How Physician-Assisted Suicide Happens Around the World

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A new review brings some evidence to a practice that’s been controversial for decades.

By Francie Diep

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(Photo: Theo Heimann/Getty Images)

The right of an ill patient to receive help dying remains contentious, with courts around the world still debating the issue more than 70 years after Switzerland became the first country to decriminalize physician-assisted suicide. Just last week, New Mexico’s Supreme Court reversed a district court’s decision on physician-assisted suicide, making it a prosecutable act. Meanwhile, Canada passed a law last month allowing for physician-assisted suicide in limited cases. Canada’s law followed extensive back-and-forth about the rules on who exactly can request the procedure. (Do you have to be near death? Or just have an incurable condition?)

A new review of the existing research on physician-assisted suicide brings some data to the debate. The review covers studies of what happened after states legalized euthanasia and suicide-pill prescriptions. Such studies offer critical information for voters and judges considering the issue. Below, a few highlights from the research:

Where Is It Legal?

Laws can always change, but, right now, physician-assisted suicide is legal in Belgium, Canada, Colombia, Luxembourg, the Netherlands, and Switzerland. It’s also legal in California, Montana, Oregon, Vermont, and Washington.

How Does It Work?

Different countries and states have varying laws about who may request physician-assisted suicide — about what prognoses they must have and how old they must be, for example. Some countries allow doctors to administer death-dealing medicines directly to their patients. In the United States, you may request a prescription for medicines that hasten death, but you have to take them yourself.

In every American state, it’s legal for patients or their proxies to stop life-sustaining treatments. That’s not considered physician-assisted suicide.

Who Uses It?

Even where it’s legal, very few ill people follow through with physician-assisted suicide. Among Oregon and Washington’s databases, physician-assisted suicide usually accounts for less than half of 1 percent of deaths in a year. Yet it’s not an uncommon request: The most recent rigorous survey, published in 1998, suggests 18 percent of American doctors have had someone ask for physician-assisted suicide services. More than half of American oncologists have fielded such a request.

Most Washingtonians and Oregonians who die by physician-assisted suicide have cancer. Most commonly, they say they want the procedure because they’re afraid of losing their independence, dignity, and enjoyment of life activities. They’re most likely to be older, white, and well-educated.

The Dutch and Belgians avail themselves of physician-assisted suicide more often than Americans do, in the single-digit percentages.

Are There Any Problems or Abuses?

“Existing data do not indicate widespread abuse of these practices,” the review’s authors write. It doesn’t appear physician-assisted suicide disproportionately affects the disenfranchised, for example.

Nevertheless, the researchers point to places where right-to-die policies can be improved. In Washington and Oregon, a large majority — 81 percent — of people who participated in physician-assisted suicide were enrolled in hospice care. It might help to push that closer to 100 percent. Hospice care can go a long way toward helping those facing terminal illnesses with physical and mental distress.

One recent study of Oregonians found that, compared to terminally ill people who didn’t ask about physician-assisted suicide, those interested in the procedure were more likely to feel depressed and hopeless, and less likely to be spiritual. And while therapy might relieve depression, in Oregon, less than 5 percent of people participating in physician-assisted suicide received a psychiatric evaluation beforehand. In Washington, less than 4 percent were referred to a psychiatrist.

There’s some evidence that physician-assisted suicide doesn’t always work as smoothly as hoped. Between 1998 and 2015, Oregon reported that, in 2 percent of cases, people regurgitated their pills. Less than 1 percent re-gained consciousness after taking their medicines. In Washington, only two-thirds of people died within 90 minutes of taking their prescriptions. The reported lag between ingestion and death lasted up to 30 hours.

It’s difficult to tell the true rates of complications, however, because in many cases — 44 percent in Oregon — doctors didn’t report that information. They need to submit that data systematically, the review’s authors write. Every medical procedure is going to have complications sometimes, but we need to know if physician-assisted suicide is working at an acceptable rate, or if we need to improve the procedure, or seek alternatives.

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