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021 Is the request for physician-assisted dying (PAD) the ultimate form of shared decision-making (SDM)?
  1. François Blot
  1. Ethics Committee, Gustave Roussy Institute, Cancer Campus Grand Paris, Villejuif, France


To this question, the director of a French expert centre replied: ‘PAD cannot be based on a SDM process. SDM is an informed negotiation between professional, patient and family members aiming to reach a common agreement. This happens when the therapeutic framework still provides for several options. When applying for PAD, the patient feels that there are no possible alternatives. It is not a negotiation but an act that the professional may (or not) agree to perform based on his/her personal values, not on his/her medical expertise. The risk is to impose on the patient a new discussion of values when what he needs is to be heard and accompanied.’The point is: does the exchange between a professional and a person requesting PAD have a medical significance, or is it just a question of personal values? In this second case, the professional is there to ratify (or not, thus activating his conscience clause) a decision definitively taken by the patient, excluding any dynamic process to make it only the ultimate syringe holder, devoid of any aptitude for human relationship. Robots with artificial intelligence can do that. In the first case, two human beings discuss a complex situation: a decision has to be made (whether or not to interrupt the person’s life). The patient expresses his/her values and preferences (at this stage, interrupt his/her life). The doctor gives his insight (is the treatment optimal? does the patient receive the right analgesics, antidepressants or anxiolytics? has everything been planned for his social situation, his family? when, how and where should the act be performed? who medically accompanies the act, possible complications and the bereavement?). Not only the decision is in accordance with the patient‘s wishes and the doctor’s mission of infallible care, but both actors are respected as human people.

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