Requests For Physician-assisted Suicide Research Articles

Colombian people's positions regarding physician-assisted suicide

The views on the acceptability of physician-assisted suicide of lay people in a Latin American country, Colombia, have been examined. In July 2019–January 2020, 134 lay people in Bogota judged the acceptability of physician-assisted suicide in 48 realistic scenarios composed of all combinations of four factors: (a) the patient's age, (b) the level of incurability of the illness, (c) the type of suffering, and (d) the patient's request for physician-assisted suicide. In all scenarios, the patients were women receiving the best possible care. The ratings were subjected to cluster analysis and analyses of variance. Three qualitatively different positions were found: Never Acceptable (13% of the sample), Depends on the Patient's Request (77%), and Always Acceptable (10%). The only important factor in increasing acceptability among people not systematically opposed was the patient's request to have her life ended. The young age of some patients did not affect participants’ positions. These empirical findings suggest that most Colombian lay people are not categorically for or against physician-assisted suicide, but judge its degree of acceptability as a function of patients’ requests and other circumstances.

The right to die: Perspectives of mental health professionals in malta

IntroductionIn their professional work, mental health professionals are continually working with individuals in distress, who may express a wish to end their lives.ObjectivesTo understand the perspectives of mental health professionals towards a person’s right to die.MethodsA mixed-method technique was used: Stage 1 involved a validated online questionnaire sent to all professionals working within the public mental health services in Malta. Stage 2 consisted of a multidisciplinary discussion between six professionals asked to hypothetically manage a terminally ill patient requesting physician-assisted suicide. Thematic analysis was subsequently applied.ResultsThe majority of mental health professionals disagreed with allowing a person to commit suicide, even in situations of crippling debt, overwhelming despair and family dishonour. Terminal illness elicited a varied response (Figure 1)Older professionals and spiritual beliefs negatively impacted acceptability of suicide (Figure 2).The discussion revealed that professionals would assess individuals requesting to end their lives, with the aim of treating any mental illness and determining mental capacity. Figure 3 highlights factors explored during the assessment. Greatest emphasis is ultimately placed on individual autonomy.ConclusionsMental health professionals consider autonomy and self-determination as imperative in evaluating a person’s right to die. Professionals agreed that, after a comprehensive psychiatric assessment and within a regulatory legal framework, they would not impede a person with terminal illness to request physician-assisted suicide, provided that one is acting autonomously. The majority would however conscientiously object to actively assisting the terminal patient in ending one’s life, since this is deemed contradictory to their professional vow of non-maleficence.

Physician-Assisted Suicide and Euthanasia in Dutch Patients with Multiple Geriatric Syndromes

Dutch physicians are allowed to carry out requests for physician-assisted suicide (PAS) or euthanasia in patients whose “suffering is unbearable, with

Romanian Lay People’s and Health Professionals’ Views about the Acceptability of Physician-Assisted Suicide

The conditions under which Physician-Assisted-Suicide (PAS) would be considered as acceptable among Romanians were examined. In July 2015-May 2016, 212 lay people and 52 health professionals judged the acceptability of PAS in 36 realistic vignettes composed of all combinations of four factors: the patient’s age, the level of incurability of the illness, the type of suffering, and the patient’s request for PAS. A majority of lay people (51%) and health professionals (85%) were opposed to PAS, quite irrespective of conditions. The most important factors determining acceptability were, for 36% of lay people, request for PAS and, for 18%, advanced age.

Physician-assisted suicide-a clean bill of health?

Physician-assisted suicide (PAS) laws have been enacted in five US States and, along with physician-administered euthanasia, in Canada and the Netherlands. Annual reports of the Oregon Health Authority and published research papers. Not all recipients of lethal drugs use them to end their lives. Improvements in palliative care provision. Rising numbers of deaths from PAS. Emergence of 'doctor shopping' and multiple-prescribing. Absence of qualitative scrutiny of assessment process. No re-assessment or oversight when prescribed drugs are ingested. Recent pressures to extend Oregon's PAS law. Reasons given for seeking PAS indicate this is a societal rather than a clinical issue and raise the question whether adjudicating on requests for legalized PAS is an appropriate role for doctors. Research into quality of decision-making in requests for PAS and into potential role of doctors as expert witnesses rather than judges in requests for PAS.

Approving or Denying Requests for Physician-Assisted Suicide in the Netherlands

In the Netherlands, terminally ill patients can apply for approval to pursue euthanasia or physician-assisted suicide, but data are sparse on the

Togolese lay people's and health professionals’ views about the acceptability of physician-assisted suicide

AimTo study the views on the acceptability of physician-assisted-suicide (PAS) of lay people and health professionals in an African country, Togo.MethodIn February–June 2012, 312 lay people and 198 health professionals...

Assisted dying in children: a framework for response?

Aims To formulate an ethical response to discussions around physician assisted suicide (PAS) in relation to children, in view of the Margot MacDonald proposals in Scotland. Methods Ethical debates around euthanasia and PAS have traditionally excluded children. In 2009 Margot Macdonald MSP laid down an Assisted Dying Bill in Scottish Parliament in which 16- and 17-year olds would be allowed to request PAS. ACT (now Together for Short Lives) established a working group to develop an algorithm for formulating responses to consultation requests, and an agreed response to the specific consultation. The Group then supported staff in the presenting evidence at the Parliamentary Hearing. Results The Group9s role is: ▶To clarify ethical terms, allowing lay members of the organisation to participate meaningfully in the debate. ▶To make core recommendations regarding the role of palliative care in ethical end-of-life management. ▶To solicit and collate members9 views where appropriate. ▶To recommend to the organisation9s Advisory Council a specific response to consultation. ▶To support individuals where necessary in giving oral evidence. In a submission in response to consultation, and subsequent evidence at Parliamentary Hearings, the Group made three responses: ▶Age is not the only determinant of the ability of a young person to make decisions. ▶The inclusion of terminal illness as a qualifying condition requires clinicians to be able to provide an accurate prognosis in an uncertain speciality. This is especially problematic in the case of young people with non-malignant conditions. ▶Proposed safeguards are unlikely to protect vulnerable young people who seek to end their life because they feel a burden to others, or who cannot see a reasonable alternative. The Group continues to work within Together for Short Lives and has hosted the organisation9s first national conference focusing on ethical issues in children9s palliative care Conclusion Membership organisations have an essential role in responding to ethical debates that impact on children, and should make recommendations based on fundamental principles of ethics and of children9s palliative care. The Group9s response to the Assisted Dying Bill is an example of good practice in facilitating such involvement.

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.

Ask the Expert: Exploring the Clinician's Concern About Physician-Assisted Suicide

Ask the Expert: Exploring the Clinician's Concern About Physician-Assisted Suicide

Views on Physician-Assisted Suicide Among Family Members of Oregon Cancer Patients

Ninety-eight Oregonians with advanced cancer and their family members participated in a cross-sectional survey to understand agreement in views on physician-assisted suicide (PAS), which was a legal option for these patients. Half of the family members would support the patient's request for PAS, 30% would oppose it, and 19% were undecided. Low religiousness and the family member's personal health concerns were associated with increasing support by the family member for PAS for the patient. Family members were able to predict patients' political views on legalized PAS, and there was moderately high agreement among family members on political views. Family members, however, were not knowledgeable about patients' interest in PAS for themselves, and there was low agreement among dyads on whether they had discussed this issue. Improved knowledge of patient-based barriers to discussing PAS may facilitate interventions for psychosocial distress in cancer patients.

Oregon Hospice Chaplains' Experiences with Patients Requesting Physician-Assisted Suicide

Oregon's Death with Dignity Act (ODDA), which legalized physician-assisted suicide (PAS) for terminally ill individuals, was enacted in 1997. Eighty-six percent of the 171 patients who have died by PAS were enrolled in hospice. To survey hospice chaplains regarding their views on the ODDA and experiences working with patients who request PAS. Single, anonymous, mailed survey. All chaplains affiliated with one of Oregon's 50 hospices. Fifty of 77 hospice chaplains whom we identified (65%) returned the survey. Forty-two percent of respondents opposed the ODDA and 40% supported it. Over half of respondents had, in the previous 3 years, worked with a patient who had made an explicit request for assisted suicide. Conversation with patients around PAS focused on the role of faith and spirituality in this decision, reasons for wanting hastened death, and family concerns or reactions to PAS. Chaplains did not feel that they had a strong influence on the patient's decisions about PAS (mean score of 4 on a 0-10 scale), though three chaplains reported a patient who withdrew their request for PAS because of the chaplain's involvement. Chaplains reported provision of a nonjudgmental presence helped the relationship with the patient. Oregon hospice chaplains are divided in their views on legalized PAS, but primarily see their role to deliver support to patients no matter what the patient's final decision regarding PAS.

ACCEPTABILITY FOR FRENCH PEOPLE OF PHISICIAN-ASSITED SUICIDE

Our aim was to understand better how people judge the acceptability of physician-assisted suicide (PAS). We found that, for people in France of all ages and for elderly people with life-threatening illnesses, acceptability is an additive combination of the number of requests for PAS, the patient's age, the amount of physical suffering, and the degree of curability of the illness, not only when judging for hypothetical patients, but also for their spouses and for themselves. PAS can be highly acceptable to people even when the patient does not satisfy all the criteria of legislation about PAS.

Physicians' Role in Physician-Assisted Suicide Discussions

Physicians of patients who request physician-assisted suicide should not avoid the subject and should try to discuss the patients' specific concerns and fears with them. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Interest in physician-assisted suicide (PAS) among Oregon cancer patients

8070 Background: Oregon remains the only U.S. state where PAS is legal. We sought to determine the level of interest in PAS among cancer patients in OR, how views changed over the course of their illness, psychosocial and medical correlates of interest in PAS, and the relationship between expressing an interest and actually requesting PAS from a physician. Methods: Patients with advanced cancer were recruited from oncology clinics at OHSU and PVAMC. Baseline medical and psychological factors were assessed using standardized instruments; patients were questioned about their attitudes towards and interest in PAS. Patients who expressed an interest in PAS at the initial survey were asked to participate in a longitudinal study. Results: 417 potential subjects were identified and 161 agreed to participate. 57% supported legalization of PAS, 38% might consider PAS for themselves, and 9% indicated a serious interest in obtaining a lethal prescription. Among 42 participants followed longitudinally for 3 to 27 months, 8 expressed interest in a lethal prescription at first evaluation but never subsequently, while 11 expressed interest at some point after the first evaluation. Interest in obtaining a lethal prescription was predicted by increasing hopelessness (p=0.03), decreasing satisfaction with medical care (p=0.002), and increasing suffering (p=0.01). Only 2 patients (1%) made an explicit request for a lethal prescription. 7% of subjects with an interest in PAS at first evaluation had discussed this with their physician, while 42% had on longitudinal follow-up. Conclusions: Interest in PAS among Oregon cancer patients is similar to that previously reported from areas where PAS is not legally sanctioned. Interest is highly variable over time, and few patients make a formal request for a lethal prescription. Less than half discussed this issue with their oncologist. Expressing an interest in PAS on a survey appears to be a marker of psychological and symptom distress, but may be neither sensitive nor specific for identifying patients who actually request PAS under legalized conditions. No significant financial relationships to disclose.

Preventing Unnecessary Deaths Among Older Adults

The United States Surgeon General has identified suicide as a national public health problem and recognized that mind and body are inseparable (U.S. Department of Health and Human Services, 1999). Poor mental health and medical conditions can lead to expressions of a desire to die, depression, suicide, and requests for physician-assisted suicide. This paper examines depression and the risks for suicide, suicide prevention, physician-assisted suicide (including the experience of Oregon's Death with Dignity Act, 1994) among older adults. The appropriate role for social workers in preventing unnecessary deaths is discussed.

Clinician-patient interactions about requests for physician-assisted suicide: a patient and family view.

Responding effectively to a patient request for physician-assisted suicide (PAS) is an important clinical skill that involves careful evaluation. Clinician responses to PAS requests, however, have only been described using data obtained from clinicians. To describe qualities of clinician-patient interactions about requests for PAS that were valued by patients and their family members. Intensive qualitative case study involving multiple longitudinal interviews conducted prospectively with patients pursuing PAS and with their family members and retrospectively with family members of deceased patients who seriously pursued PAS. The study setting was community based. Participants were recruited through patient advocacy organizations, hospices, and grief counselors. A total of 35 cases were studied: 12 were prospective and 23 were retrospective. Study procedures involved semistructured interviews that were audiotaped, transcribed, reviewed, and analyzed by a multidisciplinary research team. Three themes were identified that describe qualities of clinician-patient interactions that were valued by patients and family members: (1) openness to discussions about PAS; (2) clinician expertise in dealing with the dying process; and (3) maintenance of a therapeutic clinician-patient relationship, even when clinician and patient disagree about PAS. These patient and family accounts reveal missed opportunities for clinicians to engage in therapeutic relationships, including discussions about PAS, dying, and end-of-life care. Clinicians responding to patients requesting PAS need communication skills enabling them to discuss PAS and dying openly, as well as expertise in setting reasonable expectations, individualizing pain control, and providing accurate information about the lethal potential of medications.

Physicians' responses to patients' requests for physician-assisted suicide.

Studies show that patient requests for physician-assisted suicide (PAS) are a relatively common clinical occurrence. The purpose of this study was to describe how experienced physicians assess and respond to requests for assisted suicide. Focused ethnography in the offices of 11 acquired immunodeficiency syndrome physicians, 8 oncologists, and 1 hospice physician who had received requests for assisted suicide in their practice. Ten had facilitated PAS. Informants had a similar approach to evaluating patients who requested assisted suicide, often asking, "Why do you want to die now?" Reasons for requests fell into 3 broad categories: physical symptoms, psychological issues, and existential suffering. Physicians thought they competently addressed patients' physical symptoms, and this obviated most requests. They treated depression empirically and believed they did not assist depressed patients with assisted suicide. Physicians had difficulty addressing patients' existential suffering, which led to most facilitated requests. Informants rarely talked to colleagues about requests for assisted suicide, suggesting a "professional code of silence." Regardless of divergent attitudes about PAS, physicians respond similarly to requests for assisted suicide from their patients, creating a common ground for professional dialogue. Our sample addressed physical suffering aggressively, treated depression empirically, but struggled with requests arising from existential suffering. A professional code of silence regarding PAS creates professional isolation. Clinicians do not share knowledge or receive social support from peers about their decisions regarding assisted suicide. Educational strategies drawing on approaches used by experienced clinicians may create an atmosphere that enables physicians with divergent beliefs to discuss this difficult subject.

Responding to legal requests for physician-assisted suicide. University of Pennsylvania Center for Bioethics Assisted Suicide Consensus Panel.

In 1998, 15 terminally ill Oregon residents ended their lives with overdoses of medications supplied legally by their physicians. Many more people consider this possibility. This paper examines the ways in which the physician's response to requests for assisted suicide may change in an era of legalization, articulates some of the resulting conceptual challenges, and provides practical advice to physicians facing such requests. In areas where it is legal, assisted dying becomes one of the many options that can be freely considered for terminally ill patients with extreme suffering. Some patients even view assisted death as a right that can be expected on demand. We consider the ethical implications of disclosing assisted dying to patients as an option of last resort and suggest that physicians working in environments where assisted dying is legal are obliged to do so. However, we conclude that physicians should not encourage patients to hasten death even when practicing in jurisdictions that allow assisted dying. Furthermore, without abandoning the model, we suggest that strict informed consent does not fully address patients' needs at this time. Physicians must also focus on patients' broader biopsychosocial concerns and help them identify solutions through empathic listening and emotional support. We provide a framework and vocabulary for physicians to use when responding to requests for assisted suicide. Physicians should clarify the request, explore and address the patient's concerns, achieve a shared understanding of the goals of treatment, search for less harmful alternatives, express to the patient what they are willing to do, discuss the relevant legal issues, and share their decision making with colleagues.

How to deal with requests for assisted suicide: Some experiences and practical guidelines from the Netherlands.

In the Netherlands, physician-assisted suicide may be justifiable for patients with physical illness as well as for patients with unbearable mental suffering. Explicit requests for physician-assisted suicide are frequently made, but in psychiatric practice they are infrequently granted. In this contribution, some information on the Dutch practices related to assisted death is presented, with emphasis on assisted suicide in patients with unbearable mental suffering. The aim of this contribution is to demonstrate that the Dutch law and jurisprudence permit clinicians to deal effectively with requests for assisted suicide.