Physician-assisted Suicide Research Articles

Medical Aid in Dying: Gaining Attention in America

Medical Aid in Dying: Gaining Attention in America

Psychosocial health of patients engaging in medical aid in dying and their family members: A prospective descriptive analysis.

12032 Background: Medical Aid in Dying (MAID) allows patients (pts) with a terminal illness and less than 6 months prognosis to request a prescription that will end their life. MAID is controversial; opponents argue that negative psychological health underlies the choice, and that participation adversely effects pts and FMs. This is the first study to prospectively examine psychological health of pts and Family Members (FMs) who engaged in MAID and compare this to the psychological health of pts and FMs who did not utilize MAID. Methods: Pts and FMs were recruited prospectively from End-of-Life Washington (largest non-profit, public MAID advocacy/assistance organization in Washington State) from September 2022-January 2023 to a self-report, longitudinal study. Pts, FMs or the dyad were enrolled. Results of this study are compared to previously published results: *means (standard deviation, SD) taken from *Singer, et al. 2021; **Frikkel, et al. 2021; ^Robinson, et al. 2016 and ~Trevino, et al. 2013. + indicates no significant difference between MAID and non-MAID subjects at p > .05 level. Results: 16% (8/51) of eligible pts and 49% (20/41) of eligible FMs were recruited. 55% (n = 11) of FMs were spouses. There was no difference in sex and subjects were mostly white (pts 87.5%; FMs 95%) with college or higher degrees (pts 62.5%; FMs 85%). Most pts reported having cancer (n = 6 [75%]; neurologic condition, n = 1 [12.5%]; cirrhosis, n = 1 [12.5%]); most FMs also reported their pt had cancer (n = 17 [85%]; neurologic condition, n = 3 [15%]). There were no differences in psychological health between terminal cancer pts and FMs who engaged in MAID and advanced cancer pts & FMs who did not (see table). Conclusions: In this study, FMs and pts participating in MAID appear to have rates of negative psychological states that are in the low to moderate range. These rates appear similar to pts with advanced cancer and their FMs who are not engaging in MAID. Future research should study larger, heterogeneous populations earlier in the illness trajectory. [Table: see text]

P.143 Exploring end-of-life decision making and perspectives on Medical Assistance in Dying through the eyes of individuals living with cervical spinal cord injuries in Nova Scotia

Background: Individuals with spinal cord injuries (SCI) are invariably faced with decisions around management of their injury; from life prolonging to palliating interventions. End-of-life (EOL) decision-making has recently come to include conversations around Medical Assistance in Dying (MAID), as legislation changes have expanded access. The intersection between SCI and MAID, and other EOL decision-making has yet to be explored. We sought to discuss awareness and perspectives on MAID and EOL decision-making. Methods: We conducted hour-long semi-structured interviews with 15 individuals living with cervical SCI. Interviews took place over the telephone or virtually, and transcripts were analyzed using an iterative coding process and thematic analysis. Results: There was a global lack of awareness of options, that changed with time as participants assumed more independent roles in decision making. Participants possessed general awareness of MAID, but variable understanding of who legislation applies to. The way individuals with SCI could interact with MAID legislation brought forth interesting discussions around bodily autonomy and self-determination. Some voiced their own desire initially for MAID, while others vacillated or were more strongly opposed. Conclusions: This study emphasizes the importance of engaging with difficult conversations, and striking the balance of respecting autonomy and self-determination, within the constraints of each individual’s situation.

Ethical Issue of Physician-Assisted Suicide and Euthanasia.

With the implementation of Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life, interests of the general public on self-determination right and dignified death of patients have increased markedly in Korea. However, "self-determination" on medical care is misunderstood as decision not to sustain life, and "dignified death" as terminating life before suffering from disease in terminal stage. This belief leads that physician-assisted suicide should be accommodated is being proliferated widely in the society even without accepting euthanasia. Artificially terminating the life of a human is an unethical act even though there is any rational or motivation by the person requesting euthanasia, and there is agreement thereof has been reached while there are overseas countries that allow euthanasia. Given the fact that the essence of medical care is to enable the human to live their lives in greater comfort by enhancing their health throughout their lives, physician-assisted suicide should be deemed as one of the means of euthanasia, not as a means of dignified death. Accordingly, institutional organization and improvement of the quality of hospice palliative care to assist the patients suffering from terminal stage or intractable diseases in putting their lives in order and to more comfortably accept the end of life physically, mentally, socially, psychologically and spiritually need to be implemented first to ensure their dignified death.

Nachvollziehbarkeit als Kriterium für die Respektabilität von Sterbewünschen? Eine Kritische Auseinandersetzung mit Bettina Schöne-seiferts ,,flankiertem Bewertungssubjektivismus“

On 26 February 2020, the Federal Constitutional Court of Germany pronounced a judgement that the prohibition of assisted suicide services set out in § 217 of the Criminal Code is void. It thereby reestablished the legal state that had obtained before 2015. Furthermore, it defined the right to die as an autonomy-based right, thereby dissociating the right to take one???s life from states of extreme suffering caused by illness. The judgement implies that one can, in principle, resort to assistance for suicide even in the absence of illness and suffering. In this contribution, I deal with the problems that arise as a consequence of dissociating legitimate assisted suicide from states of illness. I analyze Bettina Schöne-Seifert???s suggestion to regard an understandable (,,nachvollziehbar“) wish to die as a wish that is protected by the right to autonomy. It turns out that the criterion of understandability is deficient: it either commits us to regarding every wish to die as understable or it undermines the anti-paternalistic requirement of respecting the patient???s autonomy

Euthanasia and Assisted Suicide: Sweetness in Bitterness

In this paper, a review of the concepts of euthanasia and assisted suicide is conducted. It begins by describing the historical trends from the beginning of the 20th century to the modern-day view. In doing this, some notable cases of these practices in the identified periods are discussed in a separate section. This qualitative study revealed that the doctrine of assisted suicide and the practice of euthanasia differ for different regions. This paper further analysed the argument for and against the doctrine of euthanasia. The theories and the school of thoughts on euthanasia are being examined. The study gives a clue to Nigeria legal perspective on euthanasia. The method of the study adopted was doctrinal in nature with the aid of textbooks, articles and internet sources. The research recommends among others, the improvement of Nigeria Constitution and legislation to promote and protect its citizen’s basic right to human dignity, personal liberty, freedom of thought and right to life as embedded in Chapter IV of the Constitution and to support their health care right. It further notes that there is absolutely no evidence of harms to society or to vulnerable individuals as a result of legalization of assisted suicide and euthanasia, rather than depriving competent adults who want to die sooner their freedom of choice.
 Keywords: Euthanasia, physician assisted suicide, Human Rights, Medical Ethics

Medical Aid in Dying: New Frontiers in Medicine, Law, and Culture

Medical aid in dying (MAID) has been a productive target for social scientific inquiry at the intersections of law and medicine over the past two decades. Insofar as MAID crystallizes and reflects personal and cultural understandings of key concepts such as individualism, dependency, dignity, and care, it is a rich site for social scientific theorizing. This article reviews and assesses the contributions of social scientific perspectives to research on MAID. We propose that social scientific research on MAID offers four distinctive contributions: its descriptive (rather than normative) orientation, its focus on cultural meanings, its insights into processes of knowledge production, and its comparative lens. The article's major sections describe ( a) attitudes toward MAID, ( b) MAID-related social movements, ( c) legalization approaches, and ( d) lived experiences of MAID in permissive jurisdictions. We conclude by reflecting on how MAID scholarship can inform social inquiry into other areas in which law and medicine converge.

Factors influencing the involvement of health care professionals in the administration of medical aid in dying in Quebec

On February 16, 2023, the Quebec provincial Minister for Health and Seniors introduced Bill 11, which would allow people suffering from serious and incurable diseases to benefit from medical aid in dying (MAID) through an advanced consent, in anticipation of incapacity. In addition, people with severe neuromotor disabilities such as quadriplegia would also be eligible for MAID if they meet the other eligibility criteria. If this bill is adopted, we can expect the number of MAID to increase in the coming years. Moreover, the number of HCPs who agree to be involved in the process of administering MAID remains relatively stable and objectively low, which generates an additional clinical, psychological and administrative burden for HCPs who agree to provide this care. Through a narrative review of the scientific literature, we found that there have been very few empirical studies about the factors that contribute (positively or negatively) to HCP involvement in the MAID process. The data show that among the factors that have been identified in the scientific literature as discouraging the involvement of HCPs in MAID, some are related to HCPs’ freedom of conscience and their core values, while others are more pragmatic and emerge from the reality of the field. Many factors influence negatively HCP participation in MAID. However, some of these factors, specifically those that are not related to the exercise of freedom of conscience, may potentially be mitigated by the implementation of appropriate resources, such as the creation of a space for safe dialogue. This article highlights the heterogeneity of factors that can interfere with the involvement of HCPs in MAID and, above all, the need for further investigation of these issues in order to adequately take them into consideration in the organization and provision of care.

Health professionals' understanding and attitude towards the End of Life Choice Act 2019: a secondary analysis of Manatū Hauora - Ministry of Health workforce surveys.

To determine socio-demographic factors associated with health professionals' understanding of the End of Life Choice Act (the Act), support for assisted dying (AD), and willingness to provide AD in New Zealand. Secondary analysis of two Manatū Hauora - Ministry of Health workforce surveys conducted in February and July 2021. Our analysis showed (1) older health professionals (age>55) had a better overall understanding of the Act than their young colleagues (age⁢35), (2) female health professionals were less likely to support and be willing to provide AD, (3) Asian health professionals were less likely to support AD compared to their Pākehā/European counterparts, (4) nurses were more likely to support AD and be willing to provide AD when compared to medical practitioners, and (5) pharmacists were more willing to provide AD when compared to medical practitioners. Several socio-demographic factors, including age, gender, ethnicity, and professional background, are significantly associated with health professionals' support and willingness to provide AD, with likely consequences for the AD workforce availability and service delivery in New Zealand. Future review of the Act could consider enhancing the roles of those professional groups with higher support and willingness to assist in providing AD services in caring for people requesting AD.

Assisted suicide from a psychiatric perspective

Assisted suicide has been the subject of controversial debates for years, particularly intensively since aruling by the Federal Constitutional Court of Germany (BVerfG) in 2020, which postulated that the only prerequisite for the legitimacy of assistance is the free decision to commit suicide. This brings the issue into the focus of psychiatry. On the one hand, because people with mental illnesses can seek assisted suicide and on the other hand, because these illnesses often but not necessarily limit the ability to make afree decision on suicide. In the area of tension between the medical obligation to life and to suicide prevention on the one hand and the obligation to respect autonomous decisions of patients on the other hand, psychiatrists are not only personally challenged to develop amoral stance, but also as aprofession to define the role and obligations of the discipline. This overview aims to contribute to this.

Prevalence of asthma in patients hospitalized for pneumonia associated to SARS-CoV-2 infection

The association between asthma and COVID-19 remains controversial. Objective. To establish the prevalence of asthma in a sample of patients with COVID-19-associated pneumonia; furthermore, to describe the clinical characteristics of patients with asthma compared to patients without asthma. Clinical data corresponding to 120 patients hospitalized for pneumonia associated with SARS-CoV-2 infection were analyzed. Patients with and without asthma were compared based on COVID-19 severity. The prevalence of asthma in patients with COVID-19 pneumonia was 3.5% (95% CI: 2.0% to 5.1%). When comparing the severity of COVID-19 among asthma patients with non-asthma patients, it did not differ based on symptoms, comorbidity, duration of symptoms, need for assisted mechanical ventilation, biomarkers of inflammation, and the occurrence of death. Patients with asthma and COVID-19 showed a high T2 phenotype, poor respiratory function, and no regular treatment for asthma control. No significant differences in the frequency of assisted mechanical ventilation or death were observed between patients hospitalized for COVID-19-associated pneumonia with and without a history of asthma.

Specialty Differences in Medical Aid in Dying Experiences: Results of a Survey of Physicians in Colorado.

In Colorado, medical aid in dying (MAiD) is legal, allowing a terminally ill person to request a prescription and self-administer a medication to end their life. Such requests are granted under certain circumstances, including a malignant neoplasm diagnosis, with a goal of peaceful death. This study examined differences in attitudes and actual participation in MAiD between oncologists and non-oncologists, using data from a recent survey of physicians regarding MAiD.

Jonathan Herring, The Right to Be Protected from Committing Suicide

The inspiration for the book, according to the author, was fired by the conversations he had with students who, when faced with the question, ‘[a] person decides they want to die and seeks the help of their doctor. What does and what should the law say the doctor should do?’1 tended to answer that the doctor should facilitate the fulfilling of the request.2 Further questioning would reveal that in their responses, these students were focusing on issues of assisted suicide. They did not mean that any member of the public who would approach a doctor for help in suicide should meet with the response ‘yes, let’s do it, how can I help you?’3 Arguably, this demonstrates that more attention should be given to the legal issues around suicide prevention in the law curriculum. A huge amount of time and energy is spent by professionals, academics, and politicians considering issues of assisted suicide for the very few situations where terminally ill people would like the law’s support for their wish to die, as Herring highlighted in Medical Law Review previously.4 It remains a pressing issue and is one of the reasons why this is a timely and important book. In the conclusion to Chapter 8 he writes, ‘[s]adly, much of the debate around end-of-life decisions in the academic literature, media and legal materials does not discuss these [suicide prevention] issues. Instead, the arguments focus on the provision of euthanasia and assisted dying.’5 One of the key points that the author seeks to highlight throughout the book is that there are positive legal obligations in relation to the prevention of suicide; Herring focuses his argument on suicide in relation to human rights articulated in the European Convention on Human Rights in Article 2 (the right to life), Article 3 (protection from torture) and Article 14 (protection from discrimination).6

Assisted Suicide and Euthanasia in Mental Disorders: Ethical Positions in the Debate between Proportionality, Dignity, and the Right to Die.

The admission of people suffering from psychiatric and neurocognitive disorders to euthanasia and physician-assisted suicide (E/PAS) in some European and non-European countries represents a controversial issue. In some countries, the initial limitation of E/PAS to cases of severe physical illness with poor prognosis in the short term has been overcome, as it was considered discriminatory; thus, E/PAS has also been made available to subjects suffering from mental disorders. This decision has raised significant ethical questions regarding the capacity and freedom of self-determination; the family, social, and economic contexts; the social consideration of the sense of dignity and the pressure on the judgment of one's personal value; the contextual therapeutic possibilities; the identification of figures involved in the validation and application; as well as the epistemological definitions of the clinical conditions in question. To these issues must be added the situation of legislative vacuum peculiar to different countries and the widespread lack of effective evaluation and control systems. Nonetheless, pessimistic indicators on global health status, availability of care and assistance, aging demographics, and socioeconomic levels suggest that there may be further pressure toward the expansion of such requests. The present paper aims to trace an international overview with the aim of providing ethical support to the debate on the matter. Precisely, the goal is the delimitation of foundations for clinical practice in the complex field of psychiatry between the recognition of the irreversibility of the disease, assessment of the state of physical and mental suffering, as well as the possibility of adopting free and informed choices.

Sue Westwood, Regulating the End of Life—Death Rights

This edited collection discusses assisted suicide and euthanasia, drawing on a range of expert views to discuss the subject holistically. In particular, assisted suicide and euthanasia are discussed from a regulatory perspective in Part 1 of the book, an ethical and moral perspective is explored in Part 2, a rights’ perspective in Part 3, and in Part 4 as ‘transgressions’ of established norms. The book presents death as a right that should be made available subject to safeguards if the individual requests it. Below I present each Chapter as it is set in the book. The book will appeal to those working in the area, and as the editor suggests, it can be read from start to finish, or one can approach the book selectively, based on interest. It is a brilliant collection of chapters, combining highly theoretical accounts on the debate, expert accounts of the rights perspective on assisted suicide and euthanasia, and some fascinating accounts of more ‘hands-on’ empirical approaches relevant to assisted suicide and euthanasia.

Against commercial-assisted suicide.

The idea of commercial-assisted suicide lives a marginal existence in the bioethical literature, despite its significant presence in popular culture. The practice of commercial-assisted suicide (CAS) is defined as suicide assistance performed for a financial reward through a contractual agreement between a customer and a service-provider, who does not necessarily need to be a medical professional. While CAS does indeed offer some potential solutions regarding the moral controversies surrounding physician-assisted suicide (PAS), I defend the idea that adopting it as policy ultimately proves morally indefensible and practically inefficient. This is due to the fact that the commodification of a given good necessarily implies the creation of a market of said good; as such, what I propose in this paper is a moral and practical evaluation of a market of CAS. In order to do so, I first examine the arguments in favor of CAS as put forward by Roland Kipke, who argues that any liberal defense of PAS necessarily implies a defense of CAS. In the first section, I argue against this idea using the liberal values of autonomy and equality of opportunity. In the second section of the paper, I argue that a market of CAS would be gravely dysfunctional due to one particular characteristic of death, namely, that is not compensable ex post. I conclude by arguing that while the practice of CAS may not prove morally problematic, the inevitable market that it will create should it be legalized most certainly will.

Social workers’ experiences with medical assistance in dying: Survey findings from Quebec, Canada

ABSTRACT As part of a larger survey, we asked social workers whether they had been involved in medical assistance in dying (MAID) so far. Of the 367 survey participants, 141 reported that they had. These were invited to describe their roles, needs, and sense of competence, focusing on their last MAID experience. Roles were diversified, beginning before and extending beyond the provision of MAID. Nearly 60% needed training on MAID. Perceived competence was lower among those lacking training. Findings point to educational needs that must be addressed to ensure the quality of end-of-life care and the well-being of social workers who engage in MAID.

Young people's perspectives on assisted dying and its potential inclusion of minors

AbstractAssisted dying legislation is available to support adult deaths in multiple international jurisdictions. In Canada, a parliamentary committee has recommended extending Medical Assistance in Dying (MAID) legislation to include ‘competent mature minors’. Even though such a policy change would affect young people, to date formal discussions about MAID for minors have excluded them. No empirical studies have elicited youth perspectives on including them in future legislation. This qualitative descriptive study uses focus groups to explore young people's perspectives on MAID and its potential extension to include minors using methodological and theoretical commitments to participatory research and children's agency. Our participants explored philosophical and medical dimensions of MAID, including pain and suffering, the choice to die, and how MAID enables a peaceful, controlled death. They unpacked the concept of maturity vis‐à‐vis age and a child/adult binary, using these reflections to posit safeguards for ensuring minors' MAID requests would be fairly evaluated. Finally, they explored relational dimensions of dying, paying particular attention to the impact of MAID on grievers. Our results illustrate that young people are capable and keen to contribute toward discussions and decisions about MAID. Our study supports the participation of young people in any extension of MAID, as well as in other high‐stakes matters that may affect them, challenging dominant assumptions that underestimate their capacities to do so.

Types of suicide pacts: a comparative analysis using the National Violent Death Reporting System.

Suicide pacts are lethal acts of violence involving multiple decedents. No study has ever compared suicide pact types using a large sample, limiting our understanding of this rare but serious phenomenon. The objective of the current study was to describe suicide pacts in the United States and empirically compare suicide pacts wherein all decedents died by self-harm with those that involved assisted suicide. Using restricted access incident-level data from the National Violent Death Reporting System, we identified 277 suicide pact incidents (225 suicide pacts wherein all decedents died by self-harm and 52 suicide pacts wherein one pact member died by assisted suicide). The two suicide pact types were compared for demographics, pact characteristics, and preceding circumstances. Compared with decedents of suicide pacts involving assisted suicide, decedents of suicide pacts wherein both members died by self-harm had significantly lower odds of being non-white, Hispanic or non-Hispanic (OR = 0.33, 95%CI: 0.18, 0.64), using an active method of suicide (i.e., ICD-10 codes X70-X83) (OR = 0.01, 95%CI: <0.01, 0.04), and experiencing interpersonal relationship problems (OR = 0.48, 95%CI: 0.27, 0.87) and a crisis within two weeks of their death (OR = 0.58, 95%CI: 0.36, 0.97), but greater odds of preceding physical health problems (OR = 3.25, 95%CI: 1.84, 6.04). Overall, our findings indicate that suicide pacts wherein all decedents died by self-harm and suicide pacts that involved an assisted suicide appear to have largely distinct profiles. While further research is required, the discrete characteristics of these two types of suicide pacts have important implications for prevention.

Clinical Outcome in Patients with COVID-19 and Comparison to Serum LDH and D-dimer Levels

Background:D-dimer and LDH are crucial biomarkers, particularly in view of the fact that they have been strongly linked to COVID-19 infection and have been linked to worse consequences in people who have severe viral infections. Objectives: To determine how D-dimer and LDH correlated with clinical effects in COVID-19 patients who were hospitalised and how they forecasted the severity of COVID-19 patients. Material and Methods: This was cross-sectional research conducted relatively early in the second wave of the pandemic. A total of 110 patients diagnosed with COVID-19 and admitted to the ICU from January 2021 to June 2021, were included in the study. The clinical outcome was evaluated in terms of discharge and death among patients requiring various forms of assisted ventilation. Results:The average age of patients was 53.16 years (± 18.47 years). 35.5% of the patients were with comorbidities of which diabetes, hypertension, and COPD were around 80%. D-dimer was deranged in 2.7% of the subjects and LDH was deranged in 60% of the study subjects at the time of admission. Coming on to the outcome, all patients were put on assisted ventilation with 71.8% on NIV, 20% on HFNO, 1% on CPAP, and 7.2% on MV. During their hospital stays, 6 (5.45%) patients died and the remaining patients were discharged. A higher D-dimer value (&gt; 1.5 μg/ml) during the hospital stay was found to be statistically significant with assisted ventilation and deaths of the admitted study subjects. Conclusion: In our investigation, the biomarker D-dimer value was more associated than LDH with mortality in patients with COVID-19 infection.