Health Care Ethics

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Mandatory reporting--those doctors who prescribe a lethal dose must report the number of prescriptions written to the state. Concern: the doctor does not have to follow up on the patient. Unless the next of kin is notified (not a requirement) that the patient requested the lethal dose, and the next of kin notifies the physician that the patient actually took the medication, there is no way to tell if the patient actually completed the act, sold the prescription, had someone else administer the dosage, etc. In fact, there is a concern that the prescriptions may fall into the hands of those other than the patient.

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I cut/pasted this into a response to Eric: Depression is a common ailment among middle-class, educated, white, 70-75 year old men suffering from terminal illness. Interestingly, this is the precise group identified as requesting PAS most often. Depression is also difficult to identify in the elderly, due to medication issues, comorbidities, chronic pain and prevailing perceptions from medical professionals, family members and others that life is not worth living once you become so impaired. Consequently, the fact that the statute(s) provide that the GP is the one to assess capacity, and a psych consult is only necessary if the GP makes the referral, there is some question as to whether the patient's requesting PAS might actually been better served through palliative programs such as Hospice. Given the alternative, would these patients have opted for Palliative services, rather than a premature death motivated by depression?

A doctor who agrees to participate in writing a prescription for a lethal dose of medication is inherently predisposed to believing that this is the right thing to do--if the patient requests it. Consequently, the doctor may not be astute at checking their own predisposition when trying to discern depression and a desire to be free from suffering and may respond well to Hospice type care, from someone who wants to die by their own hand. Moreover, unlike the Netherlands, where the GP typically stays with the patient throughout the patient's life, or at least for a number of years, doctors who participate in the PAS program may have only met the patient two weeks and 1 day (15 days) before prescribing the lethal dose. Conversely, if the doctor does have a long-standing relationship with the patient and is frustrated by their own ability to ease the patient's suffering, they may unintentionally convey to the patient that PAS is the best option. Because of the strong doctor-patient relationship, the patient might believe this is true, since they trust the GP giving the advice. 

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4. Given that perceived loss of dignity, loss of autonomy, and being a burden on loved ones is a great motivator for PAS, there is concern that vulnerable populations such as the elderly or physically disabled will be forced into positions of requesting PAS--although the evidence on this has not shown this to be true. Of course, we may not have the transparency of the system.

5. Given the belief (shared by many) that people need the option at the end-of-life, how do we explain the consistently small number of people who actually do take the prescribed medication (less than 600 since the inception of the law) vs. the steady increase for requests for palliative care over the same time period. It should be noted that the minority numbers remain consistent in the Netherlands as well, where PAS has been legal for over 25 years.

6. As we discussed in other questions this module, participating in PAS requires that the patient end their life prematurely. There is no guarantee that a patient with a 'terminal' diagnosis will die in 6 months or less, although statistically this may be the case. There is also no way to predict that unbearable suffering will coincide with a patient's ability to ingest the medication.

Please do not infer my position...I am merely consolodating some common points for review. Hope it helps.


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