Responding to Patients Requesting Physician-Assisted Death: Physician Involvement at the Very End of Life

• Published in: JAMA : the journal of the American Medical Association Vol. 315; no. 3; pp. 245 - 246
• Main Authors: Quill, Timothy E, Back, Anthony L, Block, Susan D
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 19-01-2016
• Subjects: Adult; Anxiety - psychology; Assisted suicide; Depression - psychology; Euthanasia, Passive; Female; Humans; Medical ethics; Mental Competency - psychology; Ovarian Neoplasms; Physician's Role; Right to die; Suicide, Assisted - legislation & jurisprudence; Suicide, Assisted - psychology; Symptom Assessment; Terminal Care; Terminal illnesses; Withholding Treatment
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2015.16210

Quill et al discuss why physician-assisted death should be considered important enough to be made legally available. Patients with serious illness wish to have control over their own bodies, their own lives, and concern about future physical and psychosocial distress. Some view potential access to physician-assisted death as the best option to address these concerns. Appropriate safeguards, as enacted into law in Oregon. Washington, Vermont, Montana, and (recently) California, create a context in which individual physicians and their patients need not act in secrecy. Patients should be informed about palliative care options (including hospice), have access to expert symptom management, have a predictable time window between making the request and receiving the prescription, and have access to mental health services if needed. In Oregon, where physician-assisted death has been legal for 18 years, 1 in 6 terminally ill patients talks with their families, 1 in 50 talks with their physician, and only 1 in 500 directly accesses this option. There are concerns about coercion, vulnerability, and slippery slopes--but these concerns have not been borne out by experience with legally open access to physician-assisted death in 4 states.