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June 8, 1994, Vol 271, No. 22 >
ARTICLE | June 8, 1994

Physicians and Their Patients' Suicides FREE

Steven H. Miles, MD
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JAMA. 1994;271(22):1786-1788. doi:10.1001/jama.1994.03510460078037
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References

THE AMERICAN debate about whether to legalize physicianassisted suicide touches the head and the heart of medical ethics. Participants have focused on moral philosophy or civil rights, speculated about the consequences for society or for patients' views of physicians, and criticized the current provision of end-of-life medical care.1-3 There has been little discussion about how the psychology of doctor-patient relationships may influence decisions about physician-assisted suicide. This issue is relevant to understanding how patients and physicians make decisions and to the design of policy safeguards to prevent improper assisted suicides.

Even clinician/writers have been nearly silent on the psychology of doctoring in physician-assisted suicide. Their writings have centered on moral reasoning, the need for better end-of-life care, the societal consequences of legalization, or historical norms for medical practice.2,4-7 Quill8 has looked at the complex psychology of the patient's request.8 Some clinicians, such as Goodwin9 in

REFERENCES

1 +
Kass LR.  Neither for love nor money: why doctors must not kill. Public Interest . (Winter) 1991;:25-46.
2 +
Rosner F, Rogatz P, Lowenstein R, et al.  Physician-assisted suicide. N Y State J Med . 1992;;92:388-391.
3 +
Brody H.  Assisted death—a compassionate response to a medical failure. N Engl J Med . 1992;;327:1384-1388.
4 +
Singer PA, Siegler M.  Euthanasia—a critique. N Engl J Med . 1990;;322:1881-1883.
5 +
Teno J, Lynn J.  Voluntary active euthanasia: the individual cost and public policy. J Am Geriatr Soc . 1991;;39:827-830.
6 +
Cassell CK, Meier DE.  Morals and moralism in the debate about euthanasia and assisted suicide. N Engl J Med . 1990;;323:750-752.
7 +
Wanzer SH, Federman DD, Adelstein SJ, et al.  The physician's responsibility toward hopelessly ill patients: a second look. N Engl J Med . 1989;;320:844-849.
8 +
Quill TE.  Doctor, I want to die. Will you help me? JAMA . 1993;;270:870-873.
9 +
Goodwin JS.  Mercy killing: mercy for whom? JAMA . 1990;;264:326.
10 +
Pellegrino ED.  Compassion needs reason too. JAMA . 1993;;270:874-875.
11 +
Scheidermayer DL, La Puma J.  Euthanasia. N Engl J Med . 1989;;321:120.
12 +
Angell M.  Euthanasia. N Engl J Med . 1989;;321:120.
13 +
Lifton RJ. Nazi Doctors . New York, NY: Basic Books Inc Publishers; 1986;:417-500.
14 +
Gomez C. Regulating Death: Euthanasia and the Case of the Netherlands . New York, NY: Free Press; 1991;.
15 +
Diekstra RFW.  Assisted-suicide and euthanasia: experience from the Netherlands. Ann Med . 1993;;25:5-9.
16 +
Quill TE, Cassel CK, Meier DE.  Care of the hopelessly ill: proposed clinical criteria for physician-assisted suicide. N Engl J Med . 1992;;327:1380-1384.
17 +
CeloCruz MT.  Aid-in-dying: should we decriminalize physician-assisted suicide and physician-committed euthanasia? Am J Law Med . 1993;;18:369-394.
18 +
Bonica JJ.  History of pain concepts and pain therapy. Mt Sinai J Med . 1991;;58: 191-202.
19 +
Conwell Y, Caine ED.  Rational suicide and the right to die: reality and myth. N Engl J Med . 1991;;325:1101-1102.
20 +
Roenn HS, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ.  Physician attitudes and practice in cancer pain management. Ann Intern Med . 1993;;119:121-126.
21 +
Cleeland CS, Gonin R, Hatfield AK, et al.  Pain and its treatment in outpatients with metastatic cancer. N Engl J Med . 1994;;330:592-596.
22 +
Uhlmann RF, Pearlman RA, Kain KC.  Physicians' and spouses' predictions of elderly patients' resuscitation preferences. J Gerontol . 1988;;43:M115-M121.
23 +
Uhlmann RF, Pearlman RA.  Perceived quality of life and preferences for life-sustaining treatment in older adults. Arch Intern Med . 1991;;151:495-497.
24 +
Greene MG, Adelman RD, Charon R, Friedman E.  Concordance between physicians and their older and younger patients in the primary care encounter. Gerontologist . 1989;;29:808-813.
25 +
Bach JR.  Ventilator use by Muscular Dystrophy Association patients. Arch Phys Med Rehabil . 1992;;73:179-183.
26 +
Starr JT, Pearlman RA, Uhlmann RF.  Quality of life and resuscitation decisions in elderly patients. J Gen Intern Med . 1986;;1:373-379.
27 +
Schneiderman LJ, Kaplan RM, Pearlman RA, Teetzel H.  Do physicians' own preferences for life-sustaining treatment influence their perceptions of patients' preferences? J Clin Ethics . 1993;;4:28-33.
28 +
Max MB.  Improving outcomes of analgesic treatment: is education enough? Ann Intern Med . 1990;;113:885-889.
29 +
Butler RN.  Psychiatry and the elderly: an overview. Am J Psychiatry . 1975;;132:893-900.
30 +
Clarke PJ.  Exploration of countertransference toward the dying. Am J Orthopsychiatry . 1981;;51:71-77.
31 +
Jorstad J.  Some experience in psychotherapy with suicidal patients. Acta Psychiatr Scand Suppl . 1987;;336:76-81.
32 +
Modestin J.  Counter-transference reactions contributing to completed suicide. Br J Med Psychol . 1987;;60:379-385.
33 +
Wolk-Wasserman D.  Some problems connected with the treatment of suicide attempt patients: transference and countertransference aspects. Crisis . 1987;;8:69-82.
34 +
Maltsberger JT, Buie DH.  Countertransference hate in the treatment of suicidal patients. Arch Gen Psychiatry . 1974;;30:625-633.
35 +
Hendin H.  Psychotherapy and suicide. Am J Psychother . 1981;;35:469-480.
36 +
Rotov M.  Death by suicide in the hospital: an analysis of 20 treatment failures. Am J Psychother . 1970;;24:216-217.
37 +
Helme T.  'A special defence': a psychiatric approach to formalizing euthanasia. Br J Psychiatry . 1993;;163:456-466.
38 +
Quill TE.  Death and dignity: a case of individualized decision making. N Engl J Med . 1991;;324:691-694.
39 +
Quill TE, Townsend P.  Bad news: delivery, dialogue, and dilemmas. Arch Intern Med . 1991;;151:463-468.
40 +
Caine ED, Conwell YC.  Self-determined death, the physician, and medical priorities: is there time to talk? JAMA . 1993;;270:875-876.
41 +
Benoliel JQ.  Health care providers and dying patients: critical issues in terminal care. Omega . 1987;;18:341-363.
42 +
Chemtob CM, Hamada RS, Bauer G, Kinney B, Torigoe RY.  Patients' suicides: frequency and impact on psychiatrists. Am J Psychiatry . 1988;;145:224-228.
43 +
Goldstein LS, Buongiorno PA.  Psychotherapists as suicide survivors. Am J Psychother . 1984;;38:392-398.
44 +
Kass LR.  Ethical dilemmas in the care of the ill: what is the physician's service? JAMA . 1980;;244:1811-1816.
45 +
Pick IB.  Working through in the countertransference. Int J Psychoanal . 1985;; 66(pt 2):157-166.
46 +
Orentlicher D.  Physician participation in assisted suicide. JAMA . 1990;;263:1198.
47 +
Cain J, Stacy L, Jusenius K, Figge D.  The quality of dying: financial, psychological, and ethical dilemmas. Obstet Gynecol . 1990;;76:149-152.
48 +
Campbell CS.  'Aid-in-dying' and the taking of human life. J Med Ethics . 1992;;18: 128-134.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Kass LR.  Neither for love nor money: why doctors must not kill. Public Interest . (Winter) 1991;:25-46.
2 +
Rosner F, Rogatz P, Lowenstein R, et al.  Physician-assisted suicide. N Y State J Med . 1992;;92:388-391.
3 +
Brody H.  Assisted death—a compassionate response to a medical failure. N Engl J Med . 1992;;327:1384-1388.
4 +
Singer PA, Siegler M.  Euthanasia—a critique. N Engl J Med . 1990;;322:1881-1883.
5 +
Teno J, Lynn J.  Voluntary active euthanasia: the individual cost and public policy. J Am Geriatr Soc . 1991;;39:827-830.
6 +
Cassell CK, Meier DE.  Morals and moralism in the debate about euthanasia and assisted suicide. N Engl J Med . 1990;;323:750-752.
7 +
Wanzer SH, Federman DD, Adelstein SJ, et al.  The physician's responsibility toward hopelessly ill patients: a second look. N Engl J Med . 1989;;320:844-849.
8 +
Quill TE.  Doctor, I want to die. Will you help me? JAMA . 1993;;270:870-873.
9 +
Goodwin JS.  Mercy killing: mercy for whom? JAMA . 1990;;264:326.
10 +
Pellegrino ED.  Compassion needs reason too. JAMA . 1993;;270:874-875.
11 +
Scheidermayer DL, La Puma J.  Euthanasia. N Engl J Med . 1989;;321:120.
12 +
Angell M.  Euthanasia. N Engl J Med . 1989;;321:120.
13 +
Lifton RJ. Nazi Doctors . New York, NY: Basic Books Inc Publishers; 1986;:417-500.
14 +
Gomez C. Regulating Death: Euthanasia and the Case of the Netherlands . New York, NY: Free Press; 1991;.
15 +
Diekstra RFW.  Assisted-suicide and euthanasia: experience from the Netherlands. Ann Med . 1993;;25:5-9.
16 +
Quill TE, Cassel CK, Meier DE.  Care of the hopelessly ill: proposed clinical criteria for physician-assisted suicide. N Engl J Med . 1992;;327:1380-1384.
17 +
CeloCruz MT.  Aid-in-dying: should we decriminalize physician-assisted suicide and physician-committed euthanasia? Am J Law Med . 1993;;18:369-394.
18 +
Bonica JJ.  History of pain concepts and pain therapy. Mt Sinai J Med . 1991;;58: 191-202.
19 +
Conwell Y, Caine ED.  Rational suicide and the right to die: reality and myth. N Engl J Med . 1991;;325:1101-1102.
20 +
Roenn HS, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ.  Physician attitudes and practice in cancer pain management. Ann Intern Med . 1993;;119:121-126.
21 +
Cleeland CS, Gonin R, Hatfield AK, et al.  Pain and its treatment in outpatients with metastatic cancer. N Engl J Med . 1994;;330:592-596.
22 +
Uhlmann RF, Pearlman RA, Kain KC.  Physicians' and spouses' predictions of elderly patients' resuscitation preferences. J Gerontol . 1988;;43:M115-M121.
23 +
Uhlmann RF, Pearlman RA.  Perceived quality of life and preferences for life-sustaining treatment in older adults. Arch Intern Med . 1991;;151:495-497.
24 +
Greene MG, Adelman RD, Charon R, Friedman E.  Concordance between physicians and their older and younger patients in the primary care encounter. Gerontologist . 1989;;29:808-813.
25 +
Bach JR.  Ventilator use by Muscular Dystrophy Association patients. Arch Phys Med Rehabil . 1992;;73:179-183.
26 +
Starr JT, Pearlman RA, Uhlmann RF.  Quality of life and resuscitation decisions in elderly patients. J Gen Intern Med . 1986;;1:373-379.
27 +
Schneiderman LJ, Kaplan RM, Pearlman RA, Teetzel H.  Do physicians' own preferences for life-sustaining treatment influence their perceptions of patients' preferences? J Clin Ethics . 1993;;4:28-33.
28 +
Max MB.  Improving outcomes of analgesic treatment: is education enough? Ann Intern Med . 1990;;113:885-889.
29 +
Butler RN.  Psychiatry and the elderly: an overview. Am J Psychiatry . 1975;;132:893-900.
30 +
Clarke PJ.  Exploration of countertransference toward the dying. Am J Orthopsychiatry . 1981;;51:71-77.
31 +
Jorstad J.  Some experience in psychotherapy with suicidal patients. Acta Psychiatr Scand Suppl . 1987;;336:76-81.
32 +
Modestin J.  Counter-transference reactions contributing to completed suicide. Br J Med Psychol . 1987;;60:379-385.
33 +
Wolk-Wasserman D.  Some problems connected with the treatment of suicide attempt patients: transference and countertransference aspects. Crisis . 1987;;8:69-82.
34 +
Maltsberger JT, Buie DH.  Countertransference hate in the treatment of suicidal patients. Arch Gen Psychiatry . 1974;;30:625-633.
35 +
Hendin H.  Psychotherapy and suicide. Am J Psychother . 1981;;35:469-480.
36 +
Rotov M.  Death by suicide in the hospital: an analysis of 20 treatment failures. Am J Psychother . 1970;;24:216-217.
37 +
Helme T.  'A special defence': a psychiatric approach to formalizing euthanasia. Br J Psychiatry . 1993;;163:456-466.
38 +
Quill TE.  Death and dignity: a case of individualized decision making. N Engl J Med . 1991;;324:691-694.
39 +
Quill TE, Townsend P.  Bad news: delivery, dialogue, and dilemmas. Arch Intern Med . 1991;;151:463-468.
40 +
Caine ED, Conwell YC.  Self-determined death, the physician, and medical priorities: is there time to talk? JAMA . 1993;;270:875-876.
41 +
Benoliel JQ.  Health care providers and dying patients: critical issues in terminal care. Omega . 1987;;18:341-363.
42 +
Chemtob CM, Hamada RS, Bauer G, Kinney B, Torigoe RY.  Patients' suicides: frequency and impact on psychiatrists. Am J Psychiatry . 1988;;145:224-228.
43 +
Goldstein LS, Buongiorno PA.  Psychotherapists as suicide survivors. Am J Psychother . 1984;;38:392-398.
44 +
Kass LR.  Ethical dilemmas in the care of the ill: what is the physician's service? JAMA . 1980;;244:1811-1816.
45 +
Pick IB.  Working through in the countertransference. Int J Psychoanal . 1985;; 66(pt 2):157-166.
46 +
Orentlicher D.  Physician participation in assisted suicide. JAMA . 1990;;263:1198.
47 +
Cain J, Stacy L, Jusenius K, Figge D.  The quality of dying: financial, psychological, and ethical dilemmas. Obstet Gynecol . 1990;;76:149-152.
48 +
Campbell CS.  'Aid-in-dying' and the taking of human life. J Med Ethics . 1992;;18: 128-134.

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