Physician-Assisted Suicide

October 2007 - Research led by Margaret Battin, professor of philosophy and adjunct professor of internal medicine at the University of Utah and published in the Journal of Medical Ethics has found no evidence that legalization of physician-assisted suicide results in disproportionate numbers of vulnerable people dying prematurely. Researchers explain that opponents of such legislation have claimed that it leads to a "slippery slope" making it easier to end the lives of those considered a burden.

They cite as an example the American College of Physicians who in 2005 expressed concern about:

"the risks that legalization posed to vulnerable populations, including poor persons, patients with dementia, disabled persons, those from minority groups that have experienced discrimination, those confronting costly chronic illnesses, or very young children."

Margaret Battin said:

"Fears about the impact on vulnerable people have dominated debate about physician-assisted suicide. We find no evidence to support those fears where this practice already is legal."

The study analysed data from the Netherlands and Oregon, the only American state where physician-assisted dying is legal, assessing all cases recorded as physician- assisted deaths in Oregon between 1998 and 2006, as well as three independent studies. Similarly, they studied end of life decisions in four nationwide surveys sponsored by the Dutch government between1990-2005, as well as independent research.

The study found that only a few people choose the option of physician-assisted suicide. In Oregon, the Death with Dignity Act allows doctors to issue lethal prescriptions to patients diagnosed by two physicians as having a terminal illness and less than six months to live. Since its introduction in 1997, 456 patients had requested lethal prescriptions and 292 (0.15 per cent of all deaths) had used them to end their lives.

The Netherlands passed legislation in 2002 allowing both lethal prescriptions and "voluntary active euthanasia" in which the doctor rather than the patient administers lethal medication. Dutch law is based on the principle of "intolerable suffering" rather than terminal illness. Both forms of physician-assisted dying have been tolerated in the Netherlands since the 1980s with guidance from courts and medical groups. Advance directives, requesting euthanasia in the event of a coma or dementia, are also legal. Researchers found that of 136 000 deaths annually in the Netherlands, about 1.7 per cent are by voluntary active euthanasia, 0.1 per cent by physician-assisted suicide and 0.4 per cent are "extra-legal - involving patients with no current explicit request to die, but who made one before becoming incompetent or are perceived to be suffering intolerably".

Researchers found that both in Oregon and the Netherlands, the average age of people receiving help from their doctor to die was about 70 of whom 80 per cent had cancer. They studied ten "vulnerable groups" but only AIDS patients were represented in disproportionate numbers. There was no evidence of any excess bias towards race, gender, age, socioeconomic status, disability, chronic or mental illness. There have been no prosecutions related to illegal deaths in Oregon and people from vulnerable groups have not been overrepresented in cases brought in the Netherlands.

The study found that only six people with AIDS chose physician-assisted deaths in Oregon (2 per cent of the total) but were 30 times more likely to use assisted dying than a comparable group of non-AIDS patients who died of chronic respiratory disorders. In a cohort of 131 homosexual men in Amsterdam diagnosed with AIDS between 1985 and 1992, and who had died by 1995, 22 per cent used physician-assisted suicide or euthanasia. Researchers suggest this rate may have reduced as treatments have improved.

Margaret Battin commented:

"We've known for a long time from studies elsewhere that rates of assisted dying were much higher in people with AIDS - particularly in areas with large, supportive gay communities such as San Francisco. It's not a surprise to find high rates where physician-assisted dying is legal."

Researchers concluded:

"We found no evidence to justify the grave and important concern often expressed about the potential for abuse. The evidence does show that there is no current factual support for so called slippery slope concerns about the risks of legislation of assisted dying - concerns that death in this way would be practised more frequently on persons in vulnerable groups."