Assisted suicide Archives - Page 8 of 11 - Protection of Conscience Project Library

Euthanasia is not medical treatment

J Donald Boudreau, Margaret A. Somerville

Abstract
Introduction or background
The public assumes that if euthanasia and assisted suicide were to be legalized they would be carried out by physicians.
Sources of data
In furthering critical analysis, we supplement the discourse in the ethics and palliative care literature with that from medical education and evolving jurisprudence.
Areas of agreement
Both proponents and opponents agree that the values of respect for human life and for individuals’ autonomy are relevant to the debate.
Areas of controversy
Advocates of euthanasia and assisted suicide give priority to the right to personal autonomy and avoid discussions of harmful impacts of these practices on medicine, law and society. Opponents give priority to respect for life and identify such harmful effects. These both require euthanasia to remain legally prohibited.
Growing points
Proposals are emerging that if society legalizes euthanasia it should not be mandated to physicians.
Areas timely for developing research
The impact of characterizing euthanasia as ‘medical treatment’ on physicians’ professional identity and on the institutions of medicine and law should be examined in jurisdictions where assisted suicide and euthanasia have been de-criminalized.

Boudreau JD, Somerville MA. Euthanasia is not medical treatment. Br Med Bull. 2013;106(1):45-66.

(Correspondence) Redefining Physicians’ Role in Assisted Dying

Edward Lowenstein, Marcia Angell

New England Journal of Medicine, NEJM — New England Journal of Medicine

Extract
To the Editor: As two of the original petitioners to bring a Death with Dignity Act before Massachusetts voters, we are pleased that Prokopetz and Lehmann believe “there is a compelling case for legalizing assisted dying,” as they state in their Perspective article (July 12 issue).¹ However, we oppose their idea that physicians who agree that assisted dying is sometimes indicated might outsource the actual writing of the prescription to a government agency, presumably because they find that final step “incompatible with the physician’s role as healer” (in the words of the statement on the subject by the American Medical . . .

Angell M., Lowenstein E. Letter re: Redefining Physicians’ Role in Assisted Dying. N Engl J Med 2013; 368:485-486 January 31, 2013 DOI: 10.1056/NEJMc1209798

Assisted dying – the current situation in Flanders: euthanasia embedded in palliative care

Paul Vanden Berghe, Arsène Mullie, Marc Desmet, Gert Huysmans

Journal Summary
In Flanders (the Dutch-speaking, northern part of Belgium), in the course of the last ten years, physician-assisted dying and euthanasia have become embedded in palliative care. Paul Vanden Berghe, Arsène Mullie, Marc Desmet and Gert Huysmans, from the Federation of Palliative Care Flanders, describe how this major change happened and what issues it raises.

Berghe PV, Mullie A, Desmet M, Huysmans G. Assisted dying – the current situation in Flanders: euthanasia embedded in palliative care. European J Palliative Care. 2013;20(6):266-272.

Death by request in Switzerland: Post-traumatic stress disorder and complicated grief after witnessing assisted suicide

B Wagner, J Müller, A Maercker

Abstract
Background: Despite continuing political, legal and moral debate on the subject, assisted suicide is permitted in only a few countries worldwide. However, few studies have examined the impact that witnessing assisted suicide has on the mental health of family members or close friends.
Methods: A cross-sectional survey of 85 family members or close friends who were present at an assisted suicide was conducted in December 2007. Full or partial Post-Traumatic Distress Disorder (PTSD; Impact of Event Scale–Revised), depression and anxiety symptoms (Brief Symptom Inventory) and complicated grief (Inventory of Complicated Grief) were assessed at 14 to 24 months post-loss.
Results: Of the 85 participants, 13% met the criteria for full PTSD (cut-off 35), 6.5% met the criteria for subthreshold PTSD (cut-off 25), and 4.9% met the criteria for complicated grief. The prevalence of depression was 16%; the prevalence of anxiety was 6%.
Conclusion: A higher prevalence of PTSD and depression was found in the present sample than has been reported for the Swiss population in general. However, the prevalence of complicated grief in the sample was comparable to that reported for the general Swiss population. Therefore, although there seemed to be no complications in the grief process, about 20% of respondents experienced full or subthreshold PTSD related to the loss of a close person through assisted suicide.

Wagner B, Müller J, Maercker A. Death by request in Switzerland: Post-traumatic stress disorder and complicated grief after witnessing assisted suicide. European Psychiatry. 2012; 27(7): 542-546.

Recognizing conscience in abortion provision

Lisa Harris

Extract
The exercise of conscience in health care is generally considered synonymous with refusal to participate in contested medical services, especially abortion. This depiction neglects the fact that the provision of abortion care is also conscience-based. The persistent failure to recognize abortion provision as “conscientious” has resulted in laws that do not protect caregivers who are compelled by conscience to provide abortion services, contributes to the ongoing stigmatization of abortion providers, and leaves theoretical and practical blind spots in bioethics with respect to positive claims of conscience — that is, conscience-based claims for offering care, rather than for refusing to provide it.

Harris L. Recognizing conscience in abortion provision. N Engl J Med 2012; 367:981-983

Redefining Physicians’ Role in Assisted Dying

Julian J.Z. Prokopetz, Lisa Soleymani Lehmann

Journal Summary
Data from places with legal assisted dying have allayed concerns about potential abuses and patient safety, but a lingering challenge comes from the medical establishment. Creating a centralized mechanism for prescribing lethal medication could overcome this hurdle.

Prokopetz JJZ, Lehmann LS. Redefining Physicians’ Role in Assisted Dying. N Engl J Med 2012; 367:97-99 July 12, 2012

What makes killing wrong?

Walter Sinnott-Armstrong, Franklin G Miller

Abstract
What makes an act of killing morally wrong is not that the act causes loss of life or consciousness but rather that the act causes loss of all remaining abilities. This account implies that it is not even pro tanto morally wrong to kill patients who are universally and irreversibly disabled, because they have no abilities to lose. Applied to vital organ transplantation, this account undermines the dead donor rule and shows how current practices are compatible with morality.

Sinnott-Armstrong W, Miller FG. What makes killing wrong? J Medical Ethics 2013;39:3-7.

‘To thine own self be true’: On the loss of integrity as a kind of suffering

Henri Wijsbek

Abstract
One of the requirements in the Dutch regulation for euthanasia and assisted suicide is that the doctor must be satisfied ‘that the patient’s suffering is unbearable, and that there is no prospect of improvement.’ In the notorious Chabot case, a psychiatrist assisted a 50 year old woman in suicide, although she did not suffer from any somatic disease, nor strictly speaking from any psychiatric condition. In Seduced by Death, Herbert Hendin concluded that apparently the Dutch regulation now allows physicians to assist anyone in suicide simply because he or she is unhappy. In this paper, I reject Hendin’s conclusion and in particular his description of Mrs Boomsma as someone who was ‘simply unhappy.’ After a detailed narration of her lifestory, I turn to the American philosopher Harry Frankfurt’s account of volitional incapacity and love for a more accurate characterization of her suffering. Having been through what she had, she could only go on living as another person than the one she had been when she was a happy mother. That would have violated her integrity, and that she could not bring herself to do.

Wijsbek H. ‘To thine own self be true’: On the loss of integrity as a kind of suffering. Bioethics. 2012 Jan;26(1):1-7.

Process and Outcomes of Euthanasia Requests Under the Belgian Act on Euthanasia: A Nationwide Survey

Yanna Van Wesemael, Joachim Cohen, Johan Bilsen, Tinne Smets, Bregje D Onwuteaka-Philipsen, Luc Deliens

Abstract
Context: Since 2002, the administration of a lethal drug by a physician at the explicit request of the patient has been legal in Belgium. The incidence of euthanasia in Belgium has been studied, but the process and outcomes of euthanasia requests have not been investigated.

Objectives: To describe which euthanasia requests were granted, withdrawn, and rejected since the enactment of the euthanasia law in terms of the characteristics of the patient, treating physician, and aspects of the consultation with a second physician.

Methods: A representative sample of 3006 Belgian physicians received a questionnaire investigating their most recent euthanasia request.

Results: The response rate was 34%. Since 2002, 39% of respondents had received a euthanasia request. Forty-eight percent of requests had been carried out, 5% had been refused, 10% had been withdrawn, and in 23%, the patient had died before euthanasia could be performed. Physicians’ characteristics associated with receiving a request were not being religious, caring for a high number of terminally ill patients, and having experience in palliative care. Patient characteristics associated with granting a request were age, having cancer, loss of dignity, having no depression, and suffering without prospect of improvement as a reason for requesting euthanasia. A positive initial position toward the request from the attending physician and positive advice from the second physician also contributed to having a request granted.

Conclusion: Under the Belgian Act on Euthanasia, about half of the requests are granted. Factors related to the reason for the request, position of the attending physician toward the request, and advice from the second physician influence whether a request is granted or not.

Wesemael YV, Cohen J, Bilsen J, Smets T, Onwuteaka-Philipsen BD, Deliens L. Process and outcomes of Euthanasia Requests Under the Belgian Act on Euthanasia: A Nationwide Survey. J Pain Symptom Manage. 2011 May 16;42(5):721-733.

Physician-assisted deaths under the euthanasia law in Belgium: A population-based survey

Kenneth Chambaere, Johan Bilsen, Joachim Cohen, Bregje D Onwuteaka-Philipsen, Freddy Mortier, Luc Deliens

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Abstract
Background: Legalization of euthanasia and physician-assisted suicide has been heavily debated in many countries. To help inform this debate, we describe the practices of euthanasia and assisted suicide, and the use of life-ending drugs without an explicit request from the patient, in Flanders, Belgium, where euthanasia is legal.

Methods: We mailed a questionnaire regarding the use of life-ending drugs with or without explicit patient request to physicians who certified a representative sample (n = 6927) of death certificates of patients who died in Flanders between June and November 2007.

Results: The response rate was 58.4%. Overall, 208 deaths involving the use of life-ending drugs were reported: 142 (weighted prevalence 2.0%) were with an explicit patient request (euthanasia or assisted suicide) and 66 (weighted prevalence 1.8%) were without an explicit request. Euthanasia and assisted suicide mostly involved patients less than 80 years of age, those with cancer and those dying at home. Use of life-ending drugs without an explicit request mostly involved patients 80 years of older, those with a disease other than cancer and those in hospital. Of the deaths without an explicit request, the decision was not discussed with the patient in 77.9% of cases. Compared with assisted deaths with the patient’s explicit re quest, those without an explicit request were more likely to have a shorter length of treatment of the terminal illness, to have cure as a goal of treatment in the last week, to have a shorter estimated time by which life was shortened and to involve the administration of opioids.

Interpretation: Physician-assisted deaths with an explicit patient request (euthanasia and assisted suicide) and without an explicit request occurred in different patient groups and under different circumstances. Cases without an explicit request often involved patients whose diseases had unpredictable end-of-life trajectories. Although opioids were used in most of these cases, misconceptions seem to persist about their actual life-shortening effects.

Chambaere K, Bilsen J, Cohen J, Onwuteaka-Philipsen BD, Mortier F, Deliens L. Physician-assisted deaths under the euthanasia law in Belgium: A population-based survey. Can Med Assoc J. 2010 Jun 15;182(9):895-901.