Fears that such vulnerable groups as the elderly, and those with physical and mental disabilities may be at increased risk of slipping into the lists of doctor assisted deaths are probably unfounded and the evidence that this may be so is just not there, according to an article in The British Medical Journal (BMJ), issued this week. Physician assisted deaths include voluntary active euthanasia and physician assisted suicide.
Professor Quill, professor of medicine, psychiatry and medical humanities, University of Rochester, USA, writes that physician assisted death has been openly practiced for over two-and-a-half decades in The Netherlands, in fact, it was legalized in 2002. Physician assisted suicide became legal in the state of Oregon, USA, in 1997.
There have been concerns surrounding the practice of physician assisted death, explains Quill. However, evidence is now available which addresses the risks and benefits of legalizing it.
According to a study published in the Journal of Medical Ethics, which examined data from Oregon and The Netherlands, there was no evidence of any increase in the incidence of physician assisted death among the elderly, females, individuals with low socioeconomic status, under-eighteens, and patients with mental illness or physical disabilities.
These findings appear to neutralize the main arguments against the legalization of the practice – that vulnerable groups would increasingly bear the brunt of deaths.
Another fear is that the practice would become more commonplace over time. However, the evidence dismisses that concern as well. Physician assisted deaths made up one per thousand deaths each year in Oregon – frequency of this type of death has remained unchanged for the last nine years. The same has happened in The Netherlands, where hospice and palliative care have grown in recent years.
According to data from the USA, there are higher rates of assisted death where the procedure is not allowed. This evidence, although not directly comparable, says Quill, leads one to conclude that legalization brings about safeguards which protect patients.
According to a recent study, out of six Western European countries, four had higher rates of unreported assisted deaths than total assisted deaths in The Netherlands.
Limited data indicates that the practice of terminal sedation, a legal procedure in the USA since 1997, accounts for up to 44% of deaths, compared to 7.1% in the Netherlands.
Patients who are dying are currently faced with a wide array of doubts and choices – the physical and psychological challenges they experience are more complex, explains Quill.
Studies suggest that results are more favorable when doctors and patients work jointly with families in an environment that is sincere and accountable.
Terminally ill patients and their families need doctors to be as objective and honest as possible in these discussions, concludes Quill.
“Editorial: Physician assisted death in vulnerable populations”
BMJ Volume 335, pp 625-6
doi: 10.1136/bmj.39336.629271.BE
http://www.bmj.com
Written by: Christian Nordqvist