{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T05:41:18Z","timestamp":1793511678821,"version":"4.5.0"},"reference-count":47,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"unspecified","delay-in-days":153,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S1478951525000240_sec1a\">\n\t    <jats:title>Background<\/jats:title>\n\t    <jats:p>Moral distress affects a significant proportion of clinicians who have received requests and participated in euthanasia or physician-assisted suicide (E\/PAS) globally. It has been reported that personal and professional support needs are often unaddressed, with only a minority of those reporting adverse impacts seeking support.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S1478951525000240_sec2b\">\n\t    <jats:title>Objectives<\/jats:title>\n\t    <jats:p>This study aimed to review studies from 2017 to 2023 for the perceived risks, harms, and benefits to doctors of administering E\/PAS and the ethical implications for the profession of medicine resulting from this practice.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S1478951525000240_sec3c\">\n\t    <jats:title>Methods<\/jats:title>\n\t    <jats:p>The search explored original research papers published in peer-reviewed English language literature between June 2017 and December 2023 to extend prior reviews. This included both studies reporting quantitative and qualitative data, with a specific focus on the impact on, or response from, physicians to their participation in E\/PAS. The quantitative review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The qualitative review used the Critical Appraisal Skills Programme to assess whether studies were valid, reliable, and trustworthy.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S1478951525000240_sec4d\">\n\t    <jats:title>Results<\/jats:title>\n\t    <jats:p>Thirty studies (quantitative <jats:italic>n<\/jats:italic> = 5, qualitative <jats:italic>n<\/jats:italic> = 22, mixed methods <jats:italic>n<\/jats:italic> = 3) were identified and fulfilled acceptable research assessment criteria. The following 5 themes arose from the synthesis of qualitative studies: (1) experience of the request prior to administration; (2) the doctor\u2019s role and agency in the death of a patient; (3) moral distress post-administration; (4) workload and burnout; and (5) professional guidance and support. Both quantitative and qualitative studies showed a significant proportion of clinicians (45.8\u201380%) have been adversely affected by their involvement in E\/PAS, with only a minority of those reporting adverse impacts seeking support.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S1478951525000240_sec5e\">\n\t    <jats:title>Significance of results<\/jats:title>\n\t    <jats:p>Participation in E\/PAS can reward some and cause moral distress in others. For many clinicians, this can include significant adverse personal and professional consequences, thereby impacting the medical profession as a whole.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/s1478951525000240","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T06:39:22Z","timestamp":1748932762000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":5,"title":["Narrative review of the impact on physicians of administering euthanasia or physician-assisted suicide and its association with moral distress"],"prefix":"10.1017","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5164-9510","authenticated-orcid":false,"given":"Priyanka","family":"Pinto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald Blaise","family":"Fogarty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kissane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"S1478951525000240_ref45","first-page":"754","article-title":"Reasons for wanting assisted suicide\u2014a retrospective evaluation of telephone inquiries","volume":"120","author":"Batzler","year":"2023","journal-title":"Deutsches \u00c4rzteblatt International"},{"key":"S1478951525000240_ref21","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951519000518"},{"key":"S1478951525000240_ref35","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2020.12.019"},{"key":"S1478951525000240_ref38","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-022-00834-4"},{"key":"S1478951525000240_ref13","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2018-105120"},{"key":"S1478951525000240_ref2","doi-asserted-by":"publisher","DOI":"10.5694\/mja17.00891"},{"key":"S1478951525000240_ref36","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmx041"},{"key":"S1478951525000240_ref37","doi-asserted-by":"publisher","DOI":"10.3399\/BJGPO.2022.0015"},{"key":"S1478951525000240_ref26","doi-asserted-by":"publisher","DOI":"10.1177\/0269216320968517"},{"key":"S1478951525000240_ref34","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2016-103405"},{"key":"S1478951525000240_ref33","doi-asserted-by":"publisher","DOI":"10.1006\/ceps.1996.0004"},{"key":"S1478951525000240_ref4","first-page":"1650","article-title":"The social impact of physician-assisted death legalisation","volume":"149","author":"Bellolio","year":"2021","journal-title":"Revista M\u00e9dica de Chile"},{"key":"S1478951525000240_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.npls.2016.01.001"},{"key":"S1478951525000240_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2018.05.006"},{"key":"S1478951525000240_ref44","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2021.114568"},{"key":"S1478951525000240_ref27","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2020-107125"},{"key":"S1478951525000240_ref42","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2009.07.003"},{"key":"S1478951525000240_ref6","doi-asserted-by":"publisher","DOI":"10.1177\/2050312120913452"},{"key":"S1478951525000240_ref41","first-page":"1","article-title":"Attitudes toward and experiences with assisted-death services and psychological implications for health practitioners: a narrative systematic review","author":"Wibisono","year":"2022","journal-title":"Journal of Death and Dying"},{"key":"S1478951525000240_ref11","doi-asserted-by":"publisher","DOI":"10.1177\/0969733020966776"},{"key":"S1478951525000240_ref47","doi-asserted-by":"publisher","DOI":"10.46747\/cfp.6912853"},{"key":"S1478951525000240_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2022.154136"},{"key":"S1478951525000240_ref23","doi-asserted-by":"publisher","DOI":"10.1177\/082585971403000402"},{"key":"S1478951525000240_ref43","doi-asserted-by":"publisher","DOI":"10.46747\/cfp.6805e161"},{"key":"S1478951525000240_ref9","volume":"10","author":"Breitbart","year":"2012","journal-title":"Palliative and Supportive Care"},{"key":"S1478951525000240_ref16","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-019-1067-8"},{"key":"S1478951525000240_ref31","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2020-002192"},{"key":"S1478951525000240_ref25","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-053880"},{"key":"S1478951525000240_ref15","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.8499"},{"key":"S1478951525000240_ref30","article-title":"Breaching the stalemate on assisted dying: it\u2019s time to move beyond a medicalized approach","volume":"382","author":"Preston","year":"2023","journal-title":"BMJ"},{"key":"S1478951525000240_ref12","volume-title":"Critical Appraisal Skills Programme. 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Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e115"}}