Physician-assisted suicide. Finding common ground

In Washington state, practicing physicians have been forced to confront the emotional, complex issue of physician-assisted suicide sooner than physicians elsewhere in the US. The Washington State Medical Association has struggled at length with the issue and ultimately delineated a policy on safeguards for physician-assisted suicide. The Washington experience may prove instructive to other professional physician organizations even before the US Supreme Court rules on the issue.     

Physician-assisted suicide in psychiatry: developments in The Netherlands

Physician-assisted suicide can now be officially and legally carried out for psychiatric patients in The Netherlands who request it, provided that criteria are met. The authors describe two recent cases of psychiatric patients whose suicides were assisted by their psychiatrist. They critically examine the guidelines for physician-assisted suicide in psychiatry. The criteria address the decision of the patient to be assisted with suicide, which must be voluntary and well considered, and the patient's desire to die, which must endure over time. The patient's suffering must be unacceptable, and the disorder incurable. The authors conclude that important aspects of psychiatric practice are not addressed in the guidelines, which were originally developed for use in somatic medicine. The assessment of treatment prognosis in psychiatry is not accurate enough to allow a final decision about incurability. Boundaries of the psychiatric therapeutic relationship are violated in physician-assisted suicide. The therapist's inability to objectively assess the patient's wish to die is overlooked. Because the general public will continue to ask for clarity on the issue of euthanasia and physician-assisted suicide, the authors believe that an open discussion of both ethical and professional issues is the best option.     

Physician-assisted suicide. Overview of the ethical debate

Eight hundred seventy-one Israeli adolescents, 375 boys and 496 girls, mean age 16.7 +/- 1, participated in this study. Twenty-three of them lost relatives in war and 19 in road accidents. All participants were administered the Brief Symptom Inventory (BSI), the General Well-being Scale (GWB), the Parental Bonding Instrument (PBI) and the Perceived Social Support-Family/Friend (PSS-Fa and PSS-Fr) measures. War-bereaved adolescents showed significantly higher scores in psychological well-being (GWB) and significantly lower scores in reported psychiatric symptoms (BSI) than accident-bereaved adolescents. War-bereaved adolescents also had significantly better BSI and GWB scores than the general nonbereaved adolescent population. These results persisted after controlling for family socio-economic status, gender, and the degrees of closeness of the deceased relative. War-bereaved adolescents did not differ either from accident-bereaved adolescents or from the nonbereaved general adolescent population in social and family support systems (PSS-Fr, PSS-Fa) and did not experience different basic parental attitudes (PBI). Results are discussed in terms of the different meanings ascribed to death in battle versus death in a road accident.     

Oregon's first year: The medicalization of control.

The results of Oregon's first year with physician-assisted suicide raise two questions. First, how will it be possible to evaluate what is actually going on in Oregon if there is no public access to the records and if physicians are shielded by patient confidentiality rules? The second question is whether the public understood that many, not most, of those who want physician-assisted suicide want it not to relieve suffering as ordinarily understood but to maintain control over their dying, something that may not correlate at all with suffering from illness and disease. This commentary reviews the existing evidence from the Netherlands and suggests that abuse of the vulnerable will likely occur in Oregon over time. It also reviews the insufficiency of the data emerging from Oregon. Finally, it addresses the various issues raised by the other commentators to the main article. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physician-assisted suicide and older patients'' perceived duty to die

The Lambert-Eaton syndrome is an autoimmune disease affecting the presynapse of the neuromuscular junction. Proximal muscle fatigue of the limbs is improved by repeated maximal voluntary contractions. Generally, patients present hypo or areflexia and frequently a dry mouth syndrome. In 50% of the cases, the Lambert-Eaton syndrome is associated with small-cell bronchogenic carcinoma. The different treatments proposed in the literature for Lambert-Eaton paraneoplastic syndrome focus on treatment of the primary tumor. Symptomatic treatment of the junctional disorder are based on cholinergic drugs, immunosuppression and immunomodulation, useful in case of unsuccessful antineoplastic therapy.     

Physician-assisted suicide and the Supreme Court: the Washington and Vacco verdicts

In June 1997, the Supreme Court decided that statutes proscribing physicians from providing lethal medication for use by competent, terminally ill patients do not violate the Due Process or Equal Protection Clauses of the Constitution. The Court returned the question of physician-assisted suicide to the states, but did not foreclose future review of state laws that may be too restrictive of care at the end of life. The conceptual distinctions between assisted suicide, refusal of life-sustaining treatment, and administration of pain medication to terminally ill patients were endorsed as important guideposts for future analyses.     

Observations on the first year of Oregon's Death with Dignity Act.

Using data from the files of Compassion in Dying, we describe 34 individuals who approached Compassion wanting to use the Death with Dignity Act and who died during the first year of the Act's implementation. Of these 34, 10 died using medication prescribed under the Act. Using first-hand data from the dying individuals, their families, and their health care teams, we provide comparisons between predicted outcomes and actual experiences, discuss important elements of the physician–patient relationship, and describe several averted suicides and homicides. We also review changes in end-of-life care in Oregon and provide recommendations about issues in need of further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

So far so good: Observations on the first year of Oregon's Death with Dignity Act.

The Supreme Court recognized that states may serve as social laboratories for developing procedures permitting physician-assisted suicide. Oregon has served as the first such laboratory. First-year results suggest the feasibility of implementing a statute right to physician-assisted suicide successfully in this country, without abuse or negative incident. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The case against preventing suicide prevention: Comments on Szasz.

Comments on the article by T. Szasz (see record 1986-27453-001) advocating against coercive suicide prevention. The present author emphasizes that people may feel differently about committing suicide after the passage of a suicidal crisis, that suicide cannot be reversed, and that it has traumatic implications for the survivors. The issue of professional liability and malpractice is also discussed. The present author maintains there are higher-order values to be considered and protected. (PsycINFO Database Record (c) 2011 APA, all rights reserved)