KILL YOURSELF

• Define
• History
• Present
• My stance
• Future

DEFINE

• Physician Assisted Suicide (PAS)
• In Physician-assisted suicide: The physician provides the necessary means and the patient performs the act.
• Not the same as Euthanasia

Untitled Slide

• Euthanasia: The physician performs the intervention
• 57% of physicians practicing today have received a request for physician-assisted suicide in some form or another

HISTORY

• 1994, Oregon approved Death with Dignity Act (DWDA)
• 1997, US supreme Court Affirmed state legislatures may choose to legalize.
• 1999, Oregon began first state to legalize it.

LEGAL IN 6 STATES

• Oregon
• Colorado
• Washington
• California
• Vermont
• Montana

Untitled Slide

• 5 states (CA, CO, OR, VT, and WA) legalized physician-assisted suicide via legislation 1 state (MT) has legal physician-assisted suicide via court ruling

ELEGIBILITY

• 18 years of age or older. Resident of that state. Capable of making and communicating health care decisions for him/herself. Diagnosed with a terminal illness that will lead to death within six months.

ETHICAL ISSUES

• Physicians have an obligation to relieve pain and suffering.
• Promote the dignity of dying patients in their care.
• Physicians save lives

WHY PATIENTS REQUEST PAS?

• Physical suffering Psychological suffering Social suffering Spiritual suffering Practical concerns

OTHER REASONS MAY INCLUDE

• Future suffering Loss of control Indignity Being a burden to others

PHYSICIAN SHOULD

• Find out causes of the specific request
• Educate about legal alternatives
• Seek counsel from other colleagues

HOW TO APPROACH THE REQUEST

• Initiate and Encourage the Discussion
• Ask questions in a calm and non-judgmental manner find out the true reason for the request.

HOW TO APPROACH THE REQUEST

• Empathetic listening skills
• Be aware of their own biased
• Put the patient's need first

LEGAL ALTERNATIVES TO PAS

• Refusal of Treatment Withdrawal of Treatment Declining Oral Intake End-of-life Sedation

REFERENCES

• Emanuel LL, ed. Regulating How We Die: The Ethical, Medical, and Legal Issues Surrounding Physician-Assisted Suicide. Cambridge, MA: Harvard University Press; 1998.

Untitled Slide

• van der Wal G, van der Maas PJ, Bosma JM, et al. Evaluation of the notification procedure for physician-assisted death in the Netherlands. N Engl J Med. 1996;335:1706-1711.

Untitled Slide