Author Affiliations: Division of General Internal Medicine and Geriatrics, Center for Ethics in Health Care, Oregon Health & Science University, Portland.
Perspectives on Care at the Close of Life Section
Editor: Margaret A. Winker, MD, Deputy Editor, JAMA.
Studies of dying patients have shown that about half would like the
option of physician-assisted suicide (PAS) to be available for possible future
use. Those percentages decrease significantly with each step patients take
toward action. Studies show that although about 10% of patients seriously
consider PAS, only 1% of dying patients specifically request it, and 1 in
10 of those patients actually receive and take a lethal prescription. However,
most patients' desires for PAS diminish as their underlying concerns are identified
and addressed directly. To help identify concerns motivating a patient's request
for PAS, physicians should talk with patients about their expectations and
fears, options for end-of-life care, goals, family concerns and burdens, suffering
or physical symptoms, sense of meaning and quality of life, and symptoms of
depression. A patient with advanced amyotrophic lateral sclerosis (ALS) who
requested PAS illustrates how a hasty response may adversely affect patient
care and the health care team. Although physicians should remain mindful of
their personal, moral, and legal concerns, these concerns should not override
their willingness to explore what motivates a patient to make this request.
When this approach is taken, suffering can be optimally alleviated and, in
almost all cases, the patient's wishes can be met without PAS.
Bascom PB, Tolle SW. Responding to Requests for Physician-Assisted Suicide: "These Are Uncharted Waters for Both of Us. . . .". JAMA. 2002;288(1):91–98. doi:10.1001/jama.288.1.91
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