Assisted Suicide - Improvements in End-of-life Decision Making

Improvements in End-of-life Decision Making

Currently only a small fraction of patients (about 15%) have clear directions in the form of a living will or a health care proxy in place to advise family members or physicians of their end-of-life wishes. This leads to uncomfortable questions if the patient suddenly no longer has the ability to speak for themselves when answers are needed to important medical questions. Even if a patient has selected a proxy they may, "be guilt-ridden, wondering whether they acted too hastily or if their decision was inconsistent with the patient's desires".

In order to preempt some of the difficulties that are associated with end-of-life care many medical schools and nursing programs now stress the importance of early discussions with the patient about their wishes and planning for the future. Unfortunately, since the views concerning physician assisted suicide are so polarized, many doctors are reluctant to discuss withholding and withdrawing life-sustaining treatment. In fact, in a recent study of 58 physicians, 19 admitted that they did not feel comfortable discussing end-of-life care with their patients.

In an effort to change the apprehension that is associated with end-of-life care new techniques are being explored to ensure more doctor to patient communication including:

• analyzing the cognitive ability of patients to make their own decisions regarding end-of-life care
• encouraging doctors to initiate end-of-life conversations
• making sure that patients are made fully aware of all options regarding their personal medical treatment
• providing counseling and support for families of patients especially in situations where a decision to remove life support and/or stop treatment is involved

In short, there are two major ways in which the physicians can more easily be made aware of the wishes of their patients. The first simply involves participation in the informed consent process, or "engaging competent patients in comprehensive discussions of treatment options and likely outcomes". The second of these methods involves advance care planning which ensures that patients tell their doctors exactly what they wish to be done in case a medical emergency arises in which they are not able to speak for themselves.