Responding to legal requests for physician-assisted suicide

In 1998, 15 terminally ill Oregon residents ended their lives with overdose s of medications supplied legally by their physicians. Many more people con sider this possibility. This paper examines the ways in which the physician 's response to requests for assisted suicide may change in an era of legali zation, articulates some of the resulting conceptual challenges, and provid es 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 suff ering. Some patients even view assisted death as a right that can be expect ed on demand. We consider the ethical implications of disclosing assisted d ying to patients as an option of last resort: and suggest that physicians w orking in environments where assisted dying is legal are obliged to do so. However, we conclude that physicians should not encourage patients to haste n death even when practicing in jurisdictions that allow assisted dying. Fu rthermore, without abandoning the model, we suggest that strict informed co nsent does not fully address patients' needs at this time. Physicians must also focus on patients' broader biopsychosocial concerns and help them iden tify 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, e xplore and address the patient's concerns, achieve a shared understanding o f 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.