GPs usually care for their patients for an extended period of time, therefore, requests to not only discontinue a patient’s treatment but to assist a patient in a suicide are likely to create intensely stressful situations for physicians. However, in order to ensure the best patient care possible, the competent communication about the option of physician assisted suicide as well as the assessment of the origin and sincerity of the request are very important. This is especially true, since patients’ requests (...) for PAS can also be an indicator for unmet needs or concerns. Twenty-three qualitative semi-structured interviews were conducted to in-depth explore this multifaceted, complex topic while enabling GPs to express possible difficulties when being asked for assistance. The analysis of the gathered data shows three main themes why GPs may find it difficult to professionally communicate about PAS: concerns for their own psychological well-being, conflicting personal values or their understanding of their professional role. In the discussion part of this paper we re-assess these different themes in order to ethically discuss and analyse how potential barriers to professional communication concerning PAS could be overcome. (shrink)

From June 26 to 27, the workshop Ironists, Reformers, or Rebels? The Role of the Social Sciences in Participatory Policy Making took place at the Collegium Helveticum of the UZH/ETH in Zurich. The organisers’ motivation was the apparently missing involvement of social scientists in public engagement processes. This impression persists because, while social scientists often observe public debates or develop participatory methods for public policy-making, they rarely take part in those processes themselves. A closer look at ethics commissions, expert committees (...) or public hearings concerned with science and technology issues shows natural scientists, physicians, lawyers and the occasional philosopher. Sociologists, anthropologists and other social scientists, on the other hand, are often not involved. Because of this imbalance, the organisers’ aim was to bring together scholars and researchers from different areas of the social sciences to consider the role of their disciplines in public policy making. This article will focus on some of the ideas about specific roles of social scientists in participatory policy-making, discussed at the workshop, and their implications and give a commentary on some future prospects of the social sciences. (shrink)

Advance directives are written documents that give patients the opportunity to communicate their preferences regarding treatments they do or do not want to receive in case they become unable to make decisions. Commonly used pre-printed forms have different formats. Some offer space for patients to appoint a surrogate decision maker, and/or to determine future medical treatments and/or give a statement of personal values. So far it is unknown which forms GPs preferably use and why they decide to do so. 23 (...) semi-structured interviews with GPs were analysed using content analysis. Interviewees mainly use short templates and medium length templates with checkboxes to indicate patients’ preferences in regards to life prolonging measures. Especially when patients faced the progression of a disease, participants use the latter version. Only then, the interviewees remarked, patients are capable to rate concrete situations reliably. GPs also realize the importance of the verbal assessment of patients’ preferences; however they rarely keep a written form of the conversation. Some GPs hand out one or more templates and ask their patients to read and think about them at home with the option to talk to them about it later on, while others prefer their patients to fill them out alone at home. Regardless of template usage, most GPs emphasize that ADs require regular updates. GPs tend to see standardized advance directives mainly as a tool to start a conversation with their patients and to identify their real preferences and values. When the patient is still not facing the progression of an already existing disease it could be sufficient to only appoint a surrogate decision maker instead of creating a full AD. However, in all other situations, appointing a surrogate decision maker should be backed up by a written statement of a patient’s general values. Patients and their relatives should always have the opportunity to ask their GP for medical advice when drafting an AD. It is crucial to regularly verify and update existing ADs within the course of a disease. (shrink)