Assisted Suicide: Experiences across Countries
Chair(s): Mark Goldblatt (Harvard Medical School, United States of America)
Access to assisted suicide affects the individuals, their loved ones and the professional team involved in their care. In this symposium we present data about experiences four different countries (Germany, Sweden, Switzerland and USA).
1. Data from 25 years of U.S. physician-assisted suicide in Oregon. (2). Issues faced by professionals within long-term care facilities for older adults in Switzerland and Canada. (3) A content analysis based on Grounded Theory to identify the limitations of psychotherapeutic approaches to dealing with requests for requests for assisted suicide in Germany (4) Swedish staff attitudes to assisted dying.
Presentations of the Symposium
U.S. physician assisted suicide: Why do older adult White males have the highest rates?
Silvia Cannetto1; John McIntosh2
1: Colorado School of Public Health; Colorado State University's Center for Ethics and Human Rights; 2: Department of Psychology, Indiana University Soouth Bend, South Bend, IN
In the United States, and specifically in Oregon, White men have the highest rates of physician assisted suicide, particularly at age 75 and older. Older adult White men also have the highest rates of suicide mortality. Older adult white men over representation among the deceased by suicide, assisted and unassisted, is a paradox in terms of social and economic vulnerability parameters. This presentation examines older adult White male suicide, assisted and not , in consideration of U.S. dominant masculinity scripts.
Assisted death within long-term care facilities for older adults: Issues faced by professionals in two countries: Switzerland and Canada.
Sylvie Lapierre1; Dolores Angela Castelli Dransart2
1: Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices (CRISE), Montreal, Canada.; 2: HES-SO University of Applied Sciences and Arts Western Switzerland, School of Social Work Fribourg, Switzerland
A request for aid in dying, through assisted suicide (Switzerland) or euthanasia (Canada),
raises various concerns at different levels (personal, professional and organisational) for
professionals involved in end-of-life care for older adults. For example, the issues include
whether assisted dying qualifies as health care and to what extent it aligns with their
professional and personal values. These issues will be addressed by drawing on the
experiences of professionals working in institutions in Switzerland or Canada.
In Switzerland, a qualitative study involving 40 professionals reported that they expressed
various stances along a continuum, ranging from the perception of assisted suicide as
possibly being part of professional practice to its rejection via the conscientious objection
clause. These positions depend on various factors such as personal or professional values,
and moral dilemmas, but also on the organizational context (how this practice is managed
and performed with the institution) and the relationship that professionals have with the
person requesting assisted suicide. The presentation will address these different aspects
and the various impacts and challenges that a request of assisted suicide is likely to raise on
a personal and on organizational level.
In Canada, many studies indicate that euthanasia is associated with suffering that goes
beyond physical pain or symptoms, often encompassing psychological, existential, and
social dimensions. In the absence of appropriate interventions and services, motives to die
might be similar between older adults who request assistance in dying and those who
contemplate suicide. In this context, professionals reflect on the role of suicide prevention to
address the needs and distress of older adults seeking euthanasia to end their suffering.
Professionals from both countries need reliable support and opportunities for emotional
expression and ethical deliberation when involved in the assisted dying process.
Psychotherapy for Assisted Suicide?
Reinhard Lindner
Institute of Social Work, University of Kassel, Kassel, Germany
The request for assisted suicide brings patients into contact with various
professionals within the healthcare system, including psychotherapists. The
motivational background is diverse, encompassing the wish for counselling in
existential, intrapsychic and interpersonal conflicts, as well as the aspiration for the
direct implementation of assisted suicide.
The study presented here comprises an analysis of session protocols from three
psychodynamically oriented psychotherapies. The present study employs a content
analysis based on Grounded Theory, with the objective of developing core themes
within the following categories: conscious motivation for psychotherapy, existing
intrapsychic and interpersonal conflicts, transference dynamics, and the forms in
which treatment ends. A particular focus is placed on the dynamics that result in the
premature termination of therapeutic interventions. This is undertaken with the
objective of identifying the limitations of psychotherapeutic approaches.
In light of the exploratory nature of the study, recommendations are put forward for
additional empirical research to be conducted into the indications, mechanisms of
treatment, and limitations of psychotherapy in the context of assisted suicide.
Attitudes towards physician-assisted suicide among staff in long-term care/home care for older adults in Sweden
Margda Waern1; Sylvie Lapierre2
1: Department of Psychiatry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden. Department of Psychotic Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.; 2: Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices (CRISE), Montreal, Canada.
Background: Suicidal thoughts and death wishes are common in long-term care facilities (LTCF), and the number of older people who need such care is on the rise.
Aim: We aimed to examine attitudes to assisted dying among staff working in LTCF and home-based care in Sweden, a country in which physician-assisted suicide is not legal.
Methods: Staff (n=735) and heads of staff (n=31) completed an anonymous survey that included questions about attitudes towards suicide and euthanasia. Items were rated on a 5-point Likert scale and proportions were aggregated for responses “strongly agree” and ”agree.”
Results: 88% of staff worked as nursing assistants. Among staff, 58% agreed that “A person suffering from a severe, incurable disease expressing wishes to die should get help to do so”, but only 32% gave a positive response to a question about legalizing physician-assisted suicide in Sweden. Among unit heads, 73% agreed to the general statement that a person should get help to die and 59% agreed to legalization.
Conclusions: Unit heads were almost twice as likely to agree to legalization of physician-assisted suicide compared to their staff. Differential responses on the more general item “should get help to die” and the item on legalizing euthanasia was observed in both staff and unit heads. Findings highlight the complexity of the issue of assisted suicide in older adults.
