Clinicians’ Perspectives on the Duty to Inform Patients About Medical Aid-in-Dying

Abstract

Background: As of 2019, ten jurisdictions in the United States have authorized physicians to prescribe a lethal dose of medication to a terminally ill patient for the purpose of hastening death. Relatively little bioethics scholarship has addressed the question of whether physicians have an obligation to inform qualifying patients about aid-in-dying (AID) in permissive jurisdictions and little is known about providers’ actual communication practices with respect to this issue. Methods: One hundred and forty-four in-depth, semi-structured interviews were conducted and analyzed using an inductive analytic approach as part of the Vermont Study on Aid-in-Dying. Results: Seventeen respondents, 14 physicians and 3 nurse practitioners, met the inclusion criteria for this sub-study. Eleven respondents indicated that they at least sometimes inform patients about AID. Respondents described multiple factors that influence whether or not they might initiate discussions of AID, including the importance of informing patients of their options for end-of-life care, worries about undue influence, and worries about the potential effects on the patient-provider relationship. For those providers who do initiate discussion of AID at least some of the time, attention to the particulars of each individual patient’s situation and the context of the discussion appear to play a role in shaping communication about AID. Conclusions: While initiating a clinical discussion of AID is undoubtedly challenging, our study provides compelling descriptive evidence that some medical providers who support AID do not unilaterally follow the conventional bioethics wisdom holding that they ought to wait for patients to introduce the topic of AID. Future research should investigate how to approach these discussions so as to minimize ethical worries about undue influence or potential negative consequences.

Keywords:

• Aid in dying/assisted suicide
• health communication
• professional-patient relations
• qualitative research
• bioethics
• United States

Acknowledgments

We are grateful for research assistance from Manisha Mishra and Dragana Lassiter, and for helpful comments from two anonymous reviewers and the AJOB EB editors.

Author Contributions

MB conceived and designed the study, and completed primary data collection. MB and EB both performed data analysis. EB drafted the manuscript, and MB and EB both revised the manuscript.

Conflicts of Interest

None.

Ethical Approval

This study was approved by the institutional review board(s) at the University of North Carolina at Chapel Hill.

Additional information

Funding

This research was supported by a UNC Junior Faculty Development award, a Greenwall Faculty Scholars Award, and a research grant from the National Science Foundation (1630010).