Discussing Physician-Assisted Dying: Physicians' Experiences
Discussing Physician-Assisted Dying: Physicians' Experiences
This study was limited in that it investigated PAD discussions only from the point of view of the physician. It would be useful to interview patients and relatives about such discussions as other studies have done (Back et al., 2002; Norwood, 2005), but it is also logistically difficult and ethically challenging. In addition, since physicians were recalling conversations and experiences as they remembered them, the information is potentially subject to the physicians' recall biases. However, since our focus was the physicians' experiences, their recollections of the experiences are what will likely influence their future practice. The physicians could have been biased to give a socially desirable response. However, steps were taken to ensure confidentiality and comfort during the interview to minimize this effect.
Although the findings are representative of the groups studied, it cannot be assumed that the findings can be applied to other geographic areas. However, the similarities and differences across the three areas suggest potential for further study in other countries. Given the qualitative nature of the research, there are no statistical inferences about the frequency of certain experiences among different groups. However, given the complexity of the subject matter, it would be difficult to obtain useful data of that nature, and the value of that data would be diminished by the lack of context. Finally, these results represent a set of experiences and opinions of physicians at one point in time, and the changing legal landscape and other influencing factors mean that these results may be different if the study were conducted at a different point in time.
Since this research was carried out, several other states in the United States have explored legalization of PAD through ballot initiatives and court rulings, with Washington and Montana succeeding in forms of legalization. The experiences of physicians in diverse settings who attempt to address patient requests for PAD provide useful information for legal policy makers and physician groups who may be trying to operationalize some form of legal PAD or to establish a framework for dealing with PAD discussion in areas where there is not a move toward legalization, but there is an acknowledgement that these conversations occur. The experiences described in this study suggest that an appropriate legal framework should allow physicians and patients to talk openly about PAD in order to fully explore the reasons for the request, and yet contain specific criteria that safeguard patients and support physicians through a difficult decision-making process by encouraging discussion with medical peers. In areas where PAD remains illegal, these experiences can inform guidelines for physicians dealing with requests that emphasize asking why the patient is bringing it up and recommend strategies to reassure the patient that he or she will not be abandoned even if the physician will not be able to participate in PAD.
PAD is a complex topic to address in the context of the doctor–patient relationship with many influencing factors. Whether or not a physician considers participation, the discussion with the patient can be an opportunity to improve care and address important needs as the patient nears the end of life. The decision should be made in the open, with agreement between patients, family members, and medical peers if possible, and physician experiences should be fundamental in formulating policy changes that provide frameworks for broaching this topic.
Limitations
This study was limited in that it investigated PAD discussions only from the point of view of the physician. It would be useful to interview patients and relatives about such discussions as other studies have done (Back et al., 2002; Norwood, 2005), but it is also logistically difficult and ethically challenging. In addition, since physicians were recalling conversations and experiences as they remembered them, the information is potentially subject to the physicians' recall biases. However, since our focus was the physicians' experiences, their recollections of the experiences are what will likely influence their future practice. The physicians could have been biased to give a socially desirable response. However, steps were taken to ensure confidentiality and comfort during the interview to minimize this effect.
Although the findings are representative of the groups studied, it cannot be assumed that the findings can be applied to other geographic areas. However, the similarities and differences across the three areas suggest potential for further study in other countries. Given the qualitative nature of the research, there are no statistical inferences about the frequency of certain experiences among different groups. However, given the complexity of the subject matter, it would be difficult to obtain useful data of that nature, and the value of that data would be diminished by the lack of context. Finally, these results represent a set of experiences and opinions of physicians at one point in time, and the changing legal landscape and other influencing factors mean that these results may be different if the study were conducted at a different point in time.
Implications
Since this research was carried out, several other states in the United States have explored legalization of PAD through ballot initiatives and court rulings, with Washington and Montana succeeding in forms of legalization. The experiences of physicians in diverse settings who attempt to address patient requests for PAD provide useful information for legal policy makers and physician groups who may be trying to operationalize some form of legal PAD or to establish a framework for dealing with PAD discussion in areas where there is not a move toward legalization, but there is an acknowledgement that these conversations occur. The experiences described in this study suggest that an appropriate legal framework should allow physicians and patients to talk openly about PAD in order to fully explore the reasons for the request, and yet contain specific criteria that safeguard patients and support physicians through a difficult decision-making process by encouraging discussion with medical peers. In areas where PAD remains illegal, these experiences can inform guidelines for physicians dealing with requests that emphasize asking why the patient is bringing it up and recommend strategies to reassure the patient that he or she will not be abandoned even if the physician will not be able to participate in PAD.
PAD is a complex topic to address in the context of the doctor–patient relationship with many influencing factors. Whether or not a physician considers participation, the discussion with the patient can be an opportunity to improve care and address important needs as the patient nears the end of life. The decision should be made in the open, with agreement between patients, family members, and medical peers if possible, and physician experiences should be fundamental in formulating policy changes that provide frameworks for broaching this topic.
