A recent interview published by New England Journal Medicine gives an overview of the doctors’ dilemmas confronting the new scenario in the Americans states where the Euthanasia Law has been approved (read HERE).
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Dr Bernard Lo is a member of the Greenwall Foundation that conforms a community of innovative bioethics researchers wwith the aims to resolve ethical dilemmas in patient care, biomedical research, and public policy.
We extract what we consider more interesting.
The interviewer said, “Because 18.2% of the U.S. population lives in jurisdictions where physician aid in dying (PAD) is now legal, physicians need to anticipate that patients may inquire about or request it. Two decades ago, when PAD was illegal throughout the United States, 18.3% of physicians reported ever having received a request for assisted suicide1; inquiries are likely to be more frequent now. But physicians may feel unprepared, uncertain, and uncomfortable when confronting these conversations, even if they’ve thought through their own position on PAD legalization.”
“After comprehensive palliative care is intensified, 46% of patients who have requested PAD change their minds.”
He suggests that “Physicians can start by clarifying what patients are asking and why. Some ways in which patients might raise the topic of PAD are listed in the box. Not every question about PAD is a request for assisted suicide. Patients might be seeking information, talking through concerns, expressing distress, or trying to ascertain the physician’s views. To clarify the patient’s motivation, physicians might say, “I’ll be glad to answer that question, but first please tell me what led you to ask.” and affirms “It’s also important for physicians to think through what actions they’re willing to take. Both physicians who support PAD and those who oppose it should try to relieve patients’ multidimensional concerns and distress. After comprehensive palliative care is intensified, 46% of patients who have requested PAD change their minds.3 “
Dr Bernard continues “Physicians who support PAD need to consider how to address the potential for adverse outcomes, including longer time to death than expected (up to 24 hours or more), awakening from unconsciousness, nausea, vomiting, and gasping.1 Reports of adverse outcomes don’t include specific information on drugs and dosages used, and how a drug will affect a particular patient is always uncertain.”
“Physicians who participate in PAD can help patients and their families plan for worst-case scenarios, such as deciding whether to call 911 if distressing symptoms develop after lethal medications are ingested. Physicians should clarify whether they or another professional, such as a hospice nurse, is willing and permitted to be present during “medication” ingestion. Some physicians who support PAD might be concerned that their presence could exert undue influence on patients who might otherwise hesitate or change their mind at the last minute. To mitigate this concern, physicians can meet privately with patients shortly before “medication” ingestion to explicitly tell them that they can change their mind without repercussions.”
What happens with doctors that oppose euthanasia law
The Doctor gives his opinion, “Physicians who oppose PAD shouldn’t stop caring for patients who ask about or request it. The physician’s professional obligation to address a patient’s suffering is particularly strong when the two have a long-term relationship. Some patients want to see their current physician for ongoing care, even knowing that the doctor respectfully opposes PAD.
“Physicians who oppose PAD understandably don’t want to compromise their moral integrity and conscience. Some might fear that discussing PAD with patients signifies support or approval and therefore makes them complicit. Complicity in PAD, however, requires clearly expressing approval, completing legal requirements, or writing a prescription for a lethal medication dose. Many physicians who oppose PAD also consider referring patients to physicians willing to provide assistance with dying to be a form of complicity.
Such physicians should instead refer patients to their state’s website about the PAD law so that patients are informed of all their options. Physicians who explore patients’ needs and concerns, try to alleviate pain and distress, and clearly state their opposition to assisted suicide aren’t complicit in PAD. Even continuing to care for a patient who has obtained a prescription from another physician need not make a physician complicit. On the contrary, by discussing the patient’s concerns and trying to address the reasons behind a request for PAD, the physician might help the patient find reasons to continue living. According to state reports from Oregon and Washington, 16% and 26%, respectively, of patients who have obtained a lethal medication did not use it”.
“19% of patients with cancer reported that they would change physicians if their doctor had participated in assisted suicide or euthanasia.”
What happens with the relationship between patients and doctors who support euthanasia law
Dr Bernard continues “Some patients might consider finding a new physician when their current physician’s views regarding PAD are discordant with their own. In one study, 2% of physicians had a patient leave their practice because of their position on PAD.5 In another, 19% of patients with cancer reported that they would change physicians if their doctor had participated in assisted suicide or euthanasia.4Patients who oppose PAD might fear that a physician who supports it would encourage them to consider it. Conversely, patients who are open to PAD might want to choose a supportive physician early in their illness. In all cases, doctors should elicit and address patients’ specific concerns and emphasize their ongoing commitment to relieving suffering.”
“Responding to inquiries about PAD is a new experience for most physicians. To fulfil their obligations to patients and be true to their own values, physicians should think through how they will respond to the challenges raised by these conversations.”
Our Observatory supports these statements founded in two permanent bioethics principles, patient autonomy and free conscience objection of medical professionals.