Physicians Should “Assist in Suicide” When It Is Appropriate
Article first published online: 27 MAR 2012
© 2012 American Society of Law, Medicine & Ethics, Inc.
The Journal of Law, Medicine & Ethics
Volume 40, Issue 1, pages 57–65, Spring 2012
How to Cite
Quill, T. E. (2012), Physicians Should “Assist in Suicide” When It Is Appropriate. The Journal of Law, Medicine & Ethics, 40: 57–65. doi: 10.1111/j.1748-720X.2012.00646.x
- Issue published online: 27 MAR 2012
- Article first published online: 27 MAR 2012
Palliative care and hospice should be the standards of care for all terminally ill patients. The first place for clinicians to go when responding to a request for assisted death is to ensure the adequacy of palliative interventions. Although such interventions are generally effective, a small percentage of patients will suffer intolerably despite receiving state-of-the-art palliative care, and a few of these patients will request a physician-assisted death. Five potential “last resort” interventions are available under these circumstances: (1) accelerating opioids for pain or dyspnea; (2) stopping potentially life-prolonging therapies; (3) voluntarily stopping eating and drinking; (4) palliative sedation (potentially to unconsciousness); and (5) physician-assisted death. Patient, family, and clinicians should search for the least harmful way to respond to intolerable end-of-life suffering in ways that are effective and also respect the values of the major participants. A system that allows an open response to such cases ultimately protects patients by ensuring a full clinical evaluation and search for alternative responses, while reinforcing the need to be responsive and to not abandon.