j%2E1525-1497%2E2005%2E40225%2Ex - Motivations for...

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Motivations for Physician-assisted Suicide Patient and Family Voices Robert A. Pearlman, MD, MPH, 1,2,3,4,5 Clarissa Hsu, PhD, 6 Helene Starks, MPH, 4 Anthony L. Back, MD, 1,2,3 Judith R. Gordon, PhD, 7 Ashok J. Bharucha, MD, 8 Barbara A. Koenig, PhD, 9 Margaret P. Battin, PhD 10 1 VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA; Departments of 2 Medicine, 3 Medical History and Ethics, and 4 Health Services, University of Washington, Seattle, WA, USA; 5 National Center for Ethics in Health Care (VHA), Washington, DC, USA; Departments of 6 Anthropology and 7 Psychology, University of Washington, Seattle, WA, USA; 8 Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; 9 Center for Biomedical Ethics, Stanford University, Stanford, CA, USA; 10 Department of Philosophy, University of Utah, Salt Lake City, UT, USA. OBJECTIVE: To obtain detailed narrative accounts of patients’ moti- vations for pursuing physician-assisted suicide (PAS). DESIGN: Longitudinal case studies. PARTICIPANTS: Sixty individuals discussed 35 cases. Participants were recruited through advocacy organizations that counsel individu- als interested in PAS, as well as hospices and grief counselors. SETTING: Participants’ homes. MEASUREMENTS AND RESULTS: We conducted a content analysis of 159 semistructured interviews with patients and their family members, and family members of deceased patients, to characterize the issues associated with pursuit of PAS. Most patients deliberated about PAS over considerable lengths of time with repeated assessments of the benefits and burdens of their current experience. Most patients were motivated to engage in PAS due to illness-related experiences (e.g., fa- tigue, functional losses), a loss of their sense of self, and fears about the future. None of the patients were acutely depressed when plann- ing PAS. CONCLUSIONS: Patients in this study engaged in PAS after a deliber- ative and thoughtful process. These motivating issues point to the im- portance of a broad approach in responding to a patient’s request for PAS. The factors that motivate PAS can serve as an outline of issues to explore with patients about the far-reaching effects of illness, including the quality of the dying experience. The factors also identify challenges for quality palliative care: assessing patients holistically, conducting repeated assessments of patients’ concerns over time, and tailoring care accordingly. KEY WORDS: physician-assisted suicide; euthanasia; decision making; end-of-life issues; qualitative research. DOI: 10.1111/j.1525-1497.2005.40225.x J GEN INTERN MED 2005; 20:234–239. T he motivation to pursue physician-assisted suicide (PAS) has been an important issue in the debates regarding the legality and appropriate response to requests for PAS. Under- standing the motivation is critically important to physicians because many of them have been asked for assistance in PAS.
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This note was uploaded on 03/30/2008 for the course NURS 10010 taught by Professor Baker during the Spring '08 term at Kent State.

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j%2E1525-1497%2E2005%2E40225%2Ex - Motivations for...

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