title: Clinician-patient interactions about requests for physician-assisted suicide: a patient and family view.
abstract: BACKGROUND
  Responding effectively to a patient request for physician-assisted suicide (PAS) is an important clinical skill that involves careful evaluation. Clinician responses to PAS requests, however, have only been described using data obtained from clinicians.
  
  
  OBJECTIVE
  To describe qualities of clinician-patient interactions about requests for PAS that were valued by patients and their family members.
  
  
  METHODS
  Intensive qualitative case study involving multiple longitudinal interviews conducted prospectively with patients pursuing PAS and with their family members and retrospectively with family members of deceased patients who seriously pursued PAS. The study setting was community based. Participants were recruited through patient advocacy organizations, hospices, and grief counselors. A total of 35 cases were studied: 12 were prospective and 23 were retrospective. Study procedures involved semistructured interviews that were audiotaped, transcribed, reviewed, and analyzed by a multidisciplinary research team.
  
  
  RESULTS
  Three themes were identified that describe qualities of clinician-patient interactions that were valued by patients and family members: (1) openness to discussions about PAS; (2) clinician expertise in dealing with the dying process; and (3) maintenance of a therapeutic clinician-patient relationship, even when clinician and patient disagree about PAS.
  
  
  CONCLUSIONS
  These patient and family accounts reveal missed opportunities for clinicians to engage in therapeutic relationships, including discussions about PAS, dying, and end-of-life care. Clinicians responding to patients requesting PAS need communication skills enabling them to discuss PAS and dying openly, as well as expertise in setting reasonable expectations, individualizing pain control, and providing accurate information about the lethal potential of medications.
authors.affiliation: Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way (S-111), Seattle, WA 98108, USA. tonyback@u.washington.edu
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Back
authors.forename: Helene
authors.initials: H
authors.lastname: Starks
authors.forename: Clarissa
authors.initials: C
authors.lastname: Hsu
authors.forename: Judith R
authors.initials: JR
authors.lastname: Gordon
authors.forename: Ashok
authors.initials: A
authors.lastname: Bharucha
authors.forename: Robert A
authors.initials: RA
authors.lastname: Pearlman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D036301:Qualitative Research; D017236:Suicide, Assisted; D013727:Terminal Care