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This list of peer-reviewed journal articles about physician-assisted dying and related issues is organized by topic:
- Implementation of Death with Dignity
- Healthcare professionals on Death with Dignity
- Legal challenges
- End-of-life care
- Palliative Sedation and Voluntary Refusal of Treatment or Food and Fluids
For books on Death with Dignity and related end-of-life issues, click here.
“Drug Price Inflation and the Cost of Assisted Death for Terminally Ill Patients—Death With Indignity,” October 6, 2016. Veena Shankaran, MD, MS;Richard J. LaFrance, PharmD; and Scott D. Ramsey, MD, PhD. JAMA Oncology.
Authors review the use of the Washington State Death with Dignity Act since 2009. The number of prescriptions dispensed in Washington State has steadily increased, and the majority of patients to whom the medications have been dispensed have ingested them. The law has generally been considered successful and patients have reported feeling grateful to have an option for physician-assisted death. However, patients and their families are raising new concerns about the high cost of medication and the unaffordability of ending their lives in this way.
“When a Patient Discusses Assisted Dying: Nursing Practice Implications.” July 2016. Rebecca H. Lehto; Douglas P. Olsen; Roxanne Raffin Chan. Journal of Hospice and Palliative Nursing, Vol. 18, No. 3, pp. 184-191.
“Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe.” July 2016. Ezekiel J. Emanuel, Bregje D. Onwuteaka-Philipsen, John W. Urwin, Joachim Cohen. JAMA, Vol. 316, No. 1 [Summary by Science Daily]
Ganzini reviews the Oregon Death with Dignity Act by discussing what the collected data present. She concludes that legalization of physician-assisted dying has not decreased the use of or quality of palliative and hospice care. She also addresses other concerns about the law, including mental illness and depression, and shows that there is much support for greater psychiatric involvement to evaluate patients for depression. However, it is unclear whether mandatory psychiatric evaluations would benefit and protect vulnerable patients and psychiatrists. Overall, the data show a slight increase in use of aid in dying over time; that the large majority of patients using the life-ending medication have similar terminal illnesses; and that patients are educated, insured, and mentally competent.
“Clinical Criteria for Physician Assisted Aid in Dying.” November 2015. David Orentlicher, MD, JD, Thaddeus Mason Pope, JD, PhD, & Ben A. Rich, JD, PhD. Journal of Palliative Medicine, Vol. 18, No. X, pp. 1-4.
Authors discusse the main areas in which the Physician Aid-in-Dying Clinical Criteria Committee deemed most important for physicians to focus on when a patient requests aid-in-dying. First, they express the importance of determining if the request is voluntary, informed, and without influence of others or of mental illness. Secondly, they asses whether the patient thoroughly understands his/her options for end-of-life carem such as hospice, stopping eating/drinking, and palliative sedation. Third, they assert that physicians must make clear the results of ingesting the life-ending medication and must be thorough in documenting the patient’s understanding through the process of requesting. Lastly, the Committee urges patients to have family present and discusses the steps of how to ingest the medications for the safest possible death.
“Implementing a Death with Dignity Program at a Comprehensive Cancer Center.” April 11, 2013. Elizabeth Trice Loggers, Helene Starks, Moreen Shannon-Dudley, Anthony L. Back, Frederick R. Appelbaum, and F. Marc Stewart. New England Journal of Medicine, Vol. 368, No. 15, pp. 1417-1424.
This article provides an institutional response to Death with Dignity through the perspective of a Washington cancer center. The cancer center found that their Death with Dignity program showed data consistent with the overall physician-assisted dying data collected in Oregon and Washington. This institution’s Death with Dignity program has elicited positive responses from physicians, patients, and families. They attribute this acceptance to the professional leadership team at the cancer center which provides great care in prescribing for and consulting with patients in the end-of-life process.
“Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey.” July 11, 2012, published online. Bregje D. Onwuteaka-Philipsen, Arianne Brinkman-Stoppelenburg, Corine Penning, Gwen JF de Jong-Krul, Prof Johannes JM van Delden, Agnes van der Heide. The Lancet.
This article analyzes the data collected in the Netherlands from the time the euthanasia laws passed in 1990 to 2010. Based on the questionnaires, they found that the incidence of euthanasia and physician assisted suicide has been stable and is comparable with the incidence before the law was passed. Further, they found that the patient groups dying by euthanasia has not shifts over the years of the study.
“The Washington State Death With Dignity Act: A Survey of Nurses Knowledge and Implications for Practice Part 1.” January/February 2012. Anita Jablonski, Janine Clymin, Dana Jacobson, Karen Feldt. Journal of Hospice & Palliative Nursing, Vol. 14, No. 1, pp. 45–52.
“Legal physician-assisted dying in Oregon and the Netherlands: The question of “vulnerable” groups. A reply to I.G. Finlay and R. George.” July, 27 2011. Margaret P. Battin, Agnes van der Heide, Linda Ganzini, Gerrit van der Wal, Bregje D. Onwuteaka. Journal of Medical Ethics, Vol. 37, No. 3, pp. 171-174.
This article defends the data the authors collected and refutes Finlay and George’s argument that being in the position to request physician assisted death makes one vulnerable by nature. The authors argue that the way opponents of physician-hastened dying define vulnerable groups is different than how they have in their studies because they recognize all types of “vulnerable” groups, not just the ten most common groups that Finlay and George identify. They argue that Finlay and George’s critique of their data merely reflects the limitations of their study.
“Quality of Death and Dying in Patients Who Request Physician-Assisted Death.” April 6, 2011. Kathryn A. Smith, Elizabeth R. Goy, Theresa A. Harvath and Linda Ganzini. Journal of Palliative Medicine, Vol. 14, No. 4, pp. 445-450.
“Mental Health Outcomes of Family Members of Oregonians Who Request Physician Aid in Dying.” December 2009. Linda Ganzini, Elizabeth R. Goy, Steven K. Dobscha, Holly Prigerson. Journal of Pain and Symptom Management, Vol. 38, No. 6, pp. 807-815.
This study shows that aid in dying does not have negative grief impacts on family members of the deceased and may lead to a more prepared death. In contrast, family members whose loved one did not pursue aid in dying expressed feelings of regret that the deceased did not fulfill their wishes. Family members of patients who used medications to hasten death also reported a higher quality of life rating in the last week of life than those who did not request aid in dying. Furthermore, this study shows that physician-assisted death does not result in prolonged mental health or severe grief symptoms among family members.
“The Inevitable Death: Oregon’s End-of-Life Choices.” November 18, 2008. Ann Jackson. Willamette Law Review, Vol. 45, No. 1, pp. 137-160.
Jackson provides an extensive overview of the Death with Dignity law in Oregon and its relationship to hospice. Use of hospice care has increased as the Death with Dignity law came into effect. This article shows that hospice staff members are generally in favor of the law because it gives Oregonians options and facilitates important end-of-life conversations.
“Prevalence of depression and anxiety in patients requesting physicians’ aid in dying: cross sectional survey.” 2008. Linda Ganzini, Elizabeth R Goy & Steven K Dobscha. The BMJ (British Medical Journal). Vol. 337, pp. 1-5.
This article aims to present the prevalence of depression among the people who request and get aid-in-dying medication from their physicians through Death with Dignity. They found that most people requesting physician-assisted death do not have a depressive disorder, but that a small portion do. They suggest that all patients go through depression tests similar to the ones used in this study to help physicians make better informed decisions about whether a patient has depression when requesting aid-in-dying.
“Why Oregon Patients Request Assisted Death: Family Members’ Views.” February, 2008. Linda Ganzini, Elizabeth R. Goy, and Steven K. Dobscha. Journal of General Internal Medicine, Vol. 23, No. 2, pp. 154-157.
This article focuses on the family members whose loved one requested physician-assisted death to gain more intimate insight into why they chose aid-in dying. They found that similar to other studies done similar to this one, that reasons related to autonomy were rated most important for why they chose physician-assisted death. The authors propose that when discussing fears with patients, physicians should focus on relieving any worries or anxieties about the future by talking with them about the dying process and by providing a concrete pain management plan that allows for the most autonomy possible.
“Legal Physician-Assisted Dying in Oregon and the Netherlands: Evidence Concerning the Impact on Patients in “Vulnerable” Groups.” October, 2007. Margaret P Battin, Agnes van der Heide, Linda Ganzini, Gerrit van der Wal, Bregje D Onwuteaka-Philipsen. Journal of Medical Ethics, Vol. 33, No. 10, pp. 591-597.
This article discusses the impact of physician-assisted death on “vulnerable populations” in both Oregon and the Netherlands. The authors show the importance of looking into the impact on certain populations and discusses both the statistical information collected as well as the societal implications of Death with Dignity and people that fear abuse of the law. They found that none of the vulnerable groups they looked at were at risk of abuse in both places except for the AIDS population. They also note that their findings do not conclude whether their results show that the safeguards of the law are working effectively or if there is unequal access to assistance.
Oregon Hospice Chaplains’ Experiences with Patients Requesting Physician-Assisted Suicide.” December 13, 2005. Bryant Carlson, Nicole Simopolous, Elizabeth R. Goy, Ann Jackson, Linda Ganzini. Journal of Palliative Medicine, Vol. 8, No. 6, pp. 1160-1166.
“Characteristics of Patients Requesting and Receiving Physician-Assisted Death.” July 14, 2003. Diane E. Meier, Carol-Ann Emmons, Ann Litke, Sylvan Wallenstein, and R. Sean Morrison. Archive of Internal Medicine, Vol. 163, No. 13, pp. 1537-1542.
This article aims to identify the characteristics of patients requesting physician-assisted death by getting surveys from physicians who have provided the life-ending medication. They found that overall patients requesting and receiving the medication are in a great deal of physical pain and have a very short amount of time left to live. Also that patients requesting assistance do not seem to be similar to the general population of dying people in the United States as far as demographics; meaning that the people using physician-assisted death are white, higher class, christian or jewish and educated individuals. They propose that physicians should have greater training in pain management to be more effective in relieving physical pain or discomfort and deciphering the difference between physical distress to the point of needing temporary sedation and the expressed want to die.
“Interest in Assisted Suicide Among Oregon Cancer Patients.” April 2003. Linda Ganzini, Tomasz M. Beer, and Matthew Brouns. Oregon Health Sciences University.
“Physicians’ Experiences with the Oregon Death with Dignity Act.” February 2000. Linda Ganzini et al. New England Journal of Medicine, Vol. 342, No. 8, pp. 557-563 [pdf]
Ganzini discusses the results of surveys given to physicians who have prescribed life-ending medication to terminally ill patients through the Death with Dignity law. The study covered the process that physicians go through when discussing physician-assisted death with a patient and provides thorough statistics for patient demographics and the reasons for requesting aid-in-death. They found no evidence that vulnerable populations are at risk and that alternative health plans presented to patients such as palliative and hospice care often gave patients an alternative route before continuing with the Death with Dignity request process.
“Legalized Physician-Assisted Suicide in Oregon, 1998-2000.” February 22, 2001. Amy D. Sullivan, Katrina Hedberg, and David Hopkins New England Journal of Medicine, Vol. 344, No. 8, pp. 605-607.
This article provides a brief overview of the characteristics of the people who died by physician-assisted death in the years 1998 to 2000. They found that a small number of people during these years died by aid-in-death and that as educational achievement increases, so does the likelihood of requesting physician assisted death. Overall the characteristics and numbers of people requesting and digesting the life-ending medication has remained similar over the time frame.
“Physician-Assisted Suicide and Patients with Human Immunodeficiency Virus Disease.” February 6, 1997. Lee R. Slome, Thomas F. Mitchell, Edwin Charlebois, Jeffrey Moulton Benevedes, and Donald I. Abrams. New England Journal of Medicine, Vol. 336, No. 6, pp. 417-421.
This article examines physicians responses to the use of aid-in-dying for AIDS patients between the years 1990-1995. The results of the study show that over the five year period, support for aid-in-dying for AIDS patients increased greatly. In 1990 28% of responding physicians said they would aid in the death of an AIDS patient that was terminal and mentally competent, and in 1995, 51% of physicians responded yes. 51% of the 117 physicians in 1995 also reported that they had performed aid-in-dying at least once for an AIDS patient.
- “Assisted dying.” June, 14, 2012. Fiona Godlee, editor in chief. British Medical Journal Vol. 344, electronic pre-release 4075.
- Physician-Assisted Death.” 2008. Timothy E. Quill and Jane Greenlaw. InL From Birth to Death and Bench to Clinic: The Hastings Center Bioethics Briefing Book for Journalists, Policymakers, and Campaigns, pp. 137-142.
- “Physician-Assisted Death in the United States: Are the Existing ‘Last Resorts’ Enough?” September-October 2008. Timothy E. Quill. Hastings Center Report, Vol. 38, No. 5, pp. 17-22.
- “Physician-Assisted Suicide: For and Against.” November 14, 2005. Andrew D. Boyd. American Medical Student Association.
- “Assisted Suicide and Nursing Ethics.” August 2004. Michele M. Mathes. MedSurg Nursing, Vol. 13, No. 4, 261-265.
- “Oregon Physicians’ Perceptions of Patients Who Request Assisted Suicide and Their Families.” July 7, 2004. Linda Ganzini, Steven K. Dobscha, and Ronald T. Heintz, Nancy Press. Journal of Palliative Medicine, Vol. 6, No. 3. pp. 381-390.
- “Experience of Oregon Nurses and Social Workers with Hospice Patients Who Request Assistance with Suicide.” August 22, 2002. Linda Ganzini, Theresa A. Harvath, Ann Jackson, Elizabeth R. Goy, Lois L. Miller, and Molly A. Delorit. New England Journal of Medicine, Vol. 347, No. 8, pp. 582-588.
- “Oregon Physicians’ Attitudes About and Experiences With End-of-Life Care Since Passage of the Oregon Death with Dignity Act.” May 9, 2001. Linda Ganzini, Heidi D. Nelson, Melinda A. Lee, Dale F. Kraemer, Terri A. Schmidt, and Molly A. Delorit. Journal of the American Medical Association, Vol. 285, No. 18, pp. 2363-2369.
- “A National Survey of Physician-Assisted Suicide and Euthanasia in the United States.” April 23, 1998. Diane E. Meier, Carol-Ann Emmons, Sylvan Wallenstein, Timothy Quill, R. Sean Morrison, and Christine K. Cassel. New England Journal of Medicine, Vol. 338, No. 17, pp.1193-1201.
- “Attitudes of Oregon Psychiatrists Toward Physician-Assisted Suicide.” November 1996. Linda Ganzini, DS Fenn, Melinda A. Lee, Ronald T. Heintz and JD Bloom. American Journal of Psychiatry, Vol. 153, No. 11, pp.1469-1475.
- “Oregon Emergency Physicians’ Experiences with, Attitudes Toward, and Concerns about Physician-Assisted Suicide.” October 1996. Terri A Schmidt, AD Zechnich, Virginia P. Tilden, Melinda A. Lee, Linda K Ganzini, Heidi D. Nelson, and Susan W. Tolle. Academic Emergency Medicine, Vol. 3, No. 10, pp.938-945.
- “Sounding Board: The Legalization of Physician-Assisted Suicide.” August 29, 1996. David Orentlicher. New England Journal of Medicine, Vol. 335, No. 9, pp. 663-667.
- “Physician-Assisted Suicide and Euthanasia in Washington State: Patient Requests and Physician Responses.” March 27, 1996. Anthony L. Back, Jeffrey I. Wallace, Helene E. Starks, and Robert A. Pearlman. Journal of the American Medical Association, Vol. 275, No. 12, pp. 919-925.
- “Attitudes of Michigan Physicians and the Public Toward Legalizing Physician-Assisted Suicide and Voluntary Euthanasia.” February 1, 1996. Jerald G. Bachman, Kirsten H. Alcser, David J. Doukas, Richard L. Lichtenstein, Amy D. Corning, and Howard Brody. New England Journal of Medicine, Vol. 334, No. 5, pp. 303-309.
- “Legalizing Assisted Suicide — Views of Physicians in Oregon.” February 1, 1996. Melinda A. Lee, Heidi D. Nelson, Virginia P. Tilden, Linda Ganzini, Terri A. Schmidt, and Susan W. Tolle. New England Journal of Medicine, Vol. 334, No. 5, pp. 310-315.
- “Congress, Controlled Substances, and Physician-Assisted Suicide — Elephants in Mousehole.” March 9, 2006. George J. Annas. The New England Journal of Medicine Vol. 354, No. 10, pp. 1079-1084.
- “The Big Chill: Inserting the DEA Into End-Of-Life Care.” January 5, 2006. Timothy E. Quill, and Diane E. Meier. New England Journal of Medicine Vol. 354, No. 1, pp. 1-3.
- “Seven Legal Barriers to End-of-Life Care: Myths, Realities, and Grains of Truth.” November 15, 2000. Alan Meisel, Lois Snyder, and Timothy Quill. Journal of the American Medical Association, Vol. 284, No. 19, pp. 2495-2501.
- “The Pain Relief Promotion Act of 1999: A Serious Threat to Palliative Care.” January 12, 2000. David Orentlicher, and Arthur Caplan. Journal of the American Medical Association, Vol. 283, No. 2, pp. 255-258.
- “How We Die: A View from Palliative Care.” January 2016. Michael Ashby. QUT Law Review, Vol. 16, No. 1, pp. 5-21.
- “Geographic Variation of Hospice Use Patterns at the End of Life.” September 2015. S.Y. Wang et al. Journal of Palliative Medicine, Vol. 18, No. 9, pp. 771-780.
- “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.” 2014. Institute of Medicine at the National Academy of Sciences [Report Brief]
- “Factors Important to Patients’ Quality of Life at the End of Life.” July, 2012. Baohui Zhang, Matthew E. Nilsson, Holly G. Prigerson. Archives of Internal Medicine.
- “NHPCO Facts and Figures: Hospice Care in America.” 2014. National Hospice and Palliative Care Organization.
- “Information of Imminent Death or Not: Does It Make a Difference?” October 10, 2011. Gunilla Lundquist, Birgit H. Rasmussen and Bertil Axelsson. Journal of Clinical Oncology. Vol. 29, No. 29, pp. 3927-3931.
- “Place of Death: Correlations With Quality of Life of Patients With Cancer and Predictors of Bereaved Caregivers’ Mental Health.” October 10, 2010. Alexi A. Wright, Nancy L. Keating, Tracy A. Balboni, Ursula A. Matulonis, Susan D. Block and Holly G. Prigerson. Journal of Clinical Oncology. Vol. 28, No. 29, pp. 4457-4464.
- “Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer.” August 19, 2010. Jennifer S. Temel, Joseph A. Greer, Alona Muzikansky, Emily R. Gallagher, Sonal Admane, Vicki A. Jackson, Constance M. Dahlin, Craig D. Blinderman, Juliet Jacobsen, William F. Pirl, J. Andrew Billings, and Thomas J. Lynch. Journal of American Medicine Vol 363, No. 8, pp. 733-742.
- “A Comparison of Methods to Communicate Treatment Preferences in Nursing Facilities: Traditional Practices Versus the Physician Orders for Life-Sustaining Treatment Program.” July 2010. Susan E. Hickman, Christine A. Nelson, Nancy A. Perrin, Alvin H. Moss, Bernard J. Hammes, and Susan W. Tolle,. Journal of the American Geriatrics Society Vol 58, No. 7, pp. 1241–1248.
- “I’m Not Ready for Hospice”: Strategies for Timely and Effective Hospice Discussions.” March 20, 2007. David J. Casarett, and Timothy E. Quill. Annals of Internal Medicine Vol 146, No. 6, pp. 443-449.
- “Book Review of Ending Life: Ethics and the Way We Die.” February 15, 2006. Reviewed by Laura Purdy. Journal of American Medicine Vol 295, No. 7, pp.830-831.
- “Improving End-of-Life Care: Why Has It Been So Difficult?” December 7, 2005. Edited by Bruce Jennings, Gregory E. Kaebnick, and Thomas H. Murray. A Hastings Center Special Report. Executive summary.
- “Dying and Decision Making — Evolution of End-of-Life Options.” April 22, 2004. Timothy E. Quill, MD. New England Journal of Medicine, Vol. 350, No. 20, 2029-2032.
- “Terminal Sedation – Good Medicine? Good Ethics? Good Law?” January 2016. Sheila McLean. QUT Law Review, Vol. 16, No. 1, pp. 113-124.
- “Last-Resort Options for Palliative Sedation.” September 15, 2009. Timothy E. Quill, Bernard Lo, Dan W. Brock, and Alan Meisel. Annals of Internal Medicine, Vol. 151, No. 6, 421-424.
- “Death by Voluntary Dehydration—What the Caregivers Say.” July 24, 2004. Sandra Jacobs. New England Journal of Medicine, Vol. 349, No. 4, pp. 325-326.
- “Voluntary refusal of food and fluids: attitudes of Oregon hospice nurses and social workers.” May, 2004. Theresa A. Harvath, Lois L. Miller, Elizabeth R. Goy, Ann Jackson, Molly A. Delorit, and Linda Ganzini. International Journal of Palliative Nursing, Vol. 10, No. 5, pp. 236-241.
- “Nurses’ Experiences with Hospice Patients Who Refuse Food and Fluids to Hasten Death.” July 24, 2003. Linda Ganzini, Elizabeth R. Goy, Lois L. Miller, Theresa A. Harvath, Ann Jackson, and Molly A. Delorit. New England Journal of Medicine, Vol. 349, No. 4, pp. 359-365.
- “Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids.” March 7, 2000. Timothy E. Quill and Ira R. Byock. Annals of Internal Medicine, Vol. 132 No. 5, pp. 408-414.
- “Depression, Competence, and the Right to Refuse Life-Saving Treatment.” July 1994. Mark D. Sullivan and Stuart J. Younger. American Journal of Psychiatry, Vol. 151, No. 7, pp. 971-978.
- “The Ethics of PAS: Morally Relevant Relationships Between Personal Assistance Services and Physician-Assisted Suicide.” 2001. Andrew I. Batavia. Archives of Physical Medicine and Rehabilitation, Vol. 12, Suppl. 2, pp. 25-31.
- “So Far, So Good: Observations on the First Year of the Oregon Death with Dignity Act.” 2000. Andrew I. Batavia. In: Special Theme Issue: Hastened Death. G. Andrew H. Benjamin, James L. Werth, Jr, and Lawrence Gostin, eds. Psychology, Public Policy and Law, Vol. 6, No. 2, pp. 291-305.
- “The Relevance of Physician and Disability Data on the Right to Physician-Assisted Suicide: Can Studies Resolve the Issue?” 2000. Andrew I. Batavia. In: Special Theme Issue: Hastened Death. G. Andrew H. Benjamin, James L. Werth, Jr, and Lawrence Gostin, eds. Psychology, Public Policy and Law, Vol. 6, No. 2, pp. 546-558.
- “Disability and Physician-Assisted Suicide.” June 1997. Andrew I. Batavia. The New England Journal of Medicine, Vol. 336, No. 23, pp. 1671-73.
- “A Disability Rights/Independent Living Perspective on Euthanasia.” May 1991. Andrew I. Batavia. The Western Journal of Medicine, Vol. 154, pp. 616-7.