Ethical Uncertainties: Diverging and Emerging Regulations of Assisted Dying/Assisted Suicide and the Potential Role of Clinical Ethics

Assisted Suicide (AS)/Assisted Dying (AD), where a physician prescribes lethal medication to a terminally ill patient who intends to take it to end his/her life, is a highly controversial matter. Sound knowledge about recent legal changes and related challenges should inform considerations for clinical ethics consultation, education, and policy making. This article describes a wide spectrum of current legal contexts for AS/AD in the United Kingdom, Italy, Austria, the United States (US), Switzerland, and Germany. This selection includes countries covering a wide range from the restrictive to the permissive extreme as well as legal gray zones of AS/AD law and practice. Issues of conscientious objection are addressed, acknowledging that both liberal as well as restrictive practices may trigger moral uncertainty or dilemmas for all those involved. One strategy to improve handling such challenges arising in patient care according to ethical norms and values has been clinical ethics support (CES) in various forms. Like legislation and practice, the involvement of CES in AS/AD differs between countries. The authors describe the role of CES in AS/AD if it exists and explore possible future roles in this changing landscape. Agreement exists that the knowledge and skills of CES are valuable for identifying and analyzing moral issues and informing policy development and education at the individual case, institutional, regional, and national levels. Good practice of handling requests for AS/AD is an example where CES overlaps with organizational clinical ethics, going beyond the acute single case perspective to wider ethical and legal considerations, which can impact patient care and support for health care professionals involved.