AUCTORES
Globalize your Research
case report
*Corresponding Author: Manisha Singh, Department of Nephrology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Citation: Julie Daniel, Masil George, Manisha Singh (2022). Physician Assisted Death -An Ethical Dilemma Revisited. International Journal of Clinical Nephrology. 4(2); DOI:10.31579/2834-5142/028
Copyright: © 2022 Manisha Singh. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 08 April 2022 | Accepted: 31 May 2022 | Published: 06 June 2022
Keywords: physician-assisted death; end-of-life care; euthanasia; ethics; goals of care
Physicians often face ethical dilemmas when providing advice regarding withdrawal of care. In the nephrology world, we are especially at risk due to the high mortality of our patients. Yet our training tends to lag behind in certain aspects of end of life goals of care discussions. Some of our patients enquire regarding physician-assisted death (PAD) as an option and our current training does not enable us to provide an informed answer. In end-stage-renal patients, opting out of dialysis will certainly result in a rapid demise for most, however, some patients request further assistance. We updated information to be, at the least, able to help our most vulnerable patients with the information. The process of dying, sometimes prolonged to weeks, is a very painful procedure, and not under the patient's control.
Withdrawal of care, even with the best palliative care options, does not always result in the control that physician-assisted death (PAD) can provide. It appears as a reasonable option to some patients at the end of life. Is PAD a part of doing “everything that can be done” to keep a patient comfortable (as a part of comfort goals of care)? The provision exists in certain states. However, moving to another state at the end of life is not really practical or even a kind option to consider.
A physician can have moral and ethical dilemma around these queries. Our paper discusses available data on this issue intending to empower providers with optimal information. Professional position guidelines do not agree with or recommend physician-assisted-death. This knowledge helps clear the conscience of providers knowing that, at the least, we are doing what most other physicians would do. The question remains: Is PAD a part of “everything that can be done” for the patient? This manuscript aims to update regarding this issue especially as there have been recently active discussions worldwide with the launch of newer technology-assisted death.
We present a case modified extensively from real life cases for academic discussion only. We do not provide any recommendation regarding the practice.
Physician assisted death is legal in California, Colorado, District of Columbia, Hawaii, Maine, New Jersey, Oregon, Vermont, and Washington. Medical aid in dying is legal Montana via court decision, but there is no statute in place. Over half of the American states have considered enacting laws to allow mentally competent adult residents with a terminal illness to voluntarily request and receive a prescription medication that would allow the person to die at a time of their choice [1]. 73% of the American public [2]and 55% of physicians [3] support aid in dying for the terminally ill. In the United States, less than 18% of physicians report having received a request for PAD, and less than 5% have complied [4]. This highlights the fact that requests for PAD are infrequent, and only a small percentage is carried through. PAD can be legally practiced in other countries such as Netherlands, Switzerland, Belgium, Luxembourg, Columbia and Canada. While the majority of physicians support medical assistance for the dying individual, only a small number of practitioners are both willing and able to provide this service.
Mr. KD is a 66 year old man on in-center hemodialysis for renal failure. He makes the following request: “Doctor, could you please change something while I am on dialysis to stop my heart?” Mr. KD developed renal failure four years ago and has been on dialysis since. His comorbid medical problems include lung cancer (for which he receives palliative chemotherapy), diabetes, poorly controlled hypertension, recurrent infection with Clostridium Difficile (three times over six months), and congestive cardiac failure with preserved ejection fraction. When we discussed goals of care, he stated that he did not want to stop dialysis to wait for death to happen over a course of several days. He wanted to die at a time and location of his choice, especially because his son was deployed overseas and he wanted his son to be present at the bedside at the time of his death. It was also important to him to have mental clarity up to the point of death.
Mr. KD had done some research and mentioned how some states have the provision of physician assisted death (PAD) and wondered if he could relocate to a state that allows him to access this.
Commonly used terms to describe expedited death process are explained below. The terms PAD and euthanasia are sometimes used synonymously. Comfort care goals are to prevent or relieve suffering as much as possible and to improve quality of life while respecting the dying person’s wishes. However, there is a major difference as illustrated in the table below.
Euthanasia | Physician Assisted Death | Comfort care/ Withdrawal of care/hospice |
Physician prescribes the medication for the purpose of causing death. | Physician prescribes the medication for the purpose of causing death. | Physician assists in comfort measures, curative intent medications can be continued on palliative care, whereas in hospice such attempts are stopped with the sole purpose to keep the patient comfortable symptomatically. |
Physician directly administers the medications for the purpose of causing death. | Patient administers the medication for the purpose of causing death. | Physician directly administers the medications for use for comfort measures. |
Table 1: Types of physician assistance in the process of death
Date | Case | Outcome |
June 1997 | Washington v. Glucksberg [Error! Reference source not found.] | Court rules: no constitutional violation by the states in banning PAD. The court left the matter of the right to a physician's aid in dying to the states. |
October 1997 | Oregon's Death with Dignity Act becomes law [Error! Reference source not found.] | Allows terminally ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose. |
November 1998 | Pathologist and PAD advocate Jack Kevorkian charged with murder [Error! Reference source not found.] | Media attention generated. Convicted of second degree murder in 1999; served eight years in prison. |
November 2008 | Washington's initiative, the Death with Dignity Act, is passed | Effective March 2009: Allows Washington residents with less than six months to live to request lethal doses of medication from medical and osteopathic physicians. |
December 2009 | Baxter v. Montana [Error! Reference source not found.] | Rights of the Terminally Ill Act protects aid prescribing physician from liability. |
November 2012 | Massachusetts initiative defeated | Death with dignity vote defeated by 51% (1.52 vs. 1.45 million) |
May 2013 | PAD legalized in Vermont. | Patient Choice and Control at End of Life Act: residents with terminal disease have the option to be prescribed a dose of medication to hasten the end of their life. |
Jan 2014 | New Mexico: Morris v. Brandenburg | In Bernalillo County, an individual's right to die is upheld. |
November 2014 | Brittany Maynard ends her life in Oregon after moving from California | Social media attention generated, encouraging a review of the California law. |
October 2015 | California’s End of Life Option Act signed to law | Legalizes physician-assisted death for Californians with terminal illnesses. |
December 2016 | Colorado’s Proposition 106 goes into effect | End of Life Options Act: made assisted death legal among patients with a terminal illness who receive a prognosis of death within six months. |
February 2017 | District of Columbia’s Death with Dignity Act goes into effect | Washington, D.C. is the sixth jurisdiction in the U.S. to enact an assisted dying statute. |
May 2018 | Ahn v. Hestrin | California’s End of Life Option Act was overturned by a county judge on a technicality. |
June 2018 | California’s End of Life Option Act reinstated | The Court of Appeals issued an immediate stay to the previous month’s judgment, putting the law back into effect. The court gives until July 2nd to file objections. |
January 2019 | The Hawaii statute, the Our Care, Our Choice Act, goes into effect | Allows patients the ability to choose their own medical care at the end of life and, at the same time, ensure robust safeguards are in place to prevent any possible abuse. |
September 2019 | New Jersey and Maine laws have been enacted | New Jersey’s Medical Aid in Dying for the Terminally Ill Act goes into effect in August. The Death with Dignity Act in Maine follows by September. |
June 2021 | New Mexico’s End of Life Options Act goes into effect | New Mexico becomes the 10th jurisdiction to enact a PAD law. |
March 2022 | Oregon removes the residency requirement in the state’s Death with Dignity Act [Error! Reference source not found.] | In a settlement to a lawsuit brought by a physician, Oregon will no longer enforce the residency requirements to receive PAD prescriptions, and the state agrees to submit a repeal for the requirement in the next legislative session. |
Table 2: Major landmarks [Error! Reference source not found., Error! Reference source not found.]
In America, the lower courts (district courts and courts of appeals) decided that death is a fundamental right protected by the constitution, but these rulings were later reversed by the Supreme Court. The Supreme Court concluded that, while there may be a liberty interest involved, the constitution does not protect this right. The state’s interest in preserving life is therefore considered more legitimate than the need to protect such freedoms. The Supreme Court did emphasize that the states would be responsible for deciding legislation.
Interestingly, constitutional law only “protects those fundamental rights and liberties which are, objectively, deeply rooted in this Nation's history and tradition” [Error! Reference source not found.]. This creates a backwards-facing judicial system that often has difficulty keeping up with the pace of science and technology, but does create a buffer that isolates short-lived swings of opinion and influence from the law.
In Oregon, where physician assisted suicide has been allowed since 1997, the statistics shed light on practical application of this provision. Nearly all of the patients were white (96.5%), and only one African American has died under this statute since its inception. 73.3% of patients had at least some college education, and nearly half (43.7%) had a bachelor’s degree or higher [Error! Reference source not found.].
Those who do not live in a jurisdiction that allows medical assistance in dying could potentially relocate to a state that does. As a result, most patient-physician relationships average only eight weeks [Error! Reference source not found.]. The physical, financial, and social burdens of traveling to another state while severely disabled or terminally ill are usually too great for those near the end of life.
Common causes for patient requests for aid in dying
Against popular belief, pain control is only reported as an end-of-life concern in 25% of cases that have utilized Oregon’s Death with Dignity Act. The loss of autonomy (91%), inability to engage in activities that make life enjoyable (90%), and the loss of dignity (76%) are the most frequently cited reasons. In contrast, financial implications are rarely a factor (4%), whereas nearly half are concerned about the loss of bodily functions (46%) or the burden placed on caregivers (44%) [Error! Reference source not found.].
Other causes include the following [Error! Reference source not found., Error! Reference source not found.]:
1. Illness related experience
2. Sense of self:
3. Fears about the future:
Ethical and legal concerns
In a world where our fates are no longer decided by the capriciousness of nature, does living eventually become a greater burden than dying? Could it be considered torture to force someone to stay alive far longer than they desire, especially if death is inevitable within a limited time span?
Healthcare providers are moral agents whose conscientious objection should be respected within the bounds of reasonable accommodation. The statutes currently in place in America protect providers and organizations who wish to refrain from prescribing or dispensing lethal medications. If a practitioner wishes to participate in assisted dying but is operating from a facility or within the staff of an entity that prohibits it, they may be subject to discipline or termination. However, they may still operate outside the scope of the sanctioning organization or as an independent contractor without punishment.
It is an ethical imperative for a patient to be aware of and have access to all services to which they are entitled. In the event that a provider objects to a patient’s request, they are obligated to refer them to another professional who is willing to comply. Similarly, care teams should be aware of the laws and policies relating to their local practice. If a patient requests aid in dying but cannot obtain it within the jurisdiction, providers should offer information on locations and facilities that provide the service.
The states currently allowing aid in dying have very similar laws which provide numerous safeguards to protect both patients and providers. Prior to March 2022, the patient was required to prove residency in the jurisdiction, though there was no minimum length of residency required. Participation is voluntary for all involved, and it is a felony similar to first degree murder to coerce or unduly influence someone to request the medication.
The positions of medical associations tend to remain conservative until after local laws have been enacted, and generally echo judicial findings. Most professional groups such as the American Academy of Hospice and Palliative Medicine were once opposed to PAD, but are increasingly taking a position of “studied neutrality” [Error! Reference source not found.].
The main concern cited by opponents of the laws is that certain populations of patients will be particularly vulnerable to abuses within the system. Such populations include those of lower income or educational status, the elderly, patients with dementia, and others [Error! Reference source not found.]. However, there have been no legitimate cases of abuse reported in America to date. Other complicating moral factors when considering PAD include concerns over surrogates’ conflict of interests, coercion or undue influence, and capacity assessments in the case of such requests. The dual axioms of beneficence and non-maleficence are guidelines that can only be defined by an action’s relative injury [Error! Reference source not found.]. This means that the ethical considerations of each case must be evaluated individually.
Current understanding of the process of PAD
Our interpretation based on the above information incorporating the different states’ approach to PAD is as follows. The process begins with a patient making two separate oral requests for aid-in-dying at least fifteen days apart. They must sign a written request in the presence of two witnesses, one of which is an uninterested party. They must discuss their wishes with the attending physician without anyone else present (except an interpreter) to ensure that the decision is voluntary. The physician will evaluate the patient’s competency for informed, rational consent, as well as their physical ability to take the medication themselves. The patient would be referred to a second physician to confirm the diagnosis, prognosis, and decisional capacity. If either physician suspects the patient may have a psychiatric disorder, they must also be referred to a mental health specialist for evaluation.
The patient should express understanding of the effects of the medication, the probable result, and the potential risks involved. The physician would clarify that the patient can take the drug whenever they want, but can choose not to take it at all or withdraw the request at any time. They should understand the importance of maintaining the drug in a safe and secure location until they are ready to ingest it. They would discuss realistic alternatives including comfort care, hospice, palliative treatment, and pain control. Finally, the provider would give another opportunity to withdraw the request. If they still desire to proceed, the physician would then write the prescription.
Before taking the medication, the patient must sign a form stating that they took it voluntarily. The attending physician is required to submit thorough documentation and a follow-up form to the state according to local laws. No contract, will, insurance policy, or other agreement may be conditioned or affected by a person’s request or denial of medical aid in dying. Death after ingestion of the drug is not considered suicide or homicide, but a natural death resulting from the underlying disease.
At a time of astronomical advances in medicine and technology, the speed of progress necessitates frequent reviews of our beliefs about medical, societal, and personal ethics. While we have succeeded in prolonging life beyond its “natural” end, the sectarian belief that physicians have no part in death may need further discussion. Physicians must continually examine their understanding of the cycle of life and death, patient rights to know their choices, and access to such care.
Acknowledgements
Authors report no conflict of interest. All listed authors are in authority for the content and subsequent revisions of the article and have contributed equally.
Funding
No funding sources.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
