Physician Assisted Death: - PowerPoint Presentation

1. Physician Assisted Death: A Look at the Process and Associated Attitudinal ResearchEthan Thaut, PA-S2, The University Of South DakotaAbstractSince it’s infancy, physician-assisted death, a term that encompasses physician-assisted suicide and euthanasia, has been one of the most controversial topics within the healthcare industry. The ethical and legal statuses of these divisive topics continue to be debated between healthcare providers and laypeople. My research, in the form of a literature review, serves two purposes: to provide a general overview of physician-assisted death (PAD), and to review existing peer-reviewed literature concerning attitudes towards physician-assisted death. MethodA study of existing peer-reviewed research regarding PAD was performed utilizing various databases through USD’s Wegner Health Science Library. Articles were collected and analyzed during Fall 2020. The key phrases “physician assisted death” and “physician assisted suicide” were utilized during the search. A total of 13 peer-reviewed works were included in the final paper. Research that contained no empirical data was analyzed but eventually excluded from this study. Due to time and space restrictions, this poster only includes selected studies from my research.Overview of Physician Assisted DeathPhysician-assisted suicide (PAS) is characterized by a healthcare provider, most commonly a physician, providing access to a lethal dose of medication to an eligible patient. The process typically involves a physician prescribing a lethal dose of a medication to a terminally ill patient. The patient then obtains the medication from a pharmacy and ingests it at a time of their choosing. Patients typically are rendered unconscious within 5 minutes of ingestion, and death occurs in most patients within 30 minutes (Blanke et al., 2017). The practice of physician assisted suicide is currently legal in several countries, nine U.S. states, and the District of Columbia.Voluntary euthanasia, also known as active euthanasia, differs from PAS in that the physician is the one who administers the lethal dose of medication to a terminally ill patient. Typically, this process involves the intravenous injection of a sedative to induce coma, followed by an intravenous dose of a medication to paralyze the respiratory muscles causing death. Eligibility requirements for voluntary euthanasia again vary depending on location but tend to be very much the same as those for assisted suicide. Voluntary euthanasia is currently legal in seven countries and one Australian state. Eligibility requirements for both practices vary by location, but in most cases, the patient must at a minimum meet the following 3 criteria. The patient must be: 1) at least 18 years old, 2) diagnosed by at least two physicians with a terminal illness, and 3) sufficiently mentally competent to request PAD services and ingest the lethal dose of medication. The majority of patients who request physician assisted death have incurable, malignant cancer, followed by incurable neurological disease, such as ALS. Several studies have determined that loss of autonomy and the inability to participate in enjoyable activities are the two leading reasons why a patient might request such services (Blanke et al., 2017, Hedberg & New, 2017, & Wang et al., 2016). Attitudes Towards PADGanzini et al. (1999) This study involved mailing a questionnaire to all physicians who were eligible to prescribe a lethal dose of medication to a terminally ill patient. 51% of the responding physicians either supported or strongly supported the state’s new Death With Dignity Act or the legalization of physician-assisted suicide. Thirty-one percent of respondents either opposed or strongly opposed the DWD act, and 30% believed that writing a lethal prescription is immoral or unethical.Periyakoil et al. (2016) involved an anonymous, online survey that was sent to residents of California and Hawaii. 72.5% of Californians and 76.6% of Hawaiians indicated support for PAS. The survey also identified age and degree of spirituality as significant predictors for support of PAS. Older respondents were more likely to support PAS, as were those who indicated that religion/spirituality were either unimportant or somewhat important (both trends that are demonstrated by other studies)Abrahao et al. (2016) surveyed physicians and allied-health professionals who had experience caring for patients suffering from ALS. The majority of respondents indicated they agreed with the nationwide legalization of PAD (60% of physician respondents and 80% of allied health professionals). The majority of respondents (77% of physicians, and 81% of AHP) believed that ALS patients who were experiencing severe disability, intolerable suffering, or loss of independence should be eligible to receive PAD. The finding of higher support from non-physician providers is consistent with other research. Hizo-abes et al. (2018) involved surveying three groups of terminally ill patients who were receiving various degrees of palliative care. The majority (50-75%) of respondents from all three groups strongly agreed that PAD should be an option for patients with terminal illness.ConclusionPhysician-assisted death, including physician-assisted suicide and voluntary euthanasia, continues to be one of the most controversial subjects in healthcare, and while a large amount of peer-reviewed literature suggests that the majority of people are in favor of PAD, there remains a relatively large proportion of individuals who are strongly opposed to it, often due to religious beliefs or professional obligations.

2. Works CitedAbrahao, A., Downar, J., Pinto, H., Dupré, N., Izenberg, A., Kingston, W., Korngut, L., O'Connell, C., Petrescu, N., Shoesmith, C., Tandon, A., Vargas-Santos, A. B., & Zinman, L. (2016). Physician-assisted death: A Canada-wide survey of ALS health care providers. Neurology, 87(11), 1152-1160. https://doi.org/10.1212/WNL.0000000000002786 Braverman, D. W., Marcus, B. S., Wakim, P. G., Mercurio, M. R., & Kopf, G. S. (2017). Health Care Professionals' Attitudes About Physician-Assisted Death: An Analysis of Their Justifications and the Roles of Terminology and Patient Competency. Journal of pain and symptom management, 54(4), 538. https://doi.org/10.1016/j.jpainsymman.2017.07.024  Buiting, H. M., Deeg, D. J. H., Knol, D. L., Ziegelmann, J. P., Pasman, H. R. W., Widdershoven, G. A. M., & Onwuteaka-Philipsen, B. D. (2012). Older peoples' attitudes towards euthanasia and an end-of-life pill in The Netherlands: 2001-2009. Journal of medical ethics, 38(5), 267-273. https://doi.org/10.1136/medethics-2011-100066  Chen, H.-P., Huang, B.-Y., Yi, T.-W., Deng, Y.-T., Liu, J., Zhang, J., Wang, Y.-Q., Zhang, Z.-Y., & Jiang, Y. (2016). Attitudes of Chinese Oncology Physicians Toward Death with Dignity. Journal of palliative medicine, 19(8), 874-878. https://doi.org/10.1089/jpm.2015.0344  Danyliv, A., & O'Neill, C. (2015). Attitudes towards legalising physician provided euthanasia in Britain: the role of religion over time. Social science & medicine (1982), 128, 52-56. https://doi.org/10.1016/j.socscimed.2014.12.030  Drum, C. E., White, G., Taitano, G., & Horner-Johnson, W. (2010). The Oregon Death with Dignity Act: results of a literature review and naturalistic inquiry. Disability and health journal, 3(1), 3-15. https://doi.org/10.1016/j.dhjo.2009.10.001  Ganzini, L., Nelson, H. D., Lee, M. A., Kraemer, D. F., Schmidt, T. A., & Delorit, M. A. (2001). Oregon physicians' attitudes about and experiences with end-of-life care since passage of the Oregon Death with Dignity Act. JAMA, 285(18), 2363-2369. http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=11343484&site=ehost-live&scope=site  Hedberg, K., & New, C. (2017). Oregon's Death With Dignity Act: 20 Years of Experience to Inform the Debate. Annals of Internal Medicine, 167(8), 579-583. https://doi.org/10.7326/m17-2300 %m 28975232  Hizo-Abes, P., Siegel, L., & Schreier, G. (2018). Exploring attitudes toward physician-assisted death in patients with life-limiting illnesses with varying experiences of palliative care: a pilot study. BMC palliative care, 17(1), 56. https://doi.org/10.1186/s12904-018-0304-6  Murphy, T. F. (2011). A philosophical obituary: Dr. Jack Kevorkian dead at 83 leaving end of life debate in the US forever changed. The American journal of bioethics : AJOB, 11(7), 3-6. https://doi.org/10.1080/15265161.2011.596400Periyakoil, V. S., Kraemer, H., & Neri, E. (2016). Multi-Ethnic Attitudes Toward Physician-Assisted Death in California and Hawaii. Journal of palliative medicine, 19(10), 1060-1065. http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=27276445&site=ehost-live&scope=site  Sheahan, L. (2016). Exploring the interface between 'physician-assisted death' and palliative care: cross-sectional data from Australasian palliative care specialists. Internal medicine journal, 46(4), 443-451. https://doi.org/10.1111/imj.13009  Wang, L. H., Elliott, M. A., Jung Henson, L., Gerena-Maldonado, E., Strom, S., Downing, S., Vetrovs, J., Kayihan, P., Paul, P., Kennedy, K., Benditt, J. O., & Weiss, M. D. (2016). Death with dignity in Washington patients with amyotrophic lateral sclerosis. Neurology, 87(20), 2117-2122. http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=27770068&site=ehost-live&scope=site