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This conceptual paper considers the practice implications of assisted dying for contemporary nursing practice within the United Kingdom in response to the publication of a parliamentary report leading to a private members' bill that will form the basis of a debate and possible change in legislation. A recurring theme within the nursing research is how nurses should respond to patients expressing an interest or making a request for assisted dying. This paper explores contemporary evidence and argues that the procedure of assisted dying is a complex (manifold) and puzzling (paradoxical) practice. The UK nursing profession may replicate recent healthcare catastrophes if the response to a proposal for assisted dying is based on a technical-rational stance, or if nurses merely coalesce around a single determinant such as patient autonomy. The paper presents two nursing communicative interventions that seek to address how to respond to a patient request for an assisted death that foregrounds the preferences and personhood of the patient whilst providing opportunities for enquiry-based approaches to enhance nursing responses to intractable suffering., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The Canadian approach to assisted dying, Medical Assistance in Dying (MAiD), as of early 2024, is assessed for its ability to protect patients from criminal healthcare serial killing (HSK) to evaluate the strength of its safeguards. MAiD occurs through euthanasia or self-administered assisted suicide (EAS) and is legal or considered in many countries and jurisdictions. Clinicians involved in HSK typically target patients with the same clinical features as MAiD-eligible patients. They may draw on similar rationales, e.g., to end perceived patient suffering and provide pleasure for the clinician. HSK can remain undetected or unconfirmed for considerable periods owing to a lack of staff background checks, poor surveillance and oversight, and a failure by authorities to act on concerns from colleagues, patients, or witnesses. The Canadian MAiD system, effectively euthanasia-based, has similar features with added opportunities for killing afforded by clinicians' exemption from criminal culpability for homicide and assisted suicide offences amid broad patient eligibility criteria. An assessment of the Canadian model offers insights for enhancing safeguards and detecting abuses in there and other jurisdictions with or considering legal EAS. Short of an unlikely recriminalization of EAS, better clinical safeguarding measures, standards, vetting and training of those involved in MAiD, and a radical restructuring of its oversight and delivery can help mitigate the possibility of abuses in a system mandated to accommodate homicidal clinicians., Competing Interests: Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose., (© 2024. The Author(s).)

In this paper, we reflect on factors that seem to have influenced the accessibility of medical assistance in dying (MAID) in the Canadian context. Since legalization in 2016, the uptake of MAID has increased rapidly to equal or exceed rates in other countries. In that MAID implementation involves numerous ethical/moral complexities, we consider four factors that appear to have influenced this growth. First, we reflect on the vague language contained within the legislation that has been interpreted by a community of practice in which making MAID accessible is an important priority. Second, we consider policies of effective referral and self-referral that have been strategies for enhancing accessibility in relation to a wider context that contains conscientious objection. Third, we examine the apparent impact of centralized clinical teams and coordination services that have enhanced accessibility for persons residing in rural and remote areas. Fourth, we reflect on ways in which public awareness of MAID has been enhanced through policies that enable healthcare providers to introduce the topic of MAID as an option within advance care planning. We conclude with a consideration of how these intersecting factors may be shaping the moral complexity inherent in the idea of making MAID accessible., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: UK campaigners for a law permitting assisted dying (AD) restricted to those with a maximum life expectancy of 6 months claim that this would largely remove the need for UK residents to seek AD in Switzerland. We wanted to discover whether this prediction was correct., Methods: We analysed the diagnoses of UK residents who had such deaths including, for the first time, data from all three of the main Swiss providers of AD to non-residents, comparing them with figures from Oregon, which has a 6-month restriction., Results: Only 22.7% of UK residents had cancer (Oregon 72.5%) while nearly half (49.6% and over half including dementias) had neurological conditions (Oregon 11.2%) and many with prognoses of much more than 6 months., Conclusion: Overall, less than half would meet a 6-month prognosis criterion. This has significant implications for patients, palliative care clinicians and legislators., Competing Interests: Competing interests: CB and GW are members of MDMY (my death my decision)., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Enduring intolerable suffering, an essential eligibility criterion in Medical Assistance in Dying (MAiD) in Canada and elsewhere, is a contradiction in terms, in that suffering must be tolerable to be endured. Cases of people who were approved for MAiD but who elected to die naturally, thus tolerating their suffering, bear out the unreliability of this central safeguard. The clinical assessment of intolerable suffering may be strengthened by adopting a definition of intolerable suffering centred on clinically evidenced physical and psychological decompensation. This argument also raises important questions about the risks of MAiD clinicians subjectively defining, approving and providing MAiD in ways that deviate from accepted legal and clinical concepts and ethics. Examples show some prolific clinicians describe MAiD in terminology that differs from such norms, as a personal mission, as personally pleasurable, and as a rights-based service. These alternative views are explored for their risks in assessing and providing MAiD for intolerable suffering. This further demonstrates the need for conceptual clarity in legislation, improved vetting and monitoring of clinicians, and a different assessment process to protect patients and clinicians., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Importance: Medical aid in dying (MAID) is legal in jurisdictions covering more than one-fifth of the US population and has been used by a largely White, educated population. The extent to which knowledge of MAID and preferences for personal use align with patterns of use is unknown., Objective: To evaluate knowledge among US adults of the legal status of MAID as well as interest in using MAID., Design, Setting, and Participants: This cross-sectional, self-report online survey study used a national Prime Panels-based sample of US adults recruited between July 16 and August 10, 2024. A total of 3227 respondents aged 18 years or older from all US states and Washington, DC, were included. Individuals from states with legal MAID, aged 60 years or older, and members of racial and ethnic minority groups were oversampled., Main Outcomes and Measures: Knowledge of the legality of MAID in the US and in respondents' state of residence as well as potential interest in future use of MAID. Descriptive statistics and χ2 tests were used to examine associations by demographic characteristics and place of residence., Results: Of 3227 respondents (mean [SD] age, 55.7 [17.4] years; 1839 women [57.0%]), 1654 (51.3%) did not know if MAID was legal the US, and 1638 (50.8%) did not know if MAID was legal in their state. Respondents in states where MAID is legal were more likely to know that MAID is legal in the US compared with those in states where MAID is not legal (728 of 2164 [33.6%] vs 216 of 1063 [20.3%]; P < .001). Across all respondents, 1420 (44.0%), including 96 of 222 Asian respondents (43.2%), 206 of 605 Black respondents (34.0%), and 129 of 308 Hispanic respondents (41.9%), reported they would definitely or probably consider MAID if they received a diagnosis of a terminal illness., Conclusions and Relevance: In this online survey study of US adults, substantial interest in using MAID as well as significant knowledge gaps regarding the legality of MAID were reported. These findings highlight the need for public education, policy initiatives, and patient-clinician discussions to ensure equitable access to patient-centered end-of-life options and informed decision-making.

The potential of the Terminally Ill Adults (End of Life) Bill to pass into law has raised critical questions for nurses, who are now confronting the possibility of involvement in assisted death. While the provisional bill contains protections against coercion or punishment of healthcare professionals who do not wish to participate in the assisted dying process, many are left wondering about the challenges they may face, even if they are in support of medically assisted death. Francesca Ramadan provides insight into nurses' complex and often contradictory experiences of assisted dying and the research, education and guidance necessary for navigating personal and professional challenges.

The article deals with assisted suicide from a German legal perspective, focussing on criminal law and constitutional law and based on this to discuss possibilities for a further regulation. It is shown that assisted suicide is exempt from punishmed under the condition of a fully responsible decision to commit suicid and the final act leading to death is carried out by the suicidal person, which means that other acts of assistance are already punishable under current law. A further component of the considerations is how, independent of a legal regulation, free responsibility should be established and, in particular, how information and counselling about alternatives should be provided against the background of the different needs of people in different life and problem situations. Overall, further legal regulation is viewed critically. Practitioners are called upon to continuously develop recommendations for dealing with suicidal ideation., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: T. Henking gibt an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von der Autorin keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2025. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Depressive disorders in older people are often accompanied by thoughts of their own death and the specific wish to die. Therefore, it can be assumed that depressive older people will express the wish for assisted suicide more frequently if legal provisions have been made. The following aspects must be taken into account when examining the decision-making capacity of those affected: depressive disorders can be reversible. Severe depressive disorders can be accompanied by an impaired capacity for judgment and making decisions, which rules out the possibility of making decisions of one's own free will. Particularly in old age, somatic comorbidities and an increased risk of loneliness are often found, which can additionally promote suicidal ideation. Without comprehensive assessments it will not be possible to clarify the actual autonomy of the will and it will be difficult to assess the permanence of the decisions made. It is also conceivable that the legal expert opinion could come to a different conclusion than the treating physician, who has followed the course of the illness during various phases of the patient's life and observed many changes in the patients will. In summary, it is currently not clearly recognizable in what form the assessment of free will could be organized in connection with possible legal regulations on assisted suicide, as long observation periods would be required for an adequate assessment., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: J. Christl und T. Supprian geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2025. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Assisted suicide, also known as physician-assisted death, remains a contentious issue for healthcare providers, involving medical ethics, legal frameworks, and individual rights. This study aims to explore the attitudes, experiences, and training needs of nurses in Austria following the legalization of assisted suicide in 2022., Methods: Utilizing a cross-sectional online survey, both quantitative and qualitative data were collected from 280 palliative and hospice care nurses across all nine Austrian states., Results: Approximately a quarter of nurses experienced a shift in their attitudes towards assisted suicide during the first year of its legalization. While a majority felt their wellbeing was unaffected, 14.5% reported a decline in mental health due to the new law. Despite both mandatory and optional training being provided by employers, 80.7% of nurses expressed a need for further education, particularly on legal and organizational aspects, practical case studies, and interdisciplinary communication. Qualitative analysis revealed diverse perspectives, with some nurses advocating for patient autonomy and empathetic support, while others preferred enhancing palliative care as an alternative to assisted suicide. Furthermore, nurses highlighted the necessity for a clear legal framework and collaborative decision-making processes., Conclusion: The study underscores the critical role of comprehensive palliative care and calls for more clarity around appropriate assisted suicide practices. Ongoing dialogue, enhanced training, and support for nurses to navigate both ethical and practical challenges posed by assisted suicide legislation is also needed. Future research should evaluate the effectiveness of these interventions and explore the long-term impacts of assisted suicide on patients, their families, and healthcare providers., Competing Interests: Declaration of competing interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The article examines the ethical responsibility of welfare organizations in the context of assisted suicide against the background of the judgement of the German Constitutional Court (BVerfG) on § 217 of the German Criminal Code (StGB). The emphasis on self-determined dying poses a particular social and ethical challenge for organizations and providers of care for the aged to consider the consequences and draw appropriate conclusions for implementation. The article outlines a theory to practice transfer in three main steps: (1) development of the ethical and social implications of assisted suicide, particularly with respect to old people and those in need of care, (2) description of an organizational ethical approach as a mediating authority to systematically transfer the value orientation into practice and (3) exemplary presentation of the current procedure in the Worker's Samaritan Foundation (Arbeiter-Samariter-Bund, ASB) as an outline of the development of a concept of action that is congruent with organizational logic, structure and culture., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: L. Tonello gibt an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von der Autorin keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2025. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Opponents of legalised assisted dying often assert that palliative care is worse in countries where assisted dying has been legalised, and imply that legalised assisted dying makes palliative care worse. This study considers five versions of this claim: that it is difficulty to access expert palliative care in countries where assisted dying has been legalised, that those countries rank low in their quality of end-of-life care; that legalising assisted dying doesn't expand patient choice in respect of palliative care; that growth in palliative care services has stalled in countries where assisted dying has been legalised; and that legalised assisted dying impedes the growth of palliative care or causes it to decline. In each case, it concludes that neither argumentation nor evidence supports these claims., (© 2024 The Author(s). Bioethics published by John Wiley & Sons Ltd.)

Background: Medical assistance in dying (MAiD) was legalized in Canada following the Carter v. Canada ruling of 2015. In spite of legalization, the ethics of MAiD remain contentious. The bioethical literature has attempted to differentiate MAiD from withdrawing life-sustaining treatment (WLT) in an effort to examine the nature of the moral difference between the two. However, this research has often neglected the firsthand experiences of the clinicians involved in these procedures. By asking physicians if they perceive the major bioethical accounts as clinically useful, we seek to distinguish between aspects of the contemporary bioethical landscape which are useful at the bedside and those which are divorced from the realities faced by clinicians., Methods: We applied a qualitative descriptive approach to explore physicians' experiences and bioethical distinctions in providing MAiD and WLT., Results: Semi-structured interviews were conducted with 21 physicians, and the transcripts were thematically analyzed to identify common patterns and divergences in their perspectives. Three core themes were found: (1) consensus on MAiD's moral equivalence with WLT despite differences between the practice, (2) discord regarding the use of the term 'killing', and (3) disjuncture between bioethical debates and practice. Theme 1 comprised of three sub-themes: (1.1) no moral difference between MAiD and WLT, (1.2) physician versus underlying medical condition as cause of death, and (1.3) relief of suffering., Conclusions: In order to have practical utility for clinical practice, it is essential for bioethicists to engage in dialogue with patients and their medical providers pursuing MAiD or WLT. Theoretical debates that are divorced from the realities of terminal illness do not assist physicians with navigating the ethical terrain of ending a patient's life. This research captures meaningful accounts regarding MAiD and WLT that is rooted in the lived experience of the providers of these services in order for bioethical debates to have substantive impact in clinical practice and in legislation surrounding future health policies., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval for this study was obtained from the University of Waterloo Office of Research Ethics (ORE #40801). Informed consent was obtained from all participants prior to commencing our study/ All research design and data collection pertaining to this study were conducted in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objectives: Since physician-assisted dying (PAD) has become a part of the clinical dialogue in the United States (US) and other Western countries, it has spawned controversy in the moral, ethical, and legal realm, with significant cross-country variation. The phenomenon of PAD includes 2 practices: Euthanasia and medical aid in dying (MAiD). Although euthanasia has been allowed in different parts of the world, in the US it is illegal. MAiD has been enacted into law in some jurisdictions. As the practice involves people at the end of life (EOL), often with cancer, and sometimes struggling with psychiatric symptoms; they gain added salience in the field of Consultation-Liaison (CL) Psychiatry in general and Psycho-Oncology in particular., Methods: The current paper reviews a case where a patient did request for MAiD and successfully carried it through, this case became more salient, as the CL Psychiatry department was intimately linked at various stages of care for the patient., Results: In describing the case several other aspects of EOL care issues were touched upon, and the various debates as well as treatment modalities, for an individual requesting for medical aid in dying were described., Significance of Results: MAiD will possibly remain a sensitive and controversial topic of discussion across the spectrum of healthcare, and as responsible and compassionate advocates for the patients, clinicians need to engage more with the debate surrounding it and facilitate informed decision making. We believe that the present case will throw light on to this enigmatic practice and help in furthering the dialogue surrounding MAiD.

Objective: To examine the public's stance on physician-assisted dying (PAD) in Taiwan across different PAD scenarios and identify demographic and psychosocial factors associated with the levels of support., Design: Cross-sectional survey design. Independent variables included individual sociodemographic characteristics, healthcare professionals, perceived quality of life, formal caregiver experience, Patient Right to Autonomy Act (PRAA) awareness and advance care planning (ACP) preparedness., Setting: An online survey of the general population in Taiwan was conducted in 2022., Participants: A total of 3922 Taiwanese adults who completed all survey questions., Outcome Measures: Agreement levels with PAD in three scenarios: terminal illnesses, unbearable non-terminal pain and severe cognitive impairments. Multivariate logistic regression was used to examine agreement with each PAD scenario as separate dependent variables in the first three models and overall agreement across all scenarios as the dependent variable in the fourth model., Results: High levels of public support for PAD were observed, with 86.2% supporting PAD for terminal illnesses, 79.2% for unbearable non-terminal pain and 72.6% for severe cognitive impairments. Support for PAD was associated with factors including younger age, male gender, lack of religious affiliation, a non-healthcare professional background, employment as a formal caregiver, lack of awareness of PRAA and higher preparedness in ACP., Conclusions: The results indicate a potential cultural shift in Taiwan towards greater emphasis on individual autonomy in end-of-life decisions. There appears to be significant public support for developing legal frameworks in favour of PAD, carefully considering the psychosocial factors that highlight the importance of individual rights in end-of-life care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

In response to increased focus on the issue of Assisted Dying (AD) in the UK due to the presentation of The Terminally Ill Adults (End of Life) Bill 2024-25 [1] and bills before parliaments in the Isle of Man, Guernsey and Scotland, the British Geriatric Society (BGS) recently developed a position statement opposing legalisation of AD in the UK [2]. We set out our key reasoning behind this position, namely the current adverse health and social care context and significant concern about whether effective safeguards can be created to protect older people with complex needs from undue harms. The BGS asks for improved, personalised, multidisciplinary care for older people at the end of their lives, including high-quality palliative and end-of-life care. It urges caution about legalisation and offers its expertise in any potential future shaping and implementation of AD legislation. This should include a conscience clause for professionals objecting to direct involvement. The main outcomes from a survey of member's opinions are also outlined [2]. The majority were against legalisation of AD; however, a significant minority were in favour, with some undecided. This diversity of opinion highlights a need for the Society to maintain balance and nuance on this difficult and emotive issue, warranting future BGS reviews if the relevant legislation changes., (© The Author(s) 2025. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

It is widely accepted that voluntary assisted dying (VAD) should be regulated but little is known about the most effective way to regulate doctors in this setting. This article reports on empirical research conducted in two Australian states where VAD is lawful (Victoria and Western Australia). Interviews were conducted with 92 participants: one group comprised doctors providing VAD and the other group was regulators in this field. Participants were asked about how best to regulate doctors providing this service. Strikingly, both regulator and doctor participant groups were consistent with each other in their views on what constituted effective regulation. The nature of VAD was perceived by participants to require special regulation, although some felt this was overdone in these states. Reported features of effective regulation included regulators taking an educative approach, regulation being perceived as acceptable by doctors, and it being responsive and nimble to provide the guidance that doctors need. Participants also considered a range of regulatory tools were required to regulate VAD effectively, and some identified a need for these tools to be employed together in a holistic way. This article concludes with a set of principles for effective regulation of VAD, discerned from the views of participants., (© The Author(s) 2025. Published by Oxford University Press.)

The article focuses on assisted dying, its legislation process and why it might be a political priority for UK lawmakers at this time. The author also raises questions about what the implications of this bill for nurses, particularly community nurses. The article mentions places outside the UK where assisted dying is already a feature of healthcare. 'Bill' or 'bills' should be taken to mean the draft legislation at the time of writing this article; these are subject to revision or even rejection in each jurisdiction either in the short or long term. It is important for nurses to think about the issue in general terms now, as it returns to the political agenda every few years. Nurses need to be able to discuss it professionally as professional standards, training and regulation will change. The questions presented give rise to polarised and strongly held views. It is important to examine any bill from a theoretical standpoint, to provide valid reasons for the position that professional nurses take, for or against these concepts in principle. There are questions of conscience and religious faith, which are challenging, but it is vital to look at the issue in an unemotional manner., Competing Interests: Declaration of interest: None

Background: The admission criteria to the medical assistance in dying (MAID) procedures (Euthanasia - E; Physician Assisted Suicide - PAS) represent a much debated issue. In most of the jurisdictions where MAID is legal, the unbearable suffering due to a terminal illness constitues the main admission condition. In contrast, those suffering from either a mental disorder or an existential discomfort are excluded. Some consider the exclusion of the former group to be protective towards those deemed vulnerable because they are not able to make free and informed decisions, while the latter is excluded to align the legal approaches to the prevailing moral models. Others consider these stances discrimination., Purpose: To prove that when someone requests MAID, his suffering should be first and foremost investigated not only and not so much for its causes, but, above all, for its key role played in understanding the MAID request., Contents: After reviewing the specific aspects of suffering in relation to his three determinants - existential suffering, mental disorder, terminal illness - the article provides the evidence that: a) such a conditions, although completely different from each other, share the same psychological processes leading to the unbeaerable suffering and then to the request for MAID or to the suicide ideation/completion; b) there is no scientific data supporting a discrimination access to MAID on the basis of the presence/absence of a terminal illness., Conclusions: Using the unbearable suffering due to a terminal illness as the sole criterion for admission to MAID violates the principle of autonomy, and, lacking scientific evidence, it does not clarify where the line is drawn between those who should be entitled to MAID and those who should not.

A final comment in this four-part exchange with A Bruce and R Beuthin addresses several inaccuracies and problematic omissions in their 'Response to Lyon: Oranges, apples and polarizing polemic.' I point out that court rulings mean that it is likely some form of assisted suicide or euthanasia (Medical Assistance in Dying or MAID) remains lawful in Canada, and I argue from this view. I further suggest that scholars writing about MAID clinicians' lived experiences must be transparent about their involvement in the practice to conform to methodological and ethical standards. Finally, I stress that the intense emotional rewards obtained by providers from ending lives may be horrifying to observers and those potentially eligible for MAID, and must be open to critical scrutiny.

The commentary focuses on the requirements for access to medical assistance in dying in countries where this practice is legal. It shows that the different solutions adopted reflect a different balance between the principles of protection of life, reduction of suffering and respect for autonomy. The article also analyses the potential ethical problems associated with the decision-making capacity of psychiatric patients. It emphasizes the need to assess the capacity on a case-by-case basis, without a priori excluding those suffering from mental disorders. It then examines the nature of existential suffering as a potential single condition for access to medical assistance in dying, highlighting its relevant ethical and social implications.

Background: The number of patients with dementia who are granted euthanasia or assisted suicide (EAS) increases yearly in the Netherlands. By law, patients need to be decisionally competent or have an advance directive. Assessment of decisional capacity is challenging as dementia progressively affects cognitive performance. We aimed to assess qualitatively which factors, and how, influence the judgment of decisional capacity in EAS cases with dementia., Methods: We performed a qualitative study of 60 dementia EAS case summaries published by the Dutch regional euthanasia review committees between 2012 and 2021. Included reports were evaluated using the grounded theory approach. All quotes related to decisional capacity were coded independently by two researchers and compared in an iterative process to formulate an overarching framework on the assessment of decisional capacity. We selected 20 patients who had an advance directive and were judged to be decisionally compromised, as well as a selection of 40 EAS cases judged to be decisionally competent, half of which also had an advance directive (purposive sampling)., Results: Decisional capacity was present in every case report. Predefined, external criteria were rarely described explicitly, but physicians indirectly referred to the (cognitive) criteria set by Appelbaum and Grisso. Whether the thresholds for these dimensional criteria were met was influenced by six supporting factors (level of communication, psychiatric comorbidity, personality, presence of an advance directive, consistency of the request, and, finally, the patient-physician relationship) that also directly contributed to the judgment of capacity. The involved physicians and executed investigations were the two contextual factors providing a background., Conclusions: Decisional capacity regarding euthanasia is a multidimensional construct, often implicitly assessed and influenced by supporting and contextual factors. The subjectivity of the final judgment poses ethical and legal issues and argues for continuous quality improvement processes., (© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Background: Medical Assistance in Dying (MAID) on psychiatric grounds is a subject of increasing relevance to Dutch mental health care. In addition to different advantages, there are disadvantages., Aim: To highlight some consequences of MAID on psychiatric grounds and to offer solutions to mitigate these., Method: Based on an experience story, we highlight some relevant consequences., Results: Various relevant themes emerge. Firstly, patients can experience pressure to choose MAID. Secondly, psychiatric disorders and suicidality in particular are dynamic and difficult to predict, which conflicts with the static nature of the MAID law. Thirdly, the possibility of MAID is an additional argument to keep the quality of mental health care sufficient, even with increasing scarcity. Finally, we have to stop talking about &lsquo;exhausted treatment options&rsquo;., Conclusion: By recognising and minimising the disadvantages of MAID on psychiatric grounds, we create space for a practice where safety and accessibility are in balance.

Background: Suicide assistance is as a complex process comprising a series of stages, ranging from initial consultations with patients about end-of-life options to counselling bereaved family members. The role of healthcare professionals and other practitioners in this process varies according to national regulations and procedural requirements. After a decision of the German Federal Constitutional Court in 2020, suicide assistance is unregulated in Germany but official data about the implementation of suicide assistance is lacking., Aims: The project "ASEP-Assisted suicide in Germany: Exploring the practice" aims to generate and disseminate scientific knowledge on the practice of assisted suicide in Germany, based on the experiences of practitioners and family members., Methods: ASEP is a prospective, observational, qualitative study comprising three phases. In Phase 1, expert interviews will be conducted to identify involved professional groups, issues and stages of the implementation of suicide assistance in Germany. In phase 2, experiences of practitioners and family members, who were involved in the practice of suicide assistance in Germany, will be collected via semi-structured interviews and analysed. In phase 3, findings of phase 2 will be discussed in focus groups with experts to identify linkages between the practice of assisted suicide and the healthcare system and to develop recommendations on how these linkages should be organised., Discussion: The results of this study will gain insights into the practice of suicide assistance for the first time in Germany. The findings are expected to inform scientific societies, professional association, and policy makers about the current practice and provide recommendations for better linkages of assisted suicide with the healthcare system. In this way, the project provides an evidence-based impetus for a more transparent and well-founded handling of assisted suicide in the German healthcare system., Trial Registration: The study was prospectively registered in the German Clinical Trials Register (Deutsches Register Klinischer Studien) (Registration N° DRKS00034574; date of registration: 04 July 2024). The study is searchable under the International Clinical Trials Registry Platform Search Portal of the World Health Organization, under the German Clinical Trials Register number., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Schwabe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Transparent patient-centered communication is essential to providing quality hospice care for patients at the end of life. This study aimed to determine and describe the current state of aid-in-dying policies in California and their effect on hospice nursing in response to narratives about leave-the-room policies presenting professional and moral challenges. In total, 97 hospice program policies were analyzed with a focus on the role of nurses at the bedside and intent to discharge patients who pursue medical aid-in-dying. It is necessary to clarify the important role of hospice nurses who care for terminally ill patients pursuing their legal right to assisted dying. The results of this study underscore the need for improved policy transparency and organizational support to enhance hospice engagement, particularly by nurses, with their patients at the end of life., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 by The Hospice and Palliative Nurses Association. All rights reserved.)

The evolving legal landscape associated with medical assistance in dying (MAiD) may pose significant challenges for hospice and palliative care professionals. In the United States, 10 states and 1 jurisdiction have passed legislation allowing MAiD. National organizations, such as the Hospice and Palliative Nurses Association, have created position statements to serve as guides to care. Given the clinical and ethical challenges associated with MAiD, a rapid review was conducted to provide current evidence for policymakers, health care professionals, and researchers to use when considering care management and policy initiatives. Using a systematic approach, publications related to MAiD between 2019 and 2024 were extracted and synthesized. The review provides definitions of terms that differentiate between MAiD, euthanasia, physician-assisted suicide, medically assisted death of the nonterminal patient, and death with dignity. A total of 23 articles were included in the review and categorized into 4 themes: (1) legal, regulatory, and policy concerns; (2) health care professional experience of MAiD; (3) patient and caregiver experience of and communication about MAiD; and (4) disparate access to MAiD., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 by The Hospice and Palliative Nurses Association. All rights reserved.)

Background: Approximately 20% of the United States' population lives in a state or jurisdiction where medical aid in dying (MAiD) is legal. It is unknown how physicians' own barriers are associated with their provision of the spectrum of MAiD services., Objective: To measure physicians' religious and/or ethical barriers to providing MAiD services and how such barriers relate to physicians' intentions and behaviors., Design: Three-wave cross-sectional survey fielded in Colorado in 2020-2021., Participants: Physicians providing care to patients likely clinically eligible for MAiD according to probabilistic sampling., Main Measures: Physicians self-reported barriers to their own participation in MAiD. We considered large ethical and/or religious barriers to be conscience-based barriers. We measured physicians' self-reported intention to participate and self-reported prior participation in MAiD since it was legalized in Colorado in 2017. We estimated differences in intention and behavior outcomes according to presence of conscience-based barriers, adjusting for physician gender, race/ethnicity, time in practice, and specialty., Key Results: Among 300 respondents, 26% reported "large" ethical and/or religious barriers to their involvement in MAiD. Physicians with longer time in practice and those identifying as non-White were more likely to report conscience-based barriers to MAiD. Comparing physicians with and without conscience-based barriers to MAiD, we found no difference in ancillary participation (discussing, referring) but significant differences in direct participation (serving as consultant [5% vs. 31%] or attending [0% vs. 22%])., Conclusions: Approximately one-quarter of physicians likely to care for MAiD-eligible patients in Colorado reported religious and/or ethical barriers to MAiD. Despite religious and/or ethical barriers, the vast majority of physicians were willing to discuss MAiD and/or refer patients seeking MAiD services. These data provide important empirical foundation for policy from hospitals and health systems as well as medical specialty groups with official positions on MAiD., Competing Interests: Declarations:. Conflict of Interest:: The authors declare that they do not have a conflict of interest., (© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Objective The introduction and implementation of voluntary assisted dying (VAD) legislation represents a major shift in Australian health policy. Given potential repercussions for health professionals, understanding how they are being affected by this legislation is important to guide future policy and legislative changes. This study aims to explore the perspectives and experiences of Australian health professionals on VAD and compare impacts on those working under different state legislation in Victoria and WA. Methods Data were collected using a cross-sectional survey design, targeting health professionals nationally, primarily doctors and nurses. The survey had closed and open-ended response options, was informed by previous publications and was piloted prior to further roll-out. Recruitment was via professional networks and social media. Quantitative data were descriptively analysed and qualitative data were coded using NVivo and thematically analysed. Results There was a final sample size of 223. Impacts on clinicians identified include inadequate remuneration, a need for ongoing support and the recognition of barriers to mandatory training. Conclusions Impacts on health practitioners, if not addressed, have future implications for workforce sustainability. Increasing numbers of trained VAD practitioners may enable distribution of clinical load and prevent burnout. VAD practitioners are not being appropriately remunerated, which could be addressed by introducing dedicated Medicare Benefits Schedule items for VAD. Attention should also be given to incentivising training, including continuing professional development accreditation and appropriate funding. Strategies to support staff could include debriefing, mentoring, peer support and psychological consultations.

Objectives: Assisted dying has been legally available in Oregon in the USA for 25 years, since when official reports have been published each year detailing the number of people who have used this option as well as sociodemographic and information about the process. The aim of this study was to examine changes over time in these data., Methods: We collated and reviewed data on 2454 assisted deaths included in annual reports on assisted deaths published by the Oregon Health Authority from 1998 to 2022. Descriptive statistics were used to describe time trends., Results: The number of assisted deaths in Oregon increased from 16 in 1998 to 278 in 2022. Over this time, patients' health funding status changed from predominantly private (65%) to predominantly government support (79.5%), and there was an increase in patients feeling a burden and describing financial concerns as reasons for choosing an assisted death. There has been a reduction in the length of the physician-patient relationship from 18 weeks in 2010 to 5 weeks in 2022, and the proportion referred for psychiatric assessment remains low (1%). Data are frequently missing, particularly around complications., Conclusions: The number and characteristics of people accessing assisted deaths, and the process, have changed since data collection started in 1998. Prospective studies are needed to examine the relationship between socioeconomic factors and the desire for an assisted death in Oregon., Competing Interests: Competing interests: CR provides content for the website ‘Keep Assisted Dying Out of Healthcare’. IF is a board member of Living & Dying Well and is co-chair of the All Party Parliamentary Group for Dying Well. AW was a part-time paid researcher for Living and Dying Well from June 2021 to June 2022., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

This letter responds to the essay "Language Matters: The Semantics and Politics of 'Assisted Dying,'" by Anna M. Elsner, Charlotte E. Frank, Marc Keller, Jordan O. McCullough, and Vanessa Rampton, in the September-October 2024 issue of the Hastings Center Report., (© 2024 The Hastings Center.)

Medical Assistance in Dying (MAID) was decriminalized in Canada in 2016 for individuals 18 years or older who met eligibility criteria. Currently, individuals younger than 18 years are legally permitted to access an assisted death in the Netherlands and Belgium, but not in Canada. To-date, no work has compared factors shaping the policy processes and outcomes in these three countries. Therefore, our objective was to explore the legalities of assisted dying for minors in the Netherlands and Belgium, along with how each jurisdiction arrived at their respective policies and why the trajectory differed in Canada. After screening and compiling peer-reviewed and grey literature, we used Yanow's interpretive method for comparative work to review included materials. We framed findings using Hajer's discourse coalition theory. The Dutch and Belgian contexts relied upon a parliamentary approach in legalizing assisted dying for mature minors that emphasized suffering, whereas Canada's approach was initiated by a Supreme Court of Canada decision and emphasized human rights. While the Netherlands and Belgium viewed mature minors as capable to make decisions about assisted dying, the Canadian position on mature minors' decisional capacity with respect to assisted dying remains unsettled. This work contributes to understanding how context and sociopolitical values shape assisted dying legislations and treatment of mature minors, while highlighting areas requiring further study amid ongoing debate in Canada., Competing Interests: Conflict of Interest Statement The authors have no conflict of interests to declare., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

This article analyses qualitative empirical research conducted by this author to gain a deeper understanding of the rationale behind conscientious objection (CO) to voluntary assisted dying (VAD) and its impact on the operation of VAD in Victoria, Australia. It begins by providing an overview of the Australian legal approach to CO in the context of VAD. It then discusses the spectrum of attitudes that exist towards VAD, illuminating some of the nuance and complexity of the individual and institutional approaches. The article then focuses on the reasons behind CO, noting that there are a range of moral reasons why people may oppose VAD. Finally, the article turns to consider the impact of CO on patient access to VAD, concluding that CO is affecting patient access in Victoria, and that Victoria should modify its legal approach so as to balance the right to CO more appropriately against the legal right to access VAD., Competing Interests: No conflict declared.

Assisted Dying (AD), the ending of a person's life pre-emptively under a legal criterion is widely debated, both in the United Kingdom (UK) and Ireland. The expectation is often those doctors closest to dying would be both the proponents and facilitators of this action. A survey of Palliative Medicine in Northern Ireland (NI) on this topic has never been previously undertaken. The Regional Palliative Medicine Group (RPMG) a representative body of all the Palliative Medicine Consultants in NI organised an anonymous 'Google Forms' survey on AD from 3/6/24 to 17/6/24 of all doctors of all grades working within Specialist Palliative Medicine at the time. The survey had a 69% response rate (56/81) demonstrating 80% of all responding doctors working within Palliative Medicine and 100% of responding Palliative Medicine Consultants and Registrars in Northern Ireland do not favour a change in legislation allowing for AD. 91% (n=51) have concerns that AD will be influenced by a lack of availability of personal care at home. 93% (n=52) are concerned that AD will be influenced by cost-saving for the patient and their family and 82% (n=46) are concerned that AD will be influenced by cost savings for health and social care. 98% (n=55) stated if AD is legalised it should not be 'part of mainstream healthcare' with 45% (n=25) saying it should be 'via the legal system' and 46% (n=26) saying 'via a separate independent facility'. 53% (n=28) 'would not' and 40% (n=21) 'don't know', if they could remain working for an organisation that undertakes AD. These results clearly show that Palliative Medicine in Northern Ireland will not be part of an AD service model. The question is who will be? Healthcare leaders now need to support their Palliative Medicine workforce by stating there will be AD-free healthcare facilities if AD is legalised., (Copyright © 2024 Ulster Medical Society.)

Introduction: According to the Swiss Federal Statistical Office (FSO), there were 6608 assisted suicides in Switzerland in the 5-year period 2018-2022; of these, 4766 cases (72%) were assisted by team members of EXIT, the largest Swiss right-to-die organization. According to EXIT-data, age-related multimorbidity is the second most common disease group in assisted dying, accounting for 27 % of all cases. For formal reasons, these symptom-oriented cases of old age assisted suicide cannot be adequately recorded in the FSO's ICD-based cause of death statistics. This «statistical weakness» implies that Switzerland is unable to provide reliable data on the phenomenon of old age assisted suicide, which is the subject of controversial debate in medical ethics and social policy. It would therefore be advisable to set up a national registry that carefully documents all cases of assisted suicide and could also critically monitor certain cases., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht. Keiner der Autoren ist Mitglied in einer der Schweizer Sterbe­hilfeorganisationen., (© 2024 Aerzteverlag medinfo AG.)

Background: Some commentators and several professional medical associations have expressed concern that legalizing medical aid in dying ("MAID") will undermine patient trust in the medical profession, particularly among historically disadvantaged patient populations. While this concern remains influential, it has been subject to limited empirical scrutiny. Objectives: This study aims to empirically assess whether MAID legalization undermines patient trust, with considerations of potential trust/demographic correlations in marginalized and minority patient populations. Design: We developed an RCT survey study that assessed patients' trust in the medical professional using the Abbreviated Wake Forest Scale ("AWFS"). Two versions of the survey were used, each distributed at random to half of participants. One survey version included notification that MAID had been legalized in the jurisdiction where patients were receiving care and the other version omitted this information. Setting/Population: We surveyed capacitated, English-speaking adult patients who were receiving care at a not-for-profit, 912-bed academic and research hospital in Washington, D.C. Of those invited to participate, 494 patients (63.2%) completed all AWFS questions, and 70.1% identified as Black or African American and 32.9% as having a physical or mental disability. Conclusions: Most of the participants not notified that MAID was legal in DC were not aware of this fact (92.5%). Patients who were notified that MAID was legal in DC were significantly more likely to report approval of MAID legalization ( p = 0.0410), but showed no significant difference in AWFS score for trust in their physicians. The study did not substantiate concerns that legalizing medical aid in dying undermines patient trust in the medical profession.

In recent decades, many jurisdictions have moved toward legalizing euthanasia and assisted suicide, alongside a near-universal increase in public acceptance of medical aid in dying. Here, we draw on a comprehensive quantitative review of current laws on assisted dying, experimental survey evidence, and four decades of time-series data to explore the relationship between these legislative transitions and change in moral attitudes. Our analyses reveal that existing laws on medical aid in dying impose a common set of eligibility restrictions, based on the patient's age, decision-making capacity, prognosis, and the nature of their illness. Fulfillment of these eligibility criteria elevates public moral approval of physician-assisted death, equally in countries with (i.e., Spain) and without (i.e., the United Kingdom) assisted dying laws. Finally, historical records of public attitudes toward euthanasia across numerous countries uncovered anticipatory growth in moral approval leading up to legalization, but no accelerated growth thereafter. Taken together, our findings suggest that the enactment of medical aid in dying laws, and their specific provisions, crystallize patterns in moral intuition., Competing Interests: Competing interests statement:The authors declare no competing interest.

Introduction: Increasing numbers of jurisdictions are legalising assisted dying (AD). Developing research protocols to study the experiences and outcomes of legislation is imperative. AD is a topic that, by nature of its complexity and inherent ethical issues, lends itself to qualitative research. Using the objectives of the statutory framework, this qualitative study aims to provide a robust review of the newly formed AD service in New Zealand and the extent to which it is safe, people-centred, dignity-enhancing, accessible and available equitably to all eligible people., Methods and Analysis: The research uses an appreciative inquiry design to focus on what is working well, what could be improved, what constitutes the 'ideal' and how to enable people to achieve that ideal. We are using online semi-structured interviews and face-to-face focus groups to explore the experiences of key stakeholders: eligible/ineligible service users; eligible/ineligible service users with impairments; families of service users; AD providers; non-providers (providers who object to AD and others who are not directly involved in providing AD but are not opposed in principle); health service leaders; and Māori community members. An estimated 110 participants will be interviewed. We will conduct thematic and regulatory analyses of data., Ethics and Dissemination: The ethical aspects of this study have been approved by the Northern A Health and Disability Ethics Committee through the full review pathway (2023 EXP 18493). To disseminate the findings, we will draft resources to support interviewee groups, to be developed with feedback from stakeholder meetings. We will submit evidence-based recommendations to inform the government review of the End of Life Choice Act 2019. Findings will be disseminated in peer-reviewed publications, conferences, webinars, media, stakeholder feedback sessions and accessible research briefings., Competing Interests: Competing interests: Associate Professors THK-C and JR sit on an AD statutory committee and the research team, both of which have processes for managing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Based on the cases in which assisted suicide (AS) has taken place in Switzerland in the context of a mental disorder or dementia, we discuss whether the slippery slope argument often brought up by opponents of assisted dying is justified. Long-term data from the Swiss Federal Statistical Office shows that while the number of cases with these «indications» is increasing (1999-2017: on average 21 cases/year vs. 2018-2022: n = 73 cases/year), the percentage share of these diseases in the total number of all AS cases has remained unchanged at around 5 %. Opponents of assisted dying believe that the slippery slope argument is already fulfilled by the fact that these cases occur at all. However, the still limited prevalence of these specific indications which still represent only a minority of assisted suicide cases over time, may be used by advocates of assisted dying to weaken the opposing viewpoint., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht. Keiner der Autoren ist Mitglied in einer der Schweizer Sterbe­hilfeorganisationen., (© 2024 Aerzteverlag medinfo AG.)

Background: In nearly all jurisdictions where it is permitted, Medical Assistance in Dying is situated in a healthcare system. Currently, limited evidence demonstrates how supply and demand factors influence access to Medical Assistance in Dying., Objective: The aim of this study is to synthesise empirical research from jurisdictions where Medical Assistance in Dying is legal to identify how supply and demand factors influence access for eligible adults., Method: An integrative review was conducted. CINAHL Complete, PubMed, ProQuest, PsycINFO and Embase databases were systematically searched for studies published between January 1998 and January 2024. Records were independently assessed against inclusion and exclusion criteria. Additional studies were identified by forward and backward citation searching. All studies were assessed for quality. Findings were analysed deductively using an established conceptual framework, and a secondary narrative synthesis was undertaken., Results: Fifty-eight studies met the inclusion criteria. Most studies (n = 32) reported results related to the supply side, 16 reported on the demand side and 10 reported on both supply and demand dimensions of access. Studies about supply showed that health service policies may obstruct access to Medical Assistance in Dying. For healthcare professionals, the practice entails an additional workload and can create tensions with colleagues. Studies of the demand for Medical Assistance in Dying focused on supporting time-critical decisions, adequate planning and caregiver support., Conclusion: Access to Medical Assistance in Dying requires the participation of health services and healthcare professionals but is hindered by policies that obstruct access and direct financial and indirect emotional labour costs. Innovative and inclusive models to promote high-quality, compassionate care at the end of life and access to Medical Assistance in Dying should be considered., Patient or Public Contribution: Patients, caregivers and service users were involved in many of the studies included in this review, and their experiences and perspectives contributed to the analysis and synthesis in this review., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

In the observation period between 1999 and 2022, the Swiss Federal Statistical Office recorded 14 170 assisted suicide (AS) cases. During this 24-year period, the annual number of cases increased significantly: While only 63 cases were observed in 1999, the number of cases in 2022 amounted to almost 1600, corresponding to 2.1 % of all deaths in Switzerland. The most common underlying disease group for AS was cancer, accounting for 40 % of cases. AS is mainly chosen by women (unchanged over time at 58 % of cases) and is primarily a geriatric phenomenon: In 2022, the median age of those who opted for assisted dying was 81 years; the median age of those who chose AS due to cancer was 77 years, while the median age of those who died with non-cancer-related AS was 84 years., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht. Keiner der Autoren ist Mitglied in einer der Schweizer Sterbehilfe-Organisationen. Für unser Forschungsprojekt erfolgte keine finanzielle Unterstützung., (Thieme. All rights reserved.)

Stories about personal experiences of assisted dying, a term comprising both instances when a lethal substance is administered by a physician or by the patient themselves, are frequently cited in law-making processes. These experiences of healthcare systems and the laws governing end-of-life procedures thereby interactively influence the future of medicine at the deathbed. With more countries legalising some form of assisted dying or opening political debate about the issue, addressing how these personal stories shape public opinions and social institutions is timely. In this current controversy, we question how medical humanities researchers are to make sense of the role of these stories in law-making, and critically reflect on a digital archive that seeks to make these interconnections visible. At the methodological level, the reciprocal interactions in assisted dying between medicine, law and the arts urges us to reconsider the conceptual foundations of interdisciplinary research in the medical humanities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

In a recent paper, Braun argued for an autonomy-based approach to assisted suicide as a way to avoid the expressivist objection to assisted dying laws. In this paper, I will argue that an autonomy-based approach actually extends the expressivist objection to assisted dying because it is not possible for one agent to assist another in pursuit of a goal without expressing that it would be good for that goal to come about. Braun argued that assisted dying should be viewed purely as an individual's autonomous action, but this requires the assistance of the medical professional to be understood as that of a non-moral automaton, such as a suicide booth. Instead, it will be argued that a beneficent motivation to promote human flourishing provides moral reasons for both non-interference in the actions, for example, suicide, of competent agents and for considering whether assisting another agent with their goal will promote their flourishing., Competing Interests: Competing interests: TD receives a School of Law Studentship from the University of Manchester., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

According to the expressivist objection, laws that only allow assisted dying for those suffering from certain medical conditions express the judgement that their lives are not worth living. I have recently argued that an autonomy-based approach that legally allows assisted suicide for all who make an autonomous request is a way to avoid the expressivist objection. In response to this, Thomas Donaldson has argued that rather than avoiding the expressivist objection, an autonomy-based approach extends this objection. According to Donaldson, this is because helping a person achieve a goal requires endorsement of that goal. In this reply, I show that Donaldson misunderstands the target of the expressivist objection: it is not aimed at an individual's attitude towards another person's death but rather at a legal regulation. Moreover, helping someone end their life does not necessarily require endorsing this goal-instead, respect for a person's autonomous choice can be another reason for providing assisted suicide. Donaldson also assumes that the autonomy-based approach requires doctors to accept autonomous requests for assisted dying. Yet, this approach merely makes it legal for individuals (not necessarily only doctors) to provide assisted suicide to autonomous persons but does not require anyone to do so., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

In recent years, several jurisdictions have passed legislation to permit medical aid in dying (MAID) worldwide, with considerable expansion in the availability of this practice. MAID has been defined as the practice of a clinician prescribing lethal drugs in response to a direct request from the patient, with a shared understanding that the patient intends to use the medication to bring about the patient's death. Wider legalization of MAID has prompted debates and legal controversies regarding the extent to which MAID should be available and its application for people experiencing mental illness as the primary indication. This article examines shifting attitudes of professional medical organizations toward MAID. We discuss the existing statutory provisions for psychiatric assessment for MAID in the United States and the implications on such assessments should MAID be expanded to include mental illness as the primary indication. This article also assesses legal disputes concerning MAID regulations and explores the role of psychiatric experts in the practice of MAID., (© 2024 American Academy of Psychiatry and the Law.)

Evaluating decisional capacity for patients seeking medical aid in dying (MAID) raises challenging legal, logistical, and ethics questions. The existing literature on the subject has been shaped largely by early disagreements over whether effective capacity assessment for such patients is ever possible, which in turn stemmed from debates over the ethics of MAID itself. In attempting to establish meaningful criteria for assessments, many jurisdictions have sought either to apply or to adapt models of capacity evaluation designed for other forms of medical decision-making, such as the widely used "four skills" model, failing to account for the fundamental differences in kind between these other decisions and MAID. This article seeks to reexamine these questions with a focus on two logistical matters (the appropriate credentialing for the evaluator and the potential liability of the evaluator) and three clinical matters (level of understanding, clinical scrutiny and certainty, and impairment) in an effort to raise legal and ethics concerns that remain unresolved, even as MAID is permitted in an increasing number of jurisdictions., (© 2024 American Academy of Psychiatry and the Law.)

Medical aid in dying refers to policies that allow terminally ill patients to seek assistance from their medical providers to obtain medications to hasten death. In this paper, we used a 7-point policy analysis model to examine the diversity of medical aid in dying policies that exist in jurisdictions (states and territories) in the U.S. and the implications of these policies for suffering at end of life. As of this writing, these practices are available in 12 jurisdictions, including 11 states and the District of Columbia. Legalization has occurred via statutory approaches in 10 jurisdictions and permissive approaches in two jurisdictions. We discuss the structures of these laws, the requirements for participation, and the limitations created by having jurisdiction-specific policies on such broad, bioethical issues. Existing laws appear to relieve suffering in patients at end of life. Jurisdictional differences create barriers to comprehensive expansion but provide insights into practice in different contexts.

In light of the proposed expansion of eligibility for physician aid in dying (PAD) in Canada to people with psychiatric disorders, there is a new subset of individuals seeking PAD-those with poverty-induced depression. The dominant account defending the expansion is known as the "parity argument." Defenders of the parity argument maintain that the expansion of PAD to those with psychiatric conditions is needed to reflect that the seriousness of a patient's suffering does not depend on the cause of that suffering. Parity accounts, as they stand, would allow cases of poverty-induced depression to qualify. I raise a moral dilemma that the parity theorist must face considering this new subset of cases-expanding access to PAD, without adequate social protections, could produce more social inequality by aiming to reduce it. I propose six recommendations that policy-makers should consider before expanding PAD given these cases, social injustice, and the social determinants of mental health., (© 2024 The Hastings Center.)

The entry into force of the Organic Law on the Regulation of Euthanasia in June 2021 obliges clinicians to reconsider their professional work, in the face of a new service that expands the limits of what was considered correct until then. This new service affects the entire healthcare system, but especially primary care professionals. Beyond the procedural and moral aspects, it is necessary to rethink the assessment of the patient who expresses a wish to die. In this review, we start with the relatively recent definition of the wish to hasten death (WTHD), its causes, epidemiology and differential diagnosis. Then, we examine the different mental frameworks found in the process of dying and the concept of a «good death». Finally, we analyse the paths that can lead to the provision of aid in dying within the framework of current legislation. The WTHD is specific to requests in case of «serious and advanced illness», not in other cases contemplated by the Law. When faced with a request to activate the Aid in Dying Prestation in the context of WTHD (that is, in the proximity of death), it becomes necessary to increase the patient's sense of control and begin to work on grief. Besides, in the face of an administrative process that will necessarily be long, adapting the therapeutic efforts and sedation should be considered as possible options. We understand that it is essential not to create false expectations for patients/families and not to overload healthcare professionals with administrative tasks that will be futile. It is difficult to balance these in the face of a request for a right to which the patient should always have access., (Copyright © 2024 The Author(s). Publicado por Elsevier España S.L.U. All rights reserved.)