Modules:

More About:

Back to Module 5: Physician-Assisted Suicide Debate Important Questions about Physician-Assisted Suicide

Why Do Patients Request Physician-Assisted Suicide?

• General Impressions
• Research Evidence

Why Do Providers Need to be Informed about Physician-Assisted Suicide?

Why Do Patients Request Physician-Assisted Suicide?

General Impressions About Why Patients Request Physician-Assisted Suicide:

• Patients ask physicians about physician-assisted suicide (PAS) for a variety of reasons

• It is a rare patient with a life-threatening illness that doesn’t think about suicide, if only in passing

• Patients may approach the physician about PAS...

• With the intent of "thinking out loud" about their response to their present and anticipated future


• Based on life-long values


• As a plea for help, signaling a crisis where unmet needs have built up over time

• For all patients, the request for PAS should prompt the physician to assess the reasons for the request

• Patients make requests for many different reasons that usually arise from one or more of the following factors:

• Physical suffering
• Psychological suffering
• Social suffering
• Spiritual suffering
• Practical concerns

• For some patients, the request is the first expression of unrelieved suffering

^top

Research Evidence

Each person will have a unique set of needs and reasons why he or she would like to hasten death. While more research is needed, available data support a few generalizations:

• In all surveys, unrelieved psychosocial and mental suffering is the most common stimulus for requests

• In one study (van der Wal et al), patients who were depressed were 4 to 5 times more likely to have made serious inquiries about PAS or euthanasia


• Other prominent reasons for requests include fears of:


• Future suffering
• Loss of control
• Indignity
• Being a burden to others

• Physical suffering, including pain, is a less frequent motivator than many think

• In one study (van der Maas), pain alone was:


• A rare motivator in 3% of requests
• One of several motivators in 46% of requests
• Not cited as a factor at all in the remaining 51% of requests


• Nonetheless, the contribution of physical suffering is important because its anticipation is a common motivator and because it is treatable (see Module 4: Pain Management; Module 6: Anxiety, Delirium, Depression; and Module 10: Common Physical Symptoms)

^top

Why Do Providers Need to be Informed about Physician-Assisted Suicide?

• Most physicians are likely to receive a request for hastened death

• Every physician must be capable of dealing with these difficult requests in a way that:

• Responds to the needs and expectations of the patient


• Offers the best possible care that is both:
• Ethical
• Legal

• The ability to respond to requests for hastened death with realistic alternatives requires:

• A working knowledge of all aspects of palliative care


• An ability to follow usual standards for information giving. See Module 2: Communicating Bad News


• Knowledge of how to provide aggressive symptom control and supportive care. See Module 4: Pain Management and Module 10: Common Physical Symptoms


• Skill at approaches to withdraw or withhold life-sustaining interventions. See Module 11: Withholding, Withdrawing Treatment


• Awareness of the pertinent legal issues. See Module 15: Legal Issues in End-of-Life Care


• An ability to work collaboratively:


• With other health care disciplines, ideally in an interdisciplinary team


• With consultative palliative care expertise, both physicians and programs, as part of the spectrum of contemporary health care. See Module 15: Legal Issues in End-of-Life Care

• The vast majority of requests for PAS or euthanasia should abate when physicians are able to:

• Assess the root causes of the specific request
• Make a commitment to the patient’s care
• Address each of the patient’s sources of suffering
• Educate the patient about legal alternatives, and
• Seek counsel from colleagues

^top

>continue