physician-assisted suicide; medical assistance in dying
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Introduction
- Physician-assisted suicide involves the physician providing the means for a patient to kill him or herself. Distinguish from euthanasia.
Epidemiology
- ~2/3 of Americans support physician-assisted suicide[8]
- more physicians support physician-assisted suicide than euthanasia; for the public, the reverse is true[8]
- among 53 older Dutch citizens who chose physician-assisted suicide/euthanasia, all had unbearable suffering due to nonterminal conditions[12]
- conditions included vision loss, hearing loss, chronic pain, arthritis, & cognitive impairment[12]
- requests for physician-assisted suicide/euthanasia are often preceded by a sequence of events, especially recurrent falls & fall consequences (fractures)[12]
- suffering occurred on multiple dimensions
- physical suffering was apparent in all cases
- impaired mobility, fears (further decline, falls, institutionalization), dependence, social isolation, & loss of meaning in daily life[12]
Management
- requests for physician-assisted suicide should always trigger a search for depression, uncontrolled pain & existential suffering
- American College of Physician recommends alternatives[11]
- talk with the patient about the reasons for the request & explore alternatives
- reassure the patient that you will not abandon him or her during end-of-life care
- facilitate advance care planning
- make sure the patient understands his or her right to refuse treatments
Notes
- legal in Washington, Oregon, California, Montana & Vermont[8]
- legal in Netherlands, Canada, Belgium, Luxembourg
- legal in Switzerland since 1942[8]
- most authoritative bodies in medicine have stated that physician-assisted suicide should not be practiced by physicians
- most polls have shown that much of the public & many physicians feel that physician-assisted suicide is moral, & the practice occurs although probably to a small degree
- euthanasia or assisted-suicide cases of patients with psychiatric disorders in the Netherlands from 2011 to 2014[7]
More general terms
Additional terms
References
- ↑ Rosenfeld K. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ Rosenfeld K. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 25-28, 2002
- ↑ Snyder L, Sulmasy DP; Ethics and Human Rights Committee, American College of Physicians-American Society of Internal Medicine. Physician-assisted suicide. Ann Intern Med. 2001 Aug 7;135(3):209-16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11487490
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 16 American College of Physicians, Philadelphia 2012
- ↑ Quill T, Arnold RM. Evaluating requests for hastened death #156. J Palliat Med. 2008 Oct;11(8):1151-2 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18980457
- ↑ Snijdewind MC et al. A study of the first year of the End-of-Life Clinic for physician-assisted dying in the Netherlands. JAMA Intern Med 2015 Aug 10 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26258534
- ↑ Jump up to: 7.0 7.1 Kim SY, De Vries RG, Peteet JR Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014. JAMA Psychiatry. Published online February 10, 2016. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26864709 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=2491354
Appelbaum PS Physician-Assisted Death for Patients With Mental Disorders - Reasons for Concern. JAMA Psychiatry. Published online February 10, 2016. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26864504 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=2491352 - ↑ Jump up to: 8.0 8.1 8.2 8.3 8.4 Zuger A Update on Euthanasia and Physician-Assisted Suicide. NEJM Journal Watch. July 14, 2016 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, Cohen J. Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe. JAMA. 2016 Jul 5;316(1):79-90. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27380345
Razmaria AA. JAMA PATIENT PAGE. End-of-Life Care. JAMA. 2016 Jul 5;316(1):115. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27380364 - ↑ Li M, Watt S, Escaf M et al Medical Assistance in Dying - Implementing a Hospital-Based Program in Canada. N Engl J Med 2017; 376:2082-2088. May 25, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28538128 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMms1700606
- ↑ van der Heide A, van Delden JJM, Onwuteaka-Philipsen BD. End-of-Life Decisions in the Netherlands over 25 Years. N Engl J Med 2017; 377:492-494. August 3, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28767342 Free Article <Internet> http://www.nejm.org/doi/full/10.1056/NEJMc1705630
- ↑ Jump up to: 11.0 11.1 Sulmasy LS, Mueller PS Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Ann Intern Med. Sept 19, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28975242 <Internet> http://annals.org/aim/article/2654458/ethics-legalization-physician-assisted-suicide-american-college-physicians-position-paper
Quill TE, Arnold RM, Youngner SJ. Physician-Assisted Suicide: Finding a Path Forward in a Changing Legal Environment. Ann Intern Med. Sept 19, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28975245 <Internet> http://annals.org/aim/article/2654459/physician-assisted-suicide-finding-path-forward-changing-legal-environment
Kussmaul WG 3rd. The Slippery Slope of Legalization of Physician-Assisted Suicide. Ann Intern Med. Sept 19, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28975201 <Internet> http://annals.org/aim/article/2654050/slippery-slope-legalization-physician-assisted-suicide
Hedberg K, New C Oregon's Death With Dignity Act: 20 Years of Experience to Inform the Debate. Ann Intern Med. Sept 19, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28975232 <Internet> http://annals.org/aim/article/2654460/oregon-s-death-dignity-act-20-years-experience-inform-debate - ↑ Jump up to: 12.0 12.1 12.2 12.3 12.4 van den Berg V et al. Euthanasia and physician-assisted suicide in patients with multiple geriatric syndromes. JAMA Intern Med 2021 Feb 1; 181:245 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33284324 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2773789
Meier DE. The treatment of patients with unbearable suffering - The slippery slope is real. JAMA Intern Med 2021 Feb 1; 181:160. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33284341 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2773781