Koocher, G. P., Benjamin, G. A. H., et al. (2023).
Professional Psychology:
Research and Practice, 54(1), 2–13.
Abstract
Significant ethical challenges arise when mental health practitioners care for patients who seek to accelerate their own dying for rational medically valid reasons. Current and proposed laws provide for medical assistance in dying (MAiD) in several U.S. jurisdictions, all of Canada, and several other nations. Differing provisions of these laws complicate their utility for some patients who seek aid in dying. Some extant laws include roles that mental health professionals might play in assessing patients’ competence or capacity to consent, mental illness, or other cognitive and behavioral factors. Practitioners who choose to accept roles in the MAiD process must consider and resolve a number of ethical challenges including potential conflicts between and among laws, ethical standards, third-party requests, personal values, and patients’ wishes. These include becoming aware of patients who may wish to act independently to end their lives when MAiD laws might otherwise exclude them. Examples from actual cases and the resultant discussion will form a basis for exploration of the ethical and legal complexities confronted when psychologists become engaged in the process either intentionally or incidentally. The lead article (Koocher) is not intended to comprehensively address MAiD in all of its complexity but rather to trigger a thoughtful discussion among the accompanying commentaries.
Impact Statement
Public Significance Statement—Current and proposed laws provide for medical assistance in dying (MAiD), sometimes described as physician-assisted suicide, in several U.S. jurisdictions, all of Canada, and in several other nations. Some such laws require psychological input, usually from either a psychologist or a psychiatrist. The limited scope of existing laws may result in some patients suffering with debilitating, painful, chronic, and fatal illnesses to consider suicide without medical assistance. With or without MAiD legislation, mental health professionals will come in contact with such patients and must consider the potentially complex ethical ramifications of caring for such patients.
Conclusion
The culture of dying in America too often involves end-of-life care provided by strangers in institutional settings. Government and professional regulators often assume a parentalistic stance that effectively diminishes personal control of the dying process. Legalized MAiD offers an important option to those suffer from an irremediable medical condition and desire access to medical procedures to hasten death in a peaceful and dignified manner. Patients confronting chronic terminal illness have legitimate interests in controlling their own dying with quality care and support. Perhaps the most valuable and meaningful aspect of dying would include the presence of a community of care that demonstrates to the dying person that they will not feel abandoned (Campbell, 2019). Psychologists can play a significant role in making this happen. Ethical, professional, and legal controversies will abound as MAiD becomes more socially prevalent, and it will.
