The implementation of Oregon's Death with Dignity Act: Reassuring, but more data are needed.

Undoubtedly, empirical data from Oregon will play a key role for academics, legislators, judges, and the public as debate over the legalization of physician-assisted suicide continues. A central issue in the debate is whether a right to assisted suicide can be limited to only the truly compelling cases, or whether it will in practice be provided to patients who choose it out of depression, coercion, or misunderstanding. Empirical research can provide critical insights into this question. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

The Chabot case. Assisted suicide from the psychiatric viewpoint

The international discussion on physician-assisted dying as well as the recent development in North Australia and Oregon point to a growing tendency to favour assisted suicide as against killing on request--last not least for reasons of public acceptance. The decision of the Supreme Court of the Netherlands in a case of suicide assisted by a psychiatrist gives the opportunity to discuss the problem from the psychiatric point of view.     

A call for civility in the disability/assisted suicide debate.

The debate over legalization of physician-assisted suicide is inherently controversial, particularly where disability issues and physician-assisted suicide intersect. This is the area addressed by C. J. Gill (see record 2001-17060-021) and A. I. Batavia (see record 2001-17060-022) in this journal's recent special issue on hastened death. In replying to Batavia's commentary, Gill accused Batavia of generally misrepresenting Gill's positions and distorting facts. Here Batavia replies to the alleged errors that Gill identified. Batavia defends his assumption that, without state interference in the private relationship between individuals and their physicians, such individuals would be able to end their suffering with the assistance of their physicians. There was very little data to cite on the level of support of disabled people for a right to assisted suicide. Individuals who lack adequate opportunity to adapt to their disabilities cannot exercise real autonomy in choosing to end their lives. Batavia contends that most people with disabilities support the right to remove life-sustaining equipment, mirroring a strong consensus in American law and ethics that individuals should be allowed to refuse care they do not want. (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)     

How to deal with requests for assisted suicide: Some experiences and practical guidelines from the Netherlands.

In the Netherlands, physician-assisted suicide may be justifiable for patients with physical illness as well as for patients with unbearable mental suffering. Explicit requests for physician-assisted suicide are frequently made, but in psychiatric practice they are infrequently granted. In this contribution, some information on the Dutch practices related to assisted death is presented, with emphasis on assisted suicide in patients with unbearable mental suffering. The aim of this contribution is to demonstrate that the Dutch law and jurisprudence permit clinicians to deal effectively with requests for assisted suicide. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic death: A look at Oregon's law.

Oregon voters approved the first American statute authorizing physician-assisted suicide, the Oregon Death With Dignity Act, in 1994. The authors of this article identify some positive and negative psychological effects of laws such as Oregon's on patients. Generally, they conclude, on the basis of psychological theory and the available data, that laws such as Oregon's benefit patients psychologically. Undoubtedly, however, there exist important possible antitherapeutic effects on patients, and the authors hope that discussion of both therapeutic and antitherapeutic consequences will stimulate future research by social scientists in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physician-assisted suicide: the dangers of legalization

The authors examine physician-assisted suicide in the light of what is known about suicide and terminal illness, exploring the potential for abuse if legalization occurs. The elderly, those frightened by illness, and the depressed of all ages would be potential victims. The authors discuss the cases that have received public attention as illustrative of these abuses.     

Misconceived sources of opposition to physician-assisted suicide.

This article addresses 2 prominent sources of opposition to physician-assisted suicide (PAS): first, the fear of abuse and, second, common moral distinctions drawn between PAS and other forms of end-of-life decisions and care. Each is grounded in a false assumption that PAS is radically different from other forms of widely accepted end-of-life decisions and care. The experience to date in Oregon gives some reassurance that the practice there permitting PAS has not been significantly abused. Moreover, the author argues that abuse, understood as decisions not in accord with what the patient wants, or would have wanted, is greatest when someone, other than the patient is the decision maker. On this ground, PAS should be less subject to abuse than other surrogate decisions about life support. Moreover, Oregon's law, like virtually all proposals to legalize PAS, contains numerous safeguards that are not present in decisions about life support generally. Second, it is argued that some prominent conceptualizations of accepted end-of-life decisions and care thought to distinguish them morally from PAS fail on closer analysis to do so. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of sotalol hydrochloride therapy on atrial signal-averaged ECG in patients with paroxysmal atrial fibrillation

BACKGROUND: There has been a continuing public debate about assisted suicide and the proper role, if any, of physicians in this practice. Legislative bans and various forms of legalization have been proposed. METHODS: We mailed questionnaires to three stratified random samples of Michigan physicians in specialties likely to involve the care of terminally ill patients: 500 in the spring of 1994, 500 in the summer of 1994, and 600 in the spring of 1995. Similar questionnaires were mailed to stratified random samples of Michigan adults: 449 in the spring of 1994 and 899 in the summer of 1994. Several different questionnaire forms were used, all of which included questions about whether physician-assisted suicide should be banned in Michigan or legalized under certain conditions. RESULTS: Usable questionnaires were returned by 1119 of 1518 physicians eligible for the study (74 percent), and 998 of 1307 eligible adults in the sample of the general public (76 percent). Asked to choose between legalization of physician-assisted suicide and an explicit ban, 56 percent of physicians and 66 percent of the public support legalization, 37 percent of physicians and 26 percent of the public preferred a ban, and 8 percent of each group were uncertain. When the physicians were given a wider range of choices, 40 percent preferred legalization, 37 percent preferred "no law" (i.e., no government regulation), 17 percent favored prohibition, and 5 percent were uncertain. If physician-assisted suicide were legal, 35 percent of physicians said they might participate if requested--22 percent would participate in either assisted suicide or voluntary euthanasia, and 13 percent would participate only in assisted suicide. Support for physician-assisted suicide was lowest among the strongly religious. CONCLUSIONS: Most Michigan physicians prefer either the legalization of physician-assisted suicide or no law at all; fewer than one fifth prefer a complete ban on the practice. Given a choice between legalization and a ban, two thirds of the Michigan public prefer legalization and one quarter prefer a ban.     

Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public

BACKGROUND: Euthanasia and physician-assisted suicide are pressing public issues. We aimed to collect empirical data on these controversial interventions, particularly on the attitudes and experiences of oncology patients. METHODS: We interviewed, by telephone with vignette-style questions, 155 oncology patients, 355 oncologists, and 193 members of the public to assess their attitudes and experiences in relation to euthanasia and physician-assisted suicide. FINDINGS: About two thirds of oncology patients and the public found euthanasia and physician-assisted suicide acceptable for patients with unremitting pain. Oncology patients and the public found euthanasia and physician-assisted suicide least acceptable in vignettes involving "burden on the family" and "life viewed as meaningless". In no vignette--even for patients with unremitting pain--did a majority of oncologists find euthanasia or physician-assisted suicide ethically acceptable. Patients actually experiencing pain were more likely to find euthanasia or physician-assisted suicide unacceptable. More than a quarter of oncology patients had seriously thought about euthanasia or physician-assisted suicide and nearly 12 percent had seriously discussed these interventions with physicians or others. Patients with depression and psychological distress were significantly more likely to have seriously discussed euthanasia, hoarded drugs, or read Final Exit. More than half of oncologists had received requests for euthanasia or physician-assisted suicide. Nearly one in seven oncologists had carried out euthanasia or physician-assisted suicide. INTERPRETATION: Euthanasia and physician-assisted suicide are important issues in the care of terminally ill patients and while oncology patients experiencing pain are unlikely to desire these interventions patients with depression are more likely to request assistance in committing suicide. Patients who request such an intervention should be evaluated and, where appropriate, treated for depression before euthanasia can be discussed seriously.     

Attitudes of Oregon psychologists toward physician-assisted suicide and the Oregon Death With Dignity Act.

Since the passage of the Oregon Death With Dignity Act (ODDA), psychologists have been grappling with how to fulfill their legally specified role in the process of physician-assisted suicide. We surveyed 423 Oregon psychologists (aged 31–76 yrs) to elicit their views on assisted suicide and the process of assessing patients who request such assistance. There was a high degree of support for assisted suicide and the ODDA, but also a minority who were highly opposed. Most survey respondents raised ethical or practical concerns with their role as assessors. Many important questions about how evaluations in this complex area should be conducted remain unanswered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors to consider before participating in a hastened death: Issues for medical professionals.

An emerging problem that health professionals face in working with terminally ill patients is how to respond to the concerns and conflicts that emerge near the end of life. Most important are those that challenge the traditional healing, caring, and therapeutic roles. Among these, perhaps none has drawn as much attention as the issue of physician-assisted dying—particularly what has been termed assisted suicide. Although the ethics of assisted dying have been actively debated by ethicists for decades, the topic is now being discussed with increasing frequency in medical, psychiatric, psychological, and legal journals. Interest has been driven by the interrelationship of changing public opinion, demographics, and the nature of the dying process; admissions of assistance by numerous physicians; and several statewide attempts at legal change, culminating in a successful voters' initiative in Oregon. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Legalization of assisted suicide. A pilot study of gerontological nurses

1. Legalization of physician-assisted suicide poses serious challenges to the Code for Nurses of the ANA, particularly in the areas of self-determination and autonomy versus sanctity of life. 2. Nurses in this pilot study were divided in their support of legalization of physician-assisted suicide for all ages (46 in favor, 54 opposed) but showed stronger support for legalization when applied to the elderly (58 in favor, 42 opposed). 3. No demographic variables realized statistical significance toward attitudes on the legalization of physician-assisted suicide or its legalization as applied to the elderly. 4. While supported conceptually, the actual practice of physician-assisted suicide was not supported by many who were in favor of legalization of physician-assisted suicide.     

Limits on legitimacy: Moral and religious convictions as constraints on deference to authority.

Various versions of legitimacy theory predict that a duty and obligation to obey legitimate authorities generally trumps people’s personal moral and religious values. However, most research has assumed rather than measured the degree to which people have a moral or religious stake in the situations studied. This study tested compliance with and reactions to legitimate authorities in the context of a natural experiment that tracked public opinion before and after the U.S. Supreme Court ruled in a case that challenged states’ rights to legalize physician-assisted suicide. Results indicated that citizens’ degree of moral conviction about the issue of physician-assisted suicide predicted post-ruling perceptions of outcome fairness, decision acceptance, and changes in perceptions of the Court’s legitimacy from pre- to post-ruling. Other results revealed that the effects of religious conviction independently predicted outcome fairness and decision acceptance but not perceptions of post-ruling legitimacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physicians' decisions about patient capacity: The Trojan horse of physician-assisted suicide.

Even if all physicians follow elaborate guidelines in determining patient capacity, their judgments will remain subjective and heavily influenced by their own personal values. Capacity guidelines are the Trojan horse of physician-assisted suicide, because their appealing and reasonable character conceals the real decision-making power placed in the hands of physicians, who in reality evaluate the patient's quality of life. We should instead concentrate our efforts on a better alternative: quality palliative care for all. (PsycINFO Database Record (c) 2010 APA, all rights reserved)