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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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    Back to Module 5: Physician-Assisted Suicide Debate
    Important Questions about Physician-Assisted Suicide

    Why Do Patients Request Physician-Assisted Suicide? 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

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    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

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    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:
    • 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
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