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Countertransference and ethics: A perspective on clinical dilemmas in end-of-life decisions

Published online by Cambridge University Press:  01 December 2003

BRIAN J. KELLY ,
FRANCIS T. VARGHESE  and
DAN PELUSI
BRIAN J. KELLY
Affiliation:
School of Medical Practice and Population Health, Faculty of Health, University of Newcastle, Orange, Australia
FRANCIS T. VARGHESE
Affiliation:
University of Queensland, Department of Psychiatry, Princess Alexandra Hospital, Brisbane, Australia
DAN PELUSI
Affiliation:
University of Queensland, Department of Psychiatry, Princess Alexandra Hospital, Brisbane, Australia
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Abstract

Ethical dilemmas in end-of-life care, such as the request for assisted suicide, must be understood in the context of the relationship that exists between patients and the clinicians treating them. This context includes the way health professionals respond to the tasks in caring for a dying patient. This article reviews the literature exploring the factors the influence clinical decision making at the end of life. The interplay of ethics, countertransference and transference are explained in detail.

Keywords

CountertransferenceEthicsEnd-of-life caregivingPhysician-assisted suicide
Type
Research Article
Information
Palliative & Supportive Care , Volume 1 , Issue 4 , December 2003 , pp. 367 - 375
Copyright
© 2003 Cambridge University Press

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References

REFERENCES

Back, A.L., Starks, H., Hsu, & C., et al. (2002). Clinician–patient interactions about requests for physician-assisted suicide. Archives of Internal Medicine, 162, 1257–1265.Google Scholar
Bascom, P.B. & Tolle, S.W. (2002). Responding to requests for physician-assisted suicide. Journal of the American Medical Association, 288, 91–98.Google Scholar
Battin, M. (1998). Physician-assisted suicide: Safe, legal, rare? In Physician-Assisted Suicide: Expanding the Debate, Battin, M.P., Rhodes, R. & Silvers, A. (eds.), pp. 63–72. New York: Routledge.
Breitbart, W., Rosenfeld, B., Pessin, & H., et al. (2000). Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. Journal of the American Medical Association, 284, 2907–2911.Google Scholar
Burleigh, M. (1994). Death and Deliverance: “Euthanasia” in Germany c1900–1944. Cambridge: Cambridge University Press.
Chochinov, H.M. (2002). Dignity-conserving care—A new model for palliative care. Journal of the American Medical Association, 287, 2253–2260.Google Scholar
Chochinov, H.M., Wilson, K.G., Enns, & M., et al. (1998). Depression, hopelessness, and suicidal ideation in the terminally ill. Psychosomatics, 19, 366–370.Google Scholar
Cohen, L.M., Steinberg, M.D., Hails, & K.C., et al. (2000). Psychiatric evaluation of death-hastening requests. Psychosomatics, 41, 195–203.Google Scholar
Emanuel, E.J., Fairclough, D., Clarridge, & B.C., et al. (2000). Attitudes and practices of U.S. oncologists regarding euthanasia and physician-assisted suicide. Annals of Internal Medicine, 133, 527–532.Google Scholar
Emanuel, L.L. (1998). Facing requests for physician-assisted suicide. Journal of the American Medical Association, 280, 643–645.Google Scholar
Foley, K. & Hendin, H. (2002). The Oregon experiment. In The Case Against Assisted Suicide: For the Right to End of Life Care, Foley, K. & Hendin, H. (eds.), pp. 144–174. Baltimore: Johns Hopkins University Press.
Gabbard, G.O. (1995). Countertransference: The emerging common ground. International Journal of Psycho-Analysis, 76, 475–485.Google Scholar
Gabbard, G.O. (1985). The role of compulsiveness in the normal physician. Journal of the American Medical Association, 254, 2926–2929.Google Scholar
Ganzini, L., Nelson, H.D., Lee, & M.A., et al. (2001). Oregon physicians' attitudes about and experiences with end-of-life care since passage of the Oregon Death with Dignity Act. Journal of the American Medical Association, 285, 2363–2369.Google Scholar
Ganzini, L., Volicer, L., Nelson, & W., et al. (2003). Pitfalls in assessment of decision-making capacity. Psychosomatics, 44, 237–243.Google Scholar
Ganzini, L., Johnston, W.S., McFarland, & B.H., et al. (1998). Attitudes of patients with amyotrophic lateral sclerosis and their caregivers toward assisted suicide. New England Journal of Medicine, 339, 967–973.Google Scholar
Glick, S.M. (1997). Unlimited human autonomy—A cultural bias? New England Journal of Medicine, 336, 954–957.Google Scholar
Goldberg, P.E. (2000). The physician–patient relationship. Archives of Family Medicine, 9, 1164–1168.Google Scholar
Gutheil, T.G. & Gabbard, G.O. (1993). The concept of boundaries in clinical practice: Theoretical and risk management dimensions. American Journal of Psychiatry, 150, 188–196.Google Scholar
Gutheil, T.G. & Simon, R. (2002). Non-sexual boundary crossings and boundary violations: The ethical dimension. Psychiatric Clinics of North America, 25, 585–592.Google Scholar
Haghbin, Z., Streltzer, J., & Danko, G.P. (1998). Assisted suicide and AIDS patients. A survey of physicians' attitudes. Psychosomatics, 39, 18–23.Google Scholar
Hamilton, N.G., Edwards, P.J., Boehnlein, & J.K., et al. (1998). The doctor–patient relationship and assisted suicide: A contribution from dynamic psychiatry. American Journal of Forensic Psychiatry, 19, 59–75.Google Scholar
Hendin, H. (1994). Seduced by death: Doctors, patients, and the Dutch cure. Issues in Law & Medicine, 10, 123–168.Google Scholar
Hendin, H. (1998). Seduced by Death. New York: WW Norton and Co.
Horton, R. (2001). Euthanasia and assisted suicide: What does the Dutch vote mean? Lancet, 357, 1222.Google Scholar
Kelly, B., Burnett, P., Badger, & S., et al. (2003a). Doctors and their patients: A context for understanding the wish to hasten death. Psycho-Oncology, 112, 375–384.Google Scholar
Kelly, B., Burnett, P., Pelusi, & D., et al. (2003b). Factors associated with the wish to hasten death: A study of patients with terminal illness. Psychological Medicine, 33, 75–81.Google Scholar
Kissane, D.W. (2001). Demoralization—Its impact on informed consent and medical care. Medical Journal of Australia, 175, 537–539.Google Scholar
Kissane, D.W. (2002). Deadly days in Darwin. In The Case Against Assisted Suicide: For the Right to End of Life Care, Foley, K. & Hendin, H. (eds.), pp. 192–212. Baltimore: Johns Hopkins University Press.
Lamont, E.B. & Christakis, N.A. (2003). Complexities in prognostication in advanced cancer. Journal of the American Medical Association, 290, 98–104.Google Scholar
Lederberg, M.S. (1997). Making a situational diagnosis. Psychiatrists at the interface of psychiatry and ethics in the consultation-liaison setting. Psychosomatics, 38, 327–338.Google Scholar
Lo, B., Ruston, D., Kates, & L.W., et al. (2002). Discussing religious and spiritual issues at the end of life. Journal of the American Medical Association, 287, 749–754.Google Scholar
Lorenz, K. (2003). Moral and practical challenges of physician-assisted suicide. Journal of the American Medical Association, 289, 2282.Google Scholar
Mann, P. (1998). Meanings of death. In Physician-Assisted Suicide: Expanding the Debate, Battin, M.P., Rhodes, R. & Silvers, A. (eds.), pp. 11–27. New York: Routledge.
Marshall, A.A. & Smith, R.C. (1995). Physicians' emotional reactions to patients: Recognizing and managing countertransference. American Journal of Gastroenterology, 90, 4–8.Google Scholar
Meier, D.E., Back, A.L., & Morrison, R.S. (2001). The inner life of physicians and care of the seriously ill. Journal of the American Medical Association, 286, 3007–3014.Google Scholar
Miles, S.H. (1994). Physicians and their patient's suicides. Journal of the American Medical Association, 271, 1786–1788.Google Scholar
Muskin, P.R. (1998). The request to die: Role for a psychodynamic perspective on physician-assisted suicide. Journal of the American Medical Association, 279, 323–328.Google Scholar
National Health and Medical Research Council. (2000). Psychosocial Clinical Practice Guidelines: Information, Support and Counselling for Women with Breast Cancer. Canberra, Australia: NHMRC.
Pellegrino, E.D. (2002). Compassion is not enough. In The Case Against Assisted Suicide: For the Right to End-of-Life Care, Foley, K. & Hendin, H. (eds.), pp. 41–51. Baltimore: Johns Hopkins University Press.
Portenoy, R.K., Coyle, N., Kash, & K.M., et al. (1997). Determinants of the willingness to endorse assisted suicide. A survey of physicians, nurses, and social workers. Psychosomatics, 38, 277–287.Google Scholar
Ramirez, A.J., Graham, J., Richards, & M.A., et al. (1995). Burnout and psychiatric disorder among cancer clinicians. British Journal of Cancer, 71, 1263–1269.Google Scholar
Ryan, C.J. & Kaye, M. (1996). Euthanasia in Australia—The Northern Territory Rights of the Terminally Ill Act. New England Journal of Medicine, 334, 326–328.Google Scholar
Sandler, J., Dare, C., & Holder, A. (1992). The Patient and the Analyst: The Basis of the Psychoanalytic Process. Guilford, CT: International Universities Press.
Slevin, M.L., Stubbs, L., Plant, & H.J., et al. (1990). Attitudes to chemotherapy: Comparing views of patients with cancer with those of doctors, nurses, and general public. British Medical Journal, 300, 1458–1460.Google Scholar
Suarez-Almazor, M.E., Newman, C., & Bruera, E. (2002). Attitudes of terminally ill cancer patients about euthanasia and assisted suicide: Predominance of psychosocial determinants over symptom distress and subsequent survival. Journal of Clinical Oncology, 20, 2134–2141.Google Scholar
The SUPPORT Investigators. (1995). A controlled trial to improve care for seriously ill hospitalized patients: The study to understand prognoses and preferences for outcomes and risks of treatment (SUPPORT). Journal of the American Medical Association, 274, 1591–1598.Google Scholar
Uhlmann, R.F. & Pearlman, R.A. (1991). Perceived quality of life and preferences for life-sustaining treatments in older adults. Archives of Internal Medicine, 151, 495–497.Google Scholar
Varghese, F.T. & Kelly, B. (1999). Countertransference and assisted suicide. In Countertransference Issues in Psychiatric Treatment, Gabbard, G. (ed.), pp. 85–116. Washington, DC: American Psychiatric Press.
Wenrich, M., Curtis, J.R., Shannon, & S.E., et al. (2001). Communicating with dying patients within the spectrum of medical care from terminal diagnosis to death. Archives of Internal Medicine, 161, 868–874.Google Scholar