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Medicine and Public Policy |

Responding to Legal Requests for Physician-Assisted Suicide

James A. Tulsky, MD; Ralph Ciampa, STM; Elliott J. Rosen, EdD, University of Pennsylvania Center for Bioethics Assisted Suicide Consensus Panel
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From Durham Veterans Affairs Medical Center and Duke University Medical Center, Durham, North Carolina; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and the Family Institute of Westchester and Phelps Memorial Hospice, Scarsdale, New York.

This paper was developed by the Assisted Suicide Consensus Panel as a part of the Finding Common Ground Project of the University of Pennsylvania Center for Bioethics. The paper was authored on behalf of the Panel by James A. Tulsky, MD; Ralph Ciampa, STM; and Elliott J. Rosen, EdD. Members of the Assisted Suicide Consensus Panel were Arthur L. Caplan, PhD, (Chair); David A. Asch, MD, MBA; Rev. Ralph Ciampa; Kathy Faber-Langendoen, MD; Joseph J. Fins, MD; John Hansen-Flaschen, MD; Barbara Coombs Lee, FNP, JD; Franklin G. Miller, PhD; Sally J. Nunn, RN; David Orentlicher, MD, JD; Timothy E. Quill, MD; Elliott Rosen, EdD; James A. Tulsky, MD; and Lois Snyder, JD (Project Director). Primary clinical staff to the Panel was Jason Karlawish, MD. Additional staffing was provided by Jennifer Klocinski.

Grant Support: The Walter and Elise Haas Fund and the Wallace Alexander Gerbode Foundation supported the development of this paper and the Finding Common Ground Project on Assisted Suicide. Dr. Tulsky is supported by a Veterans Affairs Health Services Research Career Development Award and is a Robert Wood Johnson Generalist Physician Faculty Scholar.

Request for Single Reprints: Lois Snyder, JD, Center for Bioethics, University of Pennsylvania Health System, 3401 Market Street, Suite 320, Philadelphia, PA 19104-3308; e-mail, lsnyder@mail.acponline.org.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Dr. Tulsky: Health Services Research (152), Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705.

Rev. Ciampa: Department of Pastoral Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.

Dr. Rosen: Family Institute of Westchester, 319 Harwood Building, Scarsdale, NY 10583.

Ann Intern Med. 2000;132(6):494-499. doi:10.7326/0003-4819-132-6-200003210-00012
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In 1998, 15 terminally ill Oregon residents ended their lives with overdoses of medications supplied legally by their physicians. Many more people consider this possibility. This paper examines the ways in which the physician's response to requests for assisted suicide may change in an era of legalization, articulates some of the resulting conceptual challenges, and provides practical advice to physicians facing such requests.

In areas where it is legal, assisted dying becomes one of the many options that can be freely considered for terminally ill patients with extreme suffering. Some patients even view assisted death as a right that can be expected on demand. We consider the ethical implications of disclosing assisted dying to patients as an option of last resort and suggest that physicians working in environments where assisted dying is legal are obliged to do so. However, we conclude that physicians should not encourage patients to hasten death even when practicing in jurisdictions that allow assisted dying. Furthermore, without abandoning the model, we suggest that strict informed consent does not fully address patients' needs at this time. Physicians must also focus on patients' broader biopsychosocial concerns and help them identify solutions through empathic listening and emotional support.

We provide a framework and vocabulary for physicians to use when responding to requests for assisted suicide. Physicians should clarify the request, explore and address the patient's concerns, achieve a shared understanding of the goals of treatment, search for less harmful alternatives, express to the patient what they are willing to do, discuss the relevant legal issues, and share their decision making with colleagues.





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