The Debate over Physician-Assisted Suicide: Empirical Data and Convergent Views

Te, Quill; De, Meier; Sd, Block; Ja, Billings

doi:10.7326/0003-4819-128-7-199804010-00006

Cited by 50 publications

(22 citation statements)

References 75 publications

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“…Attention should shift away from the very small number of patients who persistently want to hasten their death to the growing information about the nature of suffering at the end of life, the motivation for seeking hastened death, guidelines on evaluating such requests, and general acceptance by ethicists, clinicians, and the US courts of appropriate management strategies based on widely recognised ethical distinctions 34. No patient should turn to suicide because of treatable, reversible conditions such as pain or other physical suffering, loneliness, depression, anxiety, or concerns about being a burden on the family 35.…”

Section: Hastening Deathmentioning

confidence: 99%

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Recent advances: Palliative care

2000

BMJ

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Palliative care is defined as comprehensive, interdisciplinary care of patients and families facing a terminal illness, focusing primarily on comfort and support. 1 Key aspects include meticulous symptom control; psychosocial and spiritual care; a personalised management plan that maximises patient-determined quality of life; family oriented care that extends through the time of bereavement; and delivery of coordinated services, especially in the home but also in hospital, extended care facilities, day care centres, and specialised units. In this article I introduce current concepts about palliative care and review advances in this subject over the past five years, highlighting developments of particular interest to generalists. MethodsMy choice of topics derives from my familiarity with patterns of medical practice, particularly in the United States; presentations at meetings; review of current textbooks; and monitoring of general medical journals, selected specialty journals on pain and cancer, and nine palliative care journals (see extra box on the BMJ 's website). Why the need for palliative care?Numerous recent studies confirm earlier observations that dying people and their families experience a wide range of unmet needs, while receiving very costly care. 2 One large US study, SUPPORT, underscores many of these problems. 3 This investigation enrolled patients who were admitted to an academic hospital with common, severe medical conditions and who had a median survival of six months. Considerable suffering and inappropriate use of resources were observed. Many patients died in pain or with high "symptom burdens." 4 Doctors proved no better than chance in judging whether their patients wanted cardiopulmonary resuscitation. Family members often experienced social and financial devastation-having to quit a job or suffering major losses of income or savings-because of the illness.Doctors' prognostic estimates are important to both patients and clinicians in making good decisions about appropriate terminal care. Recent studies indicate not only that doctors seem reluctant to speak to patients about death, but also that they are inaccurate and systematically optimistic about the future, thus delaying timely sharing of information and referral to appropriate palliative care services. 5 Compared with conventional care, palliative care seems to improve patient and family satisfaction and the identification of their needs while reducing overall costs through decreased use of acute hospital care. 6 Studies of medical school curriculums, postgraduate physician training programmes, 7 and standard medical textbooks 8 reveal disappointingly little attention to end of life issues. However, numerous palliative care journals, textbooks, courses, and websites are now available to help clinicians in providing good terminal care (see extra box on the BMJ 's website for details). Increasing evidence confirms that "bedside manner" (communication and psychosocial skills) for terminal care can be taught. 9

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Section: Hastening Deathmentioning

confidence: 99%

“…Even under the best of care, however, a small fraction of patients, probably less than 1%, will persistently wish to have death hastened 34. These patients seem to be motivated more by concerns about not being able to function at a reasonable physical and mental level or about being a burden, rather than because of physical discomfort.…”

Section: Hastening Deathmentioning

confidence: 99%

Recent advances: Palliative care

2000

BMJ

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“…[23][24][25][26] Despite considerable discussion about terminal sedation in the literature, there has been very little empirical investigation of physician attitudes toward this practice. 27 We are aware of a report that 89% of 53 palliative care physicians agreed that terminal sedation was sometimes necessary, 1 and we found that 66% of 236 medical house officers in Connecticut agreed that it is ethically appropriate to provide terminal sedation to treat intractable pain associated with terminal illness. 28 Given the interest that patients, their families, and professionals have in the availability of aggressive palliation for terminally ill patients with refractory symptoms, there is a need to document attitudes toward terminal sedation among physicians who care for patients at the end of life.…”

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confidence: 93%

Internists’ attitudes towards terminal sedation in end of life care

Kaldjian

Jekel²,

Bernene³

et al. 2004

J Med Ethics

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Objective: To describe the frequency of support for terminal sedation among internists, determine whether support for terminal sedation is accompanied by support for physician assisted suicide (PAS), and explore characteristics of internists who support terminal sedation but not assisted suicide. Design: A statewide, anonymous postal survey. Setting: Connecticut, USA. Participants: 677 Connecticut members of the American College of Physicians. Measurements: Attitudes toward terminal sedation and assisted suicide; experience providing primary care to terminally ill patients; demographic and religious characteristics. Results: 78% of respondents believed that if a terminally ill patient has intractable pain despite aggressive analgesia, it is ethically appropriate to provide terminal sedation (diminish consciousness to halt the experience of pain). Of those who favoured terminal sedation, 38% also agreed that PAS is ethically appropriate in some circumstances. Along a three point spectrum of aggressiveness in end of life care, the plurality of respondents (47%) were in the middle, agreeing with terminal sedation but not with PAS. Compared with respondents who were less aggressive or more aggressive, physicians in this middle group were more likely to report having more experience providing primary care to terminally ill patients (p = 0.02) and attending religious services more frequently (p,0.001). Conclusions: Support for terminal sedation was widespread in this population of physicians, and most who agreed with terminal sedation did not support PAS. Most internists who support aggressive palliation appear likely to draw an ethical line between terminal sedation and assisted suicide.

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“…It is now accepted among psychiatrists, moreover, that such life-limiting decisions may be reached through rational thought processes that are not generated by pathologic depression, as is generally considered to be the case for ordinary, clinical suicide. [39][40][41][42][43] …”

Section: The Relevance Of Freud's Choice Of Physician-assisted Death mentioning

confidence: 99%