sarahehalford.weebly.com€¦ · Web viewThis proposal could aid many in the field, and those needing more perspectives on the subject. Participants The participants in this study

Running head: PHYSICIAN-ASSISTED SUICIDE 1

Assessing Physician-Assisted Suicide

Sarah Halford

Western Washington University

PHYSICIAN-ASSISTED SUICIDE

Abstract

The proposed study concentrates on what factors physicians, nurses, and patients

examine when considering physician-assisted suicide. Physician assisted suicide is when a

medical professional helps a patient who is terminally ill die early (McCormack, Clifford, &

Conroy, 2012). One of the purposes of the study is to hopefully breakdown an uncomfortable

barrier that coincides with the topic of suicide. The lack of studies in the United States available

to the general public proves that this proposal is necessary. The interviewers will use a set of

previously agreed upon questions to determine the common factors that each participant

considers. Having a wide variety of participants will allow for more. This proposed study would

also provide access to more research when people are contemplating the subject of physician-

assisted suicide.

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Introduction

With an endless number of ways to die, and so many of them painful, debilitating and

slow, should not each and every person have the right to choose how and when they die, when

they have experienced enough? People who are diagnosed with terminal disease have no other

option than to wait for death, except the rare few who have access to physician assisted suicide.

Physician assisted suicide is when a medical professional helps a patient who is terminally ill die

early (McCormack, Clifford, & Conroy, 2012). Lack of studies and knowledge available to the

public and Human Services professionals alike might lead to confusion or ill-informed decisions

to be made by patients pertaining to physician-assisted suicide (P.A.S.).

Suicide is a controversial subject that many don’t want to discuss. One of the purposes of

the study is to hopefully breakdown an uncomfortable barrier, as the main focus for the

qualitative study is to find out what factors physician, nurses, and patients examine when

considering physician-assisted suicide. This will aid many; medical professionals, terminal

patients, the caregivers and family of the patients. Having more information on the subject will

aid in making an irreversible decision. Human service workers may find themselves working

with those considering P.A.S. as caregivers and counselors and will find the study to have

incredible value in this inevitable situation. According to Gallagher-Thompson and Osgood one

in five of the thirty thousand successful suicide attempts in the US are committed by those over

sixty five (as cited in Abeles and Barlev, 1999). Often we overlook the elderly and the sick,

people whose quality of living is often times so incredibly poor that they only crave to pass on.

These people deserve the right to control their lives just as much as any other, which is why my

proposal is so important. This study is about putting the life and death of the people in their own

hands, through research finding a solution for letting those who are ready rest in peace.

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Review of Literature

There has been lots of research done on the subject of euthanasia and physician-assisted

suicide. The literature provides different perspectives and distinctive points of view. Although

many of these articles authors reviewed differ in some way, they also have many similarities

relating to how people define euthanasia and physician assisted suicide. Euthanasia is when the

doctor administers the life-ending drugs. Physician-assisted suicide patients take the drugs that

will end their life; the drugs they take are prescribed by doctors (McCormack, 2011). These two

types of assisted suicide have been discussed endlessly in recent years.

“Internationally, public opinion has tended to be more favorable towards assisted dying

than that of medical practitioners and the UK is no exception” (McCormack, 2011, p. 28).

Unfortunately the public does not have as much say in the subject, as the government

(McCormack, 2011). When conducting research on the subject of physician-assisted suicide you

need to keep in mind the whole aspect of the subject. Knowing how much the subjects actually

know about the subject will allow you to perceive what the interview might end up looking like.

Lack of knowledge on the subject of euthanasia and physician assisted suicide, has reinforced the

necessity for more studies to happen (Tamayo-Velazquez, Simon-Lorda, and Cruz-Piqueras,

2007). That proves even when so much effort is put into one study, it is not enough to change

the minds of the population and does not provide sufficient information for my specific question.

“In 1994, voters in Oregon approved the Death With Dignity Act, which permits patients

to ask for a prescription for medication from a physician in order to achieve a humane and

dignified death” (Abeles & Barlev, 1999). This give each individual in that state the right to

choose when they die if they pass all the requirements. The courts also decided to allow each

state to decide if physician-assisted suicide would be legal or not (Abeles & Barlev, 1999).

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Patients are valuable sources of information when conducting research. Who is better

suited to explain what the process is like when contemplating physician-assisted suicide than the

patients themselves. “As in previous research (Emanuel, Fairclough, & Emanuel, 2000; Wilson

et al., 2000), this study found that a majority (62%) of a cohort of terminally ill patients endorses

the legalization of euthanasia or PAS” (as cited in Wilson, 2007, p. 321). There opinion should

matter most, because after all this study is for the clients more than anyone else. The direct

correlation between the rise of life expectancy and elderly suicide rates brings the question to

mind, are we providing longevity without quality?

There is a balance to what quality of life consists of. There have been great medical

improvements technologically and otherwise. What is important to keep in mind is if the

improvements made to prolong life, actually improve quality of life as well (Abeles and Barlev,

1999). Understanding what is reasonable in relation to physician-assisted suicide, and what is

pushing past the realistic limit is what can prolong someone’s life, but what has to be discussed

is if it is really better for the patient?

Determining what is best for the patient, and judging how the physicians feel about the

subject are the main goal of most articles and studies. The list of criteria for physician-assisted

suicide is pretty simple, but the most important standards are that the patient must be defined as

suffering from a terminal disease and psychologically sound of mind. If the individual is

mentally sane, that person should have the choice to do as they wish to their own body (Abeles

& Barlev, 1999). “In regards to professional opinions, of the 17% who indicated they have

counseled a patient contemplating PAS, 91% favor performing a competency assessment in such

circumstances. Alternatively, 92% of those denying the need for such an assessment have never

counseled such a patient” (DiPasquale & Gluck, 2001, p. 504). Attaining that very important

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data from physicians themselves allows the researchers to analyze comfort levels for the subject,

and how much it is needed or not. This also shows how some people are not comfortable with

the idea.

DiPasquale and Gluck (2001) states:

When asked if PAS should be legalized for certain types of cases, three fourths

(75%) of the respondents said "yes" (Figure 1). Seventeen percent endorsed

willingness to participate in a PAS even if it remains illegal. However, if PAS

became legal, then 55% would themselves be willing to personally assist. (p. 502)

Many issues have arisen when discussing physician-assisted suicide, and with that have

created hesitations for approval for many. “Of the four studies that conducted a formal variate

analysis of religiosity, three showed a statistically significant association between degree of

religiosity and opposition to AVE or PAS” (McCormack, 2011, p. 26). “Religion plays a large

role in people’s opinions toward this subject. Increased degree of religiosity or faith is seen here

as a statistically significant factor in negatively influencing the attitudes of doctors towards AVE

and PAS” (McCormack, 2011, p. 29). Religion will need to be factored in when conducting any

study, since the assumption is that the majority of the population has some sort of faith. There

have been multiple surveys done that take gender into consideration.

Tamayo-Velazquez, Simon-Lorda, and Cruz-Piqueras (2007) stated:

Nurses were asked whether they thought legally capable, terminally ill patients

should have the right to be helped by health-care professionals to hasten their deaths,

if they requested as such on more than one occasion. A total of 50.3% (n 1⁄4 195)

said that they did think these patients should have such a right, compared to 35.6% (n

1⁄4 138) who said that they did not. (p. 681)

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Gender also plays a role in a person’s opinion of physician-assisted suicide. “The main

difference in terms of gender is that male nurses received statistically both more euthanasia and

more PAS requests than female nurses” (Tamayo-Velazquez, Simon-Lorda, and Cruz-Piqueras,

2007, p. 686). “A survey of 3327 nurses revealed that 92% believed giving lethal doses of drugs

to patients that had explicitly requested them was acceptable for terminally ill patients who were

suffering extreme levels of uncontrollable pain or other distress” (Tamayo-Velazquez et al.,

2007, p. 685). Taking all that data into consideration, gender separate studies should be done as

well as mixed gender studies. This will allow for a base comparison study to be preformed.

Comparing and contrasting all these statistics provide meaningful background knowledge

for my proposed research, while also highlighting where more studies need to be done. There

needs to be more concentration on each individual group that I have mentioned, and more studies

need to be based from people in the United States so that there will be even more creditable

sources for voters to use when deciding if physician-assisted suicide should become legal or not.

This information will aid individuals who are debating this subject all over the world, but can be

used specifically to inform voters in the United States who are currently under deliberation. All

in all my proposed study would provide more specific testimonials, so individuals when thinking

about this subject will have numerous sources to reference and relate too.

Methods

Research Design

Proposing a study that analyzes what factors physician, nurses, and patients examine

when considering physician-assisted suicide, it is most appropriate to use a qualitative approach.

I am proposing a need assessment study because the topic I am concentrating on is a taboo in our

society. I would use a cross-sectional/sectional design. The cross-sectional design would allow

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for me to get information from different populations, which would allow for a more holistic

study. If the study were to be done, it would hopefully narrow down all the factors that are

considered when contemplating physician-assisted suicide. As the population continues to grow,

the interest in the subject will also grow. This proposal could aid many in the field, and those

needing more perspectives on the subject.

Participants

The participants in this study would consist of a random selection of physicians, nurses,

and patients. The goal to the proposal is to get the general consensus on this subject. For that

reason, the participants will be randomly selected.

Instrument

The instrument used will be (Appendix B) a set of questions. The interviewer will stick

the stipulated line of questions, but can add more if they think it is appropriate. The interview

questions ask if the participant understands what physician-assisted suicide is. Then they are

going to be asked, how they feel about it and to explain their feelings to the best of their ability.

Lastly I ask if they feel it should be legal, and why or why not.

Data Collection

The participants would be interviewed separately to attain an uninfluenced response. The

interview would be semi structured because this will allow for the interviewer to have base

questions to ask everyone. This doesn’t mean people could not expand on the questions that

were asked, it just allows for the interviewer to have a place to start and leeway to have a better-

rounded interview. The interview will take place in a quite, neutral office of some type so the

participant is comfortable. It will take place in the morning so the participants can dedicate their

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full attention to their responses. Each interview should last around 15-30 minutes; it really just

depends on how long their responses are. Each interviewer will take notes during the interview,

then later log the information which will reassure that all the information is remembered, and

completely accurate, from the interviewer. The whole interview will be audio-recorded so

nothing the participant will be missed. The interviewer would also write in a journal, which

allows for a way to record the unstructured reactions the research participant may have. If there

were flaws in the research, then keeping a record would allow for issues to be pointed out and

changed. Information will be obtained from the informed consent (Appendix A).

Data Analysis

All the data that is collected from this research will be analyzed carefully and interpreted.

Analyzing the data will consist of someone transcribing the audio recordings verbatim, coding

interview transcripts for units of meaning, and then categorizing units of meaning into emergent

themes. While analyzing, the goal is to find common factors that physician, nurses, and patients

might have in common and where they may differ.

Feasibility

Limitations

Physician-assisted suicide will be a touchy subject for many participants, such that

unease may potentially inhibit what participants are comfortable to say. Without candid and

honest opinions the data will not have the clarity necessary to establish its importance. Previous

studies suggest that participants did not know much about this subject, so that to could limit the

success of the study. The three main groups I would focus on with this study would be

physicians, nurses, and patients. There might be a lack of willingness to participate in the study.

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This study might need some type of incentive; my worries with incentives would be that

individuals might just say what they think the interviewer would want to hear, and not what they

really think. This study is applicable to my future population interest. I believe that everyone

should have the right to choose to live or die if they have a terminal illness, but I also have

personal issues with suicide. I think having competing positions on the study will allow for a

more unbiased overall approach to the complicated issue of physician-assisted suicide.

Ethical Considerations

Keeping in mind possible consequences and being discreet with participants personal

information are important ethical considerations to keep in mind if the study were to be

conducted. I do not know what to expect as a response from each participant. So if issues were

to come up I would have to consult the proper channels after they happened, or hopefully know

how to handle any problems that may occur. I would hope that nothing like that would be

necessary, but to have a review board on hand would be something I would be helpful. When it

comes to confidentiality there could be some struggles with my study. I would discuss this study

with my peers and the public, what had already been consented too. No confidential information

would be discussed under any circumstances.

Implications

The results that we could get from this proposed study could imply that there needs to be

more discussion on the subject on physician-assisted suicide. The study might indicate that

further research is needed so that more states can make the decision to legalize or not. This

study would be very economically friendly. The only economic issue that might come up, if

during the study incentive needs to be added to get individuals to actually participate. Other than

that the study would be very inexpensive. This proposal may aid in the change of policies on the

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subject of physician-assisted suicide. Many states still do not see physician-assisted suicide as a

legal option. Having more data on the subject would allow people to look at additional literature

when contemplating making this legal in more states. This subject is still not widely accepted, so

my study may not change any policies. Hopefully it would at least get the idea out there more,

and allow for people to hear different opinions on the subjects from different perspectives

(physicians, nurses, and patients). My study may aid in the change of policies on the subject of

physician-assisted suicide.

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References

Abeles, N., & Barlev, A. (1999). End of life decisions and assisted suicide. Professional

Psychology: Research And Practice, 30(3), 229-234. doi:10.1037/0735-7028.30.3.229

DiPasquale, T., & Gluck, J. P. (2001). Psychologists, psychiatrists, and physician-assisted

suicide: The relationship between underlying beliefs and professional behavior.

Professional Psychology: Research And Practice, 32(5), 501-506. doi:10.1037/0735-

7028.32.5.501

Marlow, C. (2011). Selecting the Participants in the Research. Research methods for generalist

social work (p. 154). Pacific Grove, Calif.: Brooks/Cole Pub. Co.

McCormack, R., Clifford, M., & Conroy, M. (2012). Attitudes of UK doctors towards euthanasia

and physician-assisted suicide: A systematic literature review. Palliative Medicine, 26(1),

23-33. doi:10.1177/0269216311397688

Tamayo-Velázquez, M., Simón-Lorda, P., & Cruz-Piqueras, M. (2012). Euthanasia and

physician-assisted suicide: Knowledge, attitudes and experiences of nurses in Andalusia

(Spain). Nursing Ethics, 19(5), 677-691. doi:10.1177/0969733011436203

Wilson, K. G., Chochinov, H., McPherson, C. J., Skirko, M., Allard, P., Chary, S., & ... Clinch,

J. J. (2007). Desire for euthanasia or physician-assisted suicide in palliative cancer care.

Health Psychology, 26(3), 314-323. doi:10.1037/0278-6133.26.3.314

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Appendix AFactors Coinciding with Physician-Assisted Suicide Consent Form

PRINCIPAL INVESTIGATORSarah HalfordStudent, Human ServicesWestern Washington University 123-456-7891

DESCRIPTION:I am interested in what factors you consider when contemplating physician-assisted suicide. You as either medical professional, or patient have more connection with the subject than many. This research study will on contain one interview, which will take approximately 15-30 minutes. The interview will be audio taped using a recording device. The recordings will be typed out as word-for-word transcripts of the interview. The recording will then be erased. CONFIDENTIALTY:Only your occupation will be used within this study. You will be assigned a pseudonym and participant number for recording in a logbook. All documents will be shredded after final analysis of all data and the research report is written. Your name and any other identifiers will be kept in a locked file that is only accessible to me or my research associates. Any information from this study that is published will not identify you by name. BENEFITS:The results of this study will aid in further understanding of what factors people consider when contemplating physician-assisted suicide. There will be no direct benefit to you from participating in this study. RISKS:It is possible that the discussion might make you slightly uncomfortable. However, there are no known risks in participating in this study.CONTACT PEOPLE:If you have any questions about this research or your rights as a participant at any time during the study, please call the number listed above. VOLUNTARY NATURE OF PARTICIPATION:Your participation in this study is voluntary. If you would like to end your participation at anytime during the study, there will be no penalty or loss of benefits to you to which you are otherwise entitled. In other words, you are free to make your own choice about being in this study or not, and may quit at any time without penalty.SIGNATURE:Your signature on this consent form indicates that you fully understand the above study, what is being asked of you in this study, and that you are signing this voluntarily. If you have any questions about this study, please feel free to ask them now or at any time in the future.

Signature: ____________________________________________ Date: __________________

A copy of this consent form is available for you to keep.

(Modified from Marlow, 2011, p. 154)

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Appendix B

Factors Coinciding with Physician-Assisted Suicide Interview Questions

1. Do you know what physician-assisted suicide is?

2. Do you approve or disapprove of physician-assisted suicide?

a. Why or why not?

3. What factors do you believe are most important when considering physician-assisted

suicide?

4. Do you believe physician-assisted suicide should be legal in all 50 states?

a. Why or why not?

5. Why do you think people choose this option?

6. Would you be ok with assisting a loved one with physician-assisted suicide?

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Documents

sarahehalford.weebly.com€¦ · Web viewThis proposal could aid many in the field, and those needing more perspectives on the subject. Participants The participants in this study