Donald van Tol - Profile on Academia.edu (original) (raw)
Papers by Donald van Tol
BMJ Open
ObjectivesChronic gastrointestinal symptoms are common among children and affect their daily acti... more ObjectivesChronic gastrointestinal symptoms are common among children and affect their daily activities and quality of life. The majority will be diagnosed with a functional gastrointestinal disorder. Effective reassurance and education are, therefore, key components of the physician’s management. Qualitative studies have shown how parents and children experience specialist paediatric care, yet less is known about general practitioners (GPs), who manage most cases in the Netherlands and have a more personal and enduring relationship with their patients. Therefore, this study evaluates the expectations and experiences of parents of children visiting a GP for chronic gastrointestinal symptoms.DesignWe conducted a qualitative interview study. Online interviews were audio and video recorded, transcribed verbatim and independently analysed by the first two authors. Data were collected and analysed concurrently until data saturation was reached. Using thematic analysis, we developed a con...
Frontiers in Sociology, 2022
Feelings of sadness among young adults related to a certain phase of life or to societal factors ... more Feelings of sadness among young adults related to a certain phase of life or to societal factors run the risk of being interpreted as an individual medical problem. Therefore, healthcare professionals should more often widen their perspective and consider de-medicalization as being part of their professional responsibility too. This article presents results from a qualitative interview conducted with 13 GPs in different phases of their career to get more insight into the way they deal with complaints of sadness among young adults. All participants acted proactively but in different ways. Based on the interviews, a typology of three types of general practitioners has been created: the fast referrer, the expert, and the societal GP. There seems to be a paradox in the way GPs think about de-medicalization on a macro level and the way they act on a micro level. Elaborating on Parsons’(1951) classical concept of the sick role, this study introduces the term semi-legitimized sick role to ...
Classifiying physician-negotiated death: A matter of perspective
Psychische klachten: waarom niets doen zo lastig is
Huisarts en wetenschap
De Dokter en de dood: Over de medicalisering van het zelfgewilde levenseinde
Ziek van Gezondheid, 2013
BMC Medical Ethics BioMed Central
Research article Reporting of euthanasia and physician-assisted suicide in the Netherlands: descr... more Research article Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study
Background: The practice of euthanasia and physician-assisted suicide (PAS) in the Netherlands ha... more Background: The practice of euthanasia and physician-assisted suicide (PAS) in the Netherlands has been regulated since 2002 by the Euthanasia Act. In the ongoing debate about the interpretation of this Act, comparative information about the opinions of the different stakeholders is needed. Aim: To evaluate the opinions of Dutch physicians, nurses and the general public on the legal requirements for euthanasia and PAS. Design: A cross-sectional survey among Dutch physicians and nurses in primary and secondary care and members of the Dutch general public, followed by qualitative interviews among selected respondents. The participants were: 793 physicians, 1243 nurses and 1960 members of the general public who completed the questionnaire; 83 were interviewed. Results: Most respondents agreed with the requirement of a patient request (64-88%) and the absence of a requirement concerning life expectancy (48-71%). PAS was thought acceptable by 24-39% of respondents for patients requesting it because of mental suffering * These authors contributed equally.
The impact of disease labels on disease experience in patients with prolonged incurable cancer
Journal of Clinical Oncology, 2018
e22011Background: Advances in oncology have resulted in prolonged disease trajectories in patient... more e22011Background: Advances in oncology have resulted in prolonged disease trajectories in patients with incurable cancer inducing discussions about the ‘right’ medical terminology. The impact of ch...
Family Practice, 2017
Background. In the Netherlands, euthanasia or assisted suicide (EAS) is neither a right of the pa... more Background. In the Netherlands, euthanasia or assisted suicide (EAS) is neither a right of the patient nor a duty of the physician. Beside the legal requirements, physicians can weigh their own considerations when they decide on a request for EAS. Objective. We aim at a better understanding of the considerations that play a role when physicians decide on a request for EAS. Methods. This was a qualitative study. We analysed 33 interviews held with general practitioners (GPs) from various regions in the Netherlands. Results. The considerations found can be divided in three main types. (i) Perceived legal criteria, (ii) individual interpretations of the legal criteria and (iii) considerations unrelated to the legal criteria. Considerations of this 3rd type have not been mentioned so far in the literature and the debate on EAS. Examples are: the family should agree to EAS, the patient's attitude must reflect resignation, or conflicts must be resolved. Conclusions. Our study feeds the ethical discussion on the tension that can arise between a physician's own views on death and dying, and the views and preferences of his patients. When considerations like 'no unresolved conflicts' or 'enough resignation' influence the decision to grant a request for EAS this poses questions from an ethical and professional point of view. We hypothesise that these considerations reflect GPs' views on what 'good dying' entails and we advocate further research on this topic.
What’s in a name? : Over het classificeren van medisch handelen rond het levenseinde door huisartsen en officieren van justitie (Beschouwing)
Huisarts En Wetenschap, 2007
BMC medical ethics, Jan 28, 2015
The Dutch law states that a physician may perform euthanasia according to a written advance eutha... more The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive (AED) when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing opinions of physicians and members of the general public on the acceptability of euthanasia in patients with advanced dementia. In this qualitative study, 16 medical specialists, 19 general practitioners, 16 elderly physicians and 16 members of the general public were interviewed and asked for their opions about a vignette on euthanasia based on an AED in a patient with advanced dementia. Members of the general public perceived advanced dementia as a debilitating and degrading disease. Physicians emphasized the need for direct communication with the patient when making decisions about euthanasia. Respondent from both groups acknowledged difficulties in the assessment of patients' autonomous wishes ...
Grensgeschillen: een rechtssociologisch onderzoek naar het classificeren van euthanasie en ander ... more Grensgeschillen: een rechtssociologisch onderzoek naar het classificeren van euthanasie en ander medisch handelen rond het levenseinde. s.n.
Journal of Pain and Symptom Management, 2014
Context. The practice of euthanasia and physician-assisted suicide (EAS) is always complex, but s... more Context. 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. Objectives. To identify and categorize the characteristics of EAS requests that are more complex than others. Methods. 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. Results. Complexities can be categorized into relational difficultiesdsuch as miscommunication, invisible suffering, and the absence of a process of growth toward EASdand 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. Conclusion. 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.
European Journal of Pediatrics, 2014
Alleviation of suffering is considered to be one of the important goals of medical interventions.... more Alleviation of suffering is considered to be one of the important goals of medical interventions. Understanding of what constitutes suffering in children admitted to a pediatric intensive care unit (PICU) is lacking. This study aims to assess perceptions by parents, doctors, and nurses of suffering in critically ill children. We interviewed 124 participants (parents, physicians, and PICU nurses) caring for 29 admitted children in a 20-bed level-III PICU and performed a qualitative analysis. We found that most participants made a distinction between physical and existential suffering. Parents considered the child's suffering caused by or associated with visible signs as discomfort. Nurses linked suffering to the child's state of comfort. Physicians linked them to the intensity and impact of treatment and future perspectives of the child. Various aspects of the child's suffering and admission to a PICU caused suffering in parents. Conclusion: Parents', physicians', and nurses' perceptions of suffering overlap but also show important differences. Differences found seem to be rooted in the relation to and kind of responsibility (parental/professional) for the child. The child's illness, suffering, and hospital admission cause suffering in parents. Health-care professionals in PICUs need to be aware of these phenomena.
What’s in a name?
Huisarts en Wetenschap, 2007
Samenvatting Van Tol DG. What’s in a name? Over het classificeren van medisch handelen rond het ... more Samenvatting Van Tol DG. What’s in a name? Over het classificeren van medisch handelen rond het levenseinde door huisartsen en officieren van justitie. Huisarts Wet 2007;50(3):95-9. Artsen en juristen kunnen moeilijk door één deur. Toch hebben beide disciplines de afgelopen jaren steeds meer met elkaar te maken. Ook in geval van medisch handelen rond het levenseinde is het doen en laten
Medicalisering
Kernboek, 2014
Wat is professionaliteit?
Kernboek, 2014
Recht der Werkelijkheid, 2014
van der Vegt en Cristiano Vezzoni. 1 Opzettelijk levensbeëindigend handelen op verzoek. 2 Het toe... more van der Vegt en Cristiano Vezzoni. 1 Opzettelijk levensbeëindigend handelen op verzoek. 2 Het toedienen van sederende middelen tot het ingetreden zijn van de dood in de laatste levensfase. De terminologie is verschillend. In de beroepsgroep wordt gesproken over palliatieve sedatie. Daarmee wordt zowel sedatie tot de dood (continue sedatie) bedoeld als intermitterende sedatie. In het onderzoek is alleen gekeken naar het eerste. 3 Van de onderzoeksbevindingen is in 2011 verslag gedaan in het rapport Kennis en opvattingen van publiek en professionals over medische besluitvorming en behandeling rond het einde van het leven, Het KOPPEL-onderzoek. Dit verslag is te bestellen en te downloaden via de website van ZonMw (www. zonmw.nl/uploads/tx_vipublicaties/ZonMw_A4_RapportKOPPELDEF_klein.pdf). 4 Van Tol (2005) maakte dit onderscheid zonder het op deze wijze aan te duiden. 5 Van Tol 2005 in zijn uitwerking van het werk van Griffiths (o.a. Griffiths 2005). 24 Recht der Werkelijkheid 2014 (35) 2 Dit artikel uit Recht der Werkelijkheid is gepubliceerd door Boom Juridische uitgevers en is bestemd voor Rijks Universiteit Groningen
Journal of Psychiatric Practice, 2014
Handboek medische professionaliteit
Kernboek, 2014
BMJ Open
ObjectivesChronic gastrointestinal symptoms are common among children and affect their daily acti... more ObjectivesChronic gastrointestinal symptoms are common among children and affect their daily activities and quality of life. The majority will be diagnosed with a functional gastrointestinal disorder. Effective reassurance and education are, therefore, key components of the physician’s management. Qualitative studies have shown how parents and children experience specialist paediatric care, yet less is known about general practitioners (GPs), who manage most cases in the Netherlands and have a more personal and enduring relationship with their patients. Therefore, this study evaluates the expectations and experiences of parents of children visiting a GP for chronic gastrointestinal symptoms.DesignWe conducted a qualitative interview study. Online interviews were audio and video recorded, transcribed verbatim and independently analysed by the first two authors. Data were collected and analysed concurrently until data saturation was reached. Using thematic analysis, we developed a con...
Frontiers in Sociology, 2022
Feelings of sadness among young adults related to a certain phase of life or to societal factors ... more Feelings of sadness among young adults related to a certain phase of life or to societal factors run the risk of being interpreted as an individual medical problem. Therefore, healthcare professionals should more often widen their perspective and consider de-medicalization as being part of their professional responsibility too. This article presents results from a qualitative interview conducted with 13 GPs in different phases of their career to get more insight into the way they deal with complaints of sadness among young adults. All participants acted proactively but in different ways. Based on the interviews, a typology of three types of general practitioners has been created: the fast referrer, the expert, and the societal GP. There seems to be a paradox in the way GPs think about de-medicalization on a macro level and the way they act on a micro level. Elaborating on Parsons’(1951) classical concept of the sick role, this study introduces the term semi-legitimized sick role to ...
Classifiying physician-negotiated death: A matter of perspective
Psychische klachten: waarom niets doen zo lastig is
Huisarts en wetenschap
De Dokter en de dood: Over de medicalisering van het zelfgewilde levenseinde
Ziek van Gezondheid, 2013
BMC Medical Ethics BioMed Central
Research article Reporting of euthanasia and physician-assisted suicide in the Netherlands: descr... more Research article Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study
Background: The practice of euthanasia and physician-assisted suicide (PAS) in the Netherlands ha... more Background: The practice of euthanasia and physician-assisted suicide (PAS) in the Netherlands has been regulated since 2002 by the Euthanasia Act. In the ongoing debate about the interpretation of this Act, comparative information about the opinions of the different stakeholders is needed. Aim: To evaluate the opinions of Dutch physicians, nurses and the general public on the legal requirements for euthanasia and PAS. Design: A cross-sectional survey among Dutch physicians and nurses in primary and secondary care and members of the Dutch general public, followed by qualitative interviews among selected respondents. The participants were: 793 physicians, 1243 nurses and 1960 members of the general public who completed the questionnaire; 83 were interviewed. Results: Most respondents agreed with the requirement of a patient request (64-88%) and the absence of a requirement concerning life expectancy (48-71%). PAS was thought acceptable by 24-39% of respondents for patients requesting it because of mental suffering * These authors contributed equally.
The impact of disease labels on disease experience in patients with prolonged incurable cancer
Journal of Clinical Oncology, 2018
e22011Background: Advances in oncology have resulted in prolonged disease trajectories in patient... more e22011Background: Advances in oncology have resulted in prolonged disease trajectories in patients with incurable cancer inducing discussions about the ‘right’ medical terminology. The impact of ch...
Family Practice, 2017
Background. In the Netherlands, euthanasia or assisted suicide (EAS) is neither a right of the pa... more Background. In the Netherlands, euthanasia or assisted suicide (EAS) is neither a right of the patient nor a duty of the physician. Beside the legal requirements, physicians can weigh their own considerations when they decide on a request for EAS. Objective. We aim at a better understanding of the considerations that play a role when physicians decide on a request for EAS. Methods. This was a qualitative study. We analysed 33 interviews held with general practitioners (GPs) from various regions in the Netherlands. Results. The considerations found can be divided in three main types. (i) Perceived legal criteria, (ii) individual interpretations of the legal criteria and (iii) considerations unrelated to the legal criteria. Considerations of this 3rd type have not been mentioned so far in the literature and the debate on EAS. Examples are: the family should agree to EAS, the patient's attitude must reflect resignation, or conflicts must be resolved. Conclusions. Our study feeds the ethical discussion on the tension that can arise between a physician's own views on death and dying, and the views and preferences of his patients. When considerations like 'no unresolved conflicts' or 'enough resignation' influence the decision to grant a request for EAS this poses questions from an ethical and professional point of view. We hypothesise that these considerations reflect GPs' views on what 'good dying' entails and we advocate further research on this topic.
What’s in a name? : Over het classificeren van medisch handelen rond het levenseinde door huisartsen en officieren van justitie (Beschouwing)
Huisarts En Wetenschap, 2007
BMC medical ethics, Jan 28, 2015
The Dutch law states that a physician may perform euthanasia according to a written advance eutha... more The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive (AED) when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing opinions of physicians and members of the general public on the acceptability of euthanasia in patients with advanced dementia. In this qualitative study, 16 medical specialists, 19 general practitioners, 16 elderly physicians and 16 members of the general public were interviewed and asked for their opions about a vignette on euthanasia based on an AED in a patient with advanced dementia. Members of the general public perceived advanced dementia as a debilitating and degrading disease. Physicians emphasized the need for direct communication with the patient when making decisions about euthanasia. Respondent from both groups acknowledged difficulties in the assessment of patients' autonomous wishes ...
Grensgeschillen: een rechtssociologisch onderzoek naar het classificeren van euthanasie en ander ... more Grensgeschillen: een rechtssociologisch onderzoek naar het classificeren van euthanasie en ander medisch handelen rond het levenseinde. s.n.
Journal of Pain and Symptom Management, 2014
Context. The practice of euthanasia and physician-assisted suicide (EAS) is always complex, but s... more Context. 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. Objectives. To identify and categorize the characteristics of EAS requests that are more complex than others. Methods. 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. Results. Complexities can be categorized into relational difficultiesdsuch as miscommunication, invisible suffering, and the absence of a process of growth toward EASdand 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. Conclusion. 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.
European Journal of Pediatrics, 2014
Alleviation of suffering is considered to be one of the important goals of medical interventions.... more Alleviation of suffering is considered to be one of the important goals of medical interventions. Understanding of what constitutes suffering in children admitted to a pediatric intensive care unit (PICU) is lacking. This study aims to assess perceptions by parents, doctors, and nurses of suffering in critically ill children. We interviewed 124 participants (parents, physicians, and PICU nurses) caring for 29 admitted children in a 20-bed level-III PICU and performed a qualitative analysis. We found that most participants made a distinction between physical and existential suffering. Parents considered the child's suffering caused by or associated with visible signs as discomfort. Nurses linked suffering to the child's state of comfort. Physicians linked them to the intensity and impact of treatment and future perspectives of the child. Various aspects of the child's suffering and admission to a PICU caused suffering in parents. Conclusion: Parents', physicians', and nurses' perceptions of suffering overlap but also show important differences. Differences found seem to be rooted in the relation to and kind of responsibility (parental/professional) for the child. The child's illness, suffering, and hospital admission cause suffering in parents. Health-care professionals in PICUs need to be aware of these phenomena.
What’s in a name?
Huisarts en Wetenschap, 2007
Samenvatting Van Tol DG. What’s in a name? Over het classificeren van medisch handelen rond het ... more Samenvatting Van Tol DG. What’s in a name? Over het classificeren van medisch handelen rond het levenseinde door huisartsen en officieren van justitie. Huisarts Wet 2007;50(3):95-9. Artsen en juristen kunnen moeilijk door één deur. Toch hebben beide disciplines de afgelopen jaren steeds meer met elkaar te maken. Ook in geval van medisch handelen rond het levenseinde is het doen en laten
Medicalisering
Kernboek, 2014
Wat is professionaliteit?
Kernboek, 2014
Recht der Werkelijkheid, 2014
van der Vegt en Cristiano Vezzoni. 1 Opzettelijk levensbeëindigend handelen op verzoek. 2 Het toe... more van der Vegt en Cristiano Vezzoni. 1 Opzettelijk levensbeëindigend handelen op verzoek. 2 Het toedienen van sederende middelen tot het ingetreden zijn van de dood in de laatste levensfase. De terminologie is verschillend. In de beroepsgroep wordt gesproken over palliatieve sedatie. Daarmee wordt zowel sedatie tot de dood (continue sedatie) bedoeld als intermitterende sedatie. In het onderzoek is alleen gekeken naar het eerste. 3 Van de onderzoeksbevindingen is in 2011 verslag gedaan in het rapport Kennis en opvattingen van publiek en professionals over medische besluitvorming en behandeling rond het einde van het leven, Het KOPPEL-onderzoek. Dit verslag is te bestellen en te downloaden via de website van ZonMw (www. zonmw.nl/uploads/tx_vipublicaties/ZonMw_A4_RapportKOPPELDEF_klein.pdf). 4 Van Tol (2005) maakte dit onderscheid zonder het op deze wijze aan te duiden. 5 Van Tol 2005 in zijn uitwerking van het werk van Griffiths (o.a. Griffiths 2005). 24 Recht der Werkelijkheid 2014 (35) 2 Dit artikel uit Recht der Werkelijkheid is gepubliceerd door Boom Juridische uitgevers en is bestemd voor Rijks Universiteit Groningen
Journal of Psychiatric Practice, 2014
Handboek medische professionaliteit
Kernboek, 2014