from overseas
Research evidence from Oregon State, Washington State, the Netherlands and Belgium demonstrates that where assisted dying in its various forms is practiced:
- Numbers of people receiving assisted dying has remained low and any increase has been predominantly due to increased public awareness and improved reporting of the practice by GPs.
- Vulnerable groups have not been targeted or negatively impacted on by the practice.
- Palliative care has improved alongside legislation and continues to be delivered to a high standard.
Oregon
In 1997 the Death with Dignity Act (DWDA) was passed in Oregon. This allows terminally ill people in the State to end their lives through the voluntary self-administration of lethal medications, prescribed by a physician.
- Whilst there has been a rise in numbers of physician-assisted deaths, the overall numbers have stayed low. Deaths as a result of assisted dying have remained at under 0.2% of all deaths in Oregon State. There were 59 deaths from ingesting prescribed medications in 2009 (1)
- Patients who have had an assisted death are most often aged between 55 and 84, white, have had a 'good education', are not disabled prior to their illness, did not have mental health issues, had cancer as the underlying illness and had medical insurance (i.e. were not in any financial difficulty).
- For many, regardless of whether they use it or not, the option of an assisted death brings great comfort (the 'insurance policy'). Approximately 40% of patients do not use the prescribed life-ending medication (2).
- Loss of autonomy (97%), being less able to engage in enjoyable activities (86%) and loss of dignity (92%) are the main reasons for patients choosing an assisted death. Inadequate pain control (10.2%), burden (25%) and financial implications of the treatment (2%) are less frequently given as reasons (2).
- Between 1998 and 2006, 9.6% of patients were psychologically evaluated after they were judged to be eligible for assisted dying (1). Those who fail the psychological evaluation cannot have an assisted death.
- Improved techniques for screening out ineligible patients prior to any psychological evaluation have led to no psychological evaluations being conducted between 2007 and 2009 (3).
- Research conducted by Ganzini et al demonstrates that whilst some patients who requested assisted dying, and then died as a result of prescribed medications, had symptoms of depression all had mental capacity and were capable of making rational decisions (4).
- 1 in 4 who requested assistance had symptoms of depression and 1 in 6 who died had symptoms of depression. It is worth noting that symptoms of depression measured in the study included lack of appetite which is not uncommon in those with a terminal illness.
Washington
The Washington Death with Dignity Act came into force in 2008. This allows terminally ill people in the States to end their lives through the voluntary self-administration of lethal medications, prescribed by a physician.
- Figures from the first year show us that 36 people died after ingesting the medication. This accounts for 0.07% of all deaths in the State in 2008 (5).
- In 1998, when assisted dying was legalised in Oregon, 0.5% of deaths in Oregon were as a result of this practice.
Netherlands
The Netherlands introduced assisted dying legislation in 2002. Patients who have an incurable condition, face unbearable suffering and are mentally competent may be eligible for voluntary euthanasia or assisted dying. Both voluntary euthanasia and physician-assisted dying is practiced.
- Evidence indicates that cases of voluntary euthanasia and physician-assisted dying fell between 2001-2005 (from 2.4% to 1.7% of all deaths) (6), but that there has been an increase between 2006-2008 (from 1,923 deaths to 2,331) (7).
- Non-voluntary euthanasia (ending of life without explicit request from the patient) has fallen from 0.8% of deaths in 1990 to 0.4% in 2005 (6).
Belgium
The Belgian Act on Euthanasia was passed in May 2002. For the purpose of this Act, euthanasia is defined as a doctor intentionally terminating life at the person's request (i.e. voluntary euthanasia). The Belgian euthanasia law is not limited to terminally ill patients, but also includes those who are in a medically-futile state and suffering unbearably (mentally or physically) as the result of an illness or accident.
- Smets et al report that cases of voluntary euthanasia in Belgium have risen steadily from 0.23% (235 reported cases) of all deaths in 2003 to 0.49% (495 reported cases) in 2007 (8).
- Following the enactment of the law there has been a decrease in non-voluntary euthanasia deaths from 2.3% of all deaths in 1998 to 1.9% in 2007 (9).
- Voluntary, repeated written requests for voluntary euthanasia by the patient have remained steady between 2002/3 (99.6% of cases) and 2007 (98.2 of cases) (8).
References
(1) Summary of Oregon's Death with Dignity Act (1999-2009)
(2) 2009 Summary of Oregon's Death with Dignity Act (2010)
(3) Personal correspondence with George Eighmey, Executive Director Compassion & Choices of Oregon 22/09/09
(4) Ganzini L, Goy E, Dobscha S (2008) Prevalence of depression and anxiety in patients requesting physicians' aid in dying: cross sectional survey BMJ 337 (72): a1682
(5) Washington State Department of Health 2009 Death with Dignity Act Report (2010)
(6) Van der Heide A, Rurup M, Hanssen-de WolfJ et al End-of-life practices in the Netherlands under the Euthanasia Act New England Journal of Medicine 356(19): 1957-1965
(7) Regional euthanasia review committees: 2006/2007/2008 annual reports, Dutch Review Committee
(8) Smets T, Bilsen J, Cohen J et al (2010) Legal euthanasia in Belgium: Characteristics of all reported euthanasia cases Medical Care 42(2) 187-192
(9) Bilsen J, Cohen J, Chambaere K, Pousset G (2009) Medical end-of-life practices under the euthanasia law in Belgium New England Journal of Medicine 361(11) 1119-1121
