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Editorials

Physician assisted death in vulnerable populations; Claims of increased risk in these groups are not supported by evidence.

BY: Timothy E Quill, professor of medicine, psychiatry and medical humanities; BMJ 2007;335:625-626 (29 September).

Physician assisted death (both voluntary active euthanasia and physician assisted suicide) has been openly practised in the Netherlands for more than 25 years and formally legalised since 2002. The practice has been analysed in four major national studies between 1990 and 2007. A more restricted form of physician assisted death (physician assisted suicide only) was legalised in Oregon in 1997.

In Oregon, one in 50 dying patients talk to their doctors about assisted death and one in six talk to family members. There seems to be much conversation about end of life options, therefore, but relatively few cases of assisted death.

The Dutch practices of physician assisted death have also remained stable over the duration of four studies.

A study by Battin and colleagues published in this week’s Journal of Medical Ethics that analyses existing databases from Oregon and the Netherlands dispels many of these concerns. They found no increased incidence of physician assisted death in elderly people, women, people with low socioeconomic status, minors, people in racial and ethnic minorities, and people with physical disabilities or mental illness. The one exception was people with AIDS.

These findings call into question the claim that the risks associated with legalisation will fall most heavily on potentially vulnerable populations.

It raises the possibility that legalisation and regulation with safeguards may protect rather than facilitate the practice.

The most controversial cases in the Netherlands are the life ending acts that have no explicit requests (known as LAWER cases, doesn’t say why I’m afraid)(about 1000 cases each year). Most, but not all, of these patients were suffering greatly and had lost the ability to make decisions for themselves, and many had previously given consent for physician assisted death under such circumstances.

A recent study of six Western European countries—using the same format and questions as the Dutch studies—showed that four of the six countries where assisted death is illegal had a much higher incidence of LAWER cases than is seen in the Netherlands.

In fact, such cases were more common than cases of assisted death where voluntary consent was given.

If you want to find out more WHY THERE IS MORE EUTHANASIA in countries were it is NOT legalised, just CLICK HERE.

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