End of life decision-making, euthanasia, and physician assisted suicide in persons with neuropsychiatric conditions

神经精神疾病患者的临终决策、安乐死和医生协助自杀

• 批准号: 10684566
• 负责人: Scott Kim
• 金额: --
• 依托单位: CLINICAL CENTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10684566
• 关键词: Address; Assisted Suicide; Automobile Driving; Clinical; Collaborations; Country; Data; Decision Making; Depressed mood; Eligibility Determination; Ethical Analysis; Ethical Issues; Euthanasia; Eye; Future; Judgment; Laws; Legal; Life; Medical; Medical Futility; Mental Depression; Mental disorders; Methods; Minority; Modeling; Netherlands; Patients; Persons; Physician-Assisted Suicides; Physicians; Policies; Poverty; Public Opinion; Publishing; Reporting; Resources; Source; Specific qualifier value; Stigmatization; Switzerland; Terminal Disease; Terminally Ill; United States; Universities; analytical method; base; court; end of life; evidence base; neuropsychiatry; physically handicapped; professor; systematic review; treatment response; treatment-resistant depression; trend

In the past year, we have conducted the following projects. 1. Treatment resistant depression (TRD), psychiatric EAS, and the criterion of irremediability. One of the key criteria for psychiatric euthanasia in countries that allow it is irremediability and medical futility of the condition and the suffering arising from it. However, the current practice (as reflected in published reports that our group has studied extensively) relies on clinician judgments which may or may not reflect practices based on current evidence base. This project uses TRD as the paradigm condition and will provide a rigorous evidence-based review and analysis to answer the question: How reliable and valid is a clinician's judgment in making a prediction about a patients future clinical status and course? In so far as jurisdictional rules require consideration of evidence for answering such questions, a systematic review of relevant data will be crucial. 2. Switzerland is one of the countries that allow physician-assisted deaths. In collaboration with Professor Rafael Cohen-Almagor from University of Hull, we continue our study of the Swiss practice through the eyes of the organizational and medical experts in that country. In the past year, we focused on the relationship between lay and medical models of assisted death, as seen through the eyes of assisted suicide experts in Switzerland. We found that although the official model in Switzerland is a lay organization managed model, there is inevitable involvement of doctors due to preferred methods of dying and due to most requestors being medically ill. However, there are a variety of perspectives regarding the pros and cons of medical involvement, which we document and analyze. 3. Physician-assisted death (PAD) for people with nonterminal illnesses (PAD-NT) is a controversial practice legal in some countries and increasingly debated in others, including the United States. A major concern is that a lack of resources may drive some with mental illnesses or physical disabilities to seek PAD. We assessed US public opinion on PAD-NT under conditions of resource limitation. We found that a minority of the US public supports PAD-NT in the context of inadequate resources, with much lower support for PAD-NT for mental illness than for physical disability, suggesting that PAD-NT policy debates and future research should address the issue of whether sufficient resources must be available to potential requestors of PAD-NT. 4. Some PAD jurisdictions require intolerable suffering as a criterion for eligibility, usually requiring that it be based on a medical condition that cannot be remediated. In those jurisdictions, such as the Netherlands, some people (e.g., the Heringa case in the Netherlands) have challenged the medical suffering requirement in court, although ultimately losing the case. I wrote an analysis of the implications of using suffering as a criterion for PAD, as it can be argued that: on the one hand, it discriminates against persons who suffer from sources other than specified by law (e.g., poverty, misfortune in life) and on the other, it discriminates against those with medically qualified suffering but who do not wish to pursue PAD on those grounds as the permissibility on those grounds creates a stigmatized existence for such persons. 5. With the advent of rapidly acting treatments for depression, there is a need to revisit the often talked about situation of a depressed, terminally ill person seeking PADin regard to whether it is depression driving the request, whether the person is competent, etc. We performed an ethical analysis of this question, reviewing the emerging rapid response treatments for depression in the context of various PAD laws.

在过去的一年中，我们进行了以下项目。 1。耐药性抑郁症（TRD），精神病学和不可抑制性的标准。在允许其疾病及其遭受痛苦的国家的精神上安乐死的关键标准之一。但是，当前的做法（正如我们小组已广泛研究的已发表的报告所反映的）依赖于临床医生的判断，这些判决可能会或可能不会反映基于当前证据基础的做法。该项目将TRD用作范式条件，并将提供严格的基于证据的审查和分析来回答以下问题：临床医生在对患者未来的临床状况和课程中预测的判断时的可靠和有效？在管辖权规则需要考虑回答此类问题的证据的情况下，对相关数据的系统审查将是至关重要的。 2。瑞士是允许医师协助死亡的国家之一。与赫尔大学的拉斐尔·科恩·阿尔玛（Rafael Cohen-Almagor）教授合作，我们通过该国的组织和医学专家的眼光继续研究瑞士实践。在过去的一年中，我们专注于辅助死亡的外行与医学模型之间的关系，从瑞士的辅助自杀专家的眼中可以看出。我们发现，尽管瑞士的官方模型是一个外行组织托管模型，但由于首选的垂死方法，医生不可避免地会参与医生，并且由于大多数请求者都患有医疗病。但是，关于医疗参与的利弊，有多种观点，我们会记录和分析。 3。非末端疾病患者（PAD-NT）的医师辅助死亡（PAD）在某些国家是一种有争议的做法，在其他国家（包括美国）中越来越有争议。一个主要问题是，缺乏资源可能会促使一些精神疾病或身体残疾寻求垫子。在资源限制条件下，我们评估了我们对PAD-NT的公众舆论。我们发现，在资源不足的情况下，美国的少数公众支持PAD-NT，对PAD-NT对精神疾病的支持要比对身体残疾的支持要低得多，这表明PAD-NT政策辩论和未来的研究应解决有关是否必须提供足够资源的问题，是否必须向PAD-NT的潜在要求提供足够的资源。 4。一些垫子管辖区要求无法忍受的苦难作为资格的标准，通常要求它基于无法修复的医疗状况。在那些司法管辖区，例如荷兰，有些人（例如，荷兰的Heringa案）在法庭上对医疗苦难要求提出了质疑，尽管最终失败了此案。我写了一篇分析，分析了将苦难用作PAD标准的含义，因为可以说：一方面，它会区分遭受法律指定以外的人以外的人（例如，生活中的贫困，不幸）和其他人的痛苦，而另一方面，它不愿意与这些人抗衡，但他们不愿意遭受这些痛苦的态度，但他们却不符合束缚的态度。人。 5。随着迅速采取抑郁症治疗的出现，有必要重新审视经常谈论沮丧的，绝症的人，寻求padin的人对抑郁症的看法，是否正在抑郁症，是否有能力驱动该请求，是否有能力，是否有能力进行此问题，对这个问题进行了道德分析，审查了各种PAD法律中新出现的对抑郁症的急速应对措施。