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Responses to assisted suicide requests: an interview study with Swiss palliative care physicians
  1. Claudia Gamondi1,2,
  2. Gian Domenico Borasio1,
  3. Pam Oliver3,
  4. Nancy Preston4 and
  5. Sheila Payne4
  1. 1Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
  2. 2Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Ticino, Switzerland
  3. 3Director Pam Oliver Ltd, Research and Evaluation, Waiheke Island, New Zealand
  4. 4International Observatory on End of Life Care, University of Lancaster, Lancaster, UK
  1. Correspondence to Dr Claudia Gamondi, Palliative and Supportive Care Clinic IOSI-EOC, Ospedale San Giovanni , 6500 Bellinzona, Switzerland; claudia.gamondi{at}eoc.ch

Abstract

Objectives Assisted suicide in Switzerland is mainly performed by right-to-die societies. Medical involvement is limited to the prescription of the drug and certification of eligibility. Palliative care has traditionally been perceived as generally opposed to assisted suicide, but little is known about palliative care physicians’ involvement in assisted suicide practices. This paper aims to describe their perspectives and involvement in assisted suicide practices.

Methods A qualitative interview study was conducted with 23 palliative care physicians across Switzerland. Thematic analysis was used to interpret data.

Results Swiss palliative care physicians regularly receive assisted suicide requests while none reported having received specific training in managing these requests. Participants reported being involved in assisted suicide decision making most were not willing to prescribe the lethal drug. After advising patients of the limits on their involvement in assisted suicide, the majority explored the origins of the patient’s request and offered alternatives. Many participants struggled to reconcile their understanding of palliative care principles with patients’ wishes to exercise their autonomy. The majority of participants had no direct contact with right-to-die societies, many desired better collaboration. A desire was voiced for a more structured debate on assisted suicide availability in hospitals and clearer legal and institutional frameworks.

Conclusions The Swiss model of assisted suicide gives palliative care physicians opportunities to develop roles which are compatible with each practitioner’s values, but may not correspond to patients’ expectations. Specific education for all palliative care professionals and more structured ways to manage communication about assisted suicide are warranted.

  • palliative care
  • assisted suicide
  • assisted dying
  • decision-making
  • physicians’ attitudes
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Footnotes

  • Contributors CG conceived the study. PO collected the data. CG and PO analysed the data and prepared the results. CG, GDB, PO, NP and SP participated in the design of the study and the discussion of the results, and CG wrote the manuscript with input from all other coauthors. NP and SP oversaw the research. CG and SP are the study guarantors. The manuscript is an honest, accurate and transparent account of the study being reported; no important aspects of the study have been omitted.

  • Funding This study was funded by a grant from Oncosuisse and CG received a bursary for her PhD studies from the Gottfried und Julia Bangerter-Rhyner-Stiftung (CH).

  • Competing interests None declared.

  • Patient consent Participants of this study were physicians. They all signed the consent form.

  • Ethics approval Canton Ticino Ethical Committee (CE 2740) and Lancaster University Ethical Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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