Legal and psychological considerations in the development of a euthanasia statute for adults in the United States

Medical assistance in dying: implications for health systems from a scoping review of the literature

Objective

Medical assistance in dying (MAiD) is the medical provision of substances to end a patient’s life at their voluntary request. While legal in several countries, the implementation of MAiD is met with ethical, legislative and clinical challenges, which are often overshadowed by moral discourse. Our aim was to conduct a scoping review to explore key barriers for the integration of MAiD into existing health systems.

Methods

We searched electronic databases (CINAHL, Embase, MEDLINE, and PsycINFO) and grey literature sources from 1990 to 2017. Studies discussing barriers and/or challenges to implementing MAiD from a health system’s perspective were included. Full-text papers were screened against inclusion/exclusion criteria for article selection. A thematic content analysis was conducted to summarize data into themes to highlight key implementation barriers.

Results

The final review included 35 articles (see online Appendix 1). Six categories of implementation challenges emerged: regulatory (n = 26), legal (n = 15), social (n = 9), logistical (n = 9), financial (n = 3) and compatibility with palliative care (n = 3). Within four of the six identified implementation barriers (regulatory, legal, social and logistical) were subthemes, which described barriers related to legalizing MAiD in more detail.

Conclusion

Despite multiple challenges related to its implementation, MAiD remains a requested end-of-life option, requiring careful examination to ensure adequate integration into existing health services. Comprehensive models of care incorporating multidisciplinary teams and regulatory oversight alongside improved clinician education may be effective to streamline MAiD services.

The Psychology of Euthanasia

Abstract. Voluntary euthanasia has been legalized in several countries and associated with this development there has been much discussion concerning the relationship between the ethical principle of autonomy and the respect for human life. Psychological science should make a significant contribution to understanding how polarizing positions may be taken in such debates. However, little has been written concerning the implications of this research for the euthanasia debate and about the contributions of psychology. In the same way, very little is written about the psychologist’s role in countries where voluntary euthanasia or assisted suicide is legalized. We take as a starting assumption that there are no solutions that will meet everyone’s wishes or needs, but that an understanding of psychological ideas, can assist in developing strategies that may help people with opposing views come to some agreement. In our view, it is fundamental to a fruitful analysis, to leave aside a polarized approach and to understand that an eventual answer to the question of how we approach voluntary euthanasia will only be achieved after the hard process of carefully considering the consequences of having either legalized voluntary euthanasia or its prohibition, in the context of a psychological understanding.

Mental competence and end-of-life decision making: death row volunteering and euthanasia

This article reports on a qualitative study of defense attorneys' perceptions of the mental competence or rationality of death row inmates' decisions to waive habeas appeals and proceed directly to execution. Interviews were conducted with twenty attorneys who have either directly represented or been closely involved with would-be volunteers. Through analytic comparison with another end-of-life decision, euthanasia, this article reports on four themes from the interviews: (a) attorneys' perceptions of the legal standard of competence, (b) their perceptions of the competency evaluation process, (c) implications of competing interpretive frames (i.e., volunteering vs. suicide), and (d) the rationality of decisions to waive appeals. Implications of research findings, particularly in terms of recent restructured models of competence, are also discussed.

Euthanasia: an introduction

It has been argued that euthanasia is one of the most pressing social concerns of our times. A review of current scientific and legal materials, however, indicates that this issue is a complex and contentious one that crosses numerous perspectives and theoretical orientations. In order to provide background for the other articles in this collection, we present a brief history of attitudes toward euthanasia. In addition, various terms that are associated with the concept of euthanasia are defined. Finally, this paper provides a framework for the articles that follow by suggesting that three central issues must be addressed in order to resolve the controversies surrounding euthanasia. These are (1) the establishment of standardized criteria of euthanasia eligibility, (2) the investigation of public attitudes regarding acceptable means for engaging in euthanasia, and (3) the evaluation of the roles of professionals who are directly involved in euthanasia decisions. We hope that the following articles will provide insight into these issues.