Shifting attitudes on pre-planned death raises new questions for clinicians

September 14, 2017

Amid changing attitudes toward death and dying, some people with serious physical and/or mental illnesses are claiming a right to choose the time, place, and manner of their death. Discussions about "pre-planned death" pose new challenges for psychiatrists and other healthcare professionals to consider, according to an article in the September Journal of Psychiatric Practice.

As the concepts of assisted suicide and the 'right to die' become more accepted in society, "There's a growing likelihood that clinicians will encounter situations involving "pre-planned death by decisionally competent individuals," writes guest columnist Joel Yager, MD, of University of Colorado School of Medicine, Denver. His article seeks "to question conventional attitudes and assumptions, push readers' thoughts beyond typical comfort zones, and consider alternative modes of responding to challenges posed by pre-planned death."

Pre-Planned Death Raises Complex Personal and Professional Issues

Prompted by personal experiences and the recent passage of Colorado's "death with dignity" law, Dr. Yager reviews the shifting landscape related to pre-planned death—defined as "any death in which a decisionally capable individual takes actions to assure the end of life at a specified time, under specified circumstances, and via a specified mode of death."

Dr. Yager notes that the term pre-planned death is "neutral" as to whether the person has a "terminal, static, or progressive" medical or psychiatric illness, or whether the lethal act is administered by themselves or someone else. His discussion is limited to "decisionally capable" individuals—specifically excluding those whose wish to die results from symptoms of a treatable psychiatric illness.

Most people agree as to what constitutes a "good death," but don't get to choose the way they die. By a large majority, doctors say they would not want drastic measures to prolong life. When patients voice concerns about prolonged suffering at the end of life, Dr. Yager asks, "Shouldn't they be accorded the same dignities and care that physicians would want for themselves?"

He outlines the complex issues and terminology surrounding pre-planned death. In "physician-assisted" suicide, doctors may administer or supply to means to cause death. In pre-planned death, they may simply acknowledge the patient's intentions without interfering. "Theoretically, clinicians can accompany, witness, and be with patients as they go through actions that will lead to death," Dr. Yager writes.

He invites clinicians to think about a range of scenarios in which patients with serious medical and/or psychiatric illnesses may make a considered decision to plan their own deaths. Five states and the District of Columbia now have some type of "death with dignity" law, as do Canada and many European countries. While most discussions of these laws have focused on physician-assisted deaths, similar concerns might apply to "patient-initiated, self-conducted" deaths.

Although psychiatrists support medically assisted death in general, "they do not support such programs for psychiatric patients," according to Dr. Yager. He notes that the American Psychiatric Association has issued an opinion that psychiatrists "should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death."

"But ambiguity remains," Dr. Yager writes. "Does providing moral support for a patient or family under such circumstances constitute an intervention contributing to 'the purpose of death?'" Meanwhile, people suffering from physical or can find several movements and organizations providing information and assistance to people considering pre-planned death.

"Considerations regarding pre-planned deaths merit greater professional and public discussion," Dr. Yager concludes. "Many options exist for improving how professionals address the quality of human experiences surrounding ."

Explore further: Physician-assisted death should be listed on medical certificates of death in Canada

More information: JOEL YAGER, Contending With Preplanned Death, Journal of Psychiatric Practice (2017). DOI: 10.1097/PRA.0000000000000260

Related Stories

Physician-assisted death should be listed on medical certificates of death in Canada

December 14, 2015
Physician-assisted death should be recorded on medical certificates of death in Canada in the event that assisted dying becomes legal, according to an analysis in CMAJ (Canadian Medical Association Journal).

JAMA Viewpoint: 'Physician-assisted dying: A turning point?'

January 19, 2016
The debate over physician-assisted death (PAD) appears to be at a turning point, with a significant number of state legislatures across the country considering PAD, say two Georgetown University scholars, but, they caution, ...

Medical assistance in dying will not increase health care costs in Canada

January 23, 2017
Providing medical assistance in dying to people in Canada will not increase health care costs, and could reduce spending by between $34.7 and $138.8 million, according to a new research paper in CMAJ (Canadian Medical Association ...

Questions raised over physician-assisted suicide

June 4, 2017
Few issues in medicine have been more controversial in recent years than physician-assisted suicide, with medical experts and the general public unable to come to a consensus that balances the delicate issue of dying with ...

Does death of a sibling in childhood increase risk of death in surviving children?

April 24, 2017
Bereavement in childhood due to the death of a sibling was associated with an increased risk for death in both the short and long term, according to a new article published by JAMA Pediatrics.

Hospice workers struggle on front lines of physician-assisted death laws

July 22, 2013
Laws that allow physician-assisted death in the Pacific Northwest have provisions to protect the rights of patients, doctors and even the state, but don't consider the professionals most often on the front lines of this divisive ...

Recommended for you

Itsy bitsy spider: Fear of spiders and snakes is deeply embedded in us

October 19, 2017
Snakes and spiders evoke fear and disgust in many people, even in developed countries where hardly anybody comes into contact with them. Until now, there has been debate about whether this aversion is innate or learnt. Scientists ...

Inflamed support cells appear to contribute to some kinds of autism

October 18, 2017
Modeling the interplay between neurons and astrocytes derived from children with Autism Spectrum Disorder (ASD), researchers at University of California San Diego School of Medicine, with colleagues in Brazil, say innate ...

Study suggests psychedelic drugs could reduce criminal behavior

October 18, 2017
Classic psychedelics such as psilocybin (often called magic mushrooms), LSD and mescaline (found in peyote) are associated with a decreased likelihood of antisocial criminal behavior, according to new research from investigators ...

Taking probiotics may reduce postnatal depression

October 18, 2017
Researchers from the University of Auckland and Otago have found evidence that a probiotic given in pregnancy can help prevent or treat symptoms of postnatal depression and anxiety.

Before assigning responsibility, our minds simulate alternative outcomes, study shows

October 17, 2017
How do people assign a cause to events they witness? Some philosophers have suggested that people determine responsibility for a particular outcome by imagining what would have happened if a suspected cause had not intervened.

Schizophrenia disrupts the brain's entire communication system, researchers say

October 17, 2017
Some 40 years since CT scans first revealed abnormalities in the brains of schizophrenia patients, international scientists say the disorder is a systemic disruption to the brain's entire communication system.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.