End of life decision-making, euthanasia, and physician assisted suicide in persons with neuropsychiatric conditions

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Abstract

In the past year, we have conducted the following projects. 1. Most jurisdictions that allow euthanasia and assisted suicide (AS) regulate it through the medical profession. However, the extent and nature of how medicine should be involved are debated. Swiss AS practice is unusual in that it is managed by lay AS organizations that rely on a law that permits AS when done for nonselfish reasons. Physicians are not mentioned in the law but are usually called upon to prescribe the lethal medications and perform capacity evaluations. We analyzed in-depth interviews of 23 Swiss AS experts including ethicists, lawyers, medical practitioners, and senior officials of AS organizations for their views on AS. We found that although there was agreement on some issues (e.g., need for better end-of-life care), the interviewees preferred model for AS, and the nature of preferred medical involvement, varied, which we categorized into five types: preference for AS practice as it occurred prior to lay AS organizations; preference for the current lay model; preference for a modified lay model to increase autonomy protections while limiting medical AS normalization; preference for various types of more medicalized models of AS; and, ambivalence about any specific model of medical involvement. The rationales given for each type of model reflected varying opinions on how medicines role would likely impact AS practice and demonstrated the experts attitudes toward those impacts. We conclude that the dynamics within the Swiss AS regime, as reflected in the varying views of Swiss AS experts, shed light on the dilemmas inherent to medical scope and involvement in AS, which may have implications for debates in other jurisdictions. 2. There have been prominent media reports of persons in Canada seeking and receiving medical assistance in dying (MAID; usually provided as euthanasia, i.e., termination of life by injection upon patient request) as a second resort because they were unable to access adequate care. This occurs in Canada due to their MAID law permitting it without being a last resort option (at it is in the Netherlands, for example). We are currently examining the normative issues around such laws, whether it conflicts with established norms of medical practice as well as principles of human rights. In addition, we are conducting a survey of the Canadian public regarding their knowledge and attitudes toward such practices. 3. Normative, philosophical analysis of the principle of equality as it applies to the assisted dying debate. Equality arguments are ubiquitous in the assisted dying literature but their full implications have not been drawn out. This project attempts to sketch out the implications.