Question

Prompt #2 Ethicist Margaret Battin (1987) suggests that physicians should uphold a patient’s autonomy by informing them about humane methods for ending one’s life. Thus, the principle of autonomy creates a moral obligation for physicians to provide patients (who request it) with information on how to die.

Furthermore, some individuals create suicide kits that are available for purchase through online retailers like Ebay. One in particular, is a 3D-printed pod suicide machine called “Sarco” that fills with gas to end a person’s life.

*Should there be limits on freedom of speech when it comes to publicizing methods for killing oneself or others?

*Should physicians be the ones to inform patients about “humane” methods for ending their lives?

*Some people might argue that suicide attempts are just a cry for help. How can a physician determine if a request for euthanasia is genuine and not just a cry for help? (USLOs 8.1, 8.2, 8.3)\

Answer 1

It cannot be said that physicians be the ones to inform patients about “humane” methods for ending their lives. Responding effectively to a patient request for physician-assisted suicide (PAS) is an important clinical skill that involves careful evaluation. Clinician responses to PAS requests, however, have only been described using data obtained from clinicians.

Objective To describe qualities of clinician-patient interactions about requests for PAS that were valued by patients and their family members. Three themes were identified that describe qualities of clinician-patient interactions that were valued by patients and family members: (1) openness to discussions about PAS; (2) clinician expertise in dealing with the dying process; and (3) maintenance of a therapeutic clinician-patient relationship, even when clinician and patient disagree about PAS.

Conclusions These patient and family accounts reveal missed opportunities for clinicians to engage in therapeutic relationships, including discussions about PAS, dying, and end-of-life care. Clinicians responding to patients requesting PAS need communication skills enabling them to discuss PAS and dying openly, as well as expertise in setting reasonable expectations, individualizing pain control, and providing accurate information about the lethal potential of medications.

The term ‘euthanasia’ was not used for the intervention, medical or otherwise, to ease a patient's death or to end his or her suffering. Such intervention cannot, however, have been uncommon in antiquity, since assisting a patient's suicide was explicitly ruled out in the so-called Hippocratic oath. Whoever swore this oath (probably the members of a small Pythagorean sect of physicians) committed him- or herself to ‘give no deadly medicine to anyone if asked, nor suggest any such counsel.’ethical rationale for the physician prescribing life-ending medications for capable, terminally ill patients who will then decide for themselves whether to end their lives this way. It also provides guidance for the physician who wonders whether this service should be offered within the context of an agreement to work collaboratively as physicians. More than one ethical approach may be used to examine this clinical situation. physicians to prescribe lethal medication to patients confirmed to be terminally ill and capable of independently making and carrying out a decision to ingest deadly medication. Medicine has traditionally excluded the provision of deadly medication from proper practice.

Physicians reasonably may hold to that limit. However, honoring a repeated request from a capable, terminally ill patient to receive life-ending medication still can be considered to be a moral and permissible approach to relieve suffering. A physician choosing to expand his/her role within this narrowly defined context allows the patient to assume authority for a deeply personal decision that may belong to the patient more than to anyone else

Every patient and family member in this study recognized that asking for PAS was a special request that went beyond the usual boundaries of a clinician-patient relationship. Maintaining the clinician-patient relationship was made possible by clinician openness to discussion and clinician expertise. Also, it involved explicit negotiation about the roles of each party in the relationship as well as clinician self-awareness of emotional vulnerabilities. Patients and family members were relieved and reassured when clinicians made an explicit commitment to assist with PAS in some way. However, when clinicians declined to participate and were able to set clear boundaries about their role, as in the example below, they could still maintain an important relationship with a patient and family member.