Requests for euthanasia and physician-assisted suicide and the availability and application of palliative options

2006 ◽  
Vol 4 (4) ◽  
pp. 399-406 ◽  
Author(s):  
MARIJKE C. JANSEN-VAN DER WEIDE, ◽  
BREGJE D. ONWUTEAKA-PHILIPSEN ◽  
GERRIT VAN DER WAL
Keyword(s):  
Decision Making ◽  
Observational Study ◽  
General Practitioners ◽  
Assisted Suicide ◽  
Medical Futility ◽  
Physician Assisted Suicide

Objective: This study investigated the palliative options available when a patient requested euthanasia or physician-assisted suicide (EAS), the extent to which the options were applied, and changes in the patient's wishes.Methods: In an observational study, 3614 general practitioners (GPs) filled in a questionnaire and described their most recent request for EAS (if any) (n = 1,681).Results: Palliative options were still available in 25% of cases. In these cases options were applied in 63%; in 46% of these cases patients withdrew their request. Medication other than antibiotics, which was most frequently mentioned as a palliative option (67%), and applied most frequently (79%), together with radiotherapy, most frequently resulted in patients withdrawing their request.Significance of results: GPs include the availability of palliative options in their decision making when considering EAS. The fact that not all options are applied or, if applied, the patient persists in the request is related to autonomy of the patient, the burden on the patient, and medical futility of the option.

Factors that Influence End-Of-Life Decision Making Amongst Attending Physicians

2021 ◽  
pp. 104990912110638
Author(s):  
Suraj Pai ◽  
Tracy Andrews ◽  
Amber Turner ◽  
Aziz Merchant ◽  
Michael Shapiro
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Work Experience ◽  
Assisted Suicide ◽  
Online Survey ◽  
Care Physician ◽  
University Hospital ◽  
Physician Assisted Suicide ◽  
Eol Care ◽  
Attending Physicians

Background: Medical advances prolong life and treat illness but many patients have chronically debilitating conditions that prevent them from making end-of-life (EOL) decisions for themselves. These situations are difficult to navigate for both patient and physician. This study investigates physicians’ feelings and approach toward EOL care, physician-assisted suicide (PAS), and euthanasia. Methods: An anonymous, self-administered online survey was distributed through the New Jersey Medical School servers and American College of Surgeons forums. The survey presented clinical EOL vignettes and subjective questions regarding PAS and euthanasia. Results: We obtained 142 responses from attending physicians. Respondents were typically male (61%), married (85%), identified as Christian (54%), had more than 20 years of experience (55%), and worked at a university hospital (57%). Religious beliefs and years of work experience seemed to be significant contributors in EOL decision making, whereas gender and medical specialty were not significantly influential. Conclusion: Factors such as years of work experience and religious belief may influence medical professionals’ opinions about PAS and euthanasia and their subsequent actions regarding EOL care. In many cases, the boundaries are blurred and require further study before concrete conclusions can be made.

Ethical and Legal Issues in Intensive Care

1997 ◽  
Vol 12 (6) ◽  
pp. 298-309 ◽  
Author(s):  
John J. Paris ◽  
J. Cameron Muir ◽  
Frank E. Reardon
Keyword(s):  
Decision Making ◽  
Managed Care ◽  
Assisted Suicide ◽  
Ethical Issues ◽  
Care Delivery ◽  
Physician Behavior ◽  
Physician Assisted Suicide ◽  
Emerging Issues ◽  
Ethical And Legal Issues ◽  
Seriously Ill Patients

The findings of the SUPPORT study, the largest, most comprehensive and costly study ever undertaken on decision making for critically ill patients, revealed a wide ranging gap between patient preferences and physician behavior with regard to treatment decisions for seriously ill patients. The ethical issues raised by that disparity are intensified as we enter into a market-driven managed care delivery system. This essay explores recent ethical and legal developments on several emerging issues: the decision making process; DNR orders; brain death; withdrawal of treatment; physician assisted suicide; and the constraints of managed care.

Right to Die

2019 ◽  
pp. 71-74
Author(s):  
Elizabeth Ford
Keyword(s):  
Decision Making ◽  
Supreme Court ◽  
Assisted Suicide ◽  
Right To Die ◽  
Surrogate Decision Making ◽  
Physician Assisted Suicide ◽  
Life Sustaining Treatment ◽  
Surrogate Decision ◽  
The U.S ◽  
Right To Refuse

Chapter 7 describes three cases that involve an individual’s right, in certain circumstances, to choose death. Cruzan v. Missouri is more specifically about a right to refuse life-sustaining treatment and surrogate decision-making; Washington v. Glucksberg and Vacco v. Quill are physician-assisted suicide cases, both decided on the same day by the U.S. Supreme Court and both declaring the practice unconstitutional.

An Advance Request: The Accessibility of Medical Assistance in Dying (MAID) for Patients Who Loose Decision-Making Capacity

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Natasha Harris
Keyword(s):  
Decision Making ◽  
Assisted Suicide ◽  
Physician Assisted Suicide ◽  
Medical Assistance ◽  
Waiting Period ◽  
Medical Assistance In Dying ◽  
Decision Making Capacity

Since the legalization of Medical Assistance in Dying (MAID) in Canada in 2016, there have been discussions regarding the extension of this service to patients who lose decision-making capacity but have made a prior advance request for physician-assisted suicide. Both caregivers and physicians have shown some support for allowing patients to make advance requests for MAID. The proposed changes to the legislation would remove the mandatory 10 day waiting period and include a waiver of final consent for those who loose decision-making capacity following their MAID request.

Abstract 9923: The Ethics of Unilateral ICD and CRT-D Deactivation: Patient Perspectives

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Margaret G Daeschler ◽  
Ralph J Verdino ◽  
James N Kirkpatrick
Keyword(s):  
Assisted Suicide ◽  
Medical Center ◽  
Medical Futility ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Physician Assisted Suicide ◽  
Do Not Resuscitate ◽  
Device Management ◽  
Advanced Directives ◽  
Advance Care

Background: Decisions about deactivation of implantable cardioverter defibrillators (ICDs) are complicated. Unilateral Do-Not-Resuscitate (DNR) orders (against patient/family wishes) have been ethically justified in cases of medical futility. Unilateral deactivation of ICDs may be seen as a logical extension of a unilateral DNR order. Methods: 60 respondents who had an ICD or cardiac resynchronization therapy ICD (CRT-D) were interviewed at a quaternary medical center outpatient electrophysiology practice. Survey questions addressed the inclusion of ICD deactivation in advanced directives, whether ICD deactivation constitutes physician-assisted suicide, and whether unilateral ICD deactivation can be ethically justified. The average age was 59 (range 23-89), and 70% were male. Of the respondents, 35% had ICDs, and 65% had CRT-Ds. Respondents had had their devices for an average of 6.74 years (range 0.11-25). 82% of respondents were Caucasian, 15% were African American and 3% were Hispanic. Results: Only 15% of patients had thought about device deactivation if they were to develop a serious illness from which they were not expected to recover, and single respondents were more likely to have considered this point (38%, p=0.03). A small majority (53%) had advance directives, and only one mentioned what to do with the device. Only 3% had discussed device management with clinicians. Most (55%) believed turning off a patient’s pacemaker was no different than not performing CPR or administering external defibrillation. A majority (77%) did not consider device deactivation in accordance with patient wishes to be physician-assisted suicide. A majority (78%) responded that it was not ethical/moral for doctors to deactivate ICDs against patients’ wishes. Conclusion: In an era of cost-consciousness and scrutiny of resources, management of ICDs and CRT-Ds as patients near the end of their lives create ethical dilemmas. Few patients consider device deactivation at end of life, though a large majority believes that unilateral deactivation is not ethical or moral, even in the setting of medical futility. Advance care planning for these patients should address device deactivation.

Pressure in dealing with requests for euthanasia or assisted suicide. Experiences of general practitioners

2019 ◽  
Vol 45 (7) ◽  
pp. 425-429 ◽  
Author(s):  
Marike E de Boer ◽  
Marja F I A Depla ◽  
Marjolein den Breejen ◽  
Pauline Slottje ◽  
Bregje D Onwuteaka-Philipsen ◽  
...  
Keyword(s):  
General Practitioners ◽  
Assisted Suicide ◽  
Time Pressure ◽  
Physician Assisted Suicide ◽  
Personal Boundaries ◽  
Physician Relationship ◽  
The Relationship ◽  
Depth Interviews ◽  
Different Sources

The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide (EAS). This study aimed to explore the content of this pressure as experienced by general practitioners (GP). We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: (1) emotional blackmail, (2) control and direction by others, (3) doubts about fulfilling the criteria, (4) counterpressure by patient’s relatives, (5) time pressure around referred patients and (6) organisational pressure. We conclude that the pressure can be attributable to the patient–physician relationship and/or the relationship between the physician and the patient’s relative(s), the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account.

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