Physician-Assisted Death Scanning the Landscape: Proceedings of a Workshop (2018) / Chapter Skim
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7 Reflections on the Workshop and Evidentiary Gaps
7 Reflections on the Workshop and Evidentiary Gaps
Pages 121-134
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From page 121... ...
Ganzini also recounted how Sulmasy pointed to the importance of keeping ethical ideas in mind when asking scientific questions about physician-assisted death. She said that one of the larger themes she heard was that even if it was possible to be assured about the motivations, competence, and mental status of every patient who asks for physician-assisted death, the 121
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From page 122... ...
Raffin Professor of Medicine and Biomedical Ethics, Stanford University Co-Chair, Stanford Hospital Ethics Committee Neil Wenger Professor of Medicine, University of California, Los Angeles (UCLA) Director, UCLA Healthcare Ethics Center Chair, UCLA Medical Center Ethics Committee David Magnus and Neil Wenger served as co-chairs of the session on provider experiences and approaches.
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From page 123... ...
He said that the resources devoted to preparing institutions to deal with requests for physician-assisted death far outweigh the number of patients affected, though these efforts may enable other necessary discussions about advance care planning and palliative care. Wenger also noted the importance of paying attention to the slippery slope discussed by several speakers.
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From page 124... ...
It was clear from the presentations, Tulsky said, that creating an institutional policy requires massive stakeholder engagement and that patients must opt in rather than be offered these services by providers. It was also clear, Tulsky said, that in response to these new laws, health care systems have developed varied policies that focus as much on improving quality of end-of-life care as they do on allowing adherence to the laws.
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From page 125... ...
Reflecting on the different perspectives within various communities -- in particular, African American communities and religious groups -- Payne said he was surprised to learn that Archbishop Desmond Tutu recently voiced support for assisted death, reversing his lifelong position on the topic, in part due to observing the prolonged death of Nelson Mandela.1 Payne stressed that no minority community is a monolith and said that there is a need for ethnographic data that crosses racial-ethnic strata as well as socioeconomic strata within a racial and ethnic group. Payne said that voluntariness is the primary concern when considering vulnerable populations and physician-assisted death.
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From page 126... ...
She remarked that communication about physician aid-in-dying was mentioned several times as something that would be hard to collect data on but which is fundamental to understanding the practice, including how patients may use the existence of a legal provision to initiate discussions about end-of-life care, whether or not they actually request a prescription. Filling in gaps in understanding about how the physician-assisted death process works can compete directly with patient-centered goals that are seen as central to the process, she said.
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From page 127... ...
Kim then raised a question for the workshop participants to consider: "If we are not going to make the social commitment to have that standard of data about physician-assisted death -- and arguably, we ought not to -- then would it be better for us to stop saying that this is a data-driven entity entirely, stop even calling for data, and just agree that this is something that is on that kind of uncomfortable saddle between the political and the metaphysical? " Tulsky replied that he empathized with Kim's question because what has become clear to him over the course of the workshop was that no data will convince those who are firmly opposed to physician-assisted death to endorse the practice, nor will it convince the people who are firm advocates to oppose it.
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From page 128... ...
Some of the questions and issues listed below may have been raised by more than the one or more individuals attributed to each statement. Patient Care and Patient Choices • What are the ancillary impacts of physician-assisted death laws on the care received by people who are not accessing the option and can the impact of physician-assisted death on clinical care beyond those who received the intervention be measured?
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From page 129... ...
• Are the legal safeguards regarding mental health screening failing to screen out some people with impaired judgment who should not be getting a prescription for lethal medication? (Thaddeus Pope)
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Are disabled patients getting access to physician-assisted death who otherwise would not be eligible? Is there evidence that physician-assisted death is having ancillary negative impacts on care for disabled patients?
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From page 131... ...
What can be done to implement genuine democratic public engagement on
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From page 132... ...
• How are the various proposed expansions in laws outside of the United States likely to affect laws and regulations in this country? For example, what will be the positive and negative implications of expanding physician-assisted death to minors, of broadening or eliminating the terminal illness requirement, of modifying the self administration requirement, or allowing physician-assisted death to be included in advance directives in other countries?
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From page 133... ...
Broader Research on End of Life • What is the range and general practice of end-of-life alternatives to physician-assisted death -- proportional palliative sedation, pallia tive sedation to unconsciousness, voluntarily stopping eating and drinking? How are these alternatives being used and what are the policies governing their use?
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