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Experience with Physician-Assisted Suicide and Euthanasia

The legalization of physician-assisted suicide remains an important ethical and public policy issue. Advocates and opponents have made predictions about the beneficial and deleterious effects of legalization on society. Three recent reports provide data relevant to this question.

Physician-assisted suicide and voluntary active euthanasia have been widely and publicly practiced in the Netherlands for the last 15 years. These practices account for approximately 2% of all deaths in the Netherlands. Approximately 75% of these deaths are the result of euthanasia; the remainder are the result of physician-assisted suicide. Groenewoud and colleagues report that 15% of attempts by patients to perform suicide with lethal medications prescribed by physicians failed and required the physicians to euthanize the patients. Problems in the completion of suicide included vomiting of the medications and prolonged coma without death.

In the United States, only Oregon has explicitly legalized physician-assisted suicide, and no jurisdiction has legalized euthanasia. The Oregon Death with Dignity Act of 1997 permits a terminally ill patient to ask his or her physician to provide a lethal dose of medication and instructions on how to use it to commit suicide. Patients must make 3 requests (2 oral and 1 written) over a period of 15 days. The prognosis must be confirmed by another physician, and referral to a mental health professional must be made if either physician believes that the patient's judgment is impaired by a mental disorder.

Sullivan and colleagues report on the experiences of patients in the second year that this law has been in effect, and Ganzini and colleagues describe the results of a survey of physician experiences with the law. In 1999, 27 patients died after ingesting the lethal dosage, compared with 16 in 1998. The 27 assisted-suicide patients represent fewer than 1 in 1000 of all deaths in Oregon in 1999. Interestingly, unlike the Dutch investigators, Sullivan and colleagues found no clinical problems in the performance of physician-assisted suicide. Similarly, Ganzini and colleagues found no problems. Both groups of investigators found that patients who choose assisted suicide were demographically similar to other dying patients. About 75% utilized hospice care. Oregon physicians granted approximately 1 in 6 patient requests for lethal prescriptions, and 1 in 10 requests eventually resulted in a suicide.

Comment: The Oregon experience involves a small, highly selected group of patients compared with those in the Netherlands. Clearly, the legalization of physician-assisted suicide in Oregon is not the answer for the problems of the dying because it is used by fewer than 1 in 1000 patients. Critics have pointed out that, even in these few cases, the Oregon law is flawed because, unlike Dutch law, it does not require patients to have intractable suffering, nor does it require the counseling physician to be knowledgeable about palliative-care options. The jury remains out on whether the Oregon law will provide an acceptable alternative to palliative care for the dying patient.

— JL Bernat

James L. Bernat, MD, is Professor of Medicine (Neurology), Dartmouth Medical School Lebanon, NH.

Published in Journal Watch Neurology May 1, 2000

Citation(s):

Groenewoud JH et al. Clinical problems with the performance of euthanasia and physician-assisted suicide in the Netherlands. N Engl J Med 2000 Feb 24 342 551 -556.

• Medline abstract (Free)

Ganzini L et al. Physicians' experiences with the Oregon Death with Dignity Act. N Engl J Med 2000 Feb 24 342 557 -563.

• Medline abstract (Free)

Sullivan AD et al. Legalized physician-assisted suicide in Oregon -- The second year. N Engl J Med 2000 Feb 24 342 598 -604.

• Medline abstract (Free)

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