{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:28:09Z","timestamp":1753892889709,"version":"3.41.2"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Intro<\/jats:title><jats:p>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\u2019 opinions and reasoning when confronted with requests for AD or requests to enable AD in Switzerland.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>12 semi-structured interviews with physicians from different specialties (oncology, neurology, palliative care, psychiatry, general practice, internal medicine) were conducted, transcribed, and analyzed using thematic analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Participants were concerned with the underlying reasons for patients pursuing AD, hoping to address them. Interestingly, although many of the participants expressed skepticism towards AD and its legalization in Sweden, they still supported writing a medical certificate enabling AD in Switzerland.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1580657","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T05:47:54Z","timestamp":1750225674000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Views and experiences on writing certificates for assisted dying: interviews with Swedish physicians"],"prefix":"10.3389","volume":"16","author":[{"given":"Filip","family":"Jonsson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manne","family":"Sj\u00f6strand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrik","family":"Kihlbom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"key":"B1","unstructured":"Als- Sjuke Per Avslutade Sitt Liv \u2013 Med Hj\u00e4lp Av L\u00e4kare: Dagens Nyheter\n          \n          \n            \n              Orrenius\n              N\n            \n            \n              Hansen\n              P\n            \n          \n          \n          2020"},{"key":"B2","unstructured":"Staffan Bergstr\u00f6m Blir Av Med Legitimation Efter Att Ha Hj\u00e4lpt Man D\u00f6: Dagens Nyheter\n          \n          \n            \n              Wasell\n              C\n            \n          \n          \n          2022"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1177\/0141076818803452","article-title":"Euthanasia and assisted dying: what is the current position and what are the key arguments informing the debate","volume":"111","author":"Fontalis","year":"2018","journal-title":"J R Soc Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.21037\/apm-20-637","article-title":"Assisted dying around the world: A status quaestionis","volume":"10","author":"Mroz","year":"2021","journal-title":"Ann Palliative Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1016\/j.jpainsymman.2017.07.024","article-title":"Health care professionals\u2019 Attitudes about physician-assisted death: an analysis of their justifications and the roles of terminology and patient competency","volume":"54","author":"Braverman","year":"2017","journal-title":"J Pain symp Manage"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-021-00652-0","article-title":"Trends in Swedish physicians\u2019 Attitudes towards physician-assisted suicide: A cross-sectional study","volume":"22","author":"Lynoe","year":"2021","journal-title":"BMC Med ethics"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemep.2022.100839","article-title":"Does experience affect physicians\u2019 Attitude towards assisted suicide? A snapshot of Swedish doctors\u2019 Opinions","volume":"24","author":"Sandvik","year":"2022","journal-title":"Ethics Med Public Health"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1177\/1403494808090163","article-title":"Physician-assisted suicide: A survey of attitudes among Swedish physicians","volume":"36","author":"Lindblad","year":"2008","journal-title":"Scand J Public Health"},{"key":"B9","first-page":"20044","article-title":"Intyg f\u00f6r assisterat d\u00f6ende I schweiz v\u00e4cker sv\u00e5ra fr\u00e5gor","volume":"117","author":"Juth","year":"2020","journal-title":"L\u00e4kartidningen"},{"volume-title":"H\u00e4lso-Och Sjukv\u00e5rdslag","year":"2017","key":"B10"},{"volume-title":"Patients\u00e4kerhetslag","year":"2010","key":"B11"},{"volume-title":"L\u00e4karf\u00f6rbundets Etiska Regler","year":"2017","key":"B12"},{"volume-title":"To die with dignity. Info Brochure","year":"2019","key":"B13"},{"volume-title":"Swiss Law & Requirements","year":"","key":"B14"},{"volume-title":"Information Brochure","year":"","key":"B15"},{"volume-title":"Socialstyrelsens F\u00f6reskrifter Och Allm\u00e4nna R\u00e5d Om Att Utf\u00e4rda Intyg I H\u00e4lso- Och Sjukv\u00e5rden","year":"2018","key":"B16"},{"key":"B17","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1001\/jama.2016.8499","article-title":"Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe","volume":"316","author":"Emanuel","year":"2016","journal-title":"Jama-Journal Am Med Assoc"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2014-102091","article-title":"Suicide tourism: A pilot study on the Swiss phenomenon","volume":"41","author":"Gauthier","year":"2015","journal-title":"J Med ethics"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444","article-title":"Sample size in qualitative interview studies: guided by information power","volume":"26","author":"Malterud","year":"2016","journal-title":"Qual Health Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"B21","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-69909-7_3470-2","volume-title":"Thematic analysis : a practical guide","author":"Braun","year":"2022"},{"key":"B22","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1002\/nur.20362","article-title":"What\u2019s in a name? Qualitative description revisited","volume":"33","author":"Sandelowski","year":"2010","journal-title":"Res Nurs Health"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2016.0422","article-title":"Existential suffering part 1: definition and diagnosis 319","volume":"20","author":"Grech","year":"2017","journal-title":"J palliative Med"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016659","article-title":"Understanding patients\u2019 Experiences of the wish to hasten death: an updated and expanded systematic review and meta-ethnography","volume":"7","author":"Rodr\u00edguez-Prat","year":"2017","journal-title":"BMJ Open"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0284698","article-title":"Existential suffering as a motive for assisted suicide: difficulties, acceptability, management and roles from the perspectives of Swiss professionals","volume":"18","author":"Gaignard","year":"2023","journal-title":"PloS One"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1080\/07481187.2024.2404936","article-title":"Rational suicide? Interviews with Swedish psychiatrists","author":"Karlsson","year":"2024","journal-title":"Death Stud"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s11019-016-9744-z","article-title":"We need to talk!\u201d Barriers to GPs\u2019 communication about the option of physician-assisted suicide and their ethical implications: results from a qualitative study","volume":"20","author":"Otte","year":"2017","journal-title":"Med Health care phil"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2021.114568","article-title":"Medical practitioners\u2019 Views and experiences of being involved in assisted dying in Victoria, Australia: A qualitative interview study among participating doctors","volume":"292","author":"Sellars","year":"2022","journal-title":"Soc Sci Med"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.4414\/smw.2015.14142","article-title":"Swiss physicians\u2019 attitudes to assisted suicide: A qualitative and quantitative empirical study","volume":"145","author":"Brauer","year":"2015","journal-title":"Swiss Med week"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-019-1067-8","article-title":"Physicians\u2019 experiences with euthanasia: a cross-sectional survey amongst a random sample of Dutch physicians to explore their concerns, feelings and pressure","volume":"20","author":"Evenblij","year":"2019","journal-title":"BMC Family Pract"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2014.04.016","article-title":"Complexities in euthanasia or physician-assisted suicide as perceived by Dutch physicians and patients\u2019 relatives","volume":"48","author":"Snijdewind","year":"2014","journal-title":"J Pain symp manage"},{"volume-title":"Cancerfondsrapporten 2024 Palliativ v\u00e5rd - mer \u00e4n v\u00e5rd i livets slutskede","year":"2024","key":"B32"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1580657\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T05:47:57Z","timestamp":1750225677000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1580657\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,18]]},"references-count":32,"alternative-id":["10.3389\/fpsyt.2025.1580657"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2025.1580657","relation":{},"ISSN":["1664-0640"],"issn-type":[{"type":"electronic","value":"1664-0640"}],"subject":[],"published":{"date-parts":[[2025,6,18]]},"article-number":"1580657"}}