Signal Hill is an advocate for human rights that provides information on life issues, women's health and family support.
"I have yet to hear of a set of guidelines for euthanasia which would not lead to terrible abuses even in the opinion of those physicians who are sometimes willing to practice it. Inevitably, this form of ‘therapy’ would spread to situations in which at present it would be unthinkable." ~ Jonathan H. Pincus, M.D., Yale University ~
Related Links
The International Task Force on Euthanasia and Physician Assisted Suicide
www.internationaltaskforce.org/ index.htm
The Euthanasia Prevention Coalition
www.euthanasiaprevention.on.ca/
The Canadian Hospice and Palliative Care Association
www.chpca.net
Council of Canadians with Disability
www.ccdonline.ca
Physicians for Life
www.physiciansforlife.ca/ html/life/suicide/
The International Association for Hospice & Palliative Care
www.hospicecare.com/
Take the Pledge
www.take-the-pledge.com/
Physicians for Compassionate Care Education Foundation
www.pccef.org
Recent Research
Study: Doctors Ignore Guidelines on Euthanasia
August 1998
CHICAGO -- Doctors frequently ignore proposed guidelines for euthanasia and assisted suicide, even to the point of not consulting the patient, a new study found.
Researchers said the study, published in The Journal of the American Medical Association, found that assisted-suicide cases appear to be rare: of 355 cancer specialists surveyed, 10.7 % reported a case of either euthanasia or assisted suicide.
The study identified three main safeguards generally proposed by supporters of euthanasia and assisted suicide for terminally ill patients:- the patient must initiate and repeat the request- the patient must be evaluated by another physician- the patient must be in extreme physical pain.
Of the doctors who reported a case, only 34.2% said they adhered to all three guidelines. Patients were not involved in the decision in 15.8% of the reports ("did not participate in the decision for euthanasia or PAS"). In those cases, it was the families who asked to end the patients' lives, a finding the study called "most worrisome."
More than 60% of doctors who had a case said they did not consult with another physician, the report said.
For the complete text of the study go to:
The Practice of Euthanasia and Physician-Assisted Suicide in the United States Adherence to Proposed Safeguards and Effects on Physicians
Ezekiel J. Emanuel, MD, PhD; Elisabeth R. Daniels, BA; Diane L. Fairclough, DPH; Brian R. Clarridge, PhD JAMA. 1998;280:507-513.
British Medical Journal
October 2008
Prevalence of depression and anxiety in patients requesting physicians’ aid in dying: cross sectional survey
Linda Ganzini, professor1,2, Elizabeth R Goy, assistant professor 1,2, Steven K Dobscha, associate professor1,2
Objective To determine the prevalence of depression and anxiety in terminally ill patients pursuing aid in dying from physicians.
Results 15 study participants met "caseness" criteria for depression, and 13 met criteria for anxiety. 42 patients died by the end of the study; 18 received a prescription for a lethal drug under the Death with Dignity Act, and nine died by lethal ingestion. 15 participants who received a prescription for a lethal drug did not meet criteria for depression; three did. All three depressed participants died by legal ingestion within two months of the research interview.
Conclusion Although most terminally ill Oregonians who receive aid in dying do not have depressive disorders, the current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug.
Published 8 October 2008, doi:10.1136/bmj.a1682BMJ 2008;337:a1682
Physician-Assisted Suicide In Oregon:
A Medical Perspective
Dr. Herbert Hendin, PhD*
Dr. Kathleen Foley, PhD**
June, 2008
This Article examines the Oregon Death with Dignity Act from a medical perspective. Drawing on case studies and information provided by doctors, families, and other care givers, it finds that seemingly reasonable safeguards for the care and protection of terminally ill patients written into the Oregon law are being circumvented.
The problem lies primarily with the Oregon Public Health Division ("OPHD"), which is charged with monitoring the law. OPHD does not collect the information it would need to effectively monitor the law and in its actions and publications acts as the defender of the law rather than as the protector of the welfare of terminally ill patients. We make explicit suggestions for what OPHD would need to do to change that.
For the complete text go to:
spiorg.org/publications/HendinFoley_MichiganLawReview.pdf
*Chief Executive Officer and Medical Director, Suicide Prevention International; Professor of Psychiatry, New York Medical College.
** Attending Neurologist, Memorial Sloan-Kettering Cancer Center; Professor of Neurology, Neuroscience, and Clinical Pharmacology, Weill Medical College of Cornell University; Medical Director, International Palliative Care Initiative of the Open Society Institute.
Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands
Groenewoud et al.
NEJM 2000;342:551-556.
Background and Methods The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in the Netherlands (one conducted in 1990 and 1991 and the other in 1995 and 1996), with a total of 649 cases. We categorized clinical problems as technical problems, such as difficulty inserting an intravenous line; complications, such as myoclonus or vomiting; or problems with completion, such as a longer-than-expected interval between the administration of medications and death.
Results In 114 cases, the physician's intention was to provide assistance with suicide, and in 535, the intention was to perform euthanasia. Problems of any type were more frequent in cases of assisted suicide than in cases of euthanasia. Complications occurred in 7 percent of cases of assisted suicide, and problems with completion (a longer-than-expected time to death, failure to induce coma, or induction of coma followed by awakening of the patient) occurred in 16 percent of the cases; complications and problems with completion occurred in 3 percent and 6 percent of cases of euthanasia, respectively. The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in 12 cases) and the inability of the patient to take all the medications (in 5).
Conclusions There may be clinical problems with the performance of euthanasia and physician-assisted suicide. In the Netherlands, physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves because of the patient's inability to take the medication or because of problems with the completion of physician-assisted suicide.
Source Information
From the Department of Public Health, Erasmus University, Rotterdam (J.H.G., A.H., P.J.M.); and the Institute for Research in Extramural Medicine and the Department of Social Medicine, Vrije Universiteit, Amsterdam (B.D.O.-P., D.L.W., G.W.) — both in the Netherlands.
To Die, to Sleep: US Physicians' Religious and Other Objections to Physician-Assisted Suicide, Terminal Sedation, and Withdrawal of Life Support
Curlin et al.
AM J HOSP PALLIAT CARE 2008;25:112-120.
This study analyzes data from a national survey to estimate the proportion of physicians who currently object to physician-assisted suicide (PAS), terminal sedation (TS), and withdrawal of artificial life support (WLS), and to examine associations between such objections and physician ethnicity, religious characteristics, and experience caring for dying patients. Overall, 69% of the US physicians object to PAS, 18% to TS, and 5% to WLS. Highly religious physicians are more likely than those with low religiosity to object to both PAS (84% vs 55%) and TS (25% vs 12%). Objection to PAS or TS is also associated with being of Asian ethnicity, of Hindu religious affiliation, and having more experience caring for dying patients.
Dealing with Requests for Euthanasia: A Qualitative Study Investigating the Experience of General Practitioners
Georges et al.
J. Med. Ethics 2008;34:150-155.
Having to face a request for euthanasia when attempting to relieve a patient’s suffering was described as a very demanding experience that GPs generally would like to avoid. Nearly half of the GPs (14/30) strive to avoid euthanasia or physician assisted suicide because it was against their own personal values or because it was emotional burdening to be confronted with this issue. They explained that by being directed to promote a peaceful dying process, or the quality of end-of-life of a patient by caring and supporting the patient and the relatives it was mainly possible to shorten patient’s suffering without "intentionally hastening a patient’s death on his request."
Impact of Euthanasia on Primary Care Physicians in the Netherlands
van Marwijk et al.
Palliat Med 2007;21:609-614.
Although it is a very rare occurrence, euthanasia has a major impact on PCPs. Their relationship with the patient, their loneliness, the role of the family, and pressure from society are the main issues that emerged.
Desire for Hastened Death in Patients with Advanced Disease and the Evidence Base of Clinical Guidelines: A Systematic Review.
Hudson et al.
Palliat Med 2006;20:693-701.
Thirty-five research studies met the inclusion criteria related to reasons associated with a desire for hastened death. The factors associated with a desire to die were often complex and multifactorial; however, psychological, existential and social reasons seem to be more prominent than those directly related to physical symptoms, such as pain. Much of the evidence supporting the reasons for these statements is based on: (a) patients’ perceptions of how they may feel in the future, and (b) health professionals’ and families’ interpretations of why desire to die statements may have been made.
Attitudes of Terminally Ill Cancer Patients About Euthanasia and Assisted Suicide: Predominance of Psychosocial Determinants and Beliefs Over Symptom Distress and Subsequent Survival
Suarez-Almazor et al.
JCO 2002;20:2134-2141.
PURPOSE: Although euthanasia and physician-assisted suicide (PAS) are controversial issues, the views of those most affected, terminal patients, are seldom explored. Our objective was to assess whether the attitudes about euthanasia/PAS of terminally ill cancer patients were determined by their symptomatic distress.
RESULTS: Most patients (69%) supported euthanasia or PAS for one or more situations. The association between these attitudes and symptoms was weak... No significant associations were observed with pain, nausea, well-being, loss of appetite, depression, or subsequent survival. Agreement with euthanasia was significantly related to male sex, lack of religious beliefs, and general beliefs about the suffering of cancer patients and their families. In multivariate analysis, the only characteristics that remained statistically associated with support were the strength of religious beliefs and the perception that patients with cancer are a heavy burden on their families. Frequency of suicidal ideation was associated with poor well-being, depression, anxiety, and shortness of breath, but not with other somatic symptoms such as pain, nausea, and loss of appetite.
CONCLUSION: Symptom intensity had limited impact on the attitudes about euthanasia of terminally ill cancer patients. Our findings suggest that patient views are primarily determined by psychosocial traits and beliefs, as opposed to disease severity or symptomatic distress.
Legalising Active Euthanasia and Physician Assisted Suicide
Oliver et al.
BMJ 2002;324:846-846.
FULL TEXT Letters to the Editor
Resident Experience and Opinions About Physician-Assisted Death for Cancer Patients
Bold et al.
Arch Surg 2001;136:60-64.
Participants Residents undergoing surgical training and faculty oncologists of all specialties (surgical, medical, and radiation therapy).
Results Response rates were 39% (22 of 56) for the residents and 87% (21 of 24) for the oncologists. Of those who responded, 86% (19 of 22) of the residents would aid any of the hypothetical patients with assisted death, whereas only 19% (4 of 21) of the staff oncologists expressed willingness to perform the same service. Furthermore, 32% (7 of 22) of the residents reported previous involvement in a case of assisted death from any disease, whereas only 19% (4 of 21) of the staff oncologists reported previous direct experience with assisted death in the terminal cancer patient.
Conclusions Surgical residents tend to have more experience with assisted death and are much more willing than staff oncologists to aid terminal cancer patients with this procedure. These opinions and practices are probably not the result of medical education but are developed from personal values.
Attitudes and Desires Related to Euthanasia and Physician-Assisted Suicide Among Terminally Ill Patients and Their Caregivers
Emanuel et al.
JAMA 2000;284:2460-2468.
Participants A total of 988 patients identified by their physicians to be terminally ill with any disease except for human immunodeficiency virus infection (response rate, 87.4%) and 893 patient-designated primary caregivers (response rate, 97.6%).
Results Of the 988 terminally ill patients, a total of 60.2% supported euthanasia or PAS in a hypothetical situation, but only 10.6% reported seriously considering euthanasia or PAS for themselves. Factors associated with being less likely to consider euthanasia or PAS were feeling appreciated, being aged 65 years or older, and being African American. Factors associated with being more likely to consider euthanasia or PAS were depressive symptoms, substantial care giving needs, and pain. At the follow-up interview, half of the terminally ill patients who had considered euthanasia or PAS for themselves changed their minds, while an almost equal number began considering these interventions. Patients with depressive symptoms and dyspnea were more likely to change their minds to consider euthanasia or PAS. According to the caregivers of the 256 decedents, 14 patients (5.6%) had discussed asking the physician for euthanasia or PAS and 6 (2.5%) had hoarded drugs. Ultimately, of the 256 decedents, 1 (0.4%) died by euthanasia or PAS, 1 unsuccessfully attempted suicide, and 1 repeatedly requested for her life to be ended but the family and physicians refused.
Conclusions In this survey, a small proportion of terminally ill patients seriously considered euthanasia or PAS for themselves. Over a few months, half the patients changed their minds. Patients with depressive symptoms were more likely to change their minds about desiring euthanasia or PAS.
Attitudes and Practices Concerning the End of Life: A Comparison Between Physicians From the United States and From the Netherlands
Willems et al.
Arch Intern Med 2000;160:63-68.
Background This study compares attitudes and practices concerning the end-of-life decisions between physicians in the United States and in the Netherlands, using the same set of questions.
Methods A total of 152 physicians from Oregon and 67 from the Netherlands were interviewed using the same questions about (1) their attitudes toward increasing morphine with premature death as a likely consequence, physician-assisted suicide (PAS), and euthanasia; and (2) their involvement in cases of euthanasia, PAS, or the ending of life without an explicit request from the patient. Odds ratios, with 95% confidence intervals, were calculated to investigate relation between attitudes and various characteristics of the respondents.
Results American physicians found euthanasia less often acceptable than the Dutch, but there was similarity in attitudes concerning increasing morphine and PAS. American physicians found increasing morphine and PAS more often acceptable in cases where patients were concerned about becoming a burden to their family. There was a discrepancy between the attitudes and practices of Dutch physicians concerning PAS. The proportions of physicians having practiced euthanasia, PAS, or ending of life without an explicit request from the patient differ more between the countries than do their attitudes, with American physicians having been involved in these practices less often than the Dutch.
Conclusions In this study of American and Dutch physicians, 2 important differences emerge: different attitudes toward the patient who is concerned over being a burden, and different frequency of euthanasia and PAS in the two countries.
