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Who Chooses Physician-Assisted Suicide?


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May 22, 2002 -- Physician-assisted suicide remains a topic of heated debate. Beyond the issue of pain and suffering, those against the practice hold that low-income, poorly educated people may elect -- or be pressured -- to die rather than heap staggering medical costs on their family or their government.

But results of a new Dutch study should put this particular concern to rest.

"The choice of euthanasia or physician-assisted suicide was not associated ... with income or education level," write study author Jan H. Veldink, MD, from University Medical Center in Utrecht, Netherlands, and colleagues.

Their findings appear in the May 23 issue of The New England Journal of Medicine.

His team surveyed the doctors of 203 patients who had died from amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease) between 1994 and 1998. The doctors completed questionnaires about their patients' end-of-life decisions.

ALS usually strikes in the mid-50s. Patients experience progressive nerve degeneration that causes loss of motor function, paralysis, and eventually death -- usually due to respiratory failure. Half of patients die within three years of symptom onset. There is currently no cure.

In this study, the terms physician-assisted suicide and euthanasia both refer to death that resulted from doctor-prescribed and administered drugs. The differences between the two were mainly technical.

Overall, 20% chose to have their doctor help them die. This choice "was not associated with any particular characteristics of the disease or of the patient's care." Generally speaking, "disability before death was significantly more severe in patients who died as a result of euthanasia than among those who died in other ways," the researchers write.

An additional 20% of the patients had received palliative, or pain-relieving, care, which "probably shortened their lives," they write.

Particularly religious patients were least likely to choose assisted suicide.

Physician-assisted suicide and euthanasia are legal in the Netherlands, but physicians must operate "under strict conditions, including the presence of a voluntary and well-considered request, unbearable and hopeless suffering, and consultation with a second physician," the researchers write.

Belgium just passed similar legislation. And here in the U.S., Oregon's Death with Dignity Act has been in place, and is still a source of continuing controversy, since 1994. -->

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