Paternalism, parsed. Presenting empirical insights into the actions of physicians under the Austrian law on assisted dying.

RATIONALE: In all jurisdictions with laws standardising the process of assisted dying, physicians play a key role. That they do is a concern in the academic literature, with critics accusing physicians of medical paternalism, particularly in relation to their role in assessing requests for assisted dying. OBJECTIVE: By exploring how physicians handle medical assessments under the 2022 Austrian Dying Decree Act, we aim to add empirical insights to the overly theoretical debate on medical paternalism in the context of assisted dying. METHOD: After employing a maximum-variation sampling strategy, we conducted episodic interviews with 16 assessors recruited among 51 preselected physicians. Thematic analysis was used to interpret the interview data. RESULTS: When conducting assessments, it was crucial to physicians that they could relate to the request and empathise to the extent of imagining making the same choice if they found themselves in the requester's circumstances. They did not support requests that they could not relate to, even when the requester met the legal access criteria for assisted suicide. They did so for self-protective reasons. CONCLUSION: Criticising the practice of assessing requests for assisted dying through the lens of paternalism leads to oversimplifying the real-world complexities of the matter. Denying or shaming physicians for considering self-interested motives in their assessment practice will not make them disappear.