“We need to talk!” Barriers to GPs’ communication about the option of physician-assisted suicide and their ethical implications: results from a qualitative study

Abstract

GPs usually care for their patients for an extended period of time, therefore, requests to not only discontinue a patient’s treatment but to assist a patient in a suicide are likely to create intensely stressful situations for physicians. However, in order to ensure the best patient care possible, the competent communication about the option of physician assisted suicide (PAS) as well as the assessment of the origin and sincerity of the request are very important. This is especially true, since patients’ requests for PAS can also be an indicator for unmet needs or concerns. Twenty-three qualitative semi-structured interviews were conducted to in-depth explore this multifaceted, complex topic while enabling GPs to express possible difficulties when being asked for assistance. The analysis of the gathered data shows three main themes why GPs may find it difficult to professionally communicate about PAS: concerns for their own psychological well-being, conflicting personal values or their understanding of their professional role. In the discussion part of this paper we re-assess these different themes in order to ethically discuss and analyse how potential barriers to professional communication concerning PAS could be overcome.

Responses to assisted suicide requests: an interview study with Swiss palliative care physicians

“…Lack of training appeared to contribute to participants’ uneasiness in responding to assisted suicide requests, reflecting research with Swiss GPs 39. Responding to a specific request for assisted dying is complex and must comply with country-specific legislation 37 40 41.…”

When is hastened death considered suicide? A systematically conducted literature review about palliative care professionals’ experiences where assisted dying is legal

“…Most authors acknowledge terminology variation but do not explain their choice of terms around this topic. Some authors refer to terms used in legislation such as ‘aid in dying,’ ‘legalised physician assisted suicide,’ ‘PAS,’ ‘assisted suicide,’ or the ‘Oregon Death with Dignity Act’ [34, 35, 39, 55, 57]. Other authors choose ‘physician-assisted death’ or ‘physician–assisted dying’ as a capture term to include both euthanasia and assisted suicide instead of the terms ‘physician-assisted suicide’ or ‘assisted suicide’ [61].…”

“…A theme identified in the literature is that there are both challenges and opportunities to speak openly about issues of suicide among professionals of the same or different disciplines and between professionals and those they serve [36, 50, 52–54, 57]. The included articles suggest that with assisted dying there is a tendency to view professionals’ conversations with patients as opportunities to discuss what is relevant and important to the patient, thus improving end-of-life care.…”

Implementation of Medical Assistance in Dying: An evaluation of clinician knowledge and perceptions at a large urban multi-site rehabilitation centre in Toronto

“…[12] Coinciding with findings of a previous study, [13] the results of this study support the commonality that some providers have intense emotions and conflicting personal opinions surrounding MAID. Otte et al [14] outline three common themes expressed by providers who do not support MAID including: psychological impact on provider, religious beliefs/moral values, and professional role. Nevertheless, Canadian legislation provides room for conscientious objection among clinicians, which therefore exempts the portion of clinicians who do not support MAID from participating in interventions.…”