ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Public Mental Health
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1580657
This article is part of the Research TopicEthical and Psychiatric Considerations in Euthanasia and Medically Assisted Suicide (E/PAS)View all 9 articles
Views and experiences on writing certificates for assisted dying: Interviews with Swedish physicians
Provisionally accepted
- 1Department of Learning, Informatics, Management and Ethics, Karolinska Institutet (KI), Stockholm, Sweden
- 2Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet (KI), Stockholm, Stockholm, Sweden
- 3Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet (KI), Stockholm, Stockholm, Sweden
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The only legal option for Swedish patients who desire assisted dying (AD) is to travel to Switzerland. To access AD there, patients need medical certificates from their physicians. However, Swedish healthcare law and professional ethical guidelines lack clear directives on how physicians should handle such requests, which may place physicians in perceived ethical and professional dilemmas. How physicians reason about their professional involvement in writing such certificates has previously not been studied in a Swedish context. The aim of this study was to describe and explore physicians' opinions and reasoning when confronted with requests for AD or requests to enable AD in Switzerland. Material and Methods: 12 semistructured interviews with physicians from different specialties (oncology, neurology, palliative care, psychiatry, general practice, internal medicine) were conducted, transcribed, and analysed using thematic analysis. Results: Participants felt it was important to address the reasons why patients wanted to pursue AD, including addressing fears, optimizing care, and existential aspects. Participants felt that they should write certificates to enable AD, citing different reasons. Simultaneously, many participants argued that performing AD in Sweden should not be part of their professional role. Some participants were more positively inclined but were still concerned with perceived obstacles. Conclusion: Participants were concerned with the underlying reasons for patients pursuing AD, hoping to address them. Interestingly, although many of the participants expressed scepticism towards AD and its legalization in Sweden, they still supported writing a medical certificate enabling AD in Switzerland.
Keywords: Physician-assisted suicide, assisted dying, end-of-life, professional ethics, Medical Ethics, Sweden, semi-structured interviews
Received: 20 Feb 2025; Accepted: 02 Jun 2025.
Copyright: © 2025 Jonsson, Sjöstrand and Kihlbom. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Filip Jonsson, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet (KI), Stockholm, Sweden
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