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Deadly Business: MDs Report Experience With Assisted Suicide


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.

He says that physicians must decide for themselves if, when, and how they should help dying patients find relief from unrelenting suffering, and that those who choose to take concrete steps must do everything in their power to ensure as peaceful and untroubled a death as possible.

"You have to remember that there will probably be a relatively small proportion of physicians whose conscience allows them to participate in [physician-assisted suicide and euthanasia]," Nuland tells WebMD. "But I think for those people there should be training, and I think the natural trainers are anesthesiologists and clinical pharmacologists." He emphasizes that training in physician-assisted suicide should be readily available but totally voluntary, and it should not be part of the standard medical school curriculum.

A medical ethicist who was not involved in the studies but supports protection of private decisions between dying patients and their doctors tells WebMD that our society is not ready to publicly support either physician-assisted suicide or euthanasia.

"Doctors have a legal, moral, and ethical obligation to keep their patients out of pain, and if that involves giving them lethal prescriptions and risking that [patients] take them to kill themselves, that's perfectly fine. Even the U.S. Supreme Court says that's fine," says George J. Annas, JD, MPH, an Edward R. Utley professor, chairman of the health law department at Boston University School of Public Health, and a professor in the Boston University schools of Medicine and Law. "If you've got to kill your patient to keep them out of pain -- as long as you don't intend to kill them but intend to keep them out of pain -- that's the practice of medicine."

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