Date of Award

9-28-2009

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Margaret Drickamer, MD

Abstract

DISCUSSING PHYSICIAN-ASSISTED DYING: A QUALITATIVE STUDY OF DOCTORS EXPERIENCES IN THE US & THE NETHERLANDS. Jennifer R. Voorhees (Sponsored by Margaret A. Drickamer). Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT. This qualitative study was undertaken to further understand the complex issue of discussing physician-assisted dying (PAD) within the context of doctor-patient interactions, to elucidate the emotions of the physicians during such discussions, to explore the effects on the doctor-patient relationship, and to determine factors that influence the discussions. Semi-structured, one-on-one interviews were conducted with thirty-six physicians in the Netherlands and the United States (including Oregon) by a single interviewer. Ongoing inductive qualitative analysis, aided by NVivo7 software, directed the data sampling and saturation. Multiple coders and a multidisciplinary team analyzed emerging themes. This research found that PAD discussions were a gateway to other end-of-life issues important to patients, and intensified and strengthened doctor-patient relationships. Physicians who considered participating in PAD found the journey with patients intense but rewarding. Where PAD is legal, criteria in place were utilized by physicians to guide responsible communication, and discussions were more open and honest, with both patients and colleagues. In contrast, where PAD is illegal, conversations were less explicit, and physicians dealt with requests in relative isolation. In conclusion, PAD can be both challenging and rewarding for physicians to discuss with patients. Discussion and consideration of PAD is an energy-consuming yet enriching part of the doctor-patient relationship. Legalization is particularly helpful for providing structure and support for individual doctors who consider assisting patients.

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