Views and experiences on writing certificates for assisted dying: interviews with Swedish physicians

Area of Science:

• Medical Ethics
• End-of-Life Care
• Physician Decision-Making

Background:

• Swedish patients seeking assisted dying (AD) must travel to Switzerland.
• Physicians require medical certificates to facilitate AD abroad.
• Swedish law and ethics offer no clear guidance on physician involvement in AD certificate requests, creating dilemmas.

Purpose of the Study:

• To explore Swedish physicians' opinions and reasoning regarding requests for assisted dying (AD) or certificates enabling AD in Switzerland.
• To understand the ethical and professional considerations physicians face when confronted with such requests.

Main Methods:

• 12 semi-structured interviews were conducted with physicians across various specialties.
• Interviews were transcribed and analyzed using thematic analysis.

Main Results:

• Physicians emphasized addressing patients' underlying reasons for pursuing AD, including fears and existential concerns.
• A majority supported writing medical certificates to enable AD in Switzerland, despite reservations about performing AD within Sweden.
• Concerns were raised regarding perceived obstacles and the professional role in facilitating AD.

Conclusions:

• Physicians are willing to provide certificates for assisted dying (AD) in Switzerland, focusing on patient-centered care and addressing root causes.
• Despite skepticism towards legalizing AD in Sweden, physicians support facilitating the process for patients choosing to travel abroad.