S= AMERICAN PsyCHOLOGICAL ASSOCIATION Resolution on Assisted Dying and Justification Resolution on Assisted Dying done oy APA Covel ot Represnttves in Agu 207 SvBpeses etn Irate wh str ‘Whereas the issue of assisted dying is complex, involving areas of ethics, religion, medicine, psychology, sociology, economics, the law, pubic policy, and tne elds, and ‘Whereas in the United States there is significant socal sratifcaton related to diversity, le. age, culture, csebilty status, ethnic, gender identity, geographic locaton, heath status, immigration status, martal status, racefethricty, religion, sex, sexual otlentallon, socioeconomic status, and veteran status (Caneti, 20M; Payne, 2016; Sue, 2001): and ‘Whereas these diferences in our society are associated with an equally diverse range of views regarding assisted dying (Crawley, 2006; Gallup, 2016; Pew Research Center, 2013; and ‘Whereas in the United States decisions about assisted dying are made Inthe context of social devaluation of marginalized ‘9r0ups (e.g, Lund, Nador, Winer, & Seader, 2016 and serious social inequites in access to resources such as basic medical cate; and ‘Whereas autonomy is en important guiding principle in the law and in psychological and mecical aspects of decision-making, but in and of sel is sufficient to capture the ful ange of complex medical, fami, social, rence, psychologic, cutural, spirtual(Chochinov, 2002; Steck, Eager, Maessen, Reisch, & Zwahlen, 2013), and legal issues ( Washington etal. v Glucksberg etal, 1997) involved in the pracice of assisted dying: anc ‘Whereas public suppor for assisted dying ranges from 47-69%, but this support is weakest among groups who express concems about being pressufed to de {Le older adults, people witn disables, people with less education, women, and racial and ethnic minors) (Gallup, 206; National Council on Dsabilty, 1987; Pew Research Center, 2016}; ard ‘Whereas reasonable, well-informed people starting om diferent postions about costs ar gains associated with assistes ying disagree about te potential afects of legalizing the practice, and ‘Whereas people with diferent velues and proves can reach diferent conclusions about the advisability of assisted dying; ane ‘Whereas some evidence suggests that there are fuctuetlons n the wilt lve (Chachinoy, Tataryn, Clinch, & Dudgeon, 1998; Fried etal, 2006; Kissane, 2004) and in wishes regarding ife- sustaining treatments (Emanuel, Farclough, & Emanuel, 2000} and ‘Whereas pain, demoralization, and clinical depression are fequerily unrecogrized and under treated, which can lead to suffering that may resut in requests for assisted dying { Berghmans & Lossignol, 20'2; Ganzi, Goy, & Dobsche, 2008; kissane, 2004; Kissane, 20'2; Quill & Cassel, 2003}; and ‘Whereas evidence suggests that some people rescind thet requests for assisted dying wen they receive palaive anc comprehensive care (Chochinov, 2002; De Lima et al, 2017; Ganzini et al, 2000} and ‘Whereas psychological familial, social, and Snancial factors seem to be more important than physical factors in requests for assisted dying Emanuel, Orwutenka-Philpsen, Unwin, & Cohen , 2016; Olaham, Debscha, Goy, & Ganzin, 20" Ohnsorge Gudat,& Rehmann-Sutter, 2014; Smith, Harvath, Goy, & Ganzin, 2015) and ‘Whereas limited empirical data exst to determine the effects af assisted dying on surwvors and on society (Cooke et al, 1998; Emanuel, Fairclough, & Emanuel, 2000; Ganzin, Goy, Dobsch,& Prigerson, 2009; Sware, et al, 2003}; and ‘Whereas the empirical catabese, legal developments, and policy discourse related to assisted dying are evolving rapidly Thetetore, be it resolved that the American Psychological Association take a positon thet neither endorses nor opposes assisted dying at hs time, However,{Gven that psychologists have many areas of competence, incluaing assessment, Intervention, teaching, consultation, research, and advocacy sks that could potentially eriighten tne discourse about assisted oying, palatve anc enc-of fe ‘neatment, and suppor for people with serious advanced ilress and their care panners; and Given tat psychologists could be instrumental n helping health care providers to understand and cope wih the concerns ‘and needs of poopie with sertous advanced liness and thelr cae partners; ane {Given that psychologists may receive requests to be involved inthe education of various groups regarding assisted dying; and Given that assisted dying is legal in muttiple states anc the Distret of Columb, and psychological or psychiatric assessment and consultation s required under certain cumstances; and Gen tat practicing psychologists may be part of interprofessional pallaive care and hospice teams including ones exploring requests for assistec dying: Letitbe further resolved that the American Psychological Association will assist in preparing the profession to address the issue of assisted dying by taking the folowing actions: Acvocate for quality pallative ans ene of life care for all inalauals; and Encourage and promote the development of research on assisted dying: and Monitor legal policy, ans research develooments that may requie or encourege psychologists to Involve themselves I assisieg dying cases ane Promote policies that reduce suffering that could lead to requests for assisted dying: and Promote psychologists involvement in research on ethical dilemmas faces by clinicians and researchers dealing with Issues related to assisted dying; and Promote psychologists’ participation in nterprofessional teams and ethles committees involved wlth reviewing end-oite requests; and Encourage psychologists to obtain raining in ethics e.g, medical ethics, professional codes of conduct in the context of versity, as applied to palaive and end-of-ife decsions and care; and Encourage psychologists to inform themselves about criminal and ol laws that have bearing on assisted dying in the states in which they practice; and Encourage psychologists to recognize the powerful influence they may have with individuals who are considering assisted eying. and Encourage psychologists to identify factors leading to assisted dying requests (neluding ciical depression, cemoralzation, levels of pain and sutfering, adequacy of comfort care, and ather internal and external variables) anc to fully explore temative approaches (including hespicelpalialive care, refusal or discontinuation of life-sustaining measures, and other lend.otiife options such as voluntary stepping eating and drinking) for clients considering assisted oying, and Encourage psychologists to be aware oftheir own views about assisted dying, Including recogrizing possible biases about uality of ife and entilement to resources based on age, culture, dsabilty stalus, ethnicity, gender identity, geographic location, health status. immigration status, marta status, racefethnicy, religion, sex, sexual rientalion, socioeconomic status, and veteran status ofthe individual requesting assisted dying ; and Encourage psychologists to be especialy sensitive to the social ane cultural biases which may result in some groups anc individuals being perceived by others, andor being encouraged to perceive themselves, 2s more expendable anc less eserving of continued life (e.g, as above), Suggested Citation American Psychological Association, 2017, Resolution on Assisted Dying, Retrieved from: how apa.orgiabouypoleylassisted-dying-tesolution aspx References Berghmans,T. & Lossigno, D, (2012), Euthenasla: From ethical debate to clinical realy. European Respiratory Journal, 40, 1804-205, col 10:183/09031036,00038N2Canetio, S. $21). Legal physiian-assisted suicide inthe U.S. Issues, roles and implications for cnicans. In $. H. Qualls & 4 Kes Godley (Eds), End of fe core andl bereavement (pp, 263-284), New York Wiley, CChochinov, H.M, (2002) Dignty-conserving care—a new model for palliative care: Helping the patient feel valued. Journal of the American Medical Associaton, 287, 2253-2260, Chochinov, H.M, Tatarya, D. Clinch, J.J, & Duegeon, D. (1998), Wil to lve inthe terminal il. Lancet 254 , 816-819, 60\10,100%}ame.287:17.2253 Cooke, M, Goutlay, |, Collette, L, Boccellar, A, Chesney, M.A, & Folkman, 5. {1998}, formal caregivers ane the intention to hasten AIDS-related seath, archives of interna! Mecicine, 152 , 69-75, Crawley, LM. (2006) Racal, cultural, and ethnic factors influencing end-of lite care, Journal of Pliative Medicine, 8 (suppl. $58-569, doil01089/jpm 2005.85.58 De Lima, L,, Woodruff, R, Pettus, K, Downing, J, Butrago, R, Munyoro, E, Venkateswaran, C, Bhatnagar, S, & Radoruch, L (2017, international association for hospice and palliative care position statement: euthanasia ard physican-assisted suicide, Journal of Patiztve Medicine, 20 , 14. dot 101088/jpm.2016.0290, Emanuel, € J, Faitciough, DL & Emanuel L200}, Attitudes and desires related to euthanasia and physician assisted suicide among terminally il paients and their caregivers. Journal ofthe American Medical Association, 24 , 19, 2460-2468. €0110.100jama.284.19.2460 Emer, J, Onwuteaka Philpsen, B.D, Unwin, J. W, & Cohen, J (2016) Attitudes ang practices of euthanasia and physiian-assisted suicide in the Unite states, Canada, and Europe. Joural of tne American Medical Association, 316 (), 79 90. coi10:100¥jeme.2016.8498 Fried, TR, Byers, AL. Gallo, W. T, Van Ness, PH, Towe, V.R, OLeary, J R, & Dubin, A, (2006), Prospective study of health status preferences and changes in preferences aver tme in eléer adults, Archives of internal Medicine , 16 (8. 280- £895, 60: 10100t/archinte.166.8.290 Gallup, 2016), Eutnanasia Stil Acceptable to a Solid Majority in US. Retrieved from tp sew gatlup.com/pollI83082/euthanasie-acceptable-solid-ajoriy aspx nto:iuw galup.compol93082ieutharasia ecceptabiesolnajuty 9503) Ganzini |, Nelson, H., Schmia, T. A. Kraemer, 0, F, Deloti, M.A, & Lee, M.A, (2000), Physicians’ experiences with te (regen Death witn Dignity Act New England Journal of Medicine, 242, 987-563. dol 10.1056/NEJM200002243420808 Garin, |, Goy, E.R, & Dobscha, 5. K, (2008), Prevalence of cepression and anxiety inpatients requesting physicia ying: cross sectional survey. British Medical Journal, 377, a1682, cok 10.1136/om 1682 aid in Garin, Goy, E.R, Dodscha, §.K, & Prigerson, H, (2008), Mental neaktn outcomes of family members of Oregonians who request prysician ai in dying, Journal of Pain and Symptom Management, 38 (6), 807-215. dot 10,10160jpainsymman.2008.04.026 kissane,D. W, 2004}, The contribution of demoralzation to end oflfe cecision making. Hastings Center Report, 34 (4, 231 0 10 2307/3528690 kissane,D. W, (2012), The reef of exstental sufering, Archives of internal Medicine, 172 19), 15011505. dot 10 1004archinternmed 2012 3633, Lund, E.M. Nadorf, M.R, Winer, ES, & Seader, K. (2016s suicide an opton?: The impact of disabilty on suicide acceptability inthe context of cepression, suicidalty, and demographic factos, Journal of Afective Disorders, 189, 25:35. do 10 1016i)jad-2075.08.028 National Council on Disabil. (1997). Assisted Suicide: A Disabilty Perspective Postion Paper. Retrieved from hip sew nce gov/publications/1997/03241997 ftw ned gowpubietionsTS87/03241857) COhnsorge, K, Gudat, H, & Rehmanr-Sutter,C, (2014), What a wish to dle can mean: reasons, meanings and functions of wishes to die, reported trom 30 qualitative case studies of terminaly il cancer patients in palaive care, BMC Palative Care, 1,38, dot 10.N860472.684x13.38 Oldham RL, Dobscha SK, Goy ER, Ganzin. 2011, Atachment styles of Oregonians who request physicianassisted death Patiotive Support Care, 9 (2), 123-8. dot 10 017/S1478851510000860.Payne, R. (2016). Racialy associated disparities in hospice and palliauve care access: Acknowledging the facts while Adgressing the opportunties to improve, Journal of Paltative Medicine, 19 2}, do 10.108SIjpm 2015 0475, Pew Research Center (201), Views on enc-ot-ife medical teetments. Retfeved from hitxllpewoorum.erg/2013/21Miens om end of fe-medcaltreaimentstntpfpewforum orgiZ0T3I2Wvews-on-ene-o-ifemedicalsrestments) Pew Research Center (2018). Calfomia legalzes assisted suicide amis growing suppor for such laws, Retneved from hose pewresearch orgifacttank/70T5//05/califomie-legalizes asslsted-sulcide-amid-growing-suppor-for suchas! {tout pewresearch orgiact ark/20‘S0/05alforislegalzes assisted sucde- amie growing support or such is} Gull, TE. & Cassel, C.K. (2003, Professional organizations’ postion statements on physiclan-assisted suicide: A case for neutalty. Annats of Internal Medicine, 38, 208-21. dok 10,7326/0003-4819-138-3-200302040-00013 ‘Smith, K A, Harvath, TA, Goy, E.R, & Ganain L. (2015), Precietors of pursult of physicianassisted death, Journal of Pain and Symptom Monage, 49 (3), 585-61, do 10.1016/}jpainsymman 20%4.06.010 Stock, N, Eager, M, Maessen, M, Rolsch, T, & Zwahien, M. (2013). Euthanasia and assisted sulcide In solected European countries and US states: systematic Inerature review, Medical Core, 51, 938-944, doi 10 097/MLR 02013e3182801427 ‘ue, D.W. (2001) Multdimenstonel facets of cutural competence. The Counseling Psychologist 29 (6, 790-821 {01 10.177/0071000001296002 ‘Swale, N. 8, van der Lee, ML, van der Bom, J.G, van den Bout J, & Heintz, P.M (2003). Effects of euthaniasia on the bereaved family and frends: A cross sectional study. British Medical Journal, 327 (7408), 189. col: 10-136/bm327.7408.189 Washington etal. v, Glucksberg etal, 6211S. 702 (1997. Justification Resolution on Assisted Dying Purpose and Rationale for Resolution and Relevance to Psychology Assisted eng scent eg in sinsttes, eter tough statute o cout ein: Oregon 1984 bat ite, Weshington (2008, belt intetve, Mortana 2008, sate Supreme Court cectson, Vent 203, egisteton, alfa {208 legsator ard Colorado (20% bala ave) The Ort of Columbia she seventh utsdtionoeuthorie the ok Because was te fst aw in place, regoris Death wih Dig Ac (OWA) has been te model for ae sates, According toe Oregon Pubic Health Owsion ‘os tenet oregon govProne Pane ResorcesEvauatonescrenDeatwinDgntyAcPegetncetasa the DOA alows Oregon residents aged i who neve been dlagrased wih a teminal nes ane gen a prognosis i months or lesto fv. oootan a prescription real meceaton om thet ohysican ana seaamite the medication. The person must be eapade" of making ens commrcang heath eave decisions, aerratves such a patae car. hespice cote. ard pain conto must be ofered arte ote sever sepa must be folowee before te prescription wl be wer oe of wich s tht ether te resrbing or consutng phyelcln“beleves re patents judgments mpated by a pay or psyenological disorder, the pallet mus be refered fr 8 pychologica examination” The ODA species hat “ending Gre’ ie accordance wih ine ln does ol const suede and speecly probs euthents, where ys citer person dey acminstrs ¢ mediation een another fe see hipspube neath oregon gol ovcePartreResourcesolstonescarcyDeab win gntyAcdDocumersequrements pat (mop eave gengovPovde atneResoces/PkisorResarvDeebwtOgnyteyDecunerstecurenets >) Public suppor for @ medical assisted dying option has been stable since the 1980s (Emanuel, Onwuteake Phiipsen, Urn, & Cohen, 2016). Depending on the wording of survey questions, support ranges from 47.69%, but this support is weakest among lower social and economic status groups who, having experienced barriers in access ta care and other resources, have concerns about being pressured to dle (e,, women, racial anc ethnic minorties, people wih dsabilties, and people with less eucation, | { Canetto, 201; Emanuel, Orwauteaka-Phlpsen, Urwin, & Cohen, 2016; Gallup, 2016; Nrappil, 2016 National Council on Disabilty, 987; Pew Research Cente, 2013) Individuals with serious advances llness often express a wish to cle, andlor desire to recewve assistance in dying, regardless oft legally. This tection o suffering inthe context ofa ife-treatering conciton, from which the Individual can see no. alternative other than to accelerate death, may be expressed spontaneously or after being asked about, but is istinguishea fom acceptance of impending death or fom a wish to die naturally (Balaguer et al, 2076), terest in assisted ying may arise in response to one oF mote factors (Ohnsorge, Gude, & Rehmanr-Sutte, 2014}. including existing or anticipated physical symptoms (Ganzin, Goy & Dobscha 2009}, psychological distress (eg, depression, demoralizationhopelessness, fers} (Moter et al, 2003}, existential suffering (2.9 loss of meaning in fe} Kissane, 2012, and social or Interpersonal aspects (e.g feeling het one is a burden, need for reassurance that one is stil loved and wanted\Caneto & Hollenshead, 1999-2000; Malpas, Mitchell, & Johnson, 2012; Monforte Royo etal, 2012; Muskin, 1998 } Alternatives to assisted dying include paatve careMmospice, refusal or dscontinuation of life-sustaining treatments, voluntary cessation of eating oF drinking, ard palliative secaton, al of which require awareness of options and cecisional capacty of the indlvidual or proxy (Emanuel, von Guten, & Ferns, 1995), Pallative care can miigate many of the faciors that drwe @ patient's wish to den adtion o aggressive symptom management, and management of psychological interpersonal, and spirtual estes, palliative care includes attention to care tenor — @ fundamental stance toward patients imbued with respect and affirmation — which can profoundly shape an individual's perspective, sense of sel-o:h, feelings of being @ burden, ‘and even wilto Wve (Chachinov, 2014; Monforte Royo etal, 2012} Many heaith care professionals fee! unprepared or uncertain about how to respond to requests for assisted dying. They may be personally opposed to eri action to hasten an individual's death or they may view such requests as transient oF Unreasonable reactions that are not responsive to eatment ox do nol warrant thorough evaluation, and thus, may ciscount or ignore the statements (Hudson et al, 2006}. Heath care professionals working with individuals with advances liness need to compassionately ascertain the reasons, meanings, emotions, functions, and the context of the request for assisted dying, ‘They must explore contributing factors in the context ofthe individuals’ ives and provide a compassionate, competent, and professional response. Providers need to faciitate corversations with these incivicuals, thet heaith care providers, and their care partners (families of origin or families of choiee) regarding these wishes ane associates reasoning (rarigan, 2015, Psychologists are welkpositoned to adcress these issues, Psychologists fn health care settings serving incivicuals with acvanced liness and their care partners may id themselves ‘encountering expressions of desie for hastened death and requests for assisted dying. Psychologists have the legal ight 10 ecine to partcpate in assisted dying actives; however when It san establishes patient requrring continued care, the psychologist must meet the ethical cade of ror-abandonment and make approoriate referrals, Psychologists have theory: cctiven, evidenced-based bosies of knowledge and skils relevant to responding to these requests, adcressing the underying contributing factors, ene providing support to care partners. Nevertheless, psychologists may be In need of additonal ‘guidance and support in working wit individuals near the end-o-ife (Canela, 201; Werth, 1999) However, Because Ils the discretion ofthe physician and not a requirement ofthe law that a mental healt referral be made, ‘concerns have arisen about whether non-psychiatically rained physicians are adequately sensttve to the role of depression and other mertal heath disorders in assisted dying requests (Werth, Benjamin, & Farrerkopt, 2000). Guidelines regarding how to determine if a mental heath evaluation is necessary have been developed, but ae not Gelaled and have not been 1a3se55ed ‘or valilty (Orenticher, Pope, & Rich, 2018; Young et al, 1997 Decisions about assisted dying or about alternatives to assisted dying e.g, pallatvelhospice care; refusal, or discontinuation 0 fe-sustaning interventions) require cecisional capacity on the part of he patient Psychologists and psychiatists have an evaluate role in determining an inaividual’s capacity to end life under assisted dying legislation, should a physician suspect that @ mental health condition is Impaiting an inavicuals judgment or decisional capacty. Furthermore, whereas tests and assessments exist to evaluate decisional capacity and dlagnasable disorders, they may not be validated or reliable In their tse with individuals near the enc-oife considering assisted dying (Jul-Patterson, 206). In adtion, although psychologists have skis and knowledge in evaluating decision-making capacty, they may benef from additional training inthis area, as ‘one's own values and experiences ean affect capaciy evaluations for assisted dying (e.g, Johason, Cramer, Garant, & Nobies, 2015), Psychologists have opportunities tobe involved inthe development of publi, institutional ene organizational policies 1 raise awareness and access to mental health and pallaive care services, They can contribute to the develoament of validated, cuturaly sensttve, and informed measurement too's and tothe Imarovernent of capacty assessments for assisted dying They can develop stancards for decisional capsciy speci to requesting assisted dying (Johnson, Cramer, Conroy, & Gardener, 2014) and guidelines for referrals to a mertal heath professional, Psychologists can be instrumental in the “cevelopment, evaluation, and implementation of interventions for modifiable conditions that tigger the desie for assisted ‘eying, such as cepressian, ears of burdening care partners, enc poor communication among care partners ot with care providers. They can be a Useful adaton to Interprotessional teams responding o requests from patients for assisted dying, by helping these teams understand the factors behind the patents request and ay assisting n supportive conversations with the patient anc their care partners, Importance to Psychology and Society as a Whole Questions about assisted dying ate of erica importance because they highlight now our society chooses to care for individuals atthe culmination of te fe, when they may be most vulnerable and most ia need of support. Individuals whe3k for assistance in contaling the circumstances of ther death express a cesice fr autonomy, sef-suclency, and empathy { Ganaini, Goy, & Dabscha, 2008; Morforte-Roy, Vilavicenclo-Chavez, Tomas-Sabado, Mahtan-Chugani, & Beleguer, 2012}, In essence, they ask to have some degree of corral so that thelr dying can proceed in away that Is consistent with their preferences and values. Psychologists play an importantrole In assuring that an individuals preferences are recognizes by care partes and heath cate providers, Psychologists will encounter indivgvals who are contemplating asssted death and must be pregaredtto provide support and intervention to those inclvicuals orto their care partners. Moreover, as a discaline, psychology hes ‘much expertise to share. Our research and scholarship on interpersonal retationships, decision-making, emotions, anc communication to name a few areas, can Inform practice and policy. In sum, psychologists have an important ole to play 2s both producers and consumers of knowledge In this area (Kes-Godley, King, & Gull, 2014) Representative Scientific and Empirical Findings Related to the Resolution The quality and amount of existing -esearch on enc-otife decision-making is limited, Therefore, there are multiple ‘opportunities for extending psychological knowledge about enc-otife and about decsions that may alfect the timing of ceath. The proposed resolution serves asa clarion cal for asychological research in this area Data are available on individuals requesting medical assistance with dying and using that assistance where it's legal, nd generally nave been interpreted as indicating no widespread abuse ofthe practice (e.g, Coombs Lee, 20; Emanuel Onersteaka, Phillpsen, Unwin, & Cohen, 206; Gopal, 2015}, though others challenge this conclusion (Callahan, 2008; Hendin & Foley, 2008), Based on deta rom Oregon and Washington state, the typiea person whe chooses death with assistance under a state law isa well-educated parson aged 60-85 years ola whois lng with cancer and is enrolled in hospice or palliative care (Blenke, LeBlanc, Herhsman, Elis, & Meyskers, 2077, However, acrass countries, there is wide variation in the extent of ths practice and the specifc characteristics of those who died wth medical assistance. For instance, in Europe, assisted dying is legal for inchviéuals with nonterrinal physical or psychological reasons ene to minors (Steck, Egger, Maessen, Reisch, & Zwahlen, 2013, and In the Netherlands, a higher proportion of women than men with psyehiatle lsorcers have recelves euthanasia or assisted dying Kim, De Viles,& Poteet, 2016} To date there is no empirical evidence to suggest that vulnerable individuals have been receiving euthanasia or physician: assisted dying at rates higher than the general population (Emanuel etal, 2016), However ina leer tothe ecttor of JAMA in response to the ace by Emanuel and colleagues, Stevens and Toffler (2016) query how abuses oF the rate at which they occurred can be determined, Ifthe prescribing physician was rarely present when the drugs were taker, & 2011 review found inadequate reporting safeguards for euthanasia and assisted dying nationally and internationally, such that abuses or imisuses were nether reported nor appropriately adcressed (Perea, 20", Reasons most commonly glen far requesting assisted dying are related to desire for contol and autonomy (Emanuel eal, 2016; Steck, Egger, Maessen, Re'sch, & Zwanien, 2013; Gamondl, Pott, & Payne, 2013), Requests for assisted dying also are frequently motivated by depression and inabllty to engage in enjoyable activities (Smith, Harvath, Goy, & Garvin, 2015), Terminally il patients with depressive symotoms are more Ikely to consider assisted dying (Blank, Robison, Prigerson, & Schwartz, 200%; Emarwel et al, 2000 } These findings suggest psychological evaluation is important, as demoraizaton, cyspnea (shortness of breath) and cinical depression may lead to suffering that resuits in requests for assisted dying {Chamoaere, Cohen, Robin, Baley, & Deliens, 2015; Berghmans, & Lossignol, 2012; Gamondl, Pot, & Payne, 2013; Emanuel etal, 2000; Onnsorge, Gudat, & Rehmann-Sutter, 204; OMahony etal, 2005) Limites empirical data exist to determine the effects of assisted dying on survivors (Ganzin, Goy, Dobscha, & Prigerson, 2003; Swart, van der Lee, van der Bom, van Gen bout, & Heintz, 2003}. In @ 2008 study of the mental health outcomes of amily members of Oregonians who requested physician assisted ying, investigators found that the pursult of assisted dying id not have negative effects on surviving family members and appeared to be associated with greater preparation for, and acceptance of, death (Ganzin etal, 2003), Family members of Oregonians who eeceived a lethal prescription were more liely to beleve ther laves one's cholees were honored ane less Ikely to have regrets about how thet loved one sled {Ganain\ et al, 2003}. in & cross sectional study conclucted inthe Nether, 189 bereaved familly members of cancer patients who died as a result of assisted dying reported fewer traumatic grief symptoms, less current feeling of grief, anc less posttraumatic stress than family members of patients who died of natural causes (Swate et 2, 2003}. To the best of our knowledge, there are no empirical stucies on the effect of assisted dying on societyThe extent to which the resolution is consistent with APA's core values, and the extent to which it addresses human rights, health and welfare, and ethics ‘The APA Resolution on Assisted Dying strives to be consistent with APA's core values and to address human rts, health and welfare, and ethics. Related to continual pursuit of excellence, the resolution points tothe need for psychologists to conduct research and obtain vaiing in areas inciuding but not limited to: a) ethics; b)pariipation in Interprotessional care teams c)pallatve and enct-otife care, 0} knowledge of the context of alversity ane social statficavoncelated to culture, ethnic, rece, age, csability status, economic status, ex, gender, and religous differences; e) the assessment of oa, mood, and decisional capacity; and 9 interventions to enhance meaning as well as to reduce feelings of burden and cemoralization as each of these relate tothe desite for, and decision-making regarcing, essisted death, Psychologists may play an important ole in informing and assessing effective communication in interprotessional teams. ‘The APA Resolution on Assisted Dying seeks to suppon social justice, awareness of human diversity, awareness of systemic biases and discrimination, end inclusion as related to considerations of assisted dying, Issues in this realm include but are not limted to) significant racial and ethnic cisperties in enc-otife cate (Burgio etal, 2016; Crawley, 2005; Jorinson, 2013 b) cutural dferences in distinctive belie's about death, alttudes toward heath care systems, and values about autonomy, enttlement, ang family determination (Bullock, 2011 Cav, 201) ard c) patient centered communication as it's Vtalto Lngerstanaing the healtncare goals and expectations of indiduals (Blanch Hartigan et al, 2016; Epstoln & Street, 2007), including consideration of assisted dying, ‘The Resolution further addresses social justice and inclusion by considering varying levels of health, mental health and Pallative care Iteracy within inchacuals retaining cepacty to partcioate In mecical decision-making, Shared cecsion-making facitates an indviduats desired level of autonomous contro (Chiu, Feuz, MeMahen, Miao, & Sudore, 2016; Hoffman etal 2014), and may be even more dificult to reach within the context of low healt lteracy (Muscat etal, 2015). When consicering healt Iieracy is importent to include patient empowerment, of patient aulonomy and sel-elficacy, as @ separate yel felated concept (Schule & Nakamoto, 2013. Furth, indviduals seeking assisted dying may have fuetuaung or diminished cognitwe capacity. Psychologists working with indliduals who may request assisted dying will need to uncerstand the Physical enc cognitwe changes occuring n diverse mecical populations, and seek adequate taining to evaluate delirium, epression, and decisional capacily | also is important to try to ascertain the treatment preferences of patients with iminished capeciy in order for reatment to follow thelr values (ABA & APA, 2008; Vancervoor etal, 20%) The APA Resolution on Assisted Dying strves to promate ethical action n all hat psychologists do In relavon to research, practice, and policy related to assisted dying (Bush, Allen, Heck, & Moye, 2015; Bush Alle, & Molina, 2017), Ethical considerations commonly include but are not limited to self determination, respect for inevidual autonomy, professional competence, conflicts between ethics and law, and knowiedge of human relations It's important to remember that healthcare providers bring the'r own experiences and biases regarcing end:-of'fe care to discussions with patients ang ther famlies (Ho, Jameson, & Pavisn, 2016). n adaition, the historically pavierchal mecical system may dsentanchise many people from diverse etnnic backgrounds and other diverse identities from expressing their end-oFife desires and needs, The Resolution includes advocacy fo training of psychologists ebout ihe diverse populations they serve, to promote patient empowerment, and beter adjust polices and practices to difering perspectives about death. Likelinood of Constructive Impact on Public Opinion or Policy This upeated resolution, with a revised tile thet reflects the arogression of the discussion (e., Assisted "Dying" instead of Assisted “Sueide", corweys thatthe Association and iis members are engaged inthis evolving and expanding area of concer, Polcy-makes attention to the Issue of Assisted Dying has increased since APA's 2001 Resolution on Assisted Suicide. At that time, only one state had 2 law explicily allowing physicians to prescribe medications to patents forthe purposes of hastening the person's Geath. As previously noted, since 2008, ve additional states and the District of Columbia have legalzed assisted dying, with other states considering action as well ‘Thete ate numerous opportunities at federal, state, and loca levels for psychologists who are interested in assuming research, advocacy, or policy roles to advance the quality of care near the end-olite, including addressing stuation that may invoive assistes eying. Psychalogists can continue 10 work with ether heath care professionals and managers, faith leacers, researchers, policymakers, funders of heath care, and the public at large to improve policy and practice regarding lenc-ofife care and decision-making, The goal of widespread qualty care near the end-otife, including addressing requests for assisted dying, is attainable; however, realization ofthat goal will equire many system-wide changes in alttudes, poles, and actions. The proposed resolution serves as a cal for psychologists to become invoved in erica policy issues related to lenc.oftile care ia general and, for some psycnologists, hat might include actviy related to assisted dying,Implementation The resolution wil be broadly disseminate to APA constituencies, national heath and professional rganizaons, and pole makers active nts cea References “Amertean Bar Associaton & American Psychological Assocation, (2008), Assessment of Older Adults with Diminished opacity: A Handbook for Psychologists. Reieved from hitoutwwaw.apa.orgvaginofprogramslassessmensicapacty paychologis-hancbook pd to apa. og legngfroganslassssmerveapecy-psyraogstrenabook pd) Balaguer, A, Monfore-Royo,C, Pora-Sales, J, Alonso-Bebaro, A, Alsen, R, Areclil Herrero, A, ta. 2016). 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