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)     

Psychologists and hospice: Where we are and where we can be.

Since the early days of the hospice movement, the role of psychologists in hospice care has been discussed. This study is based on questionnaire responses from hospice programs randomly drawn from those who were members of the National Hospice and Palliative Care Organization. The results clearly demonstrate the need for psychology's role in hospice, but there is much to do to clarify and develop this role. Although psychologists have much to offer in the hospice field and end-of-life care in general, this study found that there are not many psychologists actively working in these settings. Suggestions are made for how psychologists can become more involved in the provision of hospice and other end-of-life care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rational suicide among patients who are terminally ill

Patients' end-of-life decisions challenge nurses. Often, aggressive, life prolonging strategies create ethical dilemmas for nurses when patients decide to stop treatment. In Oregon, assisted suicide is legal and will have a profound effect on nursing practice. When a patient considers suicide, nurses need to examine the patient's mental health, symptom management, and rational decision-making ability. Evaluation of suicide risk is a priority. Nurses need to recognize that medical land psychological symptoms often trigger thoughts of suicide, but prompt treatment of pain and symptoms also reduces suicide risk. Ethical issues and guidelines for management of patients considering suicide and evaluation of rationality are presented.     

The role of the psychologist in determining competence for assisted suicide/euthanasia in the terminally ill.

This paper discusses the history of assisted suicide/euthanasia and public attitudes in Canada; discusses depression in the terminally ill and the potential role of the psychologist in the assisted suicide/ euthanasia process; and specifically addresses the importance of determining competence in terminally ill patients. One area in which the services of psychologists have not been used to their fullest potential is in the care of the terminally ill, particularly in helping them make end-of-life decisions. It is very important that individuals making end-of-life decisions be assessed for mental disorders in order to ensure they are able to make competent decisions. If assisted suicide and euthanasia were to become legalized, psychologists should be involved in the assessment process in order to determine competency. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological consultation under Oregon's 1994 Death With Dignity Act: Ethics and Procedures.

The Oregon 1994 Death With Dignity Act prescribes an evaluation by a psychologist or psychiatrist when the patient is suspected to be suffering from impaired judgment. Several attempts have been made to propose procedures for assessing end-of-life mental conditions and competence. The psychologist's role may include ethical considerations, protecting patients' rights to autonomy, ensuring competent judgment, preventing unnecessary suffering and inappropriate diagnoses of mental disorders, and supporting family members and the health care team. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Steps to improve the quality of life for people who are dying.

Congress has largely ignored the public health crisis of pain and symptom management in the United States. However, the state of Oregon has taken several steps to improve quality of life for people who are dying. The author has also worked to improve the care provided to the terminally ill by introducing the Conquering Pain Act, by asking the General Accounting Office to explore why people do not receive their full hospice benefit, and by examining ways to respond to the mental health issues associated with dying. The author believes that quality end-of-life care is both a right and a responsibility and that it deserves immediate attention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Advances in hospice care

Hospice care developed in part as a reaction to the impersonal and technology-dependent end-of-life care offered by modern medicine. Unique approaches to care that emphasize interdisciplinary team management of troublesome symptoms and the promotion of quality of life as defined by the patient, are finding their way into all aspects of health care. Symptom control measures have expanded to include chemotherapy, radiation therapy, and multimodal therapies. Both the development of a unique knowledge base and advances in research have fostered the integration of hospice and palliative care into mainstream medicine.     

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)     

Physician-assisted dying: Review of issues and roles for health psychologists.

The authors review the recent empirical and theoretical literature on physician-assisted dying (PAD) since implementation of the Oregon Death With Dignity Act (ODDA) in 1997. The authors provide a brief overview of end-of-life practices; consider ethical and practical issues regarding PAD; outline governments' acts and health care organizations' current codified principles regarding PAD, including the American Psychological Association's goal to increase the visibility of psychology in end-of-life issues; examine recent data pertinent to ODDA implementation and psychologists' attitudes regarding PAD; and outline potential roles for health psychologists responding to requests for PAD and implementing PAD (where it is legal). Health psychologists can assume at least 4 roles regarding PAD: (a) policy advocates, (b) educators, (c) practitioners, and (d) researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

End-of-life algorithms.

Tools and strategies for eliciting patient preferences for end-of-life care are often absent, of poor quality, or ignored. The American Medical Association's Council on Ethical and Judicial Affairs has proposed new guidelines for the "optimal use" of advance directives. The guidelines urge the use of detailed work sheets in "tailoring end-of-life care to patients' preferences" and suggest a process to be followed by physicians in educating patients about death and dying. However, these well-intentioned guidelines face 3 key obstacles: the negative consequences of "ritualizing" end-of-life planning, physicians' inclination to disdain and to delegate to others communication about end-of-life preferences, and the tardiness of medical pedagogy in emphasizing end-of-life care and communication as crucial for the success of future physicians. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

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)     

Relationship of psychosocial and background variables to older adults' end-of-life decisions.

Aims were to determine acceptability of a full range of end-of-life decision options and identify related variables; 388 Black and White older adults ages 60–100 responded to 17 decision situations depicting terminal and nonterminal conditions with a very low quality of life, rating the acceptability of 7 end-of-life options per decision situation, and completed demographic, health, and psychosocial measures. Despite low quality of life, maintaining life (striving to live and seeking treatment) was the most acceptable option, but a significant minority of participants wished to end life (suicide, assisted suicide, or euthanasia) and a moderate number wished to defer the decision to others. In hierarchical regressions, psychosocial variables (religiosity, values, fear of death, etc.) contributed significantly (p?     

Tumor cell recognition by lymphocytes: is the MHC always essential?

More than a year has passed since the Center to Improve Care of the Dying and the Corcoran Gallery of Art sponsored the symposium entitled: A Good Dying: Shaping Health Care for the Last Months of Life. Using the National Hospice Foundation sponsored exhibition, Hospice: A Photographic Inquiry, as a backdrop, the symposium included presentations on the current state of hospice care as well as the obstacles that limit access to hospice care. This article represents an update on many of the activities of the National Hospice Organization and the greater hospice community as we continue to improve access to quality hospice care.     

Suicide after discharge from psychiatric inpatient care

People with a history of psychiatric disorder are at higher risk of suicide than people without such a history. The policy of reducing inpatient care in psychiatry has probably meant that some of the risk of suicide has shifted from the hospital to the community setting. We have quantified the risk of suicide within a year of psychiatric discharge in a population-based study in the Oxford health region, UK. We calculated suicide rates per 1000 person-years at risk (time from discharge to death, subsequent readmission, or the end of the study) and the standardised mortality ratio (SMR) for suicide, taking the value among the general population as 1. Among male patients the SMR for suicide (defined by coroner's verdict of suicide) in the first 28 days after discharge from inpatient care was 213 (95% CI 137-317); the equivalent SMR for female patients was 134 (67-240). The result was similar when we defined suicide more broadly as a suicide, open, or misadventure verdict. The suicide rate in the first 28 days after discharge was 7.1 (4.1-12) times higher for male patients and 3.0 (1.5-6.0) times higher for female patients than the rate during the remaining 48 weeks of the first year after discharge. Most of the patients studied (both those who committed suicide and those who did not) had been psychiatric inpatients for only a short time. The findings confirm that there is significant clustering of suicide soon after discharge from psychiatric care. Skilled support after discharge for high-risk patients in the community is essential. Audit of suicides that occur soon after discharge may help identify the patients at highest risk and thereby reduce the number of avoidable deaths.     

Ethics in hospice care.

Discusses 4 ethical issues that arise in hospice care: (1) What are the ethical responsibilities to the patient, family, and authorities when hospice workers discover that a patient has been given incompetent and shoddy care at a previous institution? (2) Hospices that advertise themselves as offering complete care should be prepared to deal with psychological and legal issues as well as medical ones. (3) The idea of treating the entire person must include responding to the likelihood that the patient and family may raise profound philosophical and religious questions. (4) Hospice staff should periodically examine themselves on a spiritual or philosophical level. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A report of an investigation of end-of-life care practices in health care facilities and the influences on those practices

In 1992, 82.2% of deaths in Alberta occurred in acute care hospitals or continuing care facilities. This paper outlines the end-of-life care of adult inpatients who died that year in four such facilities (n = 137). CPR was an infrequent end-of-life treatment modality (2.9%), in stark contrast to the extensive use of other medical technologies. Almost every inpatient (94.2%) died with one or more technologies in continuous operation. Although reasons were infrequently given, the desire to promote patient comfort was the most frequent influence on end-of-life technology use. The findings of this study raise issues for debate and further investigation. Chief among these issues is whether or not medical technologies promote comfort during the dying process.     

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)