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Clinician-Patient Interactions About Requests for Physician-Assisted Suicide
A Patient and Family View
Anthony L. Back, MD;
Helene Starks, MPH;
Clarissa Hsu, PhD;
Judith R. Gordon, PhD;
Ashok Bharucha, MD;
Robert A. Pearlman, MD, MPH
Arch Intern Med. 2002;162:1257-1265.
Background 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.
Participants and Methods Intensive qualitative case study involving multiple longitudinal interviews
conducted prospectively with patients pursuing PAS and with their family members
and retrospectively with family members of deceased patients who seriously
pursued PAS. The study setting was community based. Participants were recruited
through patient advocacy organizations, hospices, and grief counselors. A
total of 35 cases were studied: 12 were prospective and 23 were retrospective.
Study procedures involved semistructured interviews that were audiotaped,
transcribed, reviewed, and analyzed by a multidisciplinary research team.
Results 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.
From the Veterans Affairs Puget Sound Health Care System, Seattle Division
(Drs Back and Pearlman and Ms Starks), the Departments of Medicine (Drs Back
and Pearlman), Medical History and Ethics (Drs Back and Pearlman), Health
Services (Ms Starks and Dr Pearlman), Anthropology (Dr Hsu), and Psychology
(Dr Gordon), University of Washington, and the Seattle Institute for Biomedical
and Clinical Research (Drs Hsu and Gordon), Seattle, Wash; the Department
of Psychiatry, University of Pittsburgh, Pittsburgh, Pa (Dr Bharucha); and
the National Center for Ethics, Veterans Health Administration, Washington,
DC (Dr Pearlman).
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