There are physicians who support the legalization of physician-assisted suicide (also known as physician-assisted death or aid-in-dying), but they may have different feelings about actually practicing it themselves. Sixty percent of U.S. physicians believe physician-assisted suicide should be legal, according to the results of a recent study.1 Yet of that group, only 13% indicated they would be willing to perform the practice if it were legal.

“The idea for this nationwide study came from an earlier study that we performed,” says Lydia Dugdale, MD, MAR (ethics), one of the study’s authors. Dugdale is associate director of clinical ethics at NewYork-Presbyterian and director of the Columbia Center for Clinical Medical Ethics in New York City.2

In that previous study, 488 faculty physicians at the Yale School of Medicine were surveyed on their attitudes regarding physician-assisted suicide. Most doctors (73%) thought assisted suicide should be legalized. Only 29% of those doctors also indicated willingness to perform it.

“We wanted to know if this held true nationally, and, if so, we wanted to know why,” Dugdale explains. Researchers were surprised to find how little doctors actually understand about assisted suicide. “They are unclear about why it is requested. They think that safeguards protect patients, yet question their adequacy,” Dugdale notes. Some key findings:

About half (49%) of physicians think pain is the reason most patients seek physician-assisted suicide. This reveals physicians are generally misinformed about the reason for patients seeking physician-assisted suicide, according to Dugdale. In fact, the vast majority of patients seeking to end their lives reported concerns about a loss of autonomy and dignity, according to 2018 data from Oregon, the first state to legalize assisted suicide.3 Only 25% of patients actually reported concern about pain.

Most physicians (58%) believe current safeguards are inadequate to protect patients. One concern is physicians who are not psychiatrists are not adequately trained to screen for depression, Dugdale says. Respondents also were skeptical physicians can predict with certainty that a patient has six months or less to live. “Doctors feel that doctors are poor prognosticators,” Dugdale observes. “Yet ability to prognosticate is key to eligibility for lethal drugs.”

• Some physicians are wary of legalization. About one-third of physicians believe legalization of assisted suicide will lead to legalization of euthanasia.

Almost half (46%) of physicians believe health plans would preferentially cover lethal drugs over more expensive, potentially life-saving treatments like chemotherapy. “When it comes to matters of life and death, healthcare professionals have a moral obligation to understand clearly the ramifications and nuances of their participation,” Dugdale says.

REFERENCES

  1. Hetzler PT 3rd, Nie J, Zhou A, Dugdale LS. A report of physicians’ beliefs about physician-assisted suicide: A national study. Yale J Biol Med 2019;92:575-585.
  2. Hetzler PT 3rd, Dugdale LS. Academic physician perspectives on the legalization and practice of physician-assisted suicide. Conn Med 2016;80:559-561.
  3. Oregon Death With Dignity Act. 2018 Data Summary. Available at: http://bit.ly/2SfsUhX.