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physician-assisted suicide; medical assistance in dying

1) Physician-assisted suicide involves the physician providing the means for a patient to kill him or herself. Distinguish from euthanasia. Epidemiology: - ~2/3 of Americans support physician-assisted suicide [8] - more physicians support physician-assisted suicide than euthanasia; for the public, the reverse is true [8] - among 53 older Dutch citizens who chose physician-assisted suicide/euthanasia, all had unbearable suffering due to nonterminal conditions [12] - conditions included vision loss, hearing loss, chronic pain, arthritis, & cognitive impairment [12] - requests for physician-assisted suicide/euthanasia are often preceded by a sequence of events, especially recurrent falls & fall consequences (fractures) [12] - suffering occurred on multiple dimensions - physical suffering was apparent in all cases - impaired mobility, fears (further decline, falls, institutionalization), dependence, social isolation, & loss of meaning in daily life [12] Management: - requests for physician-assisted suicide should always trigger a search for depression, uncontrolled pain & existential suffering - American College of Physician recommends alternatives [11] - talk with the patient about the reasons for the request & explore alternatives - reassure the patient that you will not abandon him or her during end-of-life care - facilitate advance care planning - make sure the patient understands his or her right to refuse treatments Notes: - legal in Washington, Oregon, California, Montana & Vermont [8] - legal in Netherlands, Canada, Belgium, Luxembourg - legal in Switzerland since 1942 [8] - most authoritative bodies in medicine have stated that physician-assisted suicide should not be practiced by physicians - most polls have shown that much of the public & many physicians feel that physician-assisted suicide is moral, & the practice occurs although probably to a small degree - euthanasia or assisted-suicide cases of patients with psychiatric disorders in the Netherlands from 2011 to 2014 [7]

Related

palliative sedation

General

suicide

References

  1. Rosenfeld K. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  2. Rosenfeld K. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 25-28, 2002
  3. Snyder L, Sulmasy DP; Ethics and Human Rights Committee, American College of Physicians-American Society of Internal Medicine. Physician-assisted suicide. Ann Intern Med. 2001 Aug 7;135(3):209-16. PMID: 11487490
  4. Medical Knowledge Self Assessment Program (MKSAP) 16 American College of Physicians, Philadelphia 2012
  5. Quill T, Arnold RM. Evaluating requests for hastened death #156. J Palliat Med. 2008 Oct;11(8):1151-2 PMID: 18980457
  6. Snijdewind MC et al. A study of the first year of the End-of-Life Clinic for physician-assisted dying in the Netherlands. JAMA Intern Med 2015 Aug 10 PMID: 26258534
  7. Kim SY, De Vries RG, Peteet JR Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014. JAMA Psychiatry. Published online February 10, 2016. PMID: 26864709 http://archpsyc.jamanetwork.com/article.aspx?articleid=2491354 - Appelbaum PS Physician-Assisted Death for Patients With Mental Disorders - Reasons for Concern. JAMA Psychiatry. Published online February 10, 2016. PMID: 26864504 http://archpsyc.jamanetwork.com/article.aspx?articleid=2491352
  8. Zuger A Update on Euthanasia and Physician-Assisted Suicide. NEJM Journal Watch. July 14, 2016 Massachusetts Medical Society (subscription needed) http://www.jwatch.org - Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, Cohen J. Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe. JAMA. 2016 Jul 5;316(1):79-90. PMID: 27380345 - Razmaria AA. JAMA PATIENT PAGE. End-of-Life Care. JAMA. 2016 Jul 5;316(1):115. PMID: 27380364
  9. Li M, Watt S, Escaf M et al Medical Assistance in Dying - Implementing a Hospital-Based Program in Canada. N Engl J Med 2017; 376:2082-2088. May 25, 2017 PMID: 28538128 http://www.nejm.org/doi/full/10.1056/NEJMms1700606
  10. van der Heide A, van Delden JJM, Onwuteaka-Philipsen BD. End-of-Life Decisions in the Netherlands over 25 Years. N Engl J Med 2017; 377:492-494. August 3, 2017 PMID: 28767342 Free Article http://www.nejm.org/doi/full/10.1056/NEJMc1705630
  11. Sulmasy LS, Mueller PS Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Ann Intern Med. Sept 19, 2017. PMID: 28975242 http://annals.org/aim/article/2654458/ethics-legalization-physician-assisted-suicide-american-college-physicians-position-paper - Quill TE, Arnold RM, Youngner SJ. Physician-Assisted Suicide: Finding a Path Forward in a Changing Legal Environment. Ann Intern Med. Sept 19, 2017. PMID: 28975245 http://annals.org/aim/article/2654459/physician-assisted-suicide-finding-path-forward-changing-legal-environment - Kussmaul WG 3rd. The Slippery Slope of Legalization of Physician-Assisted Suicide. Ann Intern Med. Sept 19, 2017. PMID: 28975201 http://annals.org/aim/article/2654050/slippery-slope-legalization-physician-assisted-suicide - Hedberg K, New C Oregon's Death With Dignity Act: 20 Years of Experience to Inform the Debate. Ann Intern Med. Sept 19, 2017. PMID: 28975232 http://annals.org/aim/article/2654460/oregon-s-death-dignity-act-20-years-experience-inform-debate
  12. van den Berg V et al. Euthanasia and physician-assisted suicide in patients with multiple geriatric syndromes. JAMA Intern Med 2021 Feb 1; 181:245 PMID: 33284324 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2773789 - Meier DE. The treatment of patients with unbearable suffering - The slippery slope is real. JAMA Intern Med 2021 Feb 1; 181:160. PMID: 33284341 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2773781