Guidelines for Physician-Assisted Suicide: Ensuring Patient Autonomy and Safeguards

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In the context of physician-assisted suicide, it is crucial to uphold patient autonomy while implementing strict safeguards to prevent abuse. Key considerations include competency, voluntariness, pressure-free decision-making, cooling-off periods, second opinions, and ensuring physician independence through specialist committees. This comprehensive approach aims to protect vulnerable individuals and prioritize the patient's wishes in a responsible manner.

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Guidelines for Physician-assisted Suicide Raphael Cohen-Almagor Jersey assisted dying citizens jury March-May 2021

The Golden Mean Taking into consideration the will of the patient and the duty to prevent abuse. After all, human life is at stake. The state has a responsibility to protect its vulnerable populations. Jersey assisted dying citizens jury March-May 2021

Competency, voluntariness The patient expressly wishes to end his or her life and has made a signed declaration to that effect. The expressed wish to die should be voluntary, made in a sound mind, and signed in the presence of a witness who is not related to the patient s family nor to the medical team that treats him/her. Jersey assisted dying citizens jury March-May 2021

Pressure-free The decision should notbe made by the patient s family or as a result of family pressures. It is the task of social workers to examine to what extent the patient is affected by external pressures. Jersey assisted dying citizens jury March-May 2021

Cooling off period Physician-Assisted Suicide should not be rushed. The patient should state this wish repeatedly over a period of time. It is suggested that a period of not less than 14 days has to elapse since the day on which the person s declaration took effect. Jersey assisted dying citizens jury March-May 2021

Second opinion The decision-making process should include a second opinion in order to verify the medical diagnosis, minimize the chances of misdiagnosis, and in order to allow the probing of other medical options. A specialist who is not dependent on the first physician should provide the second opinion. The expert physician has a dual responsibility: The expert needs to verify that the patient s desire to die is genuine and voluntary, and that the attending physician was correct in the diagnosis that s/he made that the patient is, indeed, suffering from an incurable and irreversible disease.

Ensuring physicians independence It is advisable that the identity of the consultant be determined by a committee of specialists who will review the request for physician-assisted suicide. Jersey assisted dying citizens jury March-May 2021

Palliative care At times the patient s decision might be influenced by severe pain, and therefore the role of palliative care can be, and is, crucial. The attending physician should inform the patient of all feasible alternatives, and s/he should consult a palliative care specialist who will inform the patient about relevant measures to help the patient cope with pain and suffering, including comfort care, hospice care and pain control. Jersey assisted dying citizens jury March-May 2021

Communication The patient must be informed of his or her situation, the limited prognosis for recovery, the expected escalation of his/her disease, and the degree of suffering that may be involved. There must be an exchange of information between physicians and patients. Jersey assisted dying citizens jury March-May 2021

Patients initiative Physicians should not suggest assisted suicide to the patient. Instead, it is the patient who should have the option to ask for such assistance. Any reluctance shown by patients regarding this issue should be honored and respected. Jersey assisted dying citizens jury March-May 2021

Verification Sometime prior to the performance of PAS, a physician and a mental health specialist should visit and examine the patient. They will verify that this is the genuine wish of a sound mind person, and that the individual is not depressed, being coerced or influenced by a third party to end his or her life. Jersey assisted dying citizens jury March-May 2021

Repentance The patient must be able to rescind his or her decision to pursue physician-assisted suicide at any time and in any manner, Jersey assisted dying citizens jury March-May 2021

Role of Physician Physician-Assisted Suicide may be performed only by a physician in the presence of another physician. Jersey assisted dying citizens jury March-May 2021

Further checks and balances The decision-making team should include a lawyer who will examine the legal aspects involved and ensure there is protocol in place which will prevent possible abuse. At the very least, a public representative should be involved. Jersey assisted dying citizens jury March-May 2021

Last Resort Physician-assisted suicide will be conducted as a last resort, after exhausting all treatment options that could potentially bring the patient some relief and reduce his/her suffering. Jersey assisted dying citizens jury March-May 2021

Methods Physician-assisted suicide may be conducted in one of three ways, all of which should be discussed openly and decided upon by the physician and the patient: (1) Oral medication; (2) Self-administered, lethal intravenous infusion; (3) Self-administered lethal injection. Jersey assisted dying citizens jury March-May 2021

Humane motives Physicians may not demand a special fee for the performance of physician-assisted suicide. There must be no financial incentive to perform or assist with the procedure since the motive for Physician-Assisted Suicide is humane. Jersey assisted dying citizens jury March-May 2021

Extensive documentation There must be extensive documentationin the patient s medical file, including the disease diagnosis and prognosis by the attending and the consulting physicians; attempted treatments; the patient s reasons for seeking PAS; the patient s request in writing or documented on a video recording; documentation of conversations with the patient; the physician s offer to the patient to rescind his or her request; documentation of discussions with his or her beloved people, and a psychological report confirming the patient s condition. Jersey assisted dying citizens jury March-May 2021

Coroner examination Each report should be examined by a coroner following completion of the physician-assisted suicide. Jersey assisted dying citizens jury March-May 2021

Lethal drugs The drugs required to end one s life are known. Physicians will be allowed to use only the lethal medications authorized by the Ministry of Health. Jersey assisted dying citizens jury March-May 2021

Pharmacy log Pharmacists should be required to file a report every time lethal medications are sold. Jersey assisted dying citizens jury March-May 2021

Conscientious objection Physicians should not be coerced into taking actions that conflict with their conscience. No coercion should be involved in the process. Conscientious objection should be respected. Jersey assisted dying citizens jury March-May 2021

Monitoring and Control Committee A medical association committee should be established to investigate underlying facts of reported cases, to explore whether there were cases which did not comply with the guidelines, and to inquire whether there were unreported cases. Jersey assisted dying citizens jury March-May 2021

Sanctions Significant sanctions should be taken to punish health-care professionals who violate the guidelines, fail to consult with other physicians or to file reports, or engage in involuntary termination of life without the patient s consent or with incompetent patients. Physicians who fail to comply with the guidelines should be charged, and procedures to sanction them should be enforced by the medical disciplinary tribunal. The sanctions should be significant and include revocation of the physician s medical license. Jersey assisted dying citizens jury March-May 2021