Description
Physician Aid in Dying (PAD) (also referred to as Medical Assistance in Dying (MAiD)) has been legalized or decriminalized in well over a dozen jurisdictions around the world, and assisted dying policies continue to evolve rapidly, including in the US. Many jurisdictions are exploring whether to introduce PAD laws or expand existing law to include PAD based on a mental disorder. PAD based on a mental disorder has been permitted for two decades in the Netherlands and Belgium and 2023 marks the legalization of the practice in Canada (to be introduced as of March 2023). This session will discuss some of the lessons learnt and how this informs the practice of PAD more broadly. Dr. Marie Nicolini, MD PhD, psychiatrist and researcher at the Belgian Research Foundation Flanders and Georgetown University, will discuss the history of PAD on the basis of a mental disorder in the Netherlands and Belgium and how its legalization came about. Dr. Nicolini will summarize her extensive research on this topic and examine how the main lessons learned over the past two decades inform policymaking internationally. Finally, the session will home in on the ongoing challenge, since its legalization, of defining adequate standards for irremediability in psychiatric disorders and what this means for our understanding of the practice. Dr. John Peteet, a C/L psychiatrist working in a cancer center, will explore how capacity for PAD may differ from capacity to refuse a treatment, where the physician’s action implies crossing the bodily integrity of an objecting patient. Dr. Peteet will explore whether, in the context of PAD where a physician is deciding whether it is appropriate to offer a lethal intervention, a broader conception of what is important and allowable is needed, such as a “decision-optimizing” relationship with the patient. Case examples will illustrate the idea that what is at stake is not only the patient’s cognitive capacity and DSM diagnosis but the patient’s emotional capacity, and the professional and clinical responsibility of the doctor to the patient. Dr. K. Sonu Gaind, a University of Toronto professor and psychiatrist, a past president of the Canadian Psychiatric Association and panelist from the Council of Canadian Academies Expert Panel reviewing PAD for mental disorders, will review the Canadian experience and significant recent policy developments, which are being watched globally, as Canada moves towards providing psychiatric euthanasia by 2023. This session will also explore differences between groups who seek PAD for different reasons and discuss potential impacts of expanding PAD laws on marginalized populations suffering from life distress.
Format
Recorded webinar.
This content was recorded during the APA 2023 Annual Meeting.
Learning Objectives
- Identify the main clinical and ethical challenges of PAD based on a mental disorder and what this means for policymaking internationally
- Appreciate the challenges in assessing fully autonomous decisions regarding death in patients with legal capacity to consent
- Appreciate the tension between ‘overinclusion’ and ‘underinclusion’ in the context of expanded assisted dying laws, including the impact on vulnerable and marginalized populations
- Recognize the tension, in policy and practice, between psychiatric euthanasia and suicide prevention when considering wishes to die
Target Audience
Residents/Fellows, Psychiatrists, Psychologists
Estimate Time to Complete
Estimated Duration: 1.5 hours
Program Start Date: May 1, 2025
Program End Date: May 1, 2028
How to Earn Credit
Participants who wish to earn AMA PRA Category 1 Credit™ may do so after completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned.
Continuing Education Credit
In support of improving patient care, the American Psychiatric Association is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
The APA designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Faculty and Planner Disclosures
The American Psychiatric Association adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME activity — including faculty, planners, reviewers or others — are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.
Instructors
- Marie Nicolini, MD, PhD
- John Peteet, MD
- Karandeep Gaind, MD, FRCPC, DFAPA
Planners
- Vishal Madaan, MD, Chief of Education and Deputy Medical Director at the American Psychiatric Association.
Accessibility for Participants with Disabilities
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Technical Requirements
This internet-based CME activity is best experienced using any of the following:
- The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari
- Internet Explorer 11+
This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player.
Optimal System Configuration:
- Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version)
- Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version)
- Internet Connection: 1 Mbps or higher
Minimum Requirements:
- Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content
- Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content
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