Legalization Of Physician-assisted Suicide Research Articles

Beliefs and Attitudes toward Physician-assisted Suicide among Korean Adults.

To grasp public opinion accurately, we conducted an opinion poll on beliefs and attitudes toward physician-assisted suicide (PAS). A randomized telephone survey ensuring a representative sample was conducted, 1,007 participants aged 18 years or older (response rate, 9.5%). The main results are as follows i) 61.1% of participants thought that the current social support system for terminally ill patients and their families is insufficient; ii) 60% of participants did not recognize the term "hospice and palliative care"; iii) 81.7% of participants would not like to receive life-sustaining treatment if there is no possibility of recovery; iv) 58.4% of participants would like to receive hospice and palliative care if they are diagnosed with a terminal illness; v) the priorities for dignified dying were preparing a support system to reduce the burden of care (28.6%), economic support including reduction of medical expenses (26.7%), expansion of hospice and palliative care services (25.4%), and legalization of PAS (13.6%); and vi) 58.3% of participants agreed that the expansion of hospice and palliative care should precede the legalization of PAS. Koreans currently want other efforts, including expansion of hospice and palliative care services, instead of the legalization of PAS.

자기결정권 존중을 위해 선행해야 하는 것들: 의사조력자살과 연명의료 유보나 중단과 관련하여*

In this article I review Koh YS’s recent article concerning the legalization of physician-assisted suicide and provide additional support for the arguments he advances. Koh argues against the legalization of physican-assisted suicide and for an extension of the period in which the withholding or withdrawal of life-sustaining treatment is carried out following a patient’s request. I claim that the very arguments Koh presents against the legalization of physician-assisted suicide may be arguments against the extension. In particular, the extension presupposes a new social consensus just as the current performance period for withholding or withdrawing life-sustaining treatment was based on the social consensus that existed at the time that legislation was passed. Additionally, I argue that certain safeguards must be established or implemented to respect the right to self-determination in our society. For example, the monitoring and service of end-of-life care must be enhanced in order to prevent any coercion or abuse in individual decisions on life-sustaining treatment.

Physician-Assisted Suicide in Dementia: Paradoxes, Pitfalls and the Need for Prudence.

There has been an increasing drive towards the legalization of physician-assisted suicide (PAS) in patients with dementia, particularly in patients with advanced disease and severe cognitive impairment. Advocacy for this position is often based on utilitarian philosophical principles, on appeals to the quality of life of the patient and their caregiver(s), or on economic constraints faced by caregivers as well as healthcare systems. In this paper, two lines of evidence against this position are presented. First, data on attitudes towards euthanasia for twenty-eight countries, obtained from the World Values Survey, is analyzed. An examination of this data shows that, paradoxically, positive attitudes towards this procedure are found in more economically advanced countries, and are strongly associated with specific cultural factors. Second, the literature on existing attitudes towards PAS in cases of dementia, along with ethical arguments for and against the practice, is reviewed and specific hazards for patients, caregivers and healthcare professionals are identified. On the basis of these findings, the author suggests that the practice of PAS in dementia is not one that can be widely or safely endorsed, on both cultural and ethical grounds. Instead, the medical field should work in collaboration with governmental, social welfare and patient advocacy services to ensure optimal physical, emotional and financial support to this group of patients and their caregivers.

Physician-assisted suicide and euthanasia – who are the vulnerable?

The most widely voiced concern about physician-assisted suicide (PAS) and euthanasia is the risk that they pose to the wider community and the vulnerable, if legalised. No matter how well intentioned are the creators of the initial safeguards of PAS or euthanasia, there seems to be no sustainable way to maintain restrictions on them. It is pertinent, then, to examine the ways in which the legalisation of PAS or euthanasia, in their ever-broadening scope, might increase vulnerability to suicide and decrease the safety of members of a community.

Examining Medical Student Attitudes Towards Physician-Assisted Suicide

Physician-assisted suicide (PAS) is a highly debated issue. The Sue Rodriguez case highlighted the importance and the contentious nature of this issue in our society today. This study assessed attitudes towards PAS held by first and fourth year medical students at the University of Western Ontario via a 13 question anonymous survey. One hundred and twenty-four surveys were returned with a response rate of 53%. Respondents, especially those in fourth year, were unwilling to aid in PAS in the capacity of physicians (63% overall unwilling; P = 0.004). They wanted PAS to be an option, however, if they were patients themselves (64% overall; P = 0.002). A variety of factors were considered important in making decisions regarding PAS, especially a patient's clear understanding of medical management options. Most respondents welcomed (39%) or were neutral (45%) towards legalization of PAS. Opinions towards PAS tended not to change over the course of medical school (72% overall; P < 0.001). Students generally favoured the concept of PAS as long as they did not have to take part in it themselves. Although no differences between first and fourth year medical students were detected concerning their opinions towards PAS, willingness to participate may be affected by personal experience with patients.

의사조력자살의 합법화 : 세계적 동향

의사조력자살의 합법화 : 세계적 동향

Ethics and the Legalization of Physician-Assisted Suicide

Ethics and the Legalization of Physician-Assisted Suicide

Annals for Educators - 17 October 2017

Annals for Educators - 17 October 2017

The Legitimacy of Prohibiting Euthanasia

John Arras argues against the legalization of physician-assisted suicide and active euthanasia on the basis of social costs that he anticipates will result from legalization. Arras believes that the legalization of highly restricted physician-assisted suicide will result in the legalization of active euthanasia without special restrictions, a prediction I grant for the sake of argument. Arras further anticipates that the practices of physician-assisted suicide and euthanasia will be abused, so that many patients who engage in these practices will lose out as a result. He refers to these losses as social costs to legalization. But the social costs at play in typical public policy debates are borne by individuals other than the agent who engages in the controversial activity, specifically by people who cannot be held responsible for enduring those costs. Even if plausible interpretations of Arras’ predictions about the abuse of the practice are granted, legalization of physician-assisted suicide or euthanasia brings no social costs of this latter sort. For this reason, and also because a ban on euthanasia is unfair to those who would profit from it, the losses in utility brought about by legalization would have to be very great to justify a ban.

Managing Profound Suffering at the End-of-Life: Should expanding access to continuous deep sedation be the priority?

This paper argues that in addressing and managing profound suffering at the end-of-life, the priority should not be the legalization of physician-assisted suicide or voluntary active euthanasia in jurisdictions where these practices are not currently available. Rather, concerted efforts should be made by society and the healthcare provider community to expand patient access to proportionate distress-relieving sedation and continuous deep sedation.

How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide?

Several US states have legalized or decriminalized physician-assisted suicide (PAS) while others are considering permitting PAS. Although it has been suggested that legalization could lead to a reduction in total suicides and to a delay in those suicides that do occur, to date no research has tested whether these effects can be identified in practice. The aim of this study was to fill this gap by examining the association between the legalization of PAS and state-level suicide rates in the United States between 1990 and 2013. We used regression analysis to test the change in rates of nonassisted suicides and total suicides (including assisted suicides) before and after the legalization of PAS. Controlling for various socioeconomic factors, unobservable state and year effects, and state-specific linear trends, we found that legalizing PAS was associated with a 6.3% (95% confidence interval 2.70%-9.9%) increase in total suicides (including assisted suicides). This effect was larger in the individuals older than 65 years (14.5%, CI 6.4%-22.7%). Introduction of PAS was neither associated with a reduction in nonassisted suicide rates nor with an increase in the mean age of nonassisted suicide. Legalizing PAS has been associated with an increased rate of total suicides relative to other states and no decrease in nonassisted suicides. This suggests either that PAS does not inhibit (nor acts as an alternative to) nonassisted suicide, or that it acts in this way in some individuals but is associated with an increased inclination to suicide in other individuals.

Physician-Assisted Suicide: Legality and Ethicality

Background: Physician-assisted suicide is the process by which a physician helps a patient or a human − based on his own desire; to get his death by using a specific materials, drugs (lethal dose) or equipments, the argument about the legality and morality of assisting the patient to die is a hot topic now days. Aim: To put a spot light about ethicality and legality of physician-assisted suicide. Results: Around the world there are eleven states and nations supported the idea of physician-assisted suicide and legalize it, two religious references said that assisted suicide was thought to be a feature of the right to choose. In contrast, the great majority of world laws considered physician-assisted suicide as a crime, approximately all religious refuse the idea of assisted suicide and see it contrast with the sanctity of god. Discussion: Those whom agree with physician-assisted suicide, are defense based on the right of autonomy and the right to choice, and they insure that the human has the right to die when he wants that. On the other hand, those who are contrast physician-assisted suicide argue that it’s a killing, its may be a slippery slope, the effect of health care access on the patient decision, and this practice contrast with the sanctity of god. Conclusions: The killing is a killing regardless of concept descriptions, nor the physician or the patient have the right to assisted suicide, however, the suffering may be cared or cured, and the patient freedom or autonomy is limited by ethics and law.

If Suicide is Painless, is Painlessness Suicide?

One of the mainstays of arguments against the legalization of physician-assisted suicide (PAS) is that there are alternatives available that obviate the need for it, and that granted that the role ...

Legal physician-assisted suicide in Oregon and The Netherlands: evidence concerning the impact on patients in vulnerable groups—another perspective on Oregon's data

Battin et al examined data on deaths from physician-assisted suicide (PAS) in Oregon and on PAS and voluntary euthanasia (VE) in The Netherlands. This paper reviews the methodology used in...

The irony of supporting physician-assisted suicide: a personal account

Under other circumstances, I would have written an academic paper rehearsing the arguments for and against legalization of physician-assisted suicide: autonomy and the avoidance of pain and suffering on the pro side, the wrongness of killing, the integrity of the medical profession, and the risk of abuse, the "slippery slope," on the con side. I've always supported the pro side. What this paper is, however, is a highly personal account of the challenges to my thinking about right-to-die issues. In November 2008, my husband suffered a C2/C3 spinal cord injury in a bicycle collision, leaving him ventilator-dependent, almost completely paralyzed, and in the hospital--but fully alert and profoundly self-reflective. What if he wanted to die? This paper draws from two multimedia presentations--file:///Users/margaretbattin/Documents/BROOKE'S%20ACCIDENT/The%20Salt%20Lake%20Tribune%20%7C%20Multimedia:%20Metamorphosis.webarchive and file:///Users/margaretbattin/Documents/BROOKE'S%20ACCIDENT/The%20Salt%20Lake%20Tribune%20%7C%20Multimedia:%20Learning%20to%20live%20again.webarchive--and personal material concerning quality of life (he'd rank at the bottom on the SF-36 and similar scales) and concerning autonomy (his own accounts, verbatim). This is a detailed portrait of a man whose life involves extraordinary suffering but also luminous experience some of the time. It only makes the question harder: What if he wanted to die?

Management of a Request for Physician-Assisted Suicide

With the legalization of physician-assisted suicide (PAS) in several states, it remains controversial whether present guidelines take into account the complexity of identifying treatable sources of suffering, including underlying depression and other psychiatric disorders, in this high risk population. We present a case in which a patient with end-stage prostate cancer requested PAS; this request was in a state where PAS is not a legal option. He was evaluated psychiatrically and was not found to be depressed, but ample opportunities were found to improve his quality of life. With appropriate treatment, he lost interest in PAS as an option. We discuss the need for a comprehensive evaluation to properly assess and manage the untreated physical and emotional suffering that may influence a patient's decision to hasten death.

Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups

Background:Debates over legalisation of physician-assisted suicide (PAS) or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data...

Desire for Hastened Death Among Patients With Advanced AIDS

The recent debate over legalization of physician-assisted suicide has fueled interest in understanding factors that lead medically ill patients to seek a hastened death. The authors investigated the prevalence and predictors of desire for hastened death in 372 patients with advanced AIDS who were newly admitted to a palliative-care facility. Clinician-rated and self-report measures of desire for hastened death, depression, hopelessness, spiritual well-being, social support, pain, and physical symptom burden were administered to assess the factors that correspond to a high desire for death. The prevalence ranged from 4.6% to 8.3%, significantly lower than in previous studies of patients with advanced or terminal cancer. Multivariate models revealed significant and unique effects for both hopelessness and depression, with these variables accounting for a large proportion of the variance in each model. Authors discuss the implications of these findings for palliative care practice and the assisted-suicide debate.

Not DEA'd Yet: Gonzales v. Oregon

On January 17, Oregon Death with Dignity Act beat back yet another attempt on its life. In Gonzales v. Oregon, U.S. Supreme Court (by a six-to-three vote) affirmed decisions of two lower federal courts and made permanent a 2001 injunction against federal prosecution of physicians who prescribe narcotics under terms of act. Media coverage of decision both exaggerated and underplayed decision's significance. On one hand, Court did not go so far as to decide that Oregon's regime of physician-assisted suicide could not be preempted by federal law. As Justice Scalia coyly notes in his dissent (in which he is joined by Justice Thomas and Chief Justice Roberts), issue of federal power was simply not before Court. Justice Kennedy's majority opinion merely held that existing federal law (the Controlled Substances Act) did not authorize former Attorney General Ashcroft's issuance of a rule that physicians prescribing schedule II drugs patients under Oregon act were subject to sanction by Drug Enforcement Administration. This leaves open possibility that Congress could amend law to essentially overturn decision. On other hand, decision has implications practice of medicine that extend far beyond Oregon and legalization of physician-assisted suicide. Ashcroft's ruling had been based on a claimed power of attorney general to prohibit prescription of any schedule II drug that he determined not to be for a medical purpose. This purported power to determine what medical purposes are and are not legitimate is one that DEA prosecutions against physicians resort to increasingly frequently. Rather than seeking criminal convictions only in cases that meet CSA's requirement that drugs have been intentionally diverted outside the course of professional practice, prosecutors have sought and in some cases achieved convictions where they have been able to prove that prescribing painkillers a particular patient did not meet civil standard of good medicine--situations constituting medical malpractice. This is just one of many DEA practices that have had a chilling effect on delivery of adequate palliative care in U.S. majority opinion in Gonzales seems to cut ground out from under this strategy. Justice Kennedy, after noting extraordinary nature of authority that Ashcroft claimed CSA delegated to him, goes on to say: The importance of issue of physician-assisted suicide, which has been subject of an 'earnest and profound debate' across country, makes oblique form of claimed delegation all more suspect. …

Ending life: ethics and the way we die

Margaret Pabst Battin has established a reputation as one of the top philosophers working in bioethics today. This work is a sequel to Battin's 1994 volume The Least Worst Death. The last ten years have seen fast-moving developments in end-of-life issues, from the legalization of physician-assisted suicide in Oregon and the Netherlands to furor over proposed restrictions of scheduled drugs used for causing death, and the development of NuTech methods of assistance in dying. Battin's new collection covers a remarkably wide range of end-of-life topics, including suicide prevention, AIDS, suicide bombing, serpent-handling and other religious practices that pose a risk of death, genetic prognostication, suicide in old age, global justice and the duty to die, and suicide, physician-assisted suicide, and euthanasia, in both American and international contexts. As with the earlier volume, these new essays are theoretically adroit but draw richly from historical sources, fictional techniques, and ample factual material.