Trends in Medical Aid in Dying in Oregon and Washington

Rabadi, Luai Al; LeBlanc, Michael; Bucy, Taylor; Ellis, Lee M.; Hershman, Dawn L.; Meyskens, Frank L.; Taylor, Lynne; Blanke, Charles D.

doi:10.1001/jamanetworkopen.2019.8648

Cited by 47 publications

(43 citation statements)

References 9 publications

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“…Both the legality of euthanasia and assisted suicide (AS) as well as the adequacy of corresponding regulations to prevent abuse of these practices remain controversial and are the subject of considerable debate in medicine [1,2], ethics [3,4], law [5], at the intersection between medicine, humanities and social sciences [6,7], as well as in the mainstream media [8][9][10][11][12]. This long-standing debate aims to balance considerations of self-determination and a "right to die", protection of patients and healthcare providers, and other ethical, legal and medical issues that arise when ending human life.…”

Section: Introductionmentioning

confidence: 99%

Associations of end-of-life preferences and trust in institutions with public support for assisted suicide evidence from nationally representative survey data of older adults in Switzerland

et al. 2020

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The legality of euthanasia and assisted suicide (AS) and nature of regulations of these practices remain controversial and the subject of lively debate among experts and the general public. Our study investigates attitudes and behaviours towards AS among older adults in Switzerland where the practice of AS has a relatively long history and remains rather unregulated. We aim to explore how individuals' preferences regarding their end of life, as well as individuals' trust in institutions involved in the practice or control of AS are associated with attitudes and behaviours towards AS. We analyse nationally representative data of adults aged 55 and over from wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland (n = 2,145). While large majorities supported current legal arrangements around AS in Switzerland (81.7%) and stated that they could consider AS for themselves under certain circumstances (61.0%), only a minority either was a member of a right-to-die organisation already (4.9%) or stated they were likely to become a member of such an organisation (28.2%). Stated preferences for control over the end of life and for maintaining essential capabilities at the end of life showed a positive association with AS-related attitudes and behaviours, whereas preferences for feeling socially and spiritually connected, as well as for not being a burden displayed a negative association with our outcomes. Higher levels of trust in one's relative were positively associated with both support for the legality of AS and potential use of AS. A positive association was also found between trust in the Swiss legal system and support for the legality of AS. By contrast, trust in religious institutions displayed a negative association with all five AS-related attitudes and behaviours. Similarly, trust in healthcare insurance companies was negatively associated with potential use of AS. Taken together, older adults were generally supportive towards current practices regarding AS. This approval appears to be closely related to individuals' preferences and, at different extends, to trust in social and public institutions with regard to end-of-life issues, which is relatively high in Switzerland.

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Section: Introductionmentioning

confidence: 99%

Associations of end-of-life preferences and trust in institutions with public support for assisted suicide evidence from nationally representative survey data of older adults in Switzerland

et al. 2020

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“…Studies indicate that pain is not typically the primary motivation for requesting euthanasia or physician-assisted suicide; inadequate pain control is seen in less than 33% of patients (7). Loss of autonomy, diminished quality of life and loss of dignity are the factors most frequently associated with requests for assisted dying (22). Loss of dignity is identified as the basis for requests in 61% of cases in the Netherlands and 52% in Belgium (7).…”

Section: Motivation For Requests and Patient Demographicsmentioning

confidence: 99%

Assisted dying around the world: a status quaestionis

Mroz¹,

Dierickx²,

Deliëns³

et al. 2021

Ann Palliat Med

134

120

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Assisted dying practices, which include euthanasia and physician-assisted suicide (PAS), have expanded significantly around the world over the past 20 years. Euthanasia refers to the act of intentionally ending the life of a patient by a health care practitioner through medical means at that patient's explicit request while PAS involves the provision or prescribing of drugs by a health care practitioner for a patient to end their own life. The growing global aging population accompanied by higher levels of chronic disease and protracted illnesses have sharpened the focus on end of life issues and societal and legislative debates continue to address related moral and ethical complexities. Assisted dying practices are now legal in 18 jurisdictions, increasing the number of people with access to euthanasia and/or physician-assisted suicide (PAS) to over 200 million. New legislation is being crafted or considered in Portugal, Spain and 16 US states. Germany has recently overturned a ban on assisted dying services and New Zealand will put legalization of euthanasia to a vote in 2020. Assisted dying practice characteristics differ and there is also considerable variation in the terminology and labels used for assisted dying, which can add to the confusion and controversy around the practices. Frequency of use also varies greatly by jurisdiction, though a consistent increase has been seen in European countries including Belgium, the Netherlands and Switzerland as well as some jurisdictions with long-standing physician assisted dying laws, such as Oregon and Washington. All assisted dying legislation includes substantive and procedural requirements, such as minimum age, waiting period, health condition, physician consultation and reporting procedure, however, some are extensive and detailed while others are more limited. As access to assisted dying expands in new and existing jurisdictions, research must also expand to diligently examine the impact on patients, specifically among vulnerable populations, as well as on health care practitioners, health care systems and communities. This article will provide a thorough investigation, or 'status quaestionis' of the terminology, evolution and current legislative picture of assisted dying practices around the globe and contribute to the ongoing ethical, regulatory and practice debate, which have become increasingly important considerations for medical practice, end-of-life care and public health.

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“…Although this predilection is often advantageous for scientific progress, it introduces a problematic bias when applied to ethical questions. The appeal of the study by Al Rabadi et al 1 is that it is empirical, and by comparing data from 2 states for the first time, it can be considered novel. Because there are new reports each year and the practice of PAS is legal in only a few states, descriptive reports about PAS are published frequently.…”

Section: Cautionsmentioning

confidence: 99%

“…Those who make use of the law tend to be white, wealthy, and educated. 1,3 Despite public arguments that PAS is needed to avoid excruciating pain and other symptoms, the reasons attributed to patients who seek PAS are not uncontrolled symptoms but lost autonomy, independence, and control. 1,3 About one-third of patients die without taking the drugs, 3 which may suggest that patients only wanted the security of having a way out, but it could equally indicate that they died before using the drugs or changed their minds about using them.…”

Section: What We Knowmentioning

confidence: 99%

Physician-Assisted Suicide and the Perils of Empirical Ethical Research

Sulmasy

2019

JAMA Netw Open

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Al Rabadi et al 1 compare statistics on physician-assisted suicide (PAS) available from public databases for the states of Washington and Oregon and find similar profiles and trends, which is unsurprising given the similarity of the laws and demographic characteristics of these states. Among the unanswered questions are what such a study can contribute to medical ethics (about PAS or any other ethical controversy) and what the limits are of such work.

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Trends in Medical Aid in Dying in Oregon and Washington

Cited by 47 publications

References 9 publications

Associations of end-of-life preferences and trust in institutions with public support for assisted suicide evidence from nationally representative survey data of older adults in Switzerland

Associations of end-of-life preferences and trust in institutions with public support for assisted suicide evidence from nationally representative survey data of older adults in Switzerland

Assisted dying around the world: a status quaestionis

Physician-Assisted Suicide and the Perils of Empirical Ethical Research

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