Physician Aid In Dying Research Articles

Parity, Poverty, and Physician Aid in Dying: Policy Recommendations for PAD in Light of Social Injustices.

In light of the proposed expansion of eligibility for physician aid in dying (PAD) in Canada to people with psychiatric disorders, there is a new subset of individuals seeking PAD-those with poverty-induced depression. The dominant account defending the expansion is known as the "parity argument." Defenders of the parity argument maintain that the expansion of PAD to those with psychiatric conditions is needed to reflect that the seriousness of a patient's suffering does not depend on the cause of that suffering. Parity accounts, as they stand, would allow cases of poverty-induced depression to qualify. I raise a moral dilemma that the parity theorist must face considering this new subset of cases-expanding access to PAD, without adequate social protections, could produce more social inequality by aiming to reduce it. I propose six recommendations that policy-makers should consider before expanding PAD given these cases, social injustice, and the social determinants of mental health.

Exploring Canadian genetic counselors' perspectives and experiences with discussing medical assistance in dying (MAiD).

Medical assistance in dying (MAiD) is the Canadian equivalent of Physician aid-in-dying (PAD) in the United States. Through changes to the eligibility criteria for MAiD in 2021, Canada now has one of the most permissive assisted dying regimens in the world. This study describes Canadian genetic counselors' experiences, knowledge, and preparedness to discuss MAiD with their patients. Survey responses were collected from Canadian genetic counselors (n = 44) and were followed by semi-structured interviews with 14 survey participants. Survey data were analyzed using descriptive statistics, and interview transcripts were analyzed using phronetic iterative analysis and an interpretive description approach. Survey data revealed that genetic counselors have discussed MAiD with patients referred for cancer, neurologic, metabolic, connective tissue, and cardiac indications (n = 18, 40.9%). While most thought that it was important for genetic counselors to be knowledgeable of (n = 41, 93.2%) and prepared to discuss MAiD (n = 43, 97.7%), many were not familiar with the eligibility criteria (n = 27, 61.4%) and the process for accessing MAiD in Canada (n = 29, 65.9%). Interview participants described discussions about MAiD that were initiated by themselves or their patients. Most participants felt prepared to explore a patient's thoughts about MAiD when the patient initiated the discussion but did not feel well-prepared to share detailed information about MAiD. Participants were interested in education and professional guidance to assist them in preparing to discuss MAiD. Learning objectives were developed based on participants' suggestions to assist genetic counselors in their clinical work and self-directed research and to aid in the development of professional guidelines and educational materials for practicing genetic counselors and genetic counseling trainees. As genetic counselors continue engaging in discussions about MAiD, it is critical that these sensitive conversations are approached with increased knowledge and awareness of MAiD legislation, the ethical issues surrounding MAiD in Canada, and relevant patient resources.

Depression and Physician-Aid-in-Dying.

In this paper, I address the question of whether it is ever permissible to grant a request for physician-aid-in-dying (PAD) from an individual suffering from treatment-resistant depression. I assume for the sake of argument that PAD is sometimes permissible. There are three requirements for PAD: suffering, prognosis, and competence. First, an individual must be suffering from an illness or injury which is sufficient to cause serious, ongoing hardship. Second, one must have exhausted effective treatment options, and one's prospects for recovery must be poor. Third, the individual must be judged competent to request PAD. I argue that many cases of treatment-resistant depression meet the first two requirements. Thus, the key question concerns the third. I consider four features of depression that might compromise a person's decision-making capacity. Ultimately, I conclude that PAD requests from depressed patients can be permissibly granted in some circumstances.

Physician Aid in Dying for Dementia: The Problem With the Early vs. Late Disease Stage Distinction.

Background: Physician aid in dying (PAD) based on dementia is a contentious, highly debated topic. Several countries are considering extending their existing laws to include requests in incompetent patients based on a previously written advance directive. Discussions about this issue often invoke a distinction based on disease stage. The Dutch practice uses this distinction in classifications of dementia PAD cases and in guidance for clinicians. This paper explores the problem with this distinction for assessments of persons at the margins of competence.The Problem: Dutch guidance for clinicians uses an early vs. late-stage disease distinction to refer to requests from competent and incompetent persons. However, the use of disease stages is problematic, both conceptually and empirically. Conceptually, because it goes against very functional model of competence that guidance recognizes. Empirically, because it creates problems for classifying and evaluating patients at the margins of competence.Possible Ways Forward: Classification of cases and guidance should be based on competence, not disease stage. This requires rethinking decision-making for patients with dementia. Several possibilities are described, ranging from redefining the scope and role of advance directives in this context to exploring different types of decision-making frameworks.

Attitudes on Physician Aid-in-Dying Among Muslim Chaplains: A Qualitative Study (SCI925)

1.List 3 common themes among Muslims chaplains’ attitudes regarding Physician Aid-in-Dying.2.Describe 2 reasons for PAD being considered contrary to Islamic law and belief by Muslim chaplains.3.Recognize how Muslim chaplains define their own clinical practice and duties as it relates to spiritual care in PAD. When facing serious illness, Muslim patients and their families often call upon Muslim chaplains for aid in spiritual coping and medical decision-making in a religious context. As eight states and DC have legalized physician aid-in-dying (PAD), Muslims reflect on how to navigate PAD. However, research describing unique characteristics of spiritual care for Muslim patients is limited. Explore and educate readers about Muslim chaplains' attitudes and approaches to PAD in the context of their religious beliefs. Muslim healthcare chaplains were recruited to participate in semi-structured interviews exploring participants’ views on PAD. Two independent researchers conducted thematic analysis through an iterative process of coding to identify overarching themes, which were further examined to gain an understanding of attitudes towards PAD. Ten North American Muslim chaplains with diverse ethnic backgrounds participated. Five themes were identified:1.Cultural Differences in End-of-Life Experience: Participants qualify suffering with cultural and religious value placed on endurance and patience.2.Contrary to Islamic Law and Belief: The intention of medication causing death, as opposed to the disease, can be interpreted as defiance to God’s decree.3.Dual Identities and Roles: Chaplains recognize the conflict to adhere to religious values while caring for patients where PAD is legal. Some prefer conscientious objection to partaking in PAD and referral to colleagues.4.Duties of Chaplains: Participants emphasized the chaplain’s role to elicit patients’ values with an Islamic view of their decision, while offering support and relief of suffering.5.Autonomy and Accountability Before God: Patients and clinicians have autonomy in their decision-making with informed consent on a spiritual and metaphysical level. Muslim chaplains draw on Islamic principles to form views on PAD. Participants support individual autonomy for patient and clinician while identifying their duty as chaplains to relieve suffering.

The Nazi Analogy Muddles Our Thinking About Physician Aid-in-Dying in the US.

What has become known in bioethics as "the Nazi analogy" likens a change's potential to precipitate moral deterioration to Nazi atrocities of the mid-20th century. This analogy has been applied in physician aid-in-dying (PAD) deliberations by those fearful that a physician's role in enabling a patient's death is too similar to Nazi physicians' roles in systematic murders during the Holocaust. This article suggests the importance of carefully distinguishing between when the Nazi analogy is aptly applied and when its use is limited to urging great caution about abuse or inequity.

The Role of Rehabilitation in Patients Receiving Hospice and Palliative Care

Patients receiving palliative and hospice care experience high levels of functional loss, dependency on activities of daily living, and impairment in mobility. Physical disability affects important aspects of life, oftentimes leading to depression, poor quality of life, increased caregiver needs, increased health resource utilization, and institutionalization. Physical strength, the number of hours spent in bed, and the ability to do what one wants are important indicators of quality of life for patients with cancer and their families. Progressive debility with a sense of being a burden has been cited in the literature as a reason for desiring death among these patients. This perception of increased dependence on others serves as a strong predictor for a patient's interest in the physician aid in dying (PAD). This highlights the desire and willingness of most palliative and hospice care patients to remain physically independent during the course of their disease. Several studies have shown that maintaining the most optimal level of functional ability, especially mobility, for as long as possible is one of the main benefits of rehabilitation in the palliative and hospice care settings. Studies demonstrate that rehabilitation in patients receiving hospice and palliative care can reduce the burden of care for families and caregivers and improve patient's quality of life, sense of well-being, as well as control of pain and non-pain symptoms.

The people have spoken: Post-materialism and ballot measure voting on physician aid in dying (PAD)

For decades, public opinion polls have shown that most Americans favor physician aid in dying (PAD) but little is known about those who support PAD ballot measures. With its emphasis on self-fulfillment, personal choice, and civic and political engagement, post-materialists would argue that adopting states tend to have younger, educated, and more secular populations. County-level votes on all nine ballot measures to legalize death with dignity were subjected to multiple regression analysis. The results largely confirm the hypotheses derived from post-materialist theory, namely that education, religion, and more problematically age significant indicators of PAD ballot measure voting.

Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Crisis?

Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify ending their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons’ mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge.

Physician-Assisted Suicide (PAS)/Physician Aid in Dying (PAD) at the End of the Day

Physician-Assisted Suicide (PAS)/Physician Aid in Dying (PAD) at the End of the Day

How Should Organized Medicine Respond to Physician-Assisted Death?

Both proponents and opponents agree that wider access to high-quality palliative care and physician-patient communication about end-of-life options is the right response to the growing patient dema...

Assessing genetic counselors' experiences with physician aid-in-dying and practice implications.

Physician aid-in-dying (PAD) is now legalized in more than half a dozen states across the United States yet remains controversial among health care providers and the general public. Previous studies have described physicians' and nurses' experiences with and attitudes about PAD; however, there is no data about PAD in the context of genetic counseling. This study explores genetic counselors' experiences, understanding, training, and perspectives about PAD. Fifteen participants were recruited to complete semistructured telephone interviews. Five participants had received patient inquiries about PAD. Most participants (n=10) did not feel prepared to discuss PAD with patients and felt that they did not have adequate knowledge to answer patient questions about the practice. Participants described how the unique training, skills, and experiences of genetic counselors could be beneficial for discussing PAD with patients, in comparison to other providers. All participants supported training for genetic counselors about PAD, with many suggesting integration with education about palliative care and end-of-life planning. This is the first study to investigate PAD in the context of genetic counseling. Genetic counselors have had patients ask questions about PAD, want education and access to resources about PAD, and believe they can provide important support and guidance to patients considering PAD in some genetic counseling contexts.

PC-FACS

PC-FACS

California Could Be Landmark for PAD In a Diverse Population

California Could Be Landmark for PAD In a Diverse Population

Development of the AAS Statement on “Suicide” and “Physician Aid in Dying”

In August 2017, the American Association of Suicidology board passed a statement titled "Suicide" is not the same as "Physician aid in dying," which was developed partly in response to the fact that aid in dying is now legal in a number of jurisdictions. In Phase 1, eight members of the AAS who had indicated interest in this issue were asked to independently draft such a statement; the convener consolidated these drafts and comments into an initial statement. In Phase 2, five additional experts who might be expected to object were asked for their independent input; the convener consolidated these with the previous draft. No one objected to the statement altogether; extensive copyediting and rewording suggestions focused primarily on issues of overlap between "suicide" and "physician aid in dying." The resulting document represents an effort to try to accommodate the basic concerns of all participants. The document does not speak for or against legalization of this practice, but it may have bearing on whether suicide prevention professionals have an obligation to try to prevent such deaths and whether they may serve as consultants for psychological or psychiatric evaluations as sometimes required under US state law.

Poster Number: EI 45 - Physician Aid in Dying: Overview of Current Legal Status in the United States and Issues Pertinent to Geriatric Psychiatry

Poster Number: EI 45 - Physician Aid in Dying: Overview of Current Legal Status in the United States and Issues Pertinent to Geriatric Psychiatry

California's End of Life Option Act: What Can We Learn from One Year of Legalization? (TH312)

•Describe California's experience legalizing physician aid-in-dying, highlighting best practices and areas for improvement.•Reflect on the role of hospice and palliative care in responding to the law, both by responding to PAD requests and influencing institutional and state policies.•Explore areas for further research to improve care for patients at the end of life. California will soon mark one year of legalized physician aid-in-dying (PAD). Although not the first state to enact PAD, it is the largest and most diverse. We will report the results of a project tracking the implementation of the law through: 1) “convening” key stakeholders from around the state, and 2) empirical research. Our experience provides lessons for other localities, including recent adopters such as Colorado, and those considering legalization. We will document California's experience through three aims: 1) convening 120 multidisciplinary California stakeholders to share their experience with policy development, to discuss key issues raised during implementation, and to create a set of common data elements to be collected by health systems across the state; 2) developing and administering a survey to California institutions to understand the range of policy responses and provider attitudes; 3) executing an ethnographic study of 20 cases of PAD requests in order to capture a narrative account of the experience from the patient, family member, and provider perspectives. The session will present the “lessons learned” during the statewide stakeholder meeting and a summary of results from our empirical work. We will highlight the role of hospice and palliative care clinicians both in responding to PAD requests and in developing policies for their institutions. The panelists will raise the following questions: How should the act fit into the existing range of “options” at the end of life? How do we balance the provider right to opt-out of participating with patient interest for access to a participating provider, and what is the role of palliative care? What is the standard for providing end-of-life care that may obviate patient requests for PAD? Ethical practice demands that we track implementation, only then can we provide the best care for patients approaching the end of life.

Barriers to Physician Aid in Dying for People with Disabilities

Terminally ill people with disabilities face multiple barriers when seeking physician aid in dying (PAD) in the United States. The first is legality. Efforts to legalize the practice have been thwarted in dozens of states in part due to vocal opposition by advocates for people with disabilities who contend that legalized aid in dying discriminates against and harms people with disabilities by leading to their premature and unnecessary deaths. Some disability rights advocates disagree with their colleagues, however, and support legalization on the ground that it promotes autonomy and independence at the end of life. For proponents, legalization in six states is proving to be an illusive victory. Emerging reports from the states where PAD is legal suggest that people with disabilities may face special and impenetrable barriers when seeking legal aid in dying. This article identifies four such barriers: procedural protections embedded in PAD statutes; physician objection; cost; and a rule pertaining to California veterans. The article calls for additional study to determine the extent to which these barriers have a disparate impact on care options available to terminally-ill people with disabilities.

Responding to Patient Requests for Hastened Death: Physician Aid in Dying and the Clinical Oncologist.

Physician aid in dying (PAD) or assisted suicide is becoming legal in more US jurisdictions. Meanwhile, the needs of terminally ill patients with cancer are receiving greater attention, including the integration of palliative care into oncology practice. This article highlights a case vignette of a patient with advanced cancer who requests PAD from her oncologist, as a backdrop to help the practicing oncologist examine his or her moral stance regarding participation in aid in dying. The article concludes by offering a framework within which the practicing oncologist can receive and process a patient's request for PAD.

The End of Life Option Act: Important Considerations for Pharmacists as California Implements Physician Aid in Dying

The End of Life Option Act: Important Considerations for Pharmacists as California Implements Physician Aid in Dying