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    Deadly Business: MDs Report Experience With Assisted Suicide


    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.

    But Johanna H. Groenenwoud, MD, and colleagues from the Netherlands -- where both physician-assisted suicide and euthanasia are allowed under strictly controlled circumstances -- report that plans for a peaceful assisted suicide can sometimes go awry, and physicians may have to step in to ensure that patients do not suffer.

    In a study of more than 100 cases of intended assisted suicide and more than 500 cases of euthanasia, complications included a longer than expected time to death and failure to induce coma. In 7% of suicides, patients awakened from their comas. This happened in 16% of euthanasia cases.

    Technical complications included difficulty in finding a vein for lethal injection of medication, trouble swallowing pills or vomiting them up once they had been swallowed, or loss of consciousness before the drug could be administered. In 18% of cases where the physician's intent was to help the patient with suicide, the doctor felt it necessary to intervene by administering a lethal drug, either because of problems with completion or because the patient was unable to take medication.

    The studies pick a tentative and delicate path through the minefield that lies between the camps of right-to-die extremists such as Jack Kevorkian on one flank and right-to-life zealots on the other, says Sherwin B. Nuland, MD, clinical professor of surgery at Yale University School of Medicine. Nuland wrote an editorial accompanying the studies.

    "Opponents of physician-assisted suicide will look at these complications as evidence to support their viewpoint, and they are justified in doing so. But those who believe that in certain, carefully controlled situations, providing assistance with suicide is an ethical responsibility should see the findings in an entirely different light," Nuland writes.

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