses converge towards a death with dignity without pain, suffering, calm and at home. Their discourses coincide in legalizing euthanasia and medically assisted suicide; however, some differ when it comes to requesting them. The previous death experience of their loved ones is a factor that influences the desire for a death with dignity.


Discussion and conclusions: The experience of chronic illness is an important factor to accept medically assisted death in the future, without being a burden to others and avoiding pain and suffering at the end of life. Religion influences decisions, but a greater openness to accept the legalization of medically assisted death can be observed.

Ordóñez Vázquez, N. A., Ortiz-Millán, G., & Rivero Weber, P. (2023). Exploring the discourse of chronic patients about the legalization of medically assisted death. Revista Ciencias De La Salud, 21(3), 1–24. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.12112

Soto-Estrada G, Moreno-Altamirano L, Pahua DD. Panorama epidemiológico de México: principales causas de morbilidad y mortalidad. Rev Fac Med (Méx). 2016;59(6):8-22.

Instituto Nacional de Estadística y Geografía (Inegi). Características de las defunciones registradas en México durante 2021 [internet]. Comunicado de Prensa 24/22; 2022.

Disponible en: https://www.inegi.org.mx/contenidos/saladeprensa/boletines/2022/dr/

dr2021.pdf

Secretaría de Salud. Detección y tratamiento oportuno mejora calidad de vida de personas con lupus [internet]. 2019. Disponible en: https://acortar.link/aMrypf

Novartis. La psoriasis es la tercera enfermedad que más impacta la calidad de vida [internet]. 2021. Disponible en: https://acortar.link/eOcu36.

Organización Panamericana de la Salud, Organización Mundial de la Salud. Situación de salud en las Américas: indicadores básicos [internet]. 2016. Disponible en: https://iris.paho.org/handle/10665.2/31288

Sánchez B. El cuidado de la salud de las personas que viven situaciones de enfermedad crónica en América Latina. Actual Enferm. 2002;5(1):13-16.

Velasco BC, Trejo GG. Leyes de eutanasia en España y en el mundo: aspectos médicos. Aten Primaria. 2022;54(1):2-8. https://doi.org/10.1016/j.aprim.2021.102170

Thi Bao, NA, Thu, NH. Euthanasia and physician-assisted suicide in some countries: a comparative study. J Posit School Psychol. 2022;6(5):8048-59.

Morita T, Tsunoda J, Inoue S, Chihara S. An exploratory factor analysis of existential suffering in Japanese terminally ill cancer patients. Psychooncology. 2000;9:164-68.

Blinderman CD, Cherny NI. Existential issues do not necessarily result in existential suffering: lessons from cancer patients in Israel. Palliat Med. 2005;19:371-80. https://doi.org/10.1191/0269216305pm1038oa

Azulay, TA. La sedación terminal: aspectos éticos. An Med Interna. 2003;20(12):49-53.

Álvarez del Río A. Práctica y ética de la eutanasia. México: Fondo de Cultura Económica; 2005.

Lorda SP. La capacidad de los pacientes para tomar decisiones: una tarea todavía pendiente. Rev Asoc Esp Neuropsiq. 2008;28(2):327-50.

Schüklenk U, Johannes VD, Downie J, Mclean S, Upshur R, Weinstock D. End-of-life decision-making in Canada: the report by the Royal Society of Canada Expert Panel on End-of-Life Decision-Making. Bioethics. 2011;25:1-73.

Sleeman K. The murky issue of whether the public supports assisted dying. The Conversation [internet]; 2017. Disponible en: https://theconversation.com/the-murkyissue-of-whether-the-public-supports-assisted-dying-85279

Soler F, Pedrós F, Marín F, Ania M, Cambrón A. Las religiones contra la eutanasia [internet]. Madrid: Asociación Federal Derecho a morir Dignamente; 2016. Disponible en: https://derechoamorir.org/wp-content/uploads/2019/05/Revista-DMD-73.pdf.

Carter G, Clover K, Parkinson L, Rainbird K, Kerridge I, Ravenscroft, et al. Mental health and other clinical correlates of euthanasia attitudes in an Australian outpatient cancer population. Psycho-Oncology. 2007;16(4):295-303.

Lapierre S, Castelli Dransart DA, St-Amant K, Dubuc G, Houle M, Lacerte MM, et al. Religiosity and the wish of older adults for physician assisted-suicide. Religions.

;9(special issue):66-78.

Roesinger M, Prudlik L, Pauli S, Hendlmeier I, Noyon A, Schäufele M. Results of a representative survey among older people in Germany [alemán]. Zeitschrift für Gerontologie und Geriatrie. 2018;51(2):222-30. https://doi-org.biblioproxy.uqtr.ca/10.1007/s00391-

-1159-1

Cruz Esquivel J, Irrazábal G. Toma de decisiones al final de la vida y creencias religiosas: opiniones y posturas en relación con la muerte y la eutanasia en Argentina. Rev Latinoam Bioet. 2021;21(1):77-8. https://doi.org/10.18359/rlbi.5125

Invamer. Colombia Opina [internet]. 2021 ago;(8). Disponible en: https://www.valoraanalitik.com/wp-content/uploads/2021/08/encuesta-invamer-1.pdf.

Por el Derecho a Morir con Dignidad A.C. Encuesta Nacional sobre Muerte Digna: México 2016 [internet]. 2016. Disponible en: https://dmd.org.mx/wp-content/uploads/2017/09/

dmd-encuesta3.pdf

Centro de Opinión Pública de la Universidad del Valle de México. Hacia una muerte digna: ¿mexicanos a favor o en contra de la eutanasia? [internet]. 2020. Disponible en: https://opinionpublica.uvm.mx/estudios/hacia-una-muerte-digna-mexicanos-favor-oen-contra-de-la-eutanasia/

Agudelo BM, Estrada AP. Constructivismo y construccionismo social: algunos puntos comunes y algunas divergencias de estas corrientes teóricas. Prospectiva. 2012;17:353-78.

Atkinson R, Flint J. Accessing hidden and hard-to-reach populations: snowball research strategies. Social Research Update. 2001;33:1-5.

Barbeta-Viñas M. Las posiciones discursivas en el análisis sociológico del discurso. Rev Int Sociol. 2021;79(3):e189.

https://doi.org/10.3989/ris.2021.79.3.20.169

De Lillo L. Del encarnizamiento terapéutico a una muerte digna [internet]. Buenos Aires: Universidad de Buenos Aires, Facultad de Medicina, Departamento de Humanidades Médicas, Unidad Académica de Bioética; 2011. Disponible en: http://www.fmv-uba.org.ar/comunidad/revistasylibrosdigitales/antropologia/Vol.%20VI%20Nro.%201%20a%-C3%B1o%202011/delillo%20-%20muerte%20digna.pdf

Macías GR. El concepto legal de muerte digna [internet]. 2008. Disponible en: https://derechoamorir.org/wp-content/uploads/2018/09/2008-concepto-legal-muerte-digna.pdf

Payne SA, Langley-Evans A, Hiller R. Perceptions of a “good” death: a comparative study of the views of hospice staff and patients. Palliat Med. 1996;10:307-12.

Zhang LP, Fang XM, Zheng XZ. The perception of good death from family members of patients with advanced cancer. J Nursing. 2013;20(4):73-6.

Huang HS, Zeng TY, Mao J, Liu XH. The understanding of death in terminally ill cancer patients in China: an initial study. Camb Q Healthc Ethics. 2018;27:421-30. https://doi.

org/10.1017/s0963180117000809

Li T, Pei X, Chen X, Zhang S. Identifying end-of-life preferences among Chinese patients with cancer using the heart to heart card game. Am J Hosp Palliat Car. 2021;38:62-7. https://doi.org/10.1177/1049909120917361

Kalnina D, Skulte I. “Good death”: the circumstances in which it would be best for a person to die. The representative survey of Latvian population. SHS Web Conf. 2022;131. https://doi.org/10.1051/shsconf/202213102010

Blank K, Robison J, Doherty E, Prigerson H, Duffy J, Schwartz. Life-sustaining treatment and assisted death choices in depressed older patients. J Am Geriatr Soc. 2001;49(2):153- 61. https://doi.org/10.1046/j.1532-5415.2001.49036.x

Espino DV, Macias RL, Wood RC, Becho J, Talamantes M, Finley MR, et al. Physicianassisted suicide attitudes of older Mexican-American and non-Hispanic White adults: does ethnicity make a difference? J Am Geriatr Soc. 2010;58(7):1370-5. https://doi.org/10.1111/j.1532-5415.2010.02910.x

Lapierre S, Castelli Dransart DA, St-Amant K, Dubuc G, Houle M, Lacerte MM, et al. Religiosity and the wish of older adults for physician assisted-suicide. Religions.

;9(special issue):66-78. https://doi.org/10.3390/rel9030066

Roesinger M, Prudlik L, Pauli S, Hendlmeier I, Noyon A, Schäufele M. Results of a representative survey among older people in Germany [alemán]. Zeitschrift für Gerontologie und Geriatrie. 2018;51(2):222-30. https://doi.org/10.1007/s00391-016-1159-1

O’Neill C, Feenan D, Hughes C, McAlister DA. Physician and family assisted suicide: results from a study of public attitudes in Britain. Soc Sci Med. 2003;57(4):721-31. https://doi.org/10.1192/10.1016/s0277-9536(02)00421-5

Steck N, Egger M, Zwahlen M. Assisted and unassisted suicide in men and women: longitudinal study of the Swiss population. Br J Psychiatry. 2016;208(5):484-90. https://doi.org/10.1192/bjp.bp.114.160416

Milesi M. Proyecto de ley núm. 2726-D-03: régimen del respeto a la calidad de vida y a la dignidad de los enfermos terminales. Cámara de Diputados del Congreso de la Nación, Argentina; 2003.

Rodríguez-Prat A, Balaguer A, Booth A, et al. Understanding patients’ experiences of the wish to hasten death: an updated and expanded systematic review and meta-ethnography. BMJ Open. 2017;7:e016659. https://doi.org/10.1136/bmjopen-2017-016659

Ohnsorge K, Gudat, Rehmann-Sutter C. Intentions in wishes to die: analysis and a typology-A report of 30 qualitative case studies of terminally ill cancer patients in palliative care. Psycho Oncology. 2014;23(9):1021-6. https://doi.org/10.1002/pon.3524

Gu DN, Liu GY, Vlosky DA, Yi Z. Factors associated with place of death among the Chinese oldest old. J Appl Gerontol. 2007;26(1):34-57. https://doi.org/10.1177/0733464806296057

Keimig RK. Chronic living and delayed death in Chinese eldercare institutions. Anthropol Aging. 2020;41(1):17-30. https://doi.org/10.5195/aa.2020.210

Liu MJ, Zhou HX, Zhu JC. Influencing factors of clinical decision of family members of end of life patients in Intensive Care Unit. Nursing Res. 2016;36:4501-5.

Leboul D, Bousquet A, Chassagne A, Mathieu-Nicot F, Ridley A, Cretin E, Guirimand F, Aubry R. Understanding why patients request euthanasia when it is illegal: a qualitative study in palliative care units on the personal and practical impact of euthanasia requests. Palliat Care Soc Pract. 2022 10;16:26323524211066925. https://doi.org/10.1177/26323524211066925

Onwuteaka-Philipsen BD, Brinkman-Stoppelenburg A, Penning C, de Jong-Krul GJ, van Delden, JM, van der Heide A. Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. Lancet. 2012;380(9845):908-15. https://doi.org/10.1016/S0140-6736(12)61034-4

Oregon Public Health Division. Oregon’s Death with Dignity Act—2013 [internet]. Disponible en: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year16.pdf

Guirimand F, Dubois E, Laporte L, Richard JF, Leboul D. Death wishes and explicit requests for euthanasia in a palliative care hospital: an analysis of patients files. BMC Palliat Care. 2014;13(1):53. https://doi.org/ 10.1186/1472-684X-13-53

Chochinov, HM, Wilson KG, Enns M, Mowchun N, Lander S, Levitt M, et al. Desire for death in the terminally ill. Am J Psychiatry. 1995;152(8):1185-91. https://doi.org/ 10.1176/ajp.152.8.1185

Johansen S, Hølen JC, Kaasa S, Loge HJ, Materstvedt LJ. Attitudes towards, and wishes for, euthanasia in advanced cancer patients at a palliative medicine unit. Palliat Med. 2005;19(6):454-60. https://doi.org/ 10.1191/0269216305pm1048oa

Emanuel EJ, Faircloug DL, Emanuel LL. Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. JAMA. 2000;284(19):2460-68. https://doi.org/10.1001/jama.284.19.2460

Gerson SM, Bingley A, Preston N, Grinyer A. When is hastened death considered suicide? A systematically conducted literature review about palliative care professionals’ experiences where assisted dying is legal. BMC Palliat Car. 2019;8(1):75. https://doi.org/10.1186/s12904-019-0451-4

Crespo I, Rodríguez-Prat A, Monforte-Royo C, et al. Health-related quality of life in patients with advanced cancer who express a wish to hasten death: a comparative study.

Palliat Med. 2020;34:630-8. https://doi.org/10.1177/0269216320904

Chapple A, Ziebland S, McPherson A, Herxheimer A. What people close to death say about euthanasia and assisted suicide: a qualitative study. J Med Ethics. 2006;32(12):706-10.

https://doi.org/10.1136/jme.2006.015883

Taboada RP. El derecho a morir con dignidad. Acta bioeth. 2000;6(1):89-101. https://doi.org/10.4067/S1726-569X2000000100007

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