Physician-assisted suicide and euthanasia in the ICU — experts debate ethical issues

January 18, 2017 – Physician-assisted suicide and euthanasia (PAS/E) is a topic of intense debate in society, not least among critical care medicine specialists, who treat many patients at or near the end of life. Core ethical issues involved in PAS/E will be discussed and debated in a unique panel discussion at the Society of Critical Care Medicine's (SCCM) 46th Critical Care Congress, to be held January 21 to 25, 2017, at the Hawaii Convention Center in Honolulu, Hawaii, USA. These issues are also discussed in Critical Care Medicine, SCCM's official journal, published by Wolters Kluwer. The session will be broadcast live at http://www.sccm.org/live. Follow #SCCMLive.

"We describe major alternative perspectives on four questions central to the ethical analysis of PAS/E in the form of a dialogue between those who favor the legalization of PAS/E and those who oppose it," according to the article by Ewan C. Goligher, MD, of the University of Toronto, and coauthors. They present a "collegial" perspective on these difficult issues by a panel of critical care medicine clinicians and other experts.

Four Core Ethical Issues in PAS/E: Debate on Three Topics, Consensus on One

New laws and legal decisions have sharpened the focus on PAS/E and its implications for critical care medicine. Physician-assisted suicide refers to prescription of lethal medication to be voluntarily self-administered. Voluntary euthanasia refers to direct causation of death by a physician, at the patient's "specific, consistent, and thoroughly considered request."

The four core ethical issues debated are:

  • Are there patients for whom death is beneficial? One group of authors "find[s] it sometimes justifiable to accelerate a patient's death deliberately as a means of ending suffering." But the other group responds that the benefit from intervening to cause death is "unknown and unknowable to medicine."
  • Is PASE/E morally equivalent to withholding or withdrawing life-sustaining therapy (WWLST)? Authors on the pro side believe that PAS/E is equivalent to WWLST, the latter widely regarded as morally acceptable. But those on the con side point out notable ethical distinctions between PAS/E and WWLST that reflect differences in intent.
  • Is it morally acceptable for physicians to cause death intentionally? Supporters of PAS/E see no "sufficient rationale" why patients should be allowed to consent to passive plans that will lead to ending life (such as WWLST), but not active plans. Those opposed believe that intentionally causing death "runs counter to … the moral foundation of medicine."
  • What is a reasonable accommodation? Both sides agree that physicians have a right of conscientious objection to PAS/E. Patients should respect and expect that many physicians will be unwilling to provide PAS/E. At the same time, physicians who object should be willing to transfer the patient's care to colleagues who are willing to consider PAS/E.

The debate is timely because discussions on PAS/E have become increasingly prominent in healthcare and in society at large. PAS/E is now legal in six U.S. states and Canada. Dr. Goligher and colleagues write, "We hope that our discussion enables readers to reflect critically on their own position on PAS/E in order to care for critically ill patients and their families with ever greater compassion and humanity, and to discuss these issues among colleagues with clarity and respect."

The debate will continue at an SCCM 2017 "Hot Topics" presentation titled "Physician-Assisted Suicide and Euthanasia in the Intensive Care Unit: A Dialogue on Core Ethical Issues." The pro side will be taken by Jan Bakker, MD, PhD, FCCP, of New York University, Columbia University College of Physicians and Surgeons, Erasmus MC of Erasmus University Medical Center, Rotterdam, the Netherlands. The con side will be taken by by E. Wesley Ely, MD, MPH, FCCM, professor of medicine at Vanderbilt University School of Medicine, Nashville, Tennessee. The discussion will be moderated by Timothy G. Buchman, PhD, MD, MCCM, of Emory University School of Medicine, Atlanta, Georgia.

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Click here to read "Physician-Assisted Suicide and Euthanasia in the ICU: A Dialogue on Core Ethical Issues."

Article: "Physician-Assisted Suicide and Euthanasia in the ICU: A Dialogue on Core Ethical Issues" (doi: 10.1097/CCM.0000000000001818)

About the Society of Critical Care Medicine

The Society of Critical Care Medicine (SCCM) is the largest nonprofit medical organization dedicated to promoting excellence and consistency in the practice of critical care. With members in more than 100 countries, SCCM is the only organization that represents all professional components of the critical care team. The Society offers a variety of activities that ensures excellence in patient care, education, research and advocacy. SCCM's mission is to secure the highest quality care for all critically ill and injured patients. Visit http://www.sccm.org for more information. Follow @SCCM or visit us on Facebook.

All of the late-breaking literature releases from the 46th Critical Care Congress are available at http://www.sccm.org/literature.

About Critical Care Medicine

Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the intensive care unit and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research and advances in equipment and techniques. Follow @CritCare Med.

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