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Background and AimsEuthanasia is a controversial issue related to the right to die. Although euthanasia is mostly requested by terminally sick individuals, even in societies where it is legal, it is unclear what medical conditions lead to euthanasia requests. In this scoping review, we aimed to compile medical conditions for which euthanasia has been requested or performed around the world.MethodsThe review was preferred reporting items for systematic reviews and meta‐analysis for scoping reviews (PRISMA‐ScR) checklist. Retrieved search results were screened and unrelated documents were excluded. Data on reasons for conducting or requesting euthanasia along with the study type, setting, and publication year were extracted from documents. Human development index and euthanasia legality were also extracted. Major medical fields were used to categorize reported reasons. Group discussions were conducted if needed for this categorization. An electronic search was undertaken in MEDLINE through PubMed for published documents covering the years January 2000 to September 2022.ResultsOut of 3323 records, a total of 197 papers were included. The most common medical conditions in euthanasia requests are cancer in a terminal phase (45.4%), Alzheimer's disease and dementia (19.8%), constant unbearable physical or mental suffering (19.8%), treatment‐resistant mood disorders (12.2%), and advanced cardiovascular disorders (12.2%).ConclusionReasons for euthanasia are mostly linked to chronic or terminal physical conditions. Psychiatric disorders also lead to a substantial proportion of euthanasia requests. This review can help to identify the features shared by conditions that lead to performing or requesting euthanasia
Background and AimsEuthanasia is a controversial issue related to the right to die. Although euthanasia is mostly requested by terminally sick individuals, even in societies where it is legal, it is unclear what medical conditions lead to euthanasia requests. In this scoping review, we aimed to compile medical conditions for which euthanasia has been requested or performed around the world.MethodsThe review was preferred reporting items for systematic reviews and meta‐analysis for scoping reviews (PRISMA‐ScR) checklist. Retrieved search results were screened and unrelated documents were excluded. Data on reasons for conducting or requesting euthanasia along with the study type, setting, and publication year were extracted from documents. Human development index and euthanasia legality were also extracted. Major medical fields were used to categorize reported reasons. Group discussions were conducted if needed for this categorization. An electronic search was undertaken in MEDLINE through PubMed for published documents covering the years January 2000 to September 2022.ResultsOut of 3323 records, a total of 197 papers were included. The most common medical conditions in euthanasia requests are cancer in a terminal phase (45.4%), Alzheimer's disease and dementia (19.8%), constant unbearable physical or mental suffering (19.8%), treatment‐resistant mood disorders (12.2%), and advanced cardiovascular disorders (12.2%).ConclusionReasons for euthanasia are mostly linked to chronic or terminal physical conditions. Psychiatric disorders also lead to a substantial proportion of euthanasia requests. This review can help to identify the features shared by conditions that lead to performing or requesting euthanasia
Physician-Assisted Suicide (PAS) is considered by some patients who learn they are at risk for a cognitive decline owing to Alzheimer’s Disease. At the same time, the prospect of PAS may raise patients’ fear of imminent death. Can PAS be offered in a way that is preference-sensitive on one hand, and mitigates patients’ fear of imminent death on the other? A thought experiment of aProbabilistic Approach to PAS(Probabilistic PAS) is proposed here as a possible solution in jurisdictions where PAS is legal.Consider the following scenario: A patient diagnosed with Alzheimer’s Disease who is considering PAS might request that when he or she can no longer recognize their loved ones, their doctor will give them a lethal pill that has a 1/100 daily probability of being activated. As a result, after taking the pill, every day the patient will have a 1/100 probability of dying. The likelihood of the patient dying within a year from taking the pill is 97.4%, and within two years, it is 99.9%. As such, a Probabilistic PAS with which on any given day the probability of dying is low, can help patients avoid the fear of imminent death – which traditional PAS entails – while respecting their preference to end their lives.To examine the potential reception of a Probabilistic PAS, a survey was administered to a nationally-representative sample of US residents, using Prolific, a research participant recruitment platform. 499 participants were presented with a short description of a patient who was diagnosed with Alzheimer’s Disease, is writing an advance directive and is considering ways to end their life painlessly when they can no longer recognize their loved ones. Participants were asked about their own preferences in case they were to face a similar situation, and whether helping administer Probabilistic PAS would be ethical for the patient’s provider.498 participants responded to the question about their own preference. 73.5% indicated that they would choose one of the two PAS options. Among those, 9.8% preferred a Probabilistic PAS over traditional PAS. Men were more likely than women to favor Probabilistic PAS for themselves. 482 participants indicated which option would be most ethical for the patient’s provider to administer. 48.1% indicated one of the two PAS options as most ethical. Among those, 10.3% considered Probabilistic PAS to be more ethical than traditional PAS. Men were more likely than women to consider the provider administering Probabilistic PAS to be most ethical.A version of the Probabilistic PAS proposed here should be considered as a preference-sensitive option presented by healthcare providers to patients considering advance care planning in places where PAS is available.
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