A Probabilistic Approach to Physician-Assisted Suicide

Physician-Assisted Suicide (PAS) is considered by some patients who learn they are at risk for a cognitive decline owing to Alzheimers Disease. At the same time, the prospect of PAS may raise patients fear of imminent death. Can PAS be offered in a way that is preference-sensitive on one hand, and mitigates patients fear of imminent death on the other? A thought experiment of a Probabilistic Approach to PAS (Probabilistic PAS) is proposed here as a possible solution in jurisdictions where PAS is legal. Consider the following scenario: A patient diagnosed with Alzheimers Disease who is considering PAS might request that when he or she can no longer recognize their loved ones, their doctor will give them a lethal pill that has a 1/100 daily probability of being activated. As a result, after taking the pill, every day the patient will have a 1/100 probability of dying. The likelihood of the patient dying within a year from taking the pill is 97.4%, and within two years, it is 99.9%. As such, a Probabilistic PAS with which on any given day the probability of dying is low, can help patients avoid the fear of imminent death - which traditional PAS entails - while respecting their preference to end their lives. To examine the potential reception of a Probabilistic PAS, a survey was administered to a nationally-representative sample of US residents, using Prolific, a research participant recruitment platform. 499 participants were presented with a short description of a patient who was diagnosed with Alzheimers Disease, is writing an advance directive and is considering ways to end their life painlessly when they can no longer recognize their loved ones. Participants were asked about their own preferences in case they were to face a similar situation, and whether helping administer Probabilistic PAS would be ethical for the patients provider. 498 participants responded to the question about their own preference. 73.5% indicated that they would choose one of the two PAS options. Among those, 9.8% preferred a Probabilistic PAS over traditional PAS. Men were more likely than women to favor Probabilistic PAS for themselves. 482 participants indicated which option would be most ethical for the patients provider to administer. 48.1% indicated one of the two PAS options as most ethical. Among those, 10.3% considered Probabilistic PAS to be more ethical than traditional PAS. Men were more likely than women to consider the provider administering Probabilistic PAS to be most ethical. A version of the Probabilistic PAS proposed here should be considered as a preference-sensitive option presented by healthcare providers to patients considering advance care planning in places where PAS is available.