In the United States, patients frequently die under the care of strangers in an impersonal hospital setting, surrounded by noisy machines—a far cry from the comforts of home and being surrounded by loved ones. Medical-assisted death (eg, self-ingested or physician-assisted lethal medication), however, provides an alternative for patients seeking to avoid prolonged suffering in a hospital setting.
According to a 2021 SAGE Open Medicine article, the goals of palliative care include alleviating suffering, providing the best possible QOL, and optimizing comfort in death. The authors suggest that patients who lose the ability to communicate a desire to end treatments would benefit from advance directives that detail the type of care they desire.
Advance directives might contain items like a living will, DNR, durable power of attorney for healthcare (DPA), or physician orders for life-sustaining treatment (POLST). Living wills state patient-preferred medical or life-sustaining treatments for those who become permanently unconscious or terminally ill.
When considering end-of-life care, physicians must also consider a patient’s cultural and religious beliefs, as this improves their mental health and daily existence. According to a 2021 StatPearls article, faith helps patients to mitigate health-related anxiety. For example, some religions prohibit euthanasia. Likewise, physicians may elect to refuse providing certain elements of standardized care that may conflict with their religious or cultural beliefs. For example, some Catholic physicians may refuse to perform abortions or sterilizations.
It’s important to note, however, that such physicians may face tort liability should their patients be harmed by medical inaction. Therefore, physicians with cultural or religious-based beliefs that conflict with certain medical treatments are best advised to be transparent with patients, thereby providing the opportunity for patients to seek desired care elsewhere.
Medical-assisted death is currently legal in 11 states via the Death With Dignity Act. Physicians assisting a patient’s right-to-die options benefit from taking their cues from principles of universal ethics. According to the SAGE Open Medicine article, the principles of universal ethics include autonomy, beneficence, non-maleficence, fidelity, and justice. Doing so ensures quality care that holistically considers a patient’s needs and desires.
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