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Physicians' Responses to Patients' Requests for Physician-Assisted Suicide
R. Jeffery Kohlwes, MD, MPH;
Thomas D. Koepsell, MD, MPH;
Lorna A. Rhodes, PhD;
Robert A. Pearlman, MD, MPH
Arch Intern Med. 2001;161:657-663.
Background Studies show that patient requests for physician-assisted suicide (PAS)
are a relatively common clinical occurrence. The purpose of this study was
to describe how experienced physicians assess and respond to requests for
assisted suicide.
Methods Focused ethnography in the offices of 11 acquired immunodeficiency syndrome
physicians, 8 oncologists, and 1 hospice physician who had received requests
for assisted suicide in their practice. Ten had facilitated PAS.
Results Informants had a similar approach to evaluating patients who requested
assisted suicide, often asking, "Why do you want to die now?" Reasons for
requests fell into 3 broad categories: physical symptoms, psychological issues,
and existential suffering. Physicians thought they competently addressed patients'
physical symptoms, and this obviated most requests. They treated depression
empirically and believed they did not assist depressed patients with assisted
suicide. Physicians had difficulty addressing patients' existential suffering,
which led to most facilitated requests. Informants rarely talked to colleagues
about requests for assisted suicide, suggesting a "professional code of silence."
Conclusions Regardless of divergent attitudes about PAS, physicians respond similarly
to requests for assisted suicide from their patients, creating a common ground
for professional dialogue. Our sample addressed physical suffering aggressively,
treated depression empirically, but struggled with requests arising from existential
suffering. A professional code of silence regarding PAS creates professional
isolation. Clinicians do not share knowledge or receive social support from
peers about their decisions regarding assisted suicide. Educational strategies
drawing on approaches used by experienced clinicians may create an atmosphere
that enables physicians with divergent beliefs to discuss this difficult subject.
From the Department of Medicine, Veterans Affairs Medical Center, University
of California, San Francisco (Dr Kohlwes); and Departments of Health Services
and Epidemiology (Dr Koepsell), Medical Anthropology (Dr Rhodes), and Medicine
and Medical History and Ethics, Veterans Affairs Puget Sound Health Care System
(Dr Pearlman), University of Washington, Seattle.
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Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2001;161(5):779-780.
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