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Posted: April 29th, 2018
Physician assisted suicide legislation and its effect on end-of-life care
Physician assisted suicide (PAS) is a controversial and complex issue that has ethical, legal and social implications for patients, families, healthcare professionals and society. PAS refers to the practice of a physician providing a competent patient with a prescription medication to end his or her life, usually in the context of a terminal illness with a prognosis of six months or less. PAS is currently legal in some countries, such as Canada, Belgium, the Netherlands and Spain, and in some states in the USA, such as Oregon, Vermont and California. However, PAS remains illegal in many other jurisdictions, such as the UK, Germany and Australia.
The arguments for and against PAS are often based on different values and perspectives, such as autonomy, dignity, compassion, sanctity of life, quality of life and suffering. Some of the proponents of PAS claim that it respects the patient’s right to self-determination, relieves unbearable pain and distress, reduces the burden on the healthcare system and the family, and prevents violent and lonely suicides. Some of the opponents of PAS argue that it violates the Hippocratic oath, devalues human life, undermines the trust in the doctor-patient relationship, creates a slippery slope for abuse and coercion, and diminishes the role of palliative care.
PAS also has pragmatic implications for the provision and delivery of end-of-life care, especially palliative care. Palliative care is an approach that aims to improve the quality of life of patients with life-limiting illnesses and their families by addressing their physical, psychological, social and spiritual needs. Palliative care does not intend to hasten or postpone death, but rather to affirm life and regard dying as a normal process. Palliative care can offer effective symptom management, advance care planning, psychosocial support and bereavement care for patients and families facing death.
However, the legalization of PAS may have unintended consequences for palliative care, such as creating confusion about its goals and principles, reducing its accessibility and availability, compromising its quality and standards, influencing its funding and resources, affecting its education and training, and challenging its professional identity and integrity. Moreover, PAS may have an impact on the attitudes and expectations of patients and families towards end-of-life care, such as increasing the demand for hastened death, reducing the acceptance of natural death, undermining the communication and decision-making process, and influencing the grief and bereavement outcomes.
Therefore, it is important to consider the potential pragmatic implications of legalizing PAS for palliative care provision, patients and families, healthcare professionals and the broader community. More research is needed to understand the effects of PAS on end-of-life care practices and policies in different contexts and cultures. Increased resources and efforts should be directed towards improving the access and quality of palliative care for all patients with life-limiting illnesses before further consideration is given to allocating resources for legalizing PAS.
References:
– Hudson P., Hudson R., Philip J., Boughey M., Kelly B., Hertogh C. (2015). Legalizing physician-assisted suicide and/or euthanasia: Pragmatic implications. Palliative & Supportive Care 13(5), 1399-1409. https://doi.org/10.1017/S1478951515000176
– BMA (2021). Physician-assisted dying legislation around the world. https://www.bma.org.uk/media/4402/bma-where-is-pad-permitted-internationally-aug-2021.pdf
– Verywell Health (2021). The Pros of Right-to-Die Legislation. https://www.verywellhealth.com/arguments-in-favor-of-death-with-dignity-2614852
– Mossman D., Perlin M.L., Dorfman D., Glick T.H., Patel K., Gendel M.H., Noffsinger S.G., Silverman J.J., Drukteinis A.M., Giorgi-Guarnieri D., Bonnie R.J., Balboni M.J., Fitch W.L., Muskin P.R., Schouten R., Zonana H.V. (2015). Physician-Assisted Suicide: Considering the Evidence,
Existential Distress,
and an Emerging Role for Psychiatry.
Journal of the American Academy of Psychiatry
and
the Law 43(2), 183-190.
http://jaapl.org/content/43/2/183
– NHS (2018). Euthanasia and assisted suicide. https://www.nhs.uk/conditions/euthanasia-and-assisted-suicide/
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