Physician-assisted Suicide Research Articles

Phycian assisted suicide: A Swiss perspective - a liberal view

Abstract Switzerland is a country in which the liberal tradition is cultivated and every citizen’s free decision is honoured. Associations such as EXIT or Dignitas, which advocate the right to self-determined death, were formed here early on. They see themselves as completing the Age of Enlightenment, where the end result is an individually self-determined death. The Swiss federal government is therefore reluctant to define criminal offences. However, it is regulated that active euthanasia is prohibited. The organisations mentioned are also not allowed to act for their own benefit.Meanwhile, the number of assisted suicides is higher than the number of suicides. The extent to which the one phenomenon is related to the other is open to debate.The topic is controversial among the general public and the medical profession. Nevertheless, the Swiss Academy of Medical Science has published guidelines on dealing with dying and death, which also deal with physician-assisted suicide.Various associations, including the umbrella organisation for suicide prevention in Switzerland, Ipsilon, are in favour of special protection for vulnerable groups. Some of them also recommend that civil law provisions be made for the process of assisted suicide.Disclosure of InterestNone Declared

Suicide across time and cultures: from a philosophical debate to network analysis

Introduction Suicide is a multifaceted subject that encompasses a broad spectrum of perspectives, spanning philosophy, the arts, social sciences, neuroscience, neuropsychiatry, and public health. The history of suicide is intricately intertwined with the history of humanity itself, and examining the shifting attitudes towards suicide holds significant implications for the field of suicide prevention.ObjectivesThe objective of this paper is to offer a timeline of the social perspectives about suicidal behavior throughout history in order to showcase the influence of cultural and contextual factors.MethodsThis poster is based on the Massive Open Online Course (MOOC) “Focus on Suicidal Behaviour” provided by the European Psychiatric Association. We performed a brief overview of the chapter on history of suicide and updated data on this topic with recent literature findings.ResultsIn antiquity, suicide was sometimes regarded as justifiable, whether to preserve honor or protest injustices. However, during the Middle Ages, suicide was primarily seen as a criminal act, violating the rules of the Christian religion. The Renaissance brought about a shift in the perception of suicide, as it began to be depicted in art as a heroic or philosophical act. Moving into the Romantic period, suicide took on a tragic and noble connotation, often seen as an escape from unbearable suffering.The 19th century marked a significant turning point when the social context started being recognized as a crucial factor in the development of suicidal behavior. In the 20th century, suicide was increasingly considered a public health problem. In the 21st century, the discourse on suicide has become multifaceted. On one hand, network analysis has enabled the development of an integrated model of suicide, emphasizing the complex interactions among various risk and protective factors. On the other hand, ethical and moral debates persist regarding assisted suicide and its indications.This summary primarily centers on the historical context of suicide within Europe. However, attitudes toward suicide vary significantly across cultures. For instance, in China, suicide rates are higher for women than for men, while Japan has historically displayed a relatively tolerant attitude toward suicide, particularly within the military. In contrast, Islamic countries consider suicide a major sin and implicitly associate it with stigma.Conclusions The understanding of suicide evolves over time and is deeply influenced by cultural contexts. Familiarizing ourselves with the historical perspectives on suicide is essential for comprehending this complex social and personal phenomenon. Such knowledge forms the foundation for the creation of effective prevention strategies.Disclosure of InterestNone Declared

Euthanasia - A Novel Intricacy for Psychiatry’s Purview?

IntroductionNumerous countries, notably within Europe, have sanctioned the practice of euthanasia. Extant legal frameworks meticulously define the extent, essence, and application of euthanasia, encompassing divergent characterizations, explications of entitlements, procedural modalities, and provisions for access. Nonetheless, the precise function of psychiatrists within these legislative contours remains conspicuously nebulous.ObjectivesThe present inquiry undertakes a comprehensive evaluative review of the euthanasia phenomenon vis-à-vis the intricate tapestry of European legislative paradigms, with an emphasis on elucidating the multifaceted involvement of psychiatry within this evolving landscape.MethodsA nuanced narrative review is undertaken, encapsulating the contemporary state-of-affairs, fundamental conceptual architectures, the tenets of the Spanish Organic Law 03/2021, and the pharmaceutic armamentarium deployed in the orchestration of euthanasic practices. Additionally, the methodological blueprint employed within a prominent tertiary healthcare institution situated in Madrid is meticulously expounded.ResultsTo date, euthanasia has garnered legal imprimatur across diverse jurisdictions including, but not limited to, the Netherlands, Belgium, Colombia, Canada, Spain, and New Zealand. The ambit of assisted death and its application to the domain of mental infirmities is meticulously deconstructed. Within the overarching realm of foundational concepts, a rigorous delineation is rendered between euthanasia, medical succor in the throes of mortality, assisted self-termination, facilitated demise, provision of mortal release, judicious calibration of therapeutic enterprise, and the contours of palliative sedation. Distinction between the principal executor and the advisory consultant is rendered salient. The rubric of conscientious objection emerges as an inviolable entitlement of healthcare practitioners enmeshed in the provisionary matrix.The enduring incumbency of the psychiatrist as a pivotal appraiser of cognitive and volitional faculties holds firm. The conspicuous influence of psychopathological constellations upon the contours of euthanasia eligibility precipitates cogent deliberation.ConclusionsAs the frontiers of euthanasia expand to encompass an augmented array of legal jurisdictions, this study underscores the increasingly intricate role inhabited by psychiatrists in the matrix of evaluative assessments. The proclivity of mental maladies to exert a substantial gravitational pull upon determinations of eligibility for euthanasia accentuates the exigency for refined explication of roles and responsibilities within this evolving sphere, a clarion call resonant not only within the precincts of psychiatry but reverberating across the broader firmament of medical praxis.Disclosure of InterestNone Declared

End-of-Life Symptom Burden among Patients with Cancer Who Were Provided Medical Assistance in Dying (MAID): A Longitudinal Propensity-Score-Matched Cohort Study.

Cancer is the primary underlying condition for most Canadians who are provided Medical Assistance in Dying (MAID). However, it is unknown whether cancer patients who are provided MAID experience disproportionally higher symptom burden compared to those who are not provided MAID. Thus, we used a propensity-score-matched cohort design to evaluate longitudinal symptom trajectories over the last 12 months of patients' lives, comparing cancer patients in Alberta who were and were not provided MAID. We utilized routinely collected retrospective Patient-Reported Outcomes (PROs) data from the Edmonton Symptom Assessment System (ESAS-r) reported by Albertans with cancer who died between July 2017 and January 2019. The data were analyzed using mixed-effect models for repeated measures to compare differences in symptom trajectories between the cohorts over time. Both cohorts experienced increasing severity in all symptoms in the year prior to death (β from 0.086 to 0.231, p ≤ .001 to .002). Those in the MAID cohort reported significantly greater anxiety (β = -0.831, p = .044) and greater lack of appetite (β = -0.934, p = .039) compared to those in the non-MAID cohort. The majority (65.8%) of patients who received MAID submitted their request for MAID within one month of their death. Overall, the MAID patients did not experience disproportionally higher symptom burden. These results emphasize opportunities to address patient suffering for all patients with cancer through routine collection of PROs as well as targeted and early palliative approaches to care.

Enhancing Congenital Cardiac Postprocedural Care: A QR Code-Enabled Medical Bracelet Pilot Study.

The study aimed to evaluate the feasibility of using QR code-enabled medical bracelets for congenital heart disease (CHD) patients after hospital discharge to ensure quick communication of vital information to other medical personnel in emergency situations. A prospective study was conducted where QR code-enabled medical bracelets were given to families of postoperative pediatric cardiac patients. The QR code linked to a secure medical information sheet detailing the patient's cardiac history. Post-study surveys were completed by providers and families to assess their experiences with the bracelet. Of the 20 participants enrolled, 65% used the QR bracelet when seeking medical care. 55% found the bracelet useful, and 70% rated their experience as either "positive" or "very positive". Additionally, 80% recommended the bracelet for other patients undergoing cardiac procedures. The use of QR code bracelets for postoperative CHD patients has shown high levels of satisfaction from families and providers, potentially reducing medical errors and treatment delays.

Disparities in public awareness, practitioner availability, and institutional support contribute to differential rates of MAiD utilization: a natural experiment comparing California and Canada

ABSTRACT Even though California and Canada both legalised medical aid in dying (MAiD) in 2016 and have similarly sized populations, only 853 medically assisted deaths occurred in California versus 13,241 in Canada in 2022, the most recently reported year. Ten testable hypotheses were proposed to explain this 15-fold differential in MAiD utilisation. A demographically representative online survey of adults 60 and older in both jurisdictions (N = 556) revealed no differences in moral acceptance of MAiD or willingness to use it. However, only 25% of Californian participants were aware that MAiD was legally available versus 67% of Canadian participants. Evidence in the public domain revealed that there were 6.0 times more MAiD practitioners per capita in Canada than in California, and there was far greater support for MAiD by Canadian healthcare institutions. The evidence did not support hypotheses presuming more restrictive laws in California or greater access to palliative care/hospice. While other reasons may contribute to the difference in MAiD utilisation, limited public awareness, fewer MAiD practitioners per capita, and sparse support by healthcare institutions may significantly reduce California residents’ ability to exercise their autonomy when making end of life choices.

Residency Requirements for Medical Aid in Dying.

In 1997, when Oregon became the first U.S. jurisdiction authorizing medical aid in dying (MAID), its law included a requirement that patients be legal residents of the state. Other U.S. jurisdictions legalizing MAID followed Oregon in adopting residency requirements. Recent litigation challenges the legality, as well as the justification, for such requirements. Facing such challenges, Oregon and Vermont eliminated their MAID residency requirements. More states could follow this move, for, in certain circumstances, the U.S. Constitution's privileges and immunities clause protects citizens' right to travel to secure medical care. Policy considerations could also motivate states to reexamine whether such requirements are justified in light of existing evidence of how MAID laws have been applied.

Consciously Choosing Unconsciousness

Consciously Choosing Unconsciousness

Attitude of the Lithuanian Public toward Medical Assistance in Dying: A Cross-Sectional Study.

Euthanasia and assisted suicide, involving the intentional termination of a patient's life, are subjects of global debate influenced by cultural, ethical, and religious beliefs. This study explored the attitudes of the general public toward euthanasia, finding varying levels of support. A cross-sectional study was conducted. This research specifically evaluated the perspectives of 5804 Lithuanian residents using a survey distributed through social media, which presented medical scenarios on life-preserving interventions. Analysis indicated that gender, religion, experience in caring for patients in a terminal condition, education, and age significantly influenced the attitudes of the respondents toward end-of-life decisions. Specifically, factors like being non-religious or having less experience in caring for the terminally ill correlated with a more positive opinion regarding euthanasia and other forms of medical assistance in dying.

Words matter: ‘enduring intolerable suffering’ and the provider-side peril of Medical Assistance in Dying in Canada

Enduring intolerable suffering, an essential eligibility criterion in Medical Assistance in Dying (MAiD) in Canada and elsewhere, is a contradiction in terms, in that suffering must be tolerable to be...

La ley de eutanasia y experiencias profesionales: tensiones en la práctica clínica

ObjectiveTo analyze the process of assisted death provision in Catalonia and identify the main tensions, difficulties, and/or sources of discomfort related to professional practice. MethodA qualitative study was conducted based on interviews (n=29) and focus groups (n=19) with professionals who participated in the euthanasia process. The selection of participants combined the snowball and maximization of variability procedures, taking into account the variables of professional profile, setting, gender, age and territoriality. Intentional and theoretical sampling process. ResultsThe assisted death process is divided into four main moments: 1) reception of the request, 2) medical-bureaucratic procedure, 3) the actual procedure, and 4) closure. At each of these moments, difficulties arise that can be a source of discomfort and have to do with the limits and tensions between the legal and moral, the conception of one's own professional role, the lack of recognition of some professional roles, stress and overload, the lack of formal and informal support, and the relationship with the patient and his/her family. The bureaucratic-administrative stress derived from a protective law, with both prior and subsequent verifying control, stands out, given that it stresses the professionals immersed in a healthcare system already under high pressure after budget cuts and the COVID-19 epidemic. ConclusionsThroughout the assisted death process, the sources of distress are diverse and of a psychological, psychosocial, and structural nature. These results may lead to interventions for psychological and peer support, information, training, institutional involvement, and burden reduction.

A Brief Overview of the Islamic Ethics of Suicide and Suicide-Related Contemporary Issues from a Sunnī Perspective: A Primer for Clinicians and Researchers.

Suicide is a growing global health concern with complex socioeconomic implications. Understanding psychosocial resiliency factors may facilitate suicide prevention. Religious moral objections to suicide, including those inspired by the Islamic faith, appear to promote resilience to suicide. However, few English-language resources provide an overview of Islam's moral and ethical position on suicide, potentially hindering treatment of, and research on, suicide risk among Muslims. In the current paper, Islam's unanimous prohibition of suicide is explored and contextualized within the religion's foundational principles regarding the sanctity of life, the role and necessity of hardships, and one's responsibility to care for their body and to maintain their rights to their community. The role of harsh deterrents to suicide are contrasted with the impetus to show compassion to the deceased and the bereaved. Given the increasing focus on suicide-related topics such as euthanasia/ medical assistance in dying (MAID) and suicide contagion, Islam's ethical and legal position on suicide is discussed in the context of these contemporary moral issues.

Perspectives of Canadian health leaders on the relationship between medical assistance in dying and palliative and end-of-life care services: a qualitative study.

Medical assistance in dying (MAiD) was legalized in Canada in 2016, but coordination of MAiD and palliative and end-of-life care (PEOLC) services remains underdeveloped. We sought to understand the perspectives of health leaders across Canada on the relationship between MAiD and PEOLC services and to identify opportunities for improved coordination. In this quantitative study, we purposively sampled health leaders across Canada with expertise in MAiD, PEOLC, or both. We conducted semi-structured interviews between April 2021 and January 2022. Interview transcripts were coded independently by 2 researchers and reconciled to identify key themes using content analysis. We applied the PATH framework for Integrated Health Services to guide data collection and analysis. We conducted 36 interviews. Participants expressed diverse views about the optimal relationship between MAiD and PEOLC, and the desirability of integration, separation, or coordination of these services. We identified 11 themes to improve the relationship between the services across 4 PATH levels: client-centred services (e.g., educate public); health operations (e.g., cultivate compassionate and proactive leadership); health systems (e.g., conduct broad and inclusive consultation and planning); and intersectoral initiatives (e.g., provide standard practice guidelines across health care systems). Health leaders recognized that cooperation between MAiD and PEOLC services is required for appropriate referrals, care coordination, and patient care. They identified the need for public and provider education, standardized practice guidelines, relationship-building, and leadership. Our findings have implications for MAiD and PEOLC policy development and clinical practice in Canada and other jurisdictions.

Assisted Dying Bill [HL]: ignorance within the House?

Presently, within the United Kingdom, the House of Lords are engaged with the latest challenge to the blanket ban on any and all forms of assisted suicide. The Assisted Dying Bill [HL], which now resides in the Committee Stage, provides an exemption for medical practitioners assisting patients in self-administering medicine to end their lives. The Bill is identical to the previous Bill introduced by Lord Falconer. In light of developments within other foreign jurisdictions, the similarities and, perhaps more significantly, differences between the legislative pieces provide an interesting comparative discussion. The Canadian Medical Assistance in Dying (MAiD) legislation has been in force since 2016 and has since been amended (March 2021). As Canada is somewhat further down the ‘legal road’ in regulating assisted dying, it may prove a fruitful endeavour to use the Canadian developments to assess and predict the possible trajectory of the Assisted Dying Bill in the UK. Features of the Bill reflect similar provisions that have been adjusted or removed in the Canadian legislation, features that are of significant importance and solemnity in the context of those wishing to access assistance in dying. Such examples include that it necessitates that the patient commit the final act, are expected to die within 6 months, and that there must be a ‘reflection period’. Statistical data reporting in Canada has given valuable insight to the provision of MAiD, including some of the features highlighted. The question becomes ‘should the UK Parliament be paying more attention to the Canadian developments in the context of domestic assisted dying Bills?’ Assisted dying is irrefutably embedded deep within many aspects of society. Whether there exists sufficient differences between the societies of the two jurisdictions will determine if the UK is being unnecessarily ignorant or responsibly contextual.

No (true) right to die: barriers in access to physician-assisted death in case of psychiatric disease, advanced dementia or multiple geriatric syndromes in the Netherlands

Even in the Netherlands, where the practice of physician-assisted death (PAD) has been legalized for over 20 years, there is no such thing as a ‘right to die’. Especially patients with extraordinary requests, such as a wish for PAD based on psychiatric suffering, advanced dementia, or (a limited number of) multiple geriatric syndromes, encounter barriers in access to PAD. In this paper, we discuss whether these barriers can be justified in the context of the Dutch situation where PAD is legally permitted for those who suffer unbearably and hopelessly as a result of medical conditions. Furthermore, we explore whether there are options to address some of the barriers or their consequences, both within the Dutch legal framework or by adjusting the legal framework, and whether these options are feasible. We conclude that although there are insufficient arguments to overrule the doctor’s freedom of conscience in the Netherlands, there are ways to address some of the barriers, mainly by offering support to doctors that would be willing to support a request. Moreover, we believe it is morally required to reduce or mitigate where possible the negative consequences of the barriers for patients, such as the long waiting time for those who suffer from psychiatric disorders, because it is unlikely the adjustments suggested to the system will ensure reasonable access for these patient groups.

Correction to: The Impacts of Legalization of Physician-Assisted Suicide on Binge Drinking Among US Adults

Correction to: The Impacts of Legalization of Physician-Assisted Suicide on Binge Drinking Among US Adults

Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives

BackgroundPersons with mental illness as their sole underlying medical condition are eligible to access medical assistance in dying (MAiD) in a small number of countries, including Belgium, the Netherlands, Luxemburg and Switzerland. In Canada, it is anticipated that people experiencing mental illness as their sole underlying medical condition (MI-SUMC) will be eligible to request MAiD as of March 17th 2024. To date, few studies have addressed patient and family perspectives on MAiD MI-SUMC care processes. This study aimed to address this gap and qualitatively explore the perspectives of persons with lived experience of mental illness and family members on care considerations during MI-SUMC implementation.MethodsThirty adults with lived experience of mental illness and 25 adult family members residing in Ontario participated in this study. To facilitate participant engagement, the semi-structured interview used a persona-scenario exercise to discuss perspectives on MAiD MI-SUMC acceptability and care considerations. Framework analysis was used to inductively analyze data using NVivo 12 Pro. Steps, processes, or other care considerations suggested by the participants were charted in a framework matrix after familiarization with the narratives. Key themes were further identified. A lived-experience advisory group participated in every aspect of this study.ResultsSix themes were developed from the patient and family narratives: (1) Raising MAiD MI-SUMC awareness; (2) Sensitive Introduction of MAiD MI-SUMC in goals of care discussions; (3) Asking for MAiD MI-SUMC: a person-focused response; (4) A comprehensive circle of MAiD MI-SUMC care; (5) A holistic, person-centered assessment process; and (6) Need for support in the aftermath of the decision. These themes highlighted a congruence of views between patient and family members and described key desired process ingredients, including a person-centred non-judgmental stance by care providers, inter-professional holistic care, shared decision making, and the primacy of patient autonomy in healthcare decision making.ConclusionsFamily and patient perspectives on the implementation of MAiD MI-SUMC offer important considerations for service planning that could complement existing and emerging professional practice standards. These stakeholders’ perspectives will continue to be essential in MAiD MI-SUMC implementation efforts, to better address the needs of diverse communities and inform improvement efforts.

Soigner au seuil de la mort : l’expérience mystique d’un patient avec la thérapie assistée par la psilocybine

<p>Patients with serious illnesses like advanced cancer often experience existential and psychospiritual distress. Alleviating this form of pain and suffering has proven to be very challenging using conventional treatments. Psilocybin-assisted therapy (PAT) employs the psychoactive effects of psilocybin as a catalyst for a psychotherapeutic process grounded in indigenous traditions and within the context of a therapeutic mindset and environment (“set and setting”). This carefully curated experience of an altered state of consciousness can promote healing and psychospiritual growth independently of the disease trajectory. Current research supports the use of this form of therapy as a safe and effective therapeutic tool for such patients. This narrative case report, based upon and written from the perspective of the treating physician, describes the therapeutic journey of a patient with the fictitious name Martin, as he receives his diagnosis of a terminal illness, engages in PAT, and on to his deathbed. Martin was the first patient in Quebec to receive psilocybin treatment through Canada’s Special Access Program (SAP) and chose to end his life with medical assistance in dying (MAID), both done in the context of homecare and paid for in its entirety by the public healthcare system of Quebec.</p>

Beyond coercion: reframing the influencing other in medically assisted death

This essay considers how we are to understand the decision to end one’s life under medical aid-in-dying (MAID) statutes and the role of influencing others. Bioethical concerns about the potential...

Medical aid in dying to avoid late-stage dementia.

Many patients with dementia want the option of using medical aid in dying (MAID) to end their lives before losing decision-making capacity and other abilities that impact their desired quality of life. But, for over two decades, it has been widely understood that these patients cannot (solely because of their dementia diagnosis) satisfy three statutory eligibility requirements in all U.S. MAID laws: (1) decisional capacity, (2) the ability to self-administer the life-ending medications, and (3) a terminal condition with 6 months or less to live. Now, because of recent statutory amendments together with the use of voluntarily stopping eating and drinking (VSED) to quickly advance to a terminal condition, this dementia exclusion from MAID might no longer apply. If combining VSED and MAID is now a possibility for patients with dementia, then clinicians need more guidance on whether and when to support patients seeking to take this path. In this article, we begin to provide this guidance. First, we describe the recent case of an Oregon patient with early-stage Alzheimer's dementia who successfully used VSED to qualify for and use MAID. Second, we discuss prior barriers to using VSED as a bridge to MAID for people with dementia. Third, we describe recent legal changes that might make this path now possible.