Requests for physician-assisted suicide in German general practice: frequency, content, and motives- a qualitative analysis of GPs' experiences.

Background: Physician-assisted suicide (PAS) has been legalised in an increasing number of countries in Western Europe. In Germany, after a landmark decision by the Federal Constitutional Court in 2020, the ban on PAS was removed from the Model Medical Code of Conduct in 2021. Although the German Medical Association makes it clear that assisted suicide (AS) is not a genuine medical task, doctors have been approached about it. As long-standing, trusted companions of their patients, general practitioners (GPs) can be predestined as initial contacts for requests regarding PAS. Aim of this study is to assess the experiences of German GPs with requests for PAS.

Methods: We conducted 19 guideline-based interviews with GPs currently or formerly practicing in Germany (study period: 03/22-12/22). The verbatim transcripts were analysed using Mayring's qualitative content analysis.

Results: In contrast to vague death wishes, requests for PAS were described as occasional. Nearly all respondents had experienced them several times. Most interviewees did not observe an increase in requests following the 2020 ruling by the Federal Constitutional Court. So far, the GPs' role in PAS seems to be more of an advisory, informative, caring rather than an actively assisting one. According to the GPs' reports most patients requesting PAS suffered from at least one form of cancer. Another significant group of patients was not severely ill but advanced in age. Regardless of age or illness, the interviewed GPs frequently perceived the loss of autonomy and independence as a primary motive for requesting PAS. Most of the requests involved either the plea for a lethal drug, information on the lethal dose of prescribed medication, or unspecified requests for assistance with suicide. Patients requesting PAS were predominantly described as educated, reflective, and financially well-off individuals.

Conclusion: Individual insights into German GPs' experiences with PAS suggest a high probability for GPs to encounter requests for PAS during their practice. Knowledge of vulnerable patient groups and prominent motives behind requests for PAS can be helpful in practice, enabling physicians to better understand and adequately respond to such requests.