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    Rights statement: This is the author’s version of a work that was accepted for publication in Journal of Pain and Symptom Management. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Pain and Symptom Management, ?, ?, 2019 DOI: 10.1016/j.jpainsymman.2019.10.021

    Accepted author manuscript, 289 KB, PDF document

    Embargo ends: 1/11/20

    Available under license: CC BY-NC-ND: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

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

Research output: Contribution to journalJournal article

E-pub ahead of print
<mark>Journal publication date</mark>1/11/2019
<mark>Journal</mark>Journal of Pain and Symptom Management
Publication statusE-pub ahead of print
Early online date1/11/19
Original languageEnglish

Abstract

CONTEXT: Many jurisdictions around the world have passed medical aid in dying 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 medical aid in dying.

METHODS: Semi-structured in-depth qualitative interviews were conducted with twenty-one home hospice professionals (7 nurses, 7 social workers, 4 physicians, 3 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) medical aid in dying access and affordability, and 3) how patients have hastened their own deaths. Analysis of these data indicates 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 legalised medical aid in dying. 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 medical aid in dying. Open communication and increased education and training is needed for palliative care professionals regarding legal options, issues of suicide and suicide assessment.

Bibliographic note

This is the author’s version of a work that was accepted for publication in Journal of Pain and Symptom Management. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Pain and Symptom Management, ?, ?, 2019 DOI: 10.1016/j.jpainsymman.2019.10.021