Study: Doctor-Assisted Suicide Isn't a Slippery Slope to Abuse

On Sept. 25, the University of Utah issued a press release that says there is no evidence that legalizing doctor-assisted suicide will result in a disproportionate number of vulnerable peoples' lives being ended prematurely by doctors.

Ten vulnerable groups - the elderly, poor, women, minorities, uninsured, minors, chronically ill, less educated, psychiatric patients and those with AIDS - were examined in Oregon and the Netherlands. Although critics argue otherwise, the study led by the University of Utah found that only AIDS patients used doctor-assisted suicide at what it terms "elevated rates."

The study was conducted by U of U bioethicist Margaret Battin; public health physician Agnes van der Heide, of Erasmus Medical Center in Rotterdam; psychiatrist Linda Ganzini at Oregon Health & Science University, Portland; and physician Gerrit van der Wal and health scientist Bregje Onwuteaka-Philipsen, of the VU University Medical Center in Amsterdam. It will be published in the October 2007 issue of the "Journal of Medical Ethics."

The research group examined what is often called the "slippery slope" argument. Critics of doctor-assisted suicide have repeatedly argued that any kind of legalized physician-assisted euthanasia, regardless of how justified and desired by the patient, will be the beginning of a dangerous practice in which "vulnerable people will die in disproportionately large numbers." Specifically, the researchers asked: "Would these patients be pressured, manipulated or forced to request or accept physician-assisted dying by overburdened family members, callous physicians, or institutions or insurers concerned about their own profits?"

Of their findings, Battin said that "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."

Oregon is the only state where doctor-assisted suicide is legal. Dubbed the Death with Dignity Act, the law is tightly written and went into effect on Oct. 27, 1997. Only terminally-ill patients who are diagnosed with six months or less to live may request to use the law. Also, the patient's primary physician's diagnosis must be certified, or confirmed, by a consulting physician.

Battin and her colleagues found that in the law's first nine years, 456 patients received lethal prescriptions; 292 of those actually used the drugs to kill themselves. That's 0.15 percent of all deaths in Oregon during the same period.

In 2002, a similar law went into effect in the Netherlands, although doctor-assisted suicide and voluntary euthanasia has been openly tolerated there since the 1980s. The law allows doctors to prescribe medication for suicide or perform "voluntary active euthanasia," in which the physician rather than the patient administers the medication. The law doesn't require that a patient be terminally ill, but Battin says "you have to be facing intolerable suffering."

The researchers found that of 136,000 deaths annually, about 1.7 percent are by voluntary active euthanasia. Just 0.1 percent are by doctor-assisted suicide, and 0.4 percent are "extralegal," meaning they involve patients "with no current explicit request to die, but who either made one before becoming incompetent or are perceived to be suffering intolerably."

Overall, the researchers specifically found that elderly people, women and uninsured people don't die in disproportionate numbers where doctor- assisted death is legal, but AIDS patients do.

They also found that doctor-assisted death doesn't kill disproportionate numbers of people who are poor, uneducated, racial and ethnic minorities, minors, or people with chronic physical or mental disabilities or chronic (but not terminal) illnesses.

Neither do people with psychiatric illness, including depression and Alzheimer's disease, die in higher numbers in either Oregon or the Netherlands.

Finally, the researchers found that people who received a doctor's help in dying averaged 70 years old, and 80 percent were cancer patients

The bottom line is that "those who received physician-assisted dying...appeared to enjoy comparative social, economic, educational, professional and other privileges," say the researchers.

Sources:

Press release, Doctor-Aided Suicide: No Slippery Slope toward Abuse; http://www.newswise.com/articles/view/533654/

Death With Dignity Act; http://www.deathwithdignity.org/historyfacts/questions.asp