Since Oregon implemented its Death with Dignity Act, many additional states have followed suit demonstrating a growing understanding and acceptance of aid in dying (AID) processes. Traditionally, the patient has been the one to request and seek this option out. However, as Death with Dignity acts continue to expand, it will impact the role of physicians and bring up questions over whether physicians have the ethical obligation to facilitate a conversation about AID with patients during end of life discussions. Patients have the right to make informed decisions about their health, which implies that physicians have an obligation to discuss with and inform patients of the options that will accomplish the patients’ goals of care. We will argue that physicians have an ethical obligation to inform certain patients about AID (in qualifying states) during end of life care discussions. We will also address what this obligation encompasses and explore guidelines of when and how these conversations should occur and proceed. Earlier guidelines, presented by various palliative care and ethics experts, for proceeding with such conversations have mostly agreed that the discussion of hospice and end of life care with patients should be initiated early and that the individual goals of a patient during the remaining duration of life should be thoroughly examined before discussion of appropriate options. In discussing AID, physicians should never recommend but inform patients about the basics so that they can make an informed decision. If patients express further interest in AID, the physician should open up the dialogue to address the reasoning behind this decision versus other possible treatments to ensure that patients clearly comprehend the process and implications of their decision. Ultimately, any end of life choice should be made by patients with the full capacity to express what they envision for the remaining duration of life and to comprehend the advantages and disadvantages of all the possible options.

中文翻译：

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医生与患者的临终讨论：是否有讨论死亡援助的道德义务？

自从俄勒冈州实施《有尊严的死亡法案》以来，许多其他州也纷纷效仿，这表明人们对临终救助 (AID) 流程的理解和接受度不断提高。传统上，患者一直是请求和寻求这种选择的人。然而，随着“有尊严的死亡”行为的不断扩大，它将影响医生的角色，并引发关于医生是否有道德义务在临终讨论期间促进与患者就 AID 进行对话的问题。患者有权就他们的健康做出明智的决定，这意味着医生有义务与患者讨论并告知患者可以实现患者护理目标的选择。我们将争辩说，医生有道德义务在临终关怀讨论期间向某些患者告知 AID（在合格的州）。我们还将讨论这项义务所包含的内容，并探索有关何时以及如何进行和进行这些对话的指导方针。由各种姑息治疗和伦理专家提出的用于进行此类对话的早期指南大多同意应尽早开始与患者讨论临终关怀和临终关怀，并且患者在剩余生命期间的个人目标在讨论适当的选择之前，应该彻底检查。在讨论 AID 时，医生不应该推荐而是告知患者基本知识，以便他们做出明智的决定。如果患者对 AID 表现出进一步的兴趣，医生应展开对话以解决该决定与其他可能治疗方法背后的原因，以确保患者清楚地理解其决定的过程和影响。归根结底，任何临终选择都应该由患者充分表达他们对剩余生命的设想并理解所有可能选择的优缺点来做出。