Assisted suicide creates demanding tasks for families: results from a qualitative interview study.
C. Gamondi1, M. Pott2, N. Preston3, S. Payne3 (1Bellinzona ; 2Lausanne ; 3Lancaster GB)
Switzerland is the only country in the world where assisted suicide (AS) is performed without a specific legislation, within the law, mostly without medical participation. Assisted Suicide involves enabling the patient to obtain a lethal substance, which the person wishing to commit suicide then takes without any external assistance. In Switzerland euthanasia is against the law, but if certain conditions are met, AS is not prosecuted. Much of the national and international debate on AS is focused on ethical issues, very often viewed from opposing positions, leading to a very polarized debate, often uninformed from careful analysis of the literature. In the recent years the debate has largely focused also upon legal concerns; health care professionals participation in AS and patient’s rights. Far too little research has been conducted to investigate the experiences of family members and caregivers during and following AS in the single countries that allow this practice and to explore differences and similarities between the different countries.
To explore family members’ accounts of their involvement prior to assisted suicide in Switzerland.
A qualitative interview study in the Italian and French speaking regions of Switzerland on 28 close relatives and family carers of 18 patients who died by assisted suicide. Interpretation and analysis were performed using qualitative content analysis.
Involvement in assisted suicide was characterized by five phases; 1) Contemplation, 2) Gaining acceptance, 3) Gaining permission, 4) Organization and 5) Aftermath. Families participated in these phases with varying degrees of involvement. They played a pivotal role acting as advocates for the patients and providing practical help to obtain an assisted suicide, in addition to their role as caregivers. They represented key persons in reflecting pro and contra arguments about assisted suicide with the patients and pondering the timing of the act with them. In our study the decision appeared to be mostly taken within the close circle of the family and families seemed to play a role that appears more incisive than that described in literature Some participants opposed assisted suicide openly, but supported the patient in their decision.
Participating in assisted suicide created further demanding tasks for families in addition to their role of caregivers. It is possible that the Swiss civil model of assisted suicide allows patients and families greater autonomy in decision-making and organization of assisted suicide; on the other hand, it requires families to assume a broader moral and practical responsibility for the whole process. Clinical guidelines and policies concerning assisted dying should acknowledge and address family needs.