Medical aid in dying (MAiD), despite being legal in many jurisdictions, remains controversial ethically. Existing surveys of physicians’ perceptions of MAiD tend to focus on the legal or moral permissibility of MAiD in general. Using a novel sampling strategy, we surveyed physicians likely to have engaged in MAiD-related activities in Colorado to assess their attitudes toward contemporary ethical issues in MAiD.

Canada is six years into a new era of legalized medical assistance in dying (MAiD). The law continues to evolve, following a pattern in which Canadian courts rule that legal restrictions on eligibility for MAiD are unconstitutional and Parliament responds by gradually expanding eligibility for MAiD. The central tension underlying this dialogue between courts and government has focused on two conceptions of how to best promote and protect the interests of people who are vulnerable by virtue of intolerable and irremediable suffering due to an illness, disease, or disability. Do we, as a society, have a duty to protect vulnerable people from seeking certain medical procedures that are contrary to their interests, as those are perceived by others? Or do we have a duty to uphold their rights to autonomy, including the right to make choices within a range that may be constrained by many factors, some of which may be socially unjust? This is a recurrent problem in bioethics and medical law, which we explore through the lens of how Canadian courts and Parliament have grappled with defining eligibility for MAiD.

Objective — Despite the ongoing moral and legal debate, there is still a paucity of empirical literature on the actual occurrence of Medical Decisions at the End of Life (MDEL). Moreover, the psychiatrist's role in this scenario is still unclear. Methods — This paper systematically reviews currently available literature on euthanasia (EU) and physician assisted suicide (PAS). Published articles were selected if they reported either: 1) prevalence estimates of patients' requests of EU/PAS; and/or 2) prevalence estimates of physicians' actual EU/PAS practices. Papers exploring the issue of MDEL-related psychiatric consultation have been also included in the review. Results — The empirical evidence reported in this paper shows that EU/PAS demands and acts are not uncommon in medical practice. A conservative estimate indicates that at least 10% of physicians have granted a request of EU/PAS. The involvement of consultation-liaison psychiatrists in MDELs seems to be relatively rare. Conclusions — Euthanasia and other MDELs require physicians' thoughtful evaluation of criteria guiding professional decision-making. To this purpose, epidemiological and psychosocial research can offer a valuable contribution.

Objective: The aim of this study was to compare the results of surveys about attitudes toward euthanasia and related issues that was conducted among palliative care specialists, health care professionals of a cancer center, and first- and second-year medical students.

Methods: By means of an anonymous questionnaire with different hypothetical scenarios concerning physician assisted suicide (PAS) and related issues, 726 members of the Swiss Association for Palliative Care (SAPC), 148 health care professionals of the Institute of Oncology of Italian speaking Switzerland (IOSI), and 140 medical students of the University of Fribourg, Switzerland, were surveyed.

Results: Among palliative care specialists a decreasing number supported PAS, direct active euthanasia (DAE), DAE for psychiatric patients, DAE in incompetent patients, and life terminating acts without explicit request (LAWER). Professionals of the cancer center were more in favor of DAE and PAS than palliative care specialists, but less in favor than medical students.

Significance of results: Significant variations among different professionals exist in attitudes toward euthanasia. The hypothesis that familiarity with the care of severely ill and dying patients is an important underlying factor explaining variance has been confirmed by these surveys.