An interview study with Swiss palliative care physicians | BMJ Supportive & Palliative Care
Objectives: Assisted suicide in Switzerland is mainly performed by right-to-die societies. Medical involvement is limited to the prescription of the drug and certification of eligibility. Palliative care has traditionally been perceived as generally opposed to assisted suicide, but little is known about palliative care physicians’ involvement in assisted suicide practices. This paper aims to describe their perspectives and involvement in assisted suicide practices.
Conclusions: The Swiss model of assisted suicide gives palliative care physicians opportunities to develop roles which are compatible with each practitioner’s values, but may not correspond to patients’ expectations. Specific education for all palliative care professionals and more structured ways to manage communication about assisted suicide are warranted.
Chambaere, K. et al. Palliative Medicine. Published online: September 8, 2016
The White Paper of the European Association for Palliative Care (EAPC) on euthanasia and physician-assisted suicide in a previous issueis the result of a consensus-seeking process among representatives of the national palliative care organisations in Europe as well as the EAPC board members about the position statements that had been formulated in an earlier position paper in 2003.
With the aim of providing ‘a viewpoint from the palliative care perspective’ and an overarching ‘normative ethical framework’, the authors end by reaffirming that ‘euthanasia is not a part of palliative care’ despite noting strong dissent and a lack of consensus on pivotal statements.
Assisted dying is a widely debated issue. What can other countries’ experiences tell us about what might happen in Britain? | Kings Fund
The legalisation of assisted dying is an issue that divides opinion. Those in favour argue that the current law means that terminally ill people suffer against their wishes. Here Baroness Finlay argues against changing the law.
This is one in a series of short essays launched by the King’s Fund that take a step back from the challenges currently facing the NHS to explore a range of hypothetical scenarios for the future of health and care.
This is the first review that has explored attitudes towards assisted dying specifically in relation to dementia. This narrow overview of studies comes at a point at which assisted dying has received heightened media attention in recent years.
The review demonstrates a division of opinion across different populations as well as severity of dementia. Support in particular from professionals who would need to perform assisted dying is greater in mild dementia as this is when capacity is less of an issue. However, Bolt et al demonstrated that a small number of Dutch physicians find it conceivable they would assist death with a person with dementia.
The study suggests healthcare professionals should be mindful of the more supportive views of people with dementia and carers towards assisted dying when discussing end-of-life care options. However, extreme caution must be taken. As demonstrated in this study, not all will have such a supportive view and opinions will vary. As shown in previous reviews of attitudes towards end-of-life care in dementia, carers’ views in particular may change and span a spectrum of beliefs. Caution would also need to be taken of any other comorbid psychological disorders such as depression, which may compound an individual’s desire for assisted dying.
The authors rightly acknowledge that there are several limitations with the studies included in this review, including poor design of survey methodologies leading to biased responses and a lack of standardised measures. They highlight the need for research to explore the explanations behind the attitudes reported.
This information is important in informing on-going debate internationally about the role of assisted dying in dementia and the attitudes of those most affected about this sensitive topic of debate.
Implications for practice and research
▪ Different levels of advocating for assisted dying between people with dementia and health professionals may mean professionals need more confidence, support and awareness to have these conversations.
▪ Further qualitative research is needed to explore in more detail the views carers and people with dementia have about assisted dying.
Jacky Davies and Ilora Finley debate the Assisted Dying Bill set to be read in parliament next month. They debate whether the bill’s provision requiring a High Court judge to approve patients for assisted death is enough to protect vulnerable people.