PRACTICAL ISSUES IN PHYSICIAN-ASSISTED SUICIDE

Support for the participation of physicians in the suicides of termina lly ill patients is increasing, and the concrete effects on physician practice of a policy change with regard to physician-assisted suicide must be carefully considered. If physician-assisted suicide is legaliz ed, physicians will need to gain expertise in understanding patients' motivations for requesting physician-assisted suicide, assessing menta l status, diagnosing and treating depression, maximizing palliative in terventions, and evaluating the external pressures on the patient. The y will be asked to prognosticate not only about life expectancy but al so about the onset of functional and cognitive decline. They will need access to reliable information about effective medications and dosage s. The physician's position on physician-assisted suicide must be open to discussion between practitioner and patient. Protection of the pat ient's right to confidentiality must be balanced against the need of h ealth care professionals and institutions to know about the patient's choice. Insurance coverage and managed care options may be affected. A ll of these issues need to be further explored through research, educa tion, decision making by individual practitioners, and ongoing societa l debate.