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Can doctors detect coercion or competency?

There aren’t many doctors who want to get into the practice of ending their patient’s lives. Some will have moral or ethical concerns about ending their patient’s lives, while others will just find the practice too draining on them physically, mentally and emotionally.

In jurisdictions where assisted suicide or euthanasia are legal, it is common for people to engage in “doctor-shopping” when they want an assisted suicide or euthanasia death. If their doctor or specialist won’t approve them for euthanasia or assisted suicide, they find a doctor who will. Often the result is short relationships between doctor and patient.

Some doctors in the US state of Oregon have known their patient for less than a week before writing them a prescription for lethal drugs, even though the law requires that a doctor waits at least 15 days after receiving their initial request. Across all assisted suicide deaths in the state, the median length of relationship between doctor and patient is only 10 weeks. Another result of doctor-shopping is that a small group of doctors tend to issue most of the prescriptions. In 2018, at least one doctor wrote over 14% of all prescriptions for lethal drugs in Oregon that year (35 prescriptions).

Since 2012 in the Netherlands, patients can request euthanasia from a mobile clinic, the Levenseindekliniek, if their doctor assessed them as ineligible for euthanasia or objects to performing euthanasia. Doctors at these clinics have euthanised patients that they have known for less than a month.

Even doctors who have known their patients for years and followed the progress of their conditions can find it difficult to detect coercion and assess competency. How much harder would it be for doctors who hardly know the person in front of them? And how hard will a doctor with a bias towards ending life look into the reasons and motivations of their new patient who is asking to die?

Sources: S Kirkey, “’Take my name off the list, I can’t do any more’: Some doctors backing out of assisted death,” in National Post (26 February 2017); Oregon Public Health Division, Oregon’s Death with Dignity Act; Oregon Public Health Division, Oregon’s Death with Dignity Act: 2018 data summary (2019); M C Snijdewind, D L Willema, L Deliens, et al, “A study of the first year of the End-of-Life Clinic for physician-assisted dying in the Netherlands,” in JAMA Internal Medicine (2015) 175:10, 1633-1640.

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