Physician Assisted Death -An Ethical Dilemma Revisited

Physicians often face ethical dilemmas when providing advice regarding withdrawal of care. In the nephrology world, we are especially at risk due to the high mortality of our patients. Yet our training tends to lag behind in certain aspects of end of life goals of care discussions. Some of our patients enquire regarding physician-assisted death (PAD) as an option and our current training does not enable us to provide an informed answer. In end-stage-renal patients, opting out of dialysis will certainly result in a rapid demise for most, however, some patients request further assistance. We updated information to be, at the least, able to help our most vulnerable patients with the information. The process of dying, sometimes prolonged to weeks, is a very painful procedure, and not under the patient's control. Withdrawal of care, even with the best palliative care options, does not always result in the control that physician-assisted death (PAD) can provide. It appears as a reasonable option to some patients at the end of life. Is PAD a part of doing “everything that can be done” to keep a patient comfortable (as a part of comfort goals of care)? The provision exists in certain states. However, moving to another state at the end of life is not really practical or even a kind option to consider. A physician can have moral and ethical dilemma around these queries. Our paper discusses available data on this issue intending to empower providers with optimal information. Professional position guidelines do not agree with or recommend physician-assisted-death. This knowledge helps clear the conscience of providers knowing that, at the least, we are doing what most other physicians would do. The question remains: Is PAD a part of “everything that can be done” for the patient? This manuscript aims to update regarding this issue especially as there have been recently active discussions worldwide with the launch of newer technology-assisted death. We present a case modified extensively from real life cases for academic discussion only. We do not provide any recommendation regarding the practice.