Physician-assisted suicide: Resources for journalists

 
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Hundreds of terminally-ill Americans died in 2016 with the aid of their doctors. As of late 2017, physician-assisted suicide was legal in six states — Oregon, California, Vermont, Washington, Colorado and Montana — and the District of Columbia. As the “right-to-die” movement has gained traction in recent years, lawmakers nationwide have debated whether doctors should be able to prescribe life-ending drugs to patients who have months to live. In early 2017, the Hawaii Legislature voted to defer a decision on the issue. Meanwhile, legislators in Massachusetts have been considering the “End of Life Options Act,” which allows certain patients to receive medication “to self-administer to bring about a peaceful death.”

The topic is a contentious one, packing meetings and often pitting religious leaders who argue for the preservation of human life against patient activists who say sick adults should be able to die on their own terms. While doctors and other medical professionals are somewhat split on the issue, the American Medical Association considers assisted suicide to be “fundamentally incompatible with the physician’s role as healer.” The American Academy of Hospice and Palliative Medicine, however, has taken “a position of studied neutrality.”

It’s important to point out that assisted suicide is different than euthanasia, although some people mistakenly use the terms interchangeably. In euthanasia, a doctor directly causes a patient’s death by administering a lethal substance. In an assisted suicide, a doctor generally prescribes or dispenses a lethal drug that the patient may ingest or administer on his or her own.

To help journalists cover this subject, Journalist’s Resource has collected government reports from some of the states that allow assisted suicide. We provide them here as a resource, along with several peer-reviewed studies that look at which kinds of patients take advantage of assisted-suicide laws and how policies and trends in the United States compare to those in Europe. Some other resources are Compassion & Choices, a national advocacy organization in the U.S., and Dignity in Dying in the United Kingdom, as well as organizations that oppose assisted suicide such as Second Thoughts Massachusetts and Focus on the Family. The National Institute on Aging, part of the U.S. Department of Health and Human Services, provides general information about end-of-life care 

 

State reports

“California End of Life Option Act 2016 Data Report”
Report from the California Department of Public Health, 2017.

Summary: Between June 9, 2016 and December 31, 2016, 258 people made verbal requests to their doctors to receive aid-in-dying drugs. Of those, 191 were prescribed such drugs and 111 died following ingestion. About 90 percent of people who received the medication were white, 54 percent were women, 72 percent had some level of college education. Nearly 60 percent had cancer while another 18 percent had neuromuscular disorders such as ALS and Parkinson’s Disease.

 

“Oregon Death with Dignity Act: Data summary 2016”
Report from the Oregon Health Authority, February 2017.

Summary: “Oregon’s Death with Dignity Act (DWDA) allows terminally-ill adult Oregonians to obtain and use prescriptions from their physicians for self-administered, lethal doses of medications. The Oregon Public Health Division is required by the DWDA to collect compliance information and to issue an annual report. In 2016, 204 people received prescriptions under the DWDA. As of January 23, 2017, 133 people had died in 2016 from ingesting the prescribed medications, including 19 prescription recipients from prior years. Characteristics of DWDA patients were similar to previous years: most patients were aged 65 years or older (80.5 percent) and had cancer (78.9 percent). During 2016, no referrals were made to the Oregon Medical Board for failure to comply with DWDA requirements.”

 

“Washington State 2016 Death with Dignity Act Report”
Report from the Washington State Department of Health, September 2017.

Summary: In 2016, doctors gave life-ending drugs to 248 people in Washington who requested them. Of those, 192 died after taking the medication and 36 people died without the medication.

 

 

Academic research

“Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe”
Emanuel, Ezekiel J.; et al. JAMA, 2016. DOI: 10.1001/jama.2016.8499.

Findings: “Currently, euthanasia or physician-assisted suicide can be legally practiced in the Netherlands, Belgium, Luxembourg, Colombia, and Canada (Quebec since 2014, nationally as of June 2016). Physician-assisted suicide, excluding euthanasia, is legal in 5 U.S. states (Oregon, Washington, Montana, Vermont, and California) and Switzerland. Public support for euthanasia and physician-assisted suicide in the United States has plateaued since the 1990s (range, 47 percent-69 percent). In Western Europe, an increasing and strong public support for euthanasia and physician-assisted suicide has been reported; in Central and Eastern Europe, support is decreasing. In the United States, less than 20 percent of physicians report having received requests for euthanasia or physician-assisted suicide, and 5 percent or less have complied. In Oregon and Washington state, less than 1 percent of licensed physicians write prescriptions for physician-assisted suicide per year. In the Netherlands and Belgium, about half or more of physicians reported ever having received a request; 60 percent of Dutch physicians have ever granted such requests. Between 0.3 percent to 4.6 percent of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal. The frequency of these deaths increased after legalization. More than 70 percent of cases involved patients with cancer. Typical patients are older, white, and well-educated. Pain is mostly not reported as the primary motivation. A large portion of patients receiving physician-assisted suicide in Oregon and Washington reported being enrolled in hospice or palliative care, as did patients in Belgium. In no jurisdiction was there evidence that vulnerable patients have been receiving euthanasia or physician-assisted suicide at rates higher than those in the general population.”

 

“Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014”
Kim, Scott Y.H.; De Vries, Raymond G.; Peteet, John R. JAMA Psychiatry, 2016. DOI: 10.1001/jamapsychiatry.2015.2887.

Conclusion: “Persons receiving EAS [Euthanasia or assisted suicide] for psychiatric disorders in the Netherlands are mostly women and of diverse ages, with complex and chronic psychiatric, medical, and psychosocial histories. The granting of their EAS requests appears to involve considerable physician judgment, usually involving multiple physicians who do not always agree (sometimes without independent psychiatric input), but the euthanasia review committees generally defer to the judgments of the physicians performing the EAS.”

 

“Suicide Assisted by Right-to-Die Associations: A Population Based Cohort Study”
Steck, Nicole; et al. International Journal of Epidemiology, 2014. DOI: 10.1093/ije/dyu010.

Results: “Analyses were based on 5,004,403 Swiss residents and 1,301 assisted suicides (439 in the younger and 862 in the older group). In 1,093 (84.0 percent) assisted suicides, an underlying cause was recorded; cancer was the most common cause (508, 46.5 percent). In both age groups, assisted suicide was more likely in women than in men, those living alone compared with those living with others and in those with no religious affiliation compared with Protestants or Catholics. The rate was also higher in more educated people, in urban compared with rural areas and in neighborhoods of higher socioeconomic position. In older people, assisted suicide was more likely in the divorced compared with the married; in younger people, having children was associated with a lower rate.”

 

“Euthanasia and Assisted Suicide in Selected European Countries and U.S. States: Systematic Literature Review”
Steck, Nicole; et al. Medical Care, 2013. DOI: 10.1097/MLR.0b013e3182a0f427.

Summary: This systematic review of journal articles and reports identifies trends and examines the characteristics of assisted dying in Oregon, Washington and Montana as well as Belgium, Luxembourg, the Netherlands and Switzerland. In the Netherlands, 1.8 percent to 2.9 percent of all deaths are physician assisted deaths. In the U.S., 0.1 percent to 0.2 percent are.

 

Last updated: October 19, 2017

 

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