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Cited by 11Palliative Care and End-of-Life IssuesPalliative and Oncologic CareEthics and bioethics in healthcare

Resource Limitation and “Forced Irremediability” in Physician-Assisted Deaths for Nonterminal Mental and Physical Conditions: A Survey of the US Public

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Berens, Noah, Wasserman, David, Wakim, Paul, Bernhard, Talia, Kim, Scott Y.H.·2022·Journal of the Academy of Consultation-Liaison Psychiatry
DOI 10.1016/j.jaclp.2021.12.010PMC PMC9271133
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Abstract

Background Physician-assisted death (PAD) for people with nonterminal illnesses (PAD-NT) is a controversial practice legal in some countries and increasingly debated in others, including the United States. A major concern about legalization of PAD-NT is that a lack of resources may drive some with mental illnesses or physical disabilities to seek PAD.Objective To assess US public opinion on PAD-NT under conditions of resource limitation.Methods The authors surveyed 2139 US adults matched to the US population in sex, age, race/ethnicity, education, political affiliation, and income. After giving their opinions regarding terminal PAD and PAD-NT in response to traditional PAD survey questions, respondents were randomly presented one of 4 scenarios of persons with nonterminal conditions requesting PAD-NT who lacked adequate resources to maintain their quality of life. The type of resources lacking (social or health care) and medical condition (mental or physical disability) were varied. Respondents' views regarding PAD-NT for the scenario specifically and legalization generally were then reassessed.Results At baseline, 55.4% of respondents supported legalizing terminal PAD, and 36.9% supported legalizing PAD-NT. After analyzing the scenarios, 28.2% (range 18.6%-39.7%) agreed/strongly agreed with legalizing PAD-NT generally and 23.7% (15.2%-33.7%) agreed/strongly agreed with PAD-NT for the instance depicted, with mental illness scenarios receiving much lower support; respondents' comments suggest devaluation of life with physical disability versus with mental illness. Being politically liberal, not religious, and assigned physical disability scenarios were associated with greater support for PAD-NT in multivariable analyses.Conclusions A minority of the US public supports PAD-NT in the context of inadequate resources, with much lower support for PAD-NT for mental illness than for physical disability, suggesting that PAD-NT policy debates and future research should address the issue of whether sufficient resources must be available to potential requestors of PAD-NT.

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  • The percentage of US general population supporting legalizing MAiD-NT significantly decreased when scenarios were presented showing the possible request by patients in non-terminal state because of loss of support from health care system or poverty.

    “This percentage significantly decreased, however, when a series of scenarios were presented showing the possible request by patients in non-terminal state because of loss of support from health care system or poverty [29].”

    From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [29]

    The Results section (Attitudes towards PAD for Non-terminal Illnesses: Baseline and Post-Scenario; page unavailable) reports a statistically significant decrease in support after respondents read resource-limitation scenarios. The Survey methods describe loss of healthcare or social support, but our copy does not identify poverty as one of the scenario conditions. (LLM, conf=0.83)

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  1. [16]2017 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration; 2017. 27748105

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Authors
Berens, N., Wasserman, D., Wakim, P., Bernhard, T., & Kim, S. Y. H.
Affiliations
National Institutes of Health (US)
Corresponding author
Kim, Scott Y.H.
ORCID
Venue
Journal of the Academy of Consultation-Liaison Psychiatry
Publisher
Elsevier BV
Published
2022-07
Volume
63
Issue
4
Pages
302-313
ISSN
2667-2960 (ISSN-L)
DOI
10.1016/j.jaclp.2021.12.010
PMC
PMC9271133
OpenAlex
W4205961411
Cited by
11
References
22
Citations by year
2026: 3 · 2025: 4 · 2022: 4
FWCI
1.77
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the Academy of Consultation-Liaison Psychiatry (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • NIH Clinical Center (ZIA CL010539)
  • NIH
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
physician-assisted death, resource constraints, public opinion, mental illness, physical disability, legalization, health resources, social resources, quality of life
MeSH terms
Adult, Humans, Physicians, Public Opinion, Quality of Life, Surveys and Questionnaires, United States, Suicide, Assisted

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