Central mechanism would remove physician from assisted-dying process

By Sarah Guy

The development of a central state or federal mechanism in the USA that would confirm the authenticity and eligibility of terminally ill patients' requests for death, dispense medication, and monitor demand and use, could remove physicians from the assisted dying process, say researchers.

More than half of the American Medical Association members surveyed in 2003 objected to physician-assisted suicide, believing it is wrong to play an active role in ending a patients' life, explain Julian Prokopetz and Lisa Lehmann (Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA).

However, they envision that removing physicians from the process would mean they would not be required to take actions that are not already part of a commitment to providing high-quality care.

"Such a mechanism would not only obviate physician involvement beyond usual care but would also reduce gaps in care coordination," they write in The New England Journal of Medicine. In the US states of Oregon and Washington where assisted dying is legal: "patients whose doctors don't wish to participate in assisted dying must find another provider to acquire a prescription."

Critics of legalizing assisted suicide focus mainly on six objections, one of which is that permitting patients to take their own lives would worsen palliative care quality. But spending on, and patient ratings of palliative care in Oregon, have increased since the Death with Dignity Act (DWDA) was passed in 1997.

Furthermore, concerns about patient safety and protecting vulnerable patients have not been borne out in Oregon: "Indeed, the system's safeguards (waiting periods and psychiatric evaluation) are much more stringent than those for the well-accepted practices of withholding or withdrawing of life-sustaining treatment," say the authors, adding that many terminally ill patients have no life-sustaining treatments to withdraw.

The DWDA requires physicians to confirm a patients' prognosis and elucidate their alternatives for treatment and palliative care ‑ in Oregon, assisted suicide is seen as a last resort. Only then can lethal medication be prescribed; but it does not need to be prescribed by the physician, the authors suggest.

Obtaining the prescription from an independent authority would enable legalization of assisted suicide to "benefit those who want the option, without affecting care for those who object to the practice," propose Prokopetz and Lehmann.

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