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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 evidence.
"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 measures.
"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 that."
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.
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