What patient and psychologist characteristics are important in competency for physician-assisted suicide evaluations?

Résumé

The practice of physician-assisted suicide (PAS) is currently legal in Oregon (Oregon Death With Dignity Act, 1995), Washington (Washington Death With Dignity Act, 2008), and Montana (Baxter v. Montana, 2009). In an effort to identify important characteristics of patients and clinicians involved in evaluations of competence to request PAS, 216 licensed psychologists from Oregon and Montana were surveyed regarding their attitudes toward PAS and their personal and professional experiences with suicide. They were also asked to make a competence decision for a patient requesting PAS based on a case vignette. Cognitive ability, as indicated by a question regarding the importance of cognitive ability and components of competence that rely on reasoning skills, was the only patient factor that significantly predicted competence decisions. Results also suggested that personal characteristics of clinicians, particularly whether someone in their personal life had ever attempted suicide and their willingness to support a family member’s choice of PAS, influence their decision regarding the competence of the patient. Exploratory analyses also revealed that clinicians consider perceived burdensomeness to be of little importance when conducting a competence evaluation for PAS. In all, the largest effects were observed for the experimental vignette condition, clinician personal experience with attempted suicide, and clinician perceived importance of patient MacArthur Competence Assessment Tool for Treatment–Appreciation scores. The implications of these results are discussed, centering on recommendations for clinicians considering participating in competence evaluations for PAS and future directions for research. SUICIDE-ASSISTÉ PROFESSIONNEL-SANTÉ-MENTALE ATTITUDE COMPÉTENCE