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To the Editor: While I admire Dr Emanuel's¹ intent to synthesize an emerging literature about how to respond to requests for physician-assisted suicide (PAS), it is hard to imagine showing that algorithm to a patient and saying, "Here's what we're going to do." I think many patients would conclude that they were being forced into dropping their request, in a linear process that terminates at "no." Although I have mixed feelings about PAS, I think that physicians evaluating requests need to create an encounter in which meaningful dialogue can occur. The clinical approach must be open-minded and practical.

Emanuel's algorithm ought to have a box that explicitly recognizes that a physician could feel that a patient's request was authentic, uncoerced, uninfluenced by depression or cognitive impairment, and persistent despite very good palliative care. The reason? Physicians ought to acknowledge the possibility that a particular patient's request might be legitimate. This . . . [Full Text of this Article]

RELATED ARTICLE

Facing Requests for Physician-Assisted Suicide: Toward a Practical and Principled Clinical Skill Set
Linda L. Emanuel
JAMA. 1998;280(7):643-647.
ABSTRACT | FULL TEXT