Publication of April 2023

Discontinuing nutrition and hydration at the end of life can be a difficult decision for both caregivers and families. It is a process with an enormous symbolic significance value, involving high emotional and affective charge. There is a lack of knowledge among healthcare teams about the pathophysiology of stopping nutrition and hydration, creating a fear of “starving or dehydrating” the patient. The understanding of the pathophysiological mechanisms and symptoms related to prolonged fasting were acquired thanks to the American and British experiences during the Second World War. Therefore, we are able to explain this process to families or teams in pain to try to alleviate their apprehension regarding the situation. The present work attempts to summarize these issues in order to provide caregivers with avenues to anticipate their questions and those of the patients’ families regarding nutrition and hydration withdrawal in the advanced palliative situation.

Introduction
Despite the prevalence of domestic violence (DV) in Belgium, few studies have examined the role of general medicine practice in the management of perpetrators of DV. What is the experience of Belgian general practitioners in the management of male perpetrators of domestic violence?
Method
A qualitative study examined the history of Belgian general practitioners in the supervision of men who commit domestic violence. Through a snowball sampling and individual semi-directed interviews, we were able to collect information from five general practitioners. The heterogeneity of profiles in terms of gender, age, years of experience, type, and location of practice was preferred to obtain a rich and diversified sample. These five interviews were marked out by an interview guide and then strictly transcribed.
Results
Three main themes related to the physicians' experience were identified: [1] by what means do the physicians identify male perpetrators of violence against women (VAW) and how can they be considered as patients? Their identification is mostly made by the female victims. There is little self-identification by the perpetrators of VAW. This is a victim-centered approach. The importance of the therapeutic relationship with the male perpetrators of violence is emphasized. [2] The second theme highlights a generalized taboo among respondents towards male perpetrators of sexual violence, which has an impact on their treatment. It proposes communication and verbalization in order to include [3] general medicine in a network- centered system on the male perpetrators of violence. This system is necessary to provide support and adequate multidisciplinary management of male perpetrators of domestic abuse.
Conclusion
There is a general taboo around male perpetrators of DV. General medicine practice contributes to this taboo. There is a lack of responsibility on the part of general practitioners, leading to a poor care for male perpetrators of domestic abuse. A network system is essential for their appropriate management. Further studies are needed to evaluate the role of the front liners in preventing domestic violence.