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Antifaeff K. Social Work Practice with Medical Assistance in Dying: A Case Study. HEALTH & SOCIAL WORK 2019; 44:185-192. [PMID: 30796809 DOI: 10.1093/hsw/hlz002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/28/2018] [Accepted: 09/18/2018] [Indexed: 06/09/2023]
Abstract
Medical assistance in dying (MAiD) recently became legal in Canada, and social workers have an integral role providing psychosocial care to those considering this end-of-life care option. Research has found that most requests for assisted dying have a psychosocial dimension. Social workers are uniquely equipped to understand the personal and contextual factors informing the choice for MAiD and offer supports. A case example highlights practice opportunities for social workers throughout the MAiD process.
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Affiliation(s)
- Kelsey Antifaeff
- Vancouver General Hospital, Vancouver Coastal Health, 899 West 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
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Fujioka JK, Mirza RM, Klinger CA, McDonald LP. Medical assistance in dying: implications for health systems from a scoping review of the literature. J Health Serv Res Policy 2019; 24:207-216. [DOI: 10.1177/1355819619834962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective Medical assistance in dying (MAiD) is the medical provision of substances to end a patient’s life at their voluntary request. While legal in several countries, the implementation of MAiD is met with ethical, legislative and clinical challenges, which are often overshadowed by moral discourse. Our aim was to conduct a scoping review to explore key barriers for the integration of MAiD into existing health systems. Methods We searched electronic databases (CINAHL, Embase, MEDLINE, and PsycINFO) and grey literature sources from 1990 to 2017. Studies discussing barriers and/or challenges to implementing MAiD from a health system’s perspective were included. Full-text papers were screened against inclusion/exclusion criteria for article selection. A thematic content analysis was conducted to summarize data into themes to highlight key implementation barriers. Results The final review included 35 articles (see online Appendix 1). Six categories of implementation challenges emerged: regulatory (n = 26), legal (n = 15), social (n = 9), logistical (n = 9), financial (n = 3) and compatibility with palliative care (n = 3). Within four of the six identified implementation barriers (regulatory, legal, social and logistical) were subthemes, which described barriers related to legalizing MAiD in more detail. Conclusion Despite multiple challenges related to its implementation, MAiD remains a requested end-of-life option, requiring careful examination to ensure adequate integration into existing health services. Comprehensive models of care incorporating multidisciplinary teams and regulatory oversight alongside improved clinician education may be effective to streamline MAiD services.
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Affiliation(s)
- Jamie K. Fujioka
- Researcher, Factor-Inwentash Faculty of Social Work, Institute for Life Course and Aging, University of Toronto, Canada
- Researcher, National Initiative for the Care of the Elderly, Canada
- Researcher, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Raza M. Mirza
- Senior Research Associate, Factor-Inwentash Faculty of Social Work, Institute for Life Course and Aging, University of Toronto, Canada
- Senior Research Associate, National Initiative for the Care of the Elderly, Canada
| | - Christopher A. Klinger
- Senior Research Associate, Factor-Inwentash Faculty of Social Work, Institute for Life Course and Aging, University of Toronto, Canada
- Senior Research Associate, National Initiative for the Care of the Elderly, Canada
| | - Lynn P. McDonald
- Professor, Factor-Inwentash Faculty of Social Work, Institute for Life Course and Aging, University of Toronto, Canada
- Scientific Director, National Initiative for the Care of the Elderly, Canada
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Allan A, Allan MM. Ethical issues when working with terminally ill people who desire to hasten the ends of their lives: a western perspective. ETHICS & BEHAVIOR 2019. [DOI: 10.1080/10508422.2019.1592683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Alfred Allan
- School of Arts and Humanities, Edith Cowan University, Australia
| | - Maria M Allan
- School of Arts and Humanities, Edith Cowan University, Australia
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Contending With Preplanned Death: Questions for Clinicians. J Psychiatr Pract 2017; 23:366-374. [PMID: 28902070 DOI: 10.1097/pra.0000000000000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The goal of this column is to assist readers in reflecting on their attitudes and responses toward clinical and nonclinical situations involving preplanned deaths by decisionally capable individuals. Such circumstances range from encountering individuals in one's personal and professional lives who desire and intend to end their lives under their own terms, to having such individuals request assistance with predeath and postdeath arrangements. METHODS Attending to pertinent literature, this essay uses Socratic inquiry to question conventional assumptions and attitudes, push readers' thoughts beyond typical comfort zones, and consider alternative modes of responding to challenges posed by preplanned death. RESULTS Studies indicate that, for their own end-of-life circumstances, physicians would prefer a briefer, higher quality life to prolonged low-quality life, dignity in infirmity and death, and avoidance of terminal suffering. Lay people generally endorse similar preferences. Although contemporary society generally shuns contemplating preplanned death, cultural attitudes regarding preplanned death are rapidly evolving, and variations of "Death with Dignity" legislation have gained traction in increasing numbers of US states as well as internationally. As yet, no broad consensus exists as to how clinicians should manage circumstances involving preplanned death. CONCLUSIONS Considerations regarding preplanned deaths merit greater professional and public discussion. Many options exist for improving how professionals address the quality of human experiences surrounding death.
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Werth JL, Holdwick DJ. A Primer on Rational Suicide and Other Forms of Hastened Death. COUNSELING PSYCHOLOGIST 2016. [DOI: 10.1177/0011000000284003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article provides an overview of the major mental health issues involved in the debate over rational suicide and other forms of hastened death. In doing so, it covers the arguments for including counseling psychologists and other mental health professionals in discussions about hastened death; highlights the relevant empirical research associated with the topic, with special attention given to the studies involving psychologists and areas needing more investigation; and reviews the implications for practice and training and provides direction for those counseling psychologists who are working with persons who may be rational in their decisions to hasten death.
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Affiliation(s)
- James L. Werth
- American Psychological Association AIDS Policy Congressional Fellow,
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Ho AO. Suicide: rationality and responsibility for life. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:141-7. [PMID: 24881162 PMCID: PMC4079241 DOI: 10.1177/070674371405900305] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Death by suicide is widely held as an undesirable outcome. Most Western countries place emphasis on patient autonomy, a concept of controversy in relation to suicide. This paper explores the tensions between patients' rights and many societies' overarching desire to prevent suicide, while clarifying the relations between mental disorders, mental capacity, and rational suicide. METHODS A literature search was conducted using search terms of suicide and ethics in the PubMed and LexisNexis Academic databases. Article titles and abstracts were reviewed and deemed relevant if the paper addressed topics of rational suicide, patient autonomy or rights, or responsibility for life. Further articles were found from reference lists and by suggestion from preliminary reviewers of this paper. RESULTS Suicidal behaviour in a person cannot be reliably predicted, yet various associations and organizations have developed standards of care for managing patients exhibiting suicidal behaviour. The responsibility for preventing suicide tends to be placed on the treating clinician. In cases where a person is capable of making treatment decisions--uninfluenced by any mental disorder--there is growing interest in the concept of rational suicide. CONCLUSIONS There is much debate about whether suicide can ever be rational. Designating suicide as an undesirable event that should never occur raises the debate of who is responsible for one's life and runs the risk of erroneously attributing blame for suicide. While upholding patient rights of autonomy in psychiatric care is laudable, cases of suicidality warrant a delicate consideration of clinical judgment, duty of care, and legal obligations.
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Affiliation(s)
- Angela Onkay Ho
- Psychiatry Resident, Department of Psychiatry, University of Toronto, Toronto, Ontario
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Rogers JR, Gueulette CM, Abbey-Hines J, Carney JV, Werth JL. Rational Suicide: An Empirical Investigation of Counselor Attitudes. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6676.2001.tb01982.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Werth JL, Gordon JR. Amicus Curiae Brief for the United States Supreme Court on Mental Health Issues Associated With “Physician-Assisted Suicide”. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6678.2002.tb00179.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Werth JL, Crow L. End-of-Life Care: An Overview for Professional Counselors. JOURNAL OF COUNSELING AND DEVELOPMENT 2009. [DOI: 10.1002/j.1556-6678.2009.tb00567.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Werth JL, Lewis MM, Richmond JM. Psychologists' Involvement with Terminally Ill Individuals Who are Making End-of-Life Decisions. JOURNAL OF FORENSIC PSYCHOLOGY PRACTICE 2009. [DOI: 10.1080/15228930802427130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Niederjohn DM, Rogers DT. Objectivity in Evaluations for Assisted Suicide: Appreciating the Role of Relational and Intrapsychic Components. JOURNAL OF FORENSIC PSYCHOLOGY PRACTICE 2009. [DOI: 10.1080/15228930802427114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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WESTEFELD JOHNS, SIKES CHARLOTTE, ANSLEY TIM, YI HYUNSOOK. ATTITUDES TOWARD RATIONAL SUICIDE. JOURNAL OF LOSS & TRAUMA 2004. [DOI: 10.1080/15325020490517682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Confidentiality is one of the foundations on which psychotherapy is built. Limitations on confidentiality in the therapeutic process have been explained and explored by many authors and organizations. However, controversy and confusion continue to exist with regard to the limitations on confidentiality in situations where clients are considering their options at the end of life and after a client has died. This article review these 2 areas and provides some suggestions for future research.
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Affiliation(s)
- James L Werth
- Department of Psychology, Third Floor, Polsky Building, University of Akron, Akron, OH 44325-4301, USA.
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Richard J, Werth JL, Rogers JR. Rational and assisted suicidal communication on the Internet: case example and discussion of ethical and practice issues. ETHICS & BEHAVIOR 2002; 10:215-38. [PMID: 11695425 DOI: 10.1207/s15327019eb1003_2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The development of ethical and practice guidelines related to mental health service on the Internet has lagged behind the movement of practitioners into this area. Even for clinicians who are not offering services on the Web, the Internet has led to confusion and concern about proper roles and responsibilities. This article discusses an actual experience we had with a self-described rationally suicidal man with multiple sclerosis (MS). After presenting some background on MS, we report initial interactions with the man verbatim and summarize subsequent correspondence in an analysis of the man's claim that his decision to die was well reasoned and that he should be allowed a physician's assistance.
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Affiliation(s)
- J Richard
- Colorado Mental Health Institute at Fort Logan, 3520 West Oxford Ave., Denver, CO 80236. E-mail:
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Abstract
The leaders of many prominent health and mental health organizations have issued policy statements about the appropriateness of members of their professions being involved in assisted suicide, whether assisted suicide is ever an acceptable option for people, and what roles a professional can or should play when a client is considering assisted suicide. This article argues that only the latter focus--providing suggestions about how a professional can assist a person considering hastening death--is appropriate for an organization whose members are clinical practitioners rather than theorists. The former 2 positions, it is contended, are merely political posturing and are counterproductive to providing proper care to clients in need.
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Affiliation(s)
- J L Werth
- Department of Psychology, University of Akron, 3rd Floor, Polsky Building, OH 44325-4301. E-mail:
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Curry L, Schwartz HI, Gruman C, Blank K. Physicians' voices on physician-assisted suicide: looking beyond the numbers. ETHICS & BEHAVIOR 2002; 10:337-61. [PMID: 11785548 DOI: 10.1207/s15327019eb1004_2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Most empirical research examining physician views on physician-assisted suicide (PAS) has used quantitative methods to characterize positions and identify predictors of individual attitudes. This approach has generated limited information about the nature and depth of sentiments among physicians most impassioned about PAS. This study reports qualitative data provided by 909 physicians as part of a larger survey (N = 2,805) regarding attitudes toward and experiences with PAS and palliative care. Emergent themes illustrate important clinical, social, and ethical considerations in this area. The data illustrate the diverse and ardent responses that PAS evokes among certain physicians. The role of physicians' personal values is central to discussions about legalization of PAS. Polarized views such as those expressed by physicians in this study are not likely to be reconciled, thereby constraining the development of public policy regarding PAS.
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Affiliation(s)
- L Curry
- Braceland Center for Mental Health and Aging, Institue of Living, 400 Washington St., Hartford, CT 06106.
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DiPasquale T, Gluck JP. Psychologists, psychiatrists, and physician-assisted suicide: The relationship between underlying beliefs and professional behavior. ACTA ACUST UNITED AC 2001. [DOI: 10.1037/0735-7028.32.5.501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
For the clinician who works in a behavioral-medicine or primary-care setting, this article presents the association between medical illness and suicide. Specific illnesses such as HIV/AIDS, cancers of the brain and nervous system, and multiple sclerosis all are associated with an increased risk of suicide. Rates of major depression rise with increasing rates of serious medical illness; however, depression and associated suicidal ideation tend to be undertreated in the medically ill. When medical illness becomes terminal, the clinician's patient may be confronted with difficult end-of-life decisions. Great concern exists in the United States about the ethics of end-of-life decision making and the issue of physician-assisted suicide. The latter part of this article examines the terminally ill patient's right to refuse life-sustaining treatments or to have death hastened according to the principle of the "double effect." It also reviews psychologists' apparent acceptance of the concept of rational suicide, as well as assisted suicide under certain conditions, and offers several caveats. A reexamination of psychology's role, standards, and principles with respect to rational suicide is recommended.
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Affiliation(s)
- P M Kleespies
- Psychology Service, VA Boston Healthcare System and Boston University School of Medicine, MA 02130, USA
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Werth JL. The role of the mental health professional in helping significant others of persons who are assisted in death. DEATH STUDIES 1999; 23:239-255. [PMID: 10848153 DOI: 10.1080/074811899201064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The involvement of mental health professionals with people who are considering assisted death due to a terminal illness is beginning to be discussed more frequently in the professional literature; however, one neglected area is working with the significant others of the person who is suffering. This article covers ways both before and after the death that counselors can help significant others cope with the dying process, the decision to request assisted death, and the death itself.
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Affiliation(s)
- J L Werth
- University of Nebraska--Lincoln, USA
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