Copycats in Pilot Aircraft-Assisted Suicides after the Germanwings Incident

Aircraft-assisted pilot suicide is a rare but serious phenomenon. The aim of this study was to evaluate changes in pilot aircraft-assisted suicide risks, i.e., a copycat effect, in the U.S. and Germany after the Germanwings 2015 incident in the French Alps. Aircraft-assisted pilot suicides were searched in the U.S. National Transportation Safety Board (NTSB) accident investigation database and in the German Bundestelle für Flugunfalluntersuchung (BFU) Reports of Investigation database five years before and two years after the deliberate crash of the Germanwings flight into the French Alps in 2015. The relative risk (RR) of the aircraft-assisted pilot suicides was calculated. Two years after the incident, three out of 454 (0.66%) fatal incidents were aircraft-assisted suicides compared with six out of 1292 (0.46%) in the prior five years in the NTSB database. There were no aircraft-assisted pilot suicides in the German database during the two years after or five years prior to the Germanwings crash. The relative aircraft-assisted pilot suicide risk for the U.S. was 1.4 (95% CI 0.3–4.2) which was not statistically significant. Six of the pilots who died by suicide had told someone of their suicidal intentions. We consider changes in the rate to be within a normal variation. Responsible media coverage of aircraft incidents is important due to the large amount of publicity that these events attract.

Assisted dying is not the solution

A modern fallacy is that we can either have our own way without cost to society or someone else, or that our desires always trump another's need or freedom. This is none clearer than in the area of wanting to be killed.

Attitudes toward Preventing versus Assisting Suicide: A Correction to an Earlier Publication

A sample of 50 college students was more in favor of preventing suicide than assisting suicide. Support for assisting suicide was associated with judging-perceiving scores on the Keirsey-Bates Temperament Survey.

How do the mental health issues differ in the withholding/withdrawing of treatment versus assisted death?

This article reviews ten of the most common mental health-related arguments against assisted death and applies them to the withholding/withdrawal of treatment to determine if the concerns expressed are truly unique to assisted death. After this analysis it is suggested that the mandatory involvement of a mental health professional can alleviate many of the concerns specifically associated with assisted death and that a mental health professional may also be helpful in situations involving the withholding/withdrawal of treatment.

Kevorkian, Martha Wichorek and us: a personal account

In this short article, the authors describe their attempt to do suicide-prevention with a patient that ultimately died as the result of a physician-assisted suicide. Autopsy revealed no sign of physical disease but the patient's letters indicate a preoccupation with independence as the definition of life, and conviction that people who lose independence are no longer alive.

Policy and psychosocial considerations associated with non-physician assisted suicide: a commentary on Ogden

The report by Russel Ogden (2001) on a conference where devices designed to facilitate death were displayed and discussed highlights how far some individuals will go if they are committed to helping suffering people die. In this commentary, the author discusses the federal policy developments that have contributed to this movement and then expresses his concerns about using lay people to provide assistance with hastening death.

Assisted dying and nursing practice

PURPOSE

Nurses' views are often solicited about physician-assisted dying, a concept that incorporates both assisted suicide and active euthanasia. Yet nurses are rarely asked about their own clinical experience of assisted dying. The literature indicates that many nurses experience difficulty distinguishing professionally sanctioned end-of-life interventions from those that are not. In this article the investigator explores the social, legal, and political roots of assistance in dying, and critically examines the profession's position on nurse participation in assisted dying and the research regarding nurse-assisted dying.

SCOPE

The bioethics and nursing literature was reviewed from 1990 to 1999. The databases used were the Cumulative Index to Nursing and Allied Health Literature and Medline.

CONCLUSIONS

The complex nature of caring for highly symptomatic dying patients, and the difficulty some nurses experience in distinguishing a moral difference between hastening and assisting death, strongly indicate a need for additional nursing research that does not use a forced answer.

Successful antidepressant treatment for five terminally ill cancer patients with major depression, suicidal ideation and a desire for death

In the debate on euthanasia and physician-assisted suicide, we have to exclude terminally ill patients in whom the desire for death is caused by major depression. However, it is still not clear to what degree major depression can be treated by psychiatric intervention in this setting. We evaluated the effect of antidepressant treatment in terminally ill cancer patients. Six cancer patients with suicidal ideas thought to be due to major depression were treated with tricyclic antidepressants. Three had requested terminal sedation to relieve them from their suffering. The median survival of five of these patients was 4 weeks after diagnosis; one was lost to follow-up. The efficacy of the antidepressant treatment was assessed using the Hamilton Rating Scale for Depression (HRSD). One week after the start of treatment with antidepressants, five of the six patients showed a marked improvement in their mood and showed no further suicidal thoughts or requests for terminal sedation. The average reduction in the HRSD score was 23.4 points (14-38; SD = 9. 9). Antidepressant treatment can be effective in alleviating the desire for death due to major depression, even in terminally ill cancer patients.

[Suicide of psychiatric inpatients assisted by euthanasia advocacy groups. Cases of assisted suicide?]

The debate on passive and active euthanasia has met a controversial echo both in the German-speaking media and in professional publications within recent years. This discussion, however, largely excluded mentally ill patients. Also, euthanasia advocacy groups have usually distanced themselves from euthanasia in psychiatric patients. We report here two cases from our hospital in which inpatients with affective disorders committed assisted suicide during a hospital pass. We discuss these events under the assumption that these are cases of questionable active euthanasia in mentally ill patients whose judgement was considerably compromised by their disorder.

A better approach to care of the dying. Catholic healthcare and the Catholic community can present an alternative to physician-assisted suicide

To combat physician-assisted suicide, Catholic healthcare and the Catholic community cannot solely focus on mounting campaigns and formulating policies. They must also demonstrate an alternative way to approach death and care of the dying, taking a leadership role in improving end-of-life care. To accomplish this, Catholic healthcare must foster a culture that recognizes death as the inevitable outcome of human life and makes care for the dying as important as care for those who may get well. The ministry must acknowledge the limits of human life, human abilities, human ingenuity, and medical technology; and respect decisions to forgo life-sustaining therapies. In addition, physicians must address advance directives with patients before hospitalization and must be willing to offer hospice care as an option to dying patients and their families. More effective pain management must be devised. Catholic facilities must develop palliative care policies and commit to ongoing education to provide such care. It is essential that they pay attention to the environment in which patients die; identify the physical, psychosocial, and spiritual needs of family members; and use prayer and rituals in meaningful ways. With a clear focus on improving end-of-life care, Catholic healthcare--in partnership with other denominations--can eliminate some of the factors that can make physician-assisted suicide seem appealing to suffering people.

Report 59 of the AMA Board of Trustees (A-96). Physician-assisted suicide. Reference Committee on Amendments to Constitution and Bylaws

This Board of Trustees report calls for reaffirmation of the position of the American Medical Association (AMA) in opposition to physicians assisting their patients in committing suicide. The AMA maintains that the appropriate step for physicians is not to assist a patient in death but to provide compassion and palliative care. In providing end-of-life care, the option of allowing physicians to intentionally cause the death of patients is a line that should not be crossed. This position is based on the historical role of physicians as advocates for healing. The report discusses AMA activity to design and implement a comprehensive physician education plan on end-of-life care in response to the House of Delegates' action in adopting Board of Trustees Report 48-I-95, "Quality Care at the End of Life." This plan will further the AMA's commitment that patients should receive high quality care during every stage of life, including the end of life. The goal of this educational campaign is to advance the medical culture by making palliative treatment and care directions based on values-based advance care planning the standard of care for meeting the needs of patients at the end of life. The basis for this activity will be the acknowledgment that physicians, while unable to always provide a cure, should always be able to relieve suffering, address the psychological needs of patients at the end of life, add value to remaining life, and help patients die with dignity. The report presents information on state legislative activities and judicial actions relating to physician-assisted suicide. The report also presents a discussion on the ethical under-pinnings against physician participation in patients' suicides. This report recommends that: the AMA reaffirm current policies 140.952 and 140.966 (AMA Policy Compendium), in accordance with Council on Ethical and Judicial Affairs Opinion 2.211 (opposition to physician-assisted suicide); the AMA initiate an educational campaign to make palliative treatment and care directions based on values-based advance care planning the standard of care for meeting the needs of patients at the end of life; the AMA continue to seek out opportunities to present the views of medicine on physician-assisted suicide and improving the quality of care for patients at the end of life; the AMA disseminate this report throughout the Federation with a request that it be distributed to local physicians; and the Board of Trustees present the House of Delegates with an update on these and related activities at the 1996 Interim Meeting and the 1997 Annual Meeting.

Oncology nurses' attitudes regarding voluntary, physician-assisted dying for competent, terminally ill patients

Euthanasia and "voluntary dying" are among the most controversial issues involved in cancer care. The purpose of this descriptive study was to explore oncology nurses' attitudes about physician-assisted death (PAD) for competent, terminally ill adults who request this assistance. Questionnaires were sent to 2,000 randomly selected members of the Oncology Nursing Society. The questionnaires included demographic questions, four vignettes describing patient care situations and possible responses based on beliefs about PAD, and questions that explored awareness of organizations and legislation that promote legalization of PAD. The response rate was 61% (1,210). Findings indicate that oncology nurses hold diverse views regarding the acceptability of PAD. Although many nurses favored PAD, they also expressed a reluctance to administer the medication that would cause death. Given that PAD is an ethical and legal issue in the United States for terminally ill patients, nurses are encouraged to become informed about the concept of PAD and be prepared to actively respond to the policy-making ramifications of the assisted-death movement.