Literature Review

What the experiences of young persons can teach us about medical aid in dying for psychiatric illnessJAMA Psychiatry; Brent Kious, MD, PhD; 1/25Medical aid in dying (MAID) is becoming ever more available. While it is most often used by persons with terminal illnesses, it is also becoming more accessible to those with a primary psychiatric illness. Some countries, including the Netherlands, have long allowed MAID for persons experiencing unbearable and irremediable suffering due to a mental illness. In Canada, Quebec’s Superior Court ruled in 2019 that restricting MAID to persons with a “reasonable foreseeable natural death” violates key sections of the Canadian Charter, implying that MAID must be made available to persons with nonterminal conditions, including psychiatric illness. Meanwhile, while only persons with terminal illness can access MAID in those parts of the US that have legalized it, some physicians have argued that certain psychiatric illnesses, especially anorexia nervosa, can be terminal, opening the door to MAID for persons with a primary psychiatric illness. 

We studied 20 places around the world and found the most common diseases linked with voluntary assisted dying Medical Xpress; by Eliana Close and James Downar, The Conversation; 12/18/24 As of 2023, 282 million people lived in regions where voluntary assisted dying is legal. Jurisdictions such as the Netherlands, Belgium and Oregon have had these laws in place for decades. Other countries, including Canada, Spain, New Zealand and Australia, have passed reforms more recently. ... Debates about voluntary assisted dying are often highly polarized. Understanding the factors driving assisted dying is essential for evidence-based debates and for improving care for people with serious conditions. In a recent study, we examined data from people accessing voluntary assisted dying in 20 jurisdictions around the world. In particular we looked at what diseases they had. ...  With an international team of researchers, we looked at the role disease plays in voluntary assisted dying. We analyzed publicly available data from 20 jurisdictions in eight countries between 1999 and 2023. Overall, most people who accessed voluntary assisted dying had cancer (66.5% of cases). Neurological diseases were the second most common (8.1%), followed by heart (6.8%) and lung (4.9%) conditions. 

Contextualizing attitudes toward medical aid in dying in a national sample of interdisciplinary US hospice clinicians: hospice philosophy of care, patient-centered care, and professional exposurePalliative Care and Social Practice; Todd D Becker, John G Cagle, Cindy L Cain, Joan K Davitt, Nancy Kusmaul, Paul Sacco; 12/24Findings suggest that contextual factors-namely, the environments in which hospice clinicians practice-may shape attitudes toward MAID [medical aid in dying]. Unanticipated results indicating that hospice professionals' adherence to hospice values was not significantly associated with attitudes toward MAID underscore the need for further research on these complex associations, given previous theoretical and empirical support.

Willingness to be present throughout patient death via medical aid in dying in a national sample of interdisciplinary US hospice clinicians: a content analysis of rationalesPalliative Care and Social Practice; Todd D. Becker, Cindy L. Cain, John G. Cagle, Joan K. Davitt, Nancy Kusmaul, Paul Sacco; 10/24 The United States is one of a growing number of countries across Europe, North America, Oceania, and South America to have legalized what, domestically, is referred to as medical aid in dying (MAID). The objective of the current study was to explore attitudes toward presence throughout a patient’s death via MAID in hospice physicians, nurses, social workers, and chaplains. Participants who were willing to be present (n = 305 [74%]) attributed their willingness to personal support, definitions of quality clinical care, and values from their professional training. Those who were unwilling (n = 63 [15%]) noted personal objections to the concept of MAID, personal objections to MAID participation, and perceptions of MAID’s misalignment with healthcare. Hospice clinicians would benefit from greater professional guidance and support pertaining to MAID.

MAiD in America: A rapid review of medical assistance in dying in the United States and its implications for practice for health care professionalsJournal of Hospice and Palliative Nursing; by Kathy Howard Grubbs, Christiana M. Keinath, Sharon E. Bigger; 10/24The evolving legal landscape associated with medical assistance in dying (MAiD) may pose significant challenges for hospice and palliative care professionals. In the United States, 10 states and 1 jurisdiction have passed legislation allowing MAiD. National organizations, such as the Hospice and Palliative Nurses Association, have created position statements to serve as guides to care. Given the clinical and ethical challenges associated with MAiD, a rapid review was conducted to provide current evidence for policymakers, health care professionals, and researchers to use when considering care management and policy initiatives. Using a systematic approach, publications related to MAiD between 2019 and 2024were extracted and synthesized. The review provides definitions of terms that differentiate between MAiD, euthanasia, physician-assisted suicide, medically assisted death of the nonterminal patient, and death with dignity. A total of 23 articles were included in the review and categorized into 4 themes: (1) legal, regulatory, and policy concerns; (2) health care professional experience of MAiD; (3) patient and caregiver experience of and communication about MAiD; and (4) disparate access to MAiD.

A moral code: Ethical dilemmas in medicine — three physicians face crossroads in patient care MedPage Today; podcast by Genevieve Friedman, Perspectives Editor; 10/25/24 We are back for another episode of our medical podcast, which we hope isn't really a podcast about medicine, but a podcast about life, death, dilemma, the challenges, and sometimes the joys of medicine. ... Now, medicine is complicated because a lot of times there aren't hard and fast rules ... One treatment isn't always right or wrong for someone. One surgery isn't always successful or unsuccessful, and one diagnosis isn't always correct. Decisions aren't black and white, they're varying shades of gray. So we come up with principles to help handle this -- codes if you will. But even those get a bit marred by complexity at times. As you'll hear in this episode of Anamnesis with the theme of "A Moral Code: Ethical Dilemmas in Medicine," one of our biggest codes is "do no harm." But what is harm? Who decides what harm is, what happens if we disagree?

Hospice policy mandating two-week enrollment prior to ingesting aid-in-dying medicationAcademy of Aid-in-Dying Medicine; by Constance Holden, Jeanne Kerwin, Paula Goodman-Crews, Margaret Pabst Battin; 10/2/24[A white paper from the ACAMAID Ethics Consultation Service.] An aid-in-dying-prescribing physician is concerned about a policy that several local hospices have implemented prohibiting patients from ingesting their aid-in-dying medication during the first two weeks of enrollment. The requesting provider is concerned that this policy requires patients who have made aid-in-dying requests to wait well beyond the 48 hours mandated by law. This potentially results in undue added suffering for the patient. It is also a potentially discriminatory practice, as it leads to unequal access to care.

You cannot come to New Jersey to die, judge says New Jersey 101.5; by Eric Scott; 9/20/24 Terminally ill individuals may not travel to New Jersey to end their lives. When New Jersey's Aid in Dying law took effect in 2019, it included a provision that doctors verify a patient's residency before prescribing them medications that will end their lives. A federal judge has ruled the residency requirement does not violate the U.S. Constitution. The ruling came after terminally ill cancer patients from Delaware and Pennsylvania sued. They wanted to travel to New Jersey to end their lives. ...

[Australia] Maybe for unbearable suffering: Diverse racial, ethnic and cultural perspectives of assisted dying. A scoping reviewPalliative Medicine; Melissa J Bloomer, Laurie Saffer, Jayne Hewitt, Lise Johns, Donna McAuliffe, Ann Bonner; 8/24Perspectives on assisted dying are dynamic and evolving. Even where assisted dying is legalised, individual's cultural attributes contribute to unique perspectives of assisted dying as an end-of-life option. Thus, understanding a person's culture, beliefs, expectations and choices in illness, treatment goals and care is fundamental, extending beyond what may be already considered as part of clinician-patient care relationships and routine advance care planning.

Assisted dying bill introduced in Parliament BBC News; 7/26/24 A bill which would allow terminally ill adults with six months or fewer to live to get medical help to end their own lives has been introduced in the House of Lords, by former Labour Justice Secretary Lord Falconer. He told the BBC his bill would apply only to people "mentally able to make the decision." Their choice would also need to be approved by two doctors and the high court. Private members' bills introduced in the Lords rarely become law. However, Lord Falconer says he hopes a backbench MP will introduce a similar bill in the Commons, where it will have a greater chance of success.

Colorado End-Of-Life Options Act - year seven: 2023 data summary, with 2017-2023 trends and totalsColorado Department of Public Health & Environment; 7/24In 2023, 389 patients received prescriptions for aid-in-dying medications under the provisions of the Colorado End-of-Life Options Act. This represents a 22% increase in the number of prescriptions compared to 2022. Among those prescribed aid-in-dying medication in 2023, CDPHE has received reports for 294 patients to whom aid-in-dying medication was dispensed. Also among those prescribed aid-in-dying medication, CDPHE has received death certificates for 333 patients through routine vital records registration. Note that not all of these deceased patients were dispensed aid-in-dying medication, and deaths may have been due to ingestion of aid-in-dying medication, the underlying terminal illness or condition, or other causes.

Opposing views shared on assisted dying proposals BBC News, Isle of Man; by Rebecca Brahde; 7/1/24 Protesters both for and against proposed assisted dying laws on the Isle of Man have shared their views, ahead of an extra sitting of the House of Keys. Politicians will continue to debate legislation on Monday that would allow terminally-ill people the right to die. Millie Blenkinsop-French, from Douglas, said: "I think it is time now for us to have that choice." But Karen Owen said "one person's choice impinges on another's" and would lead to families having to have "terrifying" conversations as the end of life approaches. If the legislation is approved, there will be strict eligibility criteria: People who request an assisted death will have to be over 18, have lived on the island for at least five years and have been told by doctors they have less than 12 months to live. ... Public opinion was narrowly divided on the issue in a consultation held in April 2023 where more than 3,000 people shared their views.Editor's Note: The Isle of Man is a self-governing British Crown Dependency in the Irish Sea, between Great Britain and Ireland. We post this international article as a sample of the international scope of this extremely controversial issue, paired with similarities in different beliefs and opinions.

Delaware legislature passes Medical-Aid-in-Dying law CBS WBOC, DOver, DE; by Sean Curtis; 6/25/24 The Delaware State Senate is sending House Bill 140, or the End-of-Life Options Law, to Governor John Carney’s desk after passing it Tuesday [6/25/24]. ... Medical aid in dying would only be available to adult Delawareans diagnosed with an incurable disease or illness who have been given a prognosis of six months or less to live. The prognosis must come from at least two medical professionals, according to lawmakers. Advanced age, disability, mental illness, or chronic health conditions would not qualify a person, under the law. Those seeking medical aid in dying under HB 140 would need to demonstrate an ability to understand and grasp the consequences of their decision, as determined by a licensed psychiatrist or psychologist. ... It will now head to the Governor’s Office for Carney’s signature before becoming law, unless Carney chooses to veto the legislation.