Health Care Professionals' Attitudes About Physician-Assisted Death: An Analysis of Their Justifications and the Roles of Terminology and Patient Competency

Abstract

Context Healthcare professionals (HCPs) are crucial to physician-assisted death (PAD) provision. Objectives To quantitatively assess the favorability of justifications for or against PAD legalization among HCPs, the effect of the terms “suicide” and “euthanasia” on their views, and their support for three forms of PAD. Methods Our questionnaire presented three cases: physician-assisted suicide, euthanasia for a competent patient, and euthanasia for an incompetent patient with an advance directive for euthanasia. Respondents judged whether each case was ethical and should be legal, and selected their justifications from commonly cited reasons. The sample included physician clinicians, researchers, non-physician clinicians, and other non-clinical staff at a major academic medical center. Results Of 221 HCPs, the majority thought each case was ethical and should be legal. In order of declining favorability, justifications supporting PAD legalization were relief of suffering, right to die, mercy, acceptance of death, non-abandonment, and saving money for the healthcare system; opposing justifications were the slippery slope argument, unnecessary due to palliative care, killing patients is wrong, religious views, and suicide is wrong. Use of suicide and euthanasia terminology did not affect responses. Participants preferred physician-assisted suicide to euthanasia for a competent patient (p<0.0001) and euthanasia for an incompetent patient to euthanasia for a competent patient (p<0.005). Conclusions HCPs endorsed patient-centered justifications over other reasons, including role-specific duties. Suicide and euthanasia language did not bias HCPs against PAD, challenging claims that such value-laden terms hinder dialogue. More research is required to understand the significance of competency in shaping attitudes toward PAD.

Health Care Provider Experiences of and Perspectives on Medical Assistance in Dying: A Scoping Review of Qualitative Studies

“…Internationally, a majority of the literature on assisted dying is focused on the physician; however, some research has also examined the roles of nurses and psychiatrists (Block & Billings, 1995;Edwards, 2016;Fujioka, Mirza, McDonald, & Klinger, 2018;Groenewoud et al, 1997;Schwarz, 1999). Much of this literature, however, is focused on opinions related to the ethics of assisted dying, and whether or not the practice is justifiable (Braverman, Marcus, Wakim, Mercurio, & Kopf, 2017;Glebock Gawor, & Ostrowski, 2013). Less explored is the experience of health care professionals working with patients, caregivers, and other providers through the process of MAiD.…”

Of dilemmas and tensions: a qualitative study of palliative care physicians’ positions regarding voluntary active euthanasia in Quebec, Canada

“…Regarding non-abandonment, a similar concern was also documented among Swiss palliative care physicians, who found it difficult to accompany patients in decision-making about assisted suicide while honouring palliative care principles that do not support this practice 11. Interestingly, the theme of non-abandonment figures among the reasons that US physicians provide for supporting the decriminalisation of euthanasia 29. Research in the Netherlands has shown that tension between what physicians consider to be a good death and patients’ views and preferences can have significant implications for the implementation of physician-assisted death 30.…”

Aspectos bioéticos dos cuidados em saúde às pessoas idosas ao fim da vida [Bioethical aspects of the health care provided to older adults at the end of their lives] [Aspectos bioéticos de los cuidados de salud a adultos mayores en el final de la vida]

“…Quanto à procedência dos artigos: 45,8% foram desenvolvidos em países da América do Norte 13,14,16,18,20,22,24,26,29,33,34 , 41,7% em países da Europa 15,17,21,23,25,[30][31][32]35,36 , 8,3% em países da América do Sul 27,28 e 4,2% em um país da Oceania 19 . Os países que mais publicaram sobre esta temática foram os Estados Unidos 13,14,16,18,20,22,24,26,29,33 , seguido por Portugal 17,21,25,32 e Bélgica 23,30,31,35 .…”

“…Oito estudos compuseram esta categoria e envolveram ações 15 e procedimentos 19 relacionados à abordagem e às condutas terapêuticas em idosos próximos do fim da vida, quando os sintomas são intratáveis e refratários. Observamse cuidados como a eutanásia 22,30,31 , a morte assistida 22,31 e a sedação paliativa 23,30,31,35,36 A abordagem ética nas condutas terapêuticas frente aos cuidados ao fim da vida envolve ações de escuta, diálogo, compaixão, solicitude e manutenção da esperança, dentro da relação de cuidados, respeitando o máximo possível o grau de autonomia e atendendo às necessidades espirituais do indivíduo 15 .…”

“…A eutanásia ativa voluntária ocorre quando a morte é provocada a pedido do próprio paciente, sendo uma forma de garantia de sua autonomia. Para um paciente que não apresenta capacidade cognitiva preservada, tal cuidado é favorecido quando há uma diretriz de vontade antecipada 22 .…”