There is a lack of consensus regarding the acceptability of physician-assisted suicide (PAS) among members of the American Geriatrics Society (AGS); a total of 47% of members support and 52% of members oppose the practice, according to the results of a survey published in the Journal of the American Geriatric Society.

PAS is currently legal in 9 states and the District of Columbia, but remains controversial. To gauge member opinions, the AGS Ethics Committee developed a survey that was distributed to 1488 randomly selected members. The survey asked about the relationship of PAS to the availability of palliative care, respondents’ experiences with PAS, and concerns for special populations with regard to PAS. The first to include clinicians who work with the elderly, it was distributed on March 24, 2016, and closed on April 22, 2016.

A total of 369 AGS members responded to the survey (24.8% response rate); 60% of respondents were women and 81% were physicians. Respondents were almost equally divided regarding the acceptability of PAS, with 52% opposed to PAS and 47% believing that physicians should have PAS as an option for their patients with terminal illness.

Survey respondents were also divided about the role of PAS when high-quality palliative care is available, with 54% of respondents reporting that PAS would not be necessary and 40% believing that PAS may be necessary if high-quality palliative care is provided. A total of 25% of respondents believed that respecting a patient’s autonomy alone was sufficient to justify PAS.

“While just over one-third of respondents [37%] stated they would fulfill a patient’s request for PAS, a larger percentage [46%] indicated they would support this request. This distinction between willingness to actively vs more passively participate in PAS is consistent with findings from previous surveys of palliative care professionals,” the investigators noted.

A total of 38% of survey respondents believed the AGS should take a neutral stance on the issue of PAS and 27% endorsed the notion of the AGS supporting PAS with appropriate safeguards and education, whereas 31% suggested that the AGS discourage or prohibit the practice of PAS. Approximately 70% of respondents believed that PAS is more complex when the individual who might desire PAS belongs to a special patient population, including those with “low health literacy, low English proficiency, disability, dependency, or frailty.”

“Given the recent increase in the number of states permitting PAS and the likely increase in providers receiving requests for PAS, ethical, legal, and policy discussions regarding this practice should ensure that especially careful consideration is given to terminally ill older adults who possess one or more of the aforementioned vulnerabilities,” the authors concluded.

Reference

Rosenberg LJ, Butler JM, Caprio AJ, et al. Results from a survey of American Geriatrics Society members’ views on physician-assisted suicide. J Am Geriatr Soc. 2020;68(1):23-30.