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

Advanced Disease ◽

Patient Advocacy ◽

World Values Survey ◽

Medical Field ◽

Positive Attitudes ◽

Economic Constraints

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.

Ethical considerations at the end-of-life care

SAGE Open Medicine ◽

10.1177/20503121211000918 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110009

Author(s):

Melahat Akdeniz ◽

Bülent Yardımcı ◽

Ethem Kavukcu

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Assisted Suicide ◽

Ethical Decision Making ◽

Biomedical Ethics ◽

Artificial Nutrition ◽

Life Care ◽

Ethical Challenges ◽

Physician Assisted Suicide

The goal of end-of-life care for dying patients is to prevent or relieve suffering as much as possible while respecting the patients’ desires. However, physicians face many ethical challenges in end-of-life care. Since the decisions to be made may concern patients’ family members and society as well as the patients, it is important to protect the rights, dignity, and vigor of all parties involved in the clinical ethical decision-making process. Understanding the principles underlying biomedical ethics is important for physicians to solve the problems they face in end-of-life care. The main situations that create ethical difficulties for healthcare professionals are the decisions regarding resuscitation, mechanical ventilation, artificial nutrition and hydration, terminal sedation, withholding and withdrawing treatments, euthanasia, and physician-assisted suicide. Five ethical principles guide healthcare professionals in the management of these situations.

Euthanasia and suicide: a medical and social discourse

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2021-25(1)-20 ◽

2021 ◽

Vol 25 (1) ◽

pp. 107-112

Author(s):

V. N. Ostapenko ◽

I. V. Lantukh ◽

A. P. Lantukh

Keyword(s):

Quality Of Life ◽

Assisted Suicide ◽

Human Life ◽

Modern Science ◽

Adequate Quality ◽

The Subject ◽

Strong Explosion ◽

The Right

Annotation. The problem of suicide and euthanasia has been particularly updated with the spread of the COVID-19 pandemic, which caused a strong explosion of suicide, because medicine was not ready for it, and the man was too weak in front of its pressure. The article considers the issue of euthanasia and suicide based on philosophical messages from the position of a doctor, which today goes beyond medicine and medical ethics and becomes one of the important aspects of society. Medicine has achieved success in the continuation of human life, but it is unable to ensure the quality of life of those who are forced to continue it. In these circumstances, the admission of suicide or euthanasia pursues the refusal of the subject to achieve an adequate quality of life; an end to suffering for those who find their lives unacceptable. The reasoning that banned suicide: no one should harm or destroy the basic virtues of human nature; deliberate suicide is an attempt to harm a person or destroy human life; no one should kill himself. The criterion may be that suicide should not take place when it is committed at the request of the subject when he devalues his own life. According to supporters of euthanasia, in the conditions of the progress of modern science, many come to the erroneous opinion that medicine can have total control over human life and death. But people have the right to determine the end of their lives while using the achievements of medicine, as well as the right to demand an extension of life with the help of the same medicine. They believe that in the era of a civilized state, the right to die with medical help should be as natural as the right to receive medical care. At the same time, the patient cannot demand death as a solution to the problem, even if all means of relieving him from suffering have been exhausted. In defense of his claims, he turns to the principle of beneficence. The task of medicine is to alleviate the suffering of the patient. But if physician-assisted suicide and active euthanasia become part of health care, theoretical and practical medicine will be deprived of advances in palliative and supportive therapies. Lack of adequate palliative care is a medical, ethical, psychological, and social problem that needs to be addressed before resorting to such radical methods as legalizing euthanasia.

The Beginning and Ending of Life

Philosophical Foundations of Medical Law ◽

10.1093/oso/9780198796558.003.0011 ◽

2019 ◽

pp. 162-171

Author(s):

John Keown

Keyword(s):

Quality Of Life ◽

Human Development ◽

Assisted Suicide ◽

Human Life ◽

Terminally Ill ◽

Medical Law ◽

Life Sustaining Treatment ◽

The Law

This chapter identifies several respects in which medical law in England and Wales suffers from a lack of ethical coherence in relation to its protection of human life. It argues that it is philosophically incoherent for the law to calibrate its protection of human life according to arbitrary stages of human development such as birth, viability, the fourteenth day after fertilization, and implantation. To the extent that the law permits life-sustaining treatment to be withheld or withdrawn from incompetent patients on the ground that their ‘quality of life’ is insufficient, and even with an intent to hasten death, it again displays ethical incoherence. If legislators or judges were to make it lawful for physicians to intentionally assist suicidal refusals of treatment, or to endorse a right to physician-assisted suicide for the ‘terminally ill’, the law's ethical incoherence would be seriously aggravated.

Conscientious objection and physician-assisted suicide: a viable option in the UK?

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-001541 ◽

2018 ◽

pp. bmjspcare-2018-001541

Author(s):

Derek Willis ◽

Rob George

Keyword(s):

Assisted Suicide ◽

Conscientious Objection ◽

Future Application ◽

Medical Professionals ◽

Viable Option ◽

Medical Practitioners ◽

The Uk ◽

Legal Grounds

Conscience objection is a proposed way of ensuring that medical practitioners who object to physician-assisted suicide may avoid having to be involved in such a procedure if this is legalised. This right on the part of healthcare professionals already exists in certain circumstances. This paper examines the ethical and legal grounds for conscientious objection for medical professionals and shows how it is heavily criticised in circumstances where it is already used. The paper comes to the conclusion that as the grounds and application of conscience objection are no longer as widely accepted, its future application in any legislation can be called into question.

Physician-Assisted Suicide and Euthanasia: The Pharmacist's Perspective

OMEGA - Journal of Death and Dying ◽

10.2190/hubf-9j5l-t40f-28pp ◽

2000 ◽

Vol 40 (1) ◽

pp. 89-99 ◽

Cited By ~ 4

Author(s):

Mark E. Schneiderhan

Keyword(s):

Assisted Suicide ◽

Lethal Dose ◽

Critical Position ◽

End Of Life Decisions ◽

The Individual ◽

Effective Use ◽

Pharmaceutical Agents ◽

Special Responsibility

Pharmacists are in a critical position when pharmaceutical agents are prescribed for the purpose of physician-assisted suicide and/or euthanasia and they may need to decide whether dispensing a lethal dose of a medication is ethically and morally acceptable for a patient. In many cases, pharmacists may not even be aware that prescriptions are intended for physician-assisted suicide and/or euthanasia. Pharmacists have a special responsibility to protect patients who are contemplating end-of-life decisions such as physician- assisted suicide and euthanasia. Pharmaceutical care (“Responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life … ”) requires that the pharmacist not only understands the medications but also the individual patient and the complexities of their lives and suffering. Only in this way can pharmacists provide safe and effective use of medications for the patients they serve.

Grief After Euthanasia and Physician-Assisted Suicide

Crisis ◽

10.1027/0227-5910/a000630 ◽

2020 ◽

Vol 41 (4) ◽

pp. 255-272 ◽

Cited By ~ 2

Author(s):

Karl Andriessen ◽

Karolina Krysinska ◽

Dolores Angela Castelli Dransart ◽

Luc Dargis ◽

Brian L. Mishara

Keyword(s):

Mental Health ◽

Research Method ◽

Assisted Suicide ◽

Decision Making Process ◽

Study Quality ◽

Grief Process ◽

Increased Risk ◽

Self Reports

Abstract. Background: Several countries have regulated euthanasia and physician-assisted suicide (PAS). Research has looked at the experiences of patients, family, and professionals. However, little is known of the effects on bereaved individuals. Aims: We aimed to assess (a) what is known about the grief and mental health of people bereaved by euthanasia or PAS and (b) the quality of the research. Method: Systematic review according to PRISMA guidelines with searches in Cinahl, Embase, PsycINFO, Pubmed, and Scopus. Results: The searches identified 10 articles (eight studies), and the study quality was fair. People bereaved by euthanasia/PAS generally had similar or lower scores on measures of disordered grief, mental health, and posttraumatic stress compared with those who died naturally. Lack of social support and secrecy may compound their grief. Being involved in the decision-making process and having the feeling of honoring the deceased's will may facilitate their grief. Limitations: Studies used self-reports from non-random self-selected participants, were retrospective, and were conducted in only three countries. Conclusion: There is little evidence of increased risk of adverse grief or mental health outcomes in people bereaved by euthanasia/PAS. As more countries legalize assisted dying, high-quality studies of the factors that may hinder or facilitate the grief process are needed.

Legalizing physician-assisted suicide and/or euthanasia: Pragmatic implications

Palliative & Supportive Care ◽

10.1017/s1478951515000176 ◽

2015 ◽

Vol 13 (5) ◽

pp. 1399-1409 ◽

Cited By ~ 9

Author(s):

Peter Hudson ◽

Rosalie Hudson ◽

Jennifer Philip ◽

Mark Boughey ◽

Brian Kelly ◽

...

Keyword(s):

Palliative Care ◽

Assisted Suicide ◽

Research Community ◽

Legal Issues ◽

Care Provision ◽

Training Research ◽

Ethical And Legal Issues ◽

Practical Implications

AbstractObjective:Despite the availability of palliative care in many countries, legalization of euthanasia and physician-assisted suicide (EAS) continues to be debated—particularly around ethical and legal issues—and the surrounding controversy shows no signs of abating. Responding to EAS requests is considered one of the most difficult healthcare responsibilities. In the present paper, we highlight some of the less frequently discussed practical implications for palliative care provision if EAS were to be legalized. Our aim was not to take an explicit anti-EAS stance or expand on findings from systematic reviews or philosophical and ethico-legal treatises, but rather to offer clinical perspectives and the potential pragmatic implications of legalized EAS for palliative care provision, patients and families, healthcare professionals, and the broader community.Method:We provide insights from our multidisciplinary clinical experience, coupled with those from various jurisdictions where EAS is, or has been, legalized.Results:We believe that these issues, many of which are encountered at the bedside, must be considered in detail so that the pragmatic implications of EAS can be comprehensively considered.Significance of Results:Increased resources and effort must be directed toward training, research, community engagement, and ensuring adequate resourcing for palliative care before further consideration is given to allocating resources for legalizing euthanasia and physician-assisted suicide.

Physician-Assisted Suicide in Context: Constitutional, Regulatory, and Professional Challenges

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.1996.tb01851.x ◽

1996 ◽

Vol 24 (3) ◽

pp. 181-182

Author(s):

Bernard Lo ◽

Karen H. Rothenberg ◽

Michael Vasko

Keyword(s):

Quality Of Life ◽

Colon Cancer ◽

Disseminated Intravascular Coagulation ◽

Assisted Suicide ◽

Experimental Chemotherapy ◽

Blood Samples ◽

Intravascular Coagulation ◽

Professional Challenges

Last month, a fifty-eight-year old man developed bleeding into his cheek and oozing from sites where previously he had had blood samples drawn. This bleeding was caused by disseminated intravascular coagulation, a complication of colon cancer that had spread to his liver and lungs. This complication occurred even though he was on chemotherapy for the cancer. In the hospital, he received transfusions and was administered medicine to stop the bleeding. However, his condition did not improve. He developed more bruises. When he tried to go to the bathroom without assistance, he fell, struck his head, requiring stitches, and developed a black, swollen eye. The patient, a successful businessman, had already overcome another type of cancer—lymphoma—through chemotherapy, twenty-five years ago. In a few days, this dynamic individual who expected to start experimental chemotherapy now saw his quality of life deteriorate steadily.We talked about more chemotherapy, about hospice, and about withholding attempts at resuscitation if his heart should stop.

Does the Experience of Interpersonal Predictors of Suicidal Desire Predict Positive Attitudes Toward Physician Assisted Suicide?

OMEGA - Journal of Death and Dying ◽

10.2190/om.69.2.c ◽

2014 ◽

Vol 69 (2) ◽

pp. 137-149 ◽

Cited By ~ 3

Author(s):

Raymond P. Tucker ◽

Carmen A. Buchanan ◽

Victoria M. O'Keefe ◽

LaRicka R. Wingate

Keyword(s):

Suicidal Behavior ◽

Assisted Suicide ◽

Psychological Theory ◽

Thwarted Belongingness ◽

Perceived Burdensomeness ◽

Positive Attitudes ◽

Hastened Death ◽

Interpersonal Psychological Theory ◽

Future Work

The current study examined the relationship between Physician Assisted Suicide (PAS) attitudes and interpersonal risk factors of suicidal desire as outlined by the interpersonal-psychological theory of suicidal behavior (Joiner, 2005). It was hypothesized that both thwarted belongingness and perceived burdensomeness would be positively related to PAS acceptance. Results indicated that thwarted belongingness and perceived burdensomeness predicted significance of favorable attitudes toward PAS in a college sample. Results suggest that attitudes toward PAS may be influenced by the experience of thwarted belongingness and perceived burdensomeness and provide a clear rationale for the study of these variables in populations more apt to consider hastened death. Future work regarding the application of the interpersonal-psychological theory of suicidal behavior in hastened death research is discussed.

Introduction

10.1093/oso/9780190612757.003.0001 ◽

2021 ◽

pp. 1-9

Author(s):

Lewis A. Grossman

Keyword(s):

Assisted Suicide ◽

Patient Advocacy ◽

Court Of Appeals ◽

Fda Approval ◽

Investigational Drugs ◽

The Supreme Court ◽

The Us ◽

Patient Advocacy Group ◽

The Right

In addition to setting out the themes of the book, the Introduction tells the story of cancer patient Abigail Burroughs and the case of Abigail Alliance v. von Eschenbach (2008), a suit against the FDA brought by a patient advocacy group founded by Abigail’s father after her death. In this case, the US Court of Appeals for the DC Circuit denied terminally ill patients the right to obtain investigational drugs prior to FDA approval. Using a test established by the Supreme Court in its physician-assisted suicide decision, Washington v. Glucksberg (1997), the DC Circuit held that a right to access unapproved drugs is not “deeply rooted in this Nation’s history and tradition.” The Introduction asserts that the Abigail Alliance court’s version of history was incomplete and one-dimensional, as the rest of the book will demonstrate.