Medical Aid in Dying, Hastened Death and Suicide : A Qualitative Study of Hospice Professionals' Experiences from Washington State

Gerson, Sheri Mila and Preston, Nancy and Bingley, Amanda (2020) Medical Aid in Dying, Hastened Death and Suicide : A Qualitative Study of Hospice Professionals' Experiences from Washington State. Journal of Pain and Symptom Management, 59 (3). 679-686.e1. ISSN 0885-3924

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Abstract

CONTEXT: Many jurisdictions around the world have passed medical aid in dying (MAID) laws allowing competent eligible individuals facing life-limiting illness to self-administer prescribed medication to control timing of death. These laws do not prevent some patients who are receiving hospice services from dying by suicide without assistance. OBJECTIVES: To explore hospice professionals' experiences of patients who die by suicide or intentionally hasten death with or without legal assistance in an area where there is legalized MAID. METHODS: Semistructured in-depth qualitative interviews were conducted with 21 home hospice professionals (seven nurses, seven social workers, four physicians, and three chaplains). Thematic analysis was carried out to analyze the data. RESULTS: Three primary themes were identified from the interviews: 1) dealing with and differentiating between hastened death and suicide, 2) MAID access and affordability, and 3) how patients have hastened their own deaths. Analysis of these data indicates that there are some patients receiving hospice services who die by suicide because they are not eligible for, have no knowledge of, or lack access to legalized MAID. Hospice professionals do not consistently identify patients' deaths as suicide when they are self-inflicted and sometimes view these deaths as justified. CONCLUSION: Suicide and hastened deaths continue to be an unexamined cause of death for some home hospice patients who may have requested MAID. Open communication and increased education and training is needed for palliative care professionals regarding legal options, issues of suicide, and suicide assessment.