Deadly Business: MDs Report Experience With Assisted Suicide
Feb. 23, 2000 (Boston) -- Few inflammatory issues in medicine burn as
intensely as the questions of physician-assisted suicide and euthanasia. But in
a series of articles in the Feb. 24 issue of The New England Journal of
Medicine, researchers from Oregon, where physician-assisted suicide is
legal, and from the Netherlands, where the practice is not legal but is
accepted, attempt to balance the heat of debate with the dispassionate light of
"There is concern that with the legalization of assisted suicide, women,
poor persons, and those who are members of ethnic or racial minority groups may
request assistance with suicide because of inadequate social support or lack of
access to health care," write Linda Ganzini, MD, and her colleagues in
Oregon. However, "after two years of legally assisted suicide, we found
little evidence that vulnerable groups have been given prescriptions for lethal
medication in lieu of palliative care." Palliative care is care intended
only to ease the severity of symptoms without curing the condition.
Physician-assisted suicide, by itself a hot button issue in medical ethics
circles, is when a patient actively puts an end to his or her own life with the
help of a physician. This help usually comes in the form of a prescription for
a potentially fatal medication. Physician-assisted suicide therefore differs
from euthanasia, which is when a person other than the patient intentionally
puts the patient to death. Euthanasia is sometimes called "mercy
killing" because patients put to death in this manner typically have an
incurable or extremely painful disease.
Physicians in Oregon granted only one in six patient requests for a lethal
prescription, and only one in 10 of such requests actually resulted in suicide.
In all, 15% of eligible patients changed their minds about suicide, some
because they found sufficient relief through pain control medications or other
"As a researcher, at every point I've tried to have people who are both
very opposed and very supportive of assisted suicide look at the survey and the
results. Both sides were very relieved that physicians seemed to be operating
in a responsible and very prudent manner," says Ganzini, director of
geriatric psychiatry at the Portland VA Medical Center and associate professor
of psychiatry at Oregon Health Sciences University, in an interview with WebMD.
"Both sides were relieved that patients were getting palliative
interventions and that it was working sometimes. So I think there is common
ground there, and I think everybody should give a sigh of relief about
In a separate study, researchers from the Oregon Health Division in Portland
report that terminally ill patients who opted for and carried out suicide with
the help of their doctors in 1999 accounted for only 27 of the nearly 30,000
deaths reported in the state last year. Amy D. Sullivan, MD, MPH, and
colleagues say that patients appeared to have many complex and often
overlapping reasons for deciding to ask for help with ending their lives.
According to family members, dying patients most frequently cited physical
suffering, fears of loss of control over their lives, and concerns about loss
of bodily functions as reasons for seeking help.