Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges.
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 2007.1 2 A more restricted form of physician assisted death (physician assisted suicide only) was legalised in Oregon in 1997 and is the subject of an annual report. Although these studies do little to resolve the moral and religious questions surrounding these practices, they do answer the following questions about the risks and benefits of legalisation.
Physician assisted suicide has been legal for a decade in the US state of Oregon. But palliative care specialist David Jeffrey says there are grave questions about whether people are being helped to die, when treatment for depression could be a highly successful alternative. In this week's Scrubbing Up column Dr Jeffrey, who is based at the University of Edinburgh, says a patient should be free to end their life - but doctors should not be involved.
Ganzini and colleagues’ finding that 3 of the 18 Oregonians who received a prescription for a lethal drug met caseness criteria for depression raises concerns about the state’s Death with Dignity Act, which demands a psychiatric review only if "concern exists that the patient has a psychiatric disorder." We know that depression is common in the terminally ill and that depression may be successfully treated in this population. We know that depression may impair a person’s capacity when requesting physician assisted suicide, and we know that non-psychiatrically trained physicians are poor at detecting depression. We also know that these four facts are true for delirium in patients who are terminally ill. There is a strong argument for including mandatory psychiatric review in any legislation that enables physician assisted death, to detect and protect those who would not have requested assistance to die had they not been depressed or delirious.
In this report, Professor Knaplund discusses the Montana Supreme Court case of Baxter v. State of Montana (2009 MT 449), which ruled on the issue of a doctor's liability in a physician aid in dying (PAD) situation. In this case, the plaintiff was suffering from mutual symptoms related to his terminal lymphocytic leukemia and the chemotheraphy treatments he was receiving for it. Along with several other named plaintiffs, including board-certified physicians and the group Compassion and Choice, Mr. Baxter sued to have the state's homicide statute declared to of the constitutional rights of those who are dying to seek a physician's aid in achieving death.
Battin et al examined data on deaths from PAS in Oregon and on PAS and VE in The Netherlands. This paper reviews the methodology used and questions the conclusions drawn from it—namely, that there is for the most part ‘no evidence of heightened risk’ to vulnerable people from the legalisation of PAS or VE. This critique focuses on the evidence about PAS in Oregon. It suggests that vulnerability to PAS cannot be categorised simply by reference to race, gender or other socioeconomic status and that the impetus to seek PAS derives from factors, including emotional state, reactions to loss, personality type and situation and possibly to PAS contagion, all factors that apply across the social spectrum. It also argues that the highest resort to PAS in Oregon is among the elderly and that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS.
In their critique of our paper "Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in "vulnerable" groups," I.G. Finlay and R. George claim to challenge our underlying assumptions and methodology with "another perspective on Oregon's data." In our view, however, they miss the point of our paper and address a quite different issue. While we welcome their attempt to further explore issues about assisted dying, we do not believe they have in any way undercut our argument that where assisted dying is already legal (at the time of our study, Oregon and the Netherlands), there is no current evidence for the claim that legalized physician-assisted suicide or euthanasia will have disproportionate impact on patients in vulnerable groups.
This paper examines the controversial and complex issues of euthanasia and physician-assisted suicide (PAS). I begin by defining and distinguishing these two terms and explain how they relate to each other. I also describe the medical doctrine of double effect, in which relieving pain comes at the expense of hastening death. Then, I give a brief overview of the common law defense of necessity, which is practically the sole defense available to or used by physicians accused of committing euthanasia or PAS. Finally, I analyze the legal doctrines of euthanasia and PAS, focusing on legislation and cases in the European Union — primarily the United Kingdom, the Netherlands, and Switzerland — and the U.S. states of Oregon, Washington, and Montana.
No country has a blanket policy of mandatory psychiatric review but the specialty contributes in circumstances of exclusive mental disorder or when there is doubt regarding capacity and sound judgement. The absence of a mandatory role for psychiatrists means that reversible psychopathology may be missed. As a result, the patient's decision to end his/her life may be more informed by treatable mental disorder than by his/her lifelong preferences.
This article examines the reporting requirements in four jurisdictions in which assisted dying (euthanasia and/or assisted suicide) is legally regulated: the Netherlands, Belgium, Oregon and Switzerland. These jurisdictions were chosen because each had a substantial amount of empirical evidence available. We assess the available empirical evidence on reporting and what it tells us about the effectiveness of such requirements in encouraging reporting. We also look at the nature of requirements on regulatory bodies to refer cases not meeting the legal criteria to either prosecutorial or disciplinary authorities. We assess the evidence available on the outcomes of reported cases, including the rate of referral and the ultimate disposition of referred cases.
Some form of assisted dying (voluntary euthanasia and/or assisted suicide) is lawful in the Netherlands, Belgium, Oregon, and Switzerland. In order to be lawful in these jurisdictions, a valid request must precede the provision of assistance to die. Non-adherence to the criteria for valid requests for assisted dying may be a trigger for civil and/or criminal liability, as well as disciplinary sanctions where the assistor is a medical professional. In this article, we review the criteria and evidence in respect of requests for assisted dying in the Netherlands, Belgium, Oregon, and Switzerland, with the aim of establishing whether individuals who receive assisted dying do so on the basis of valid requests. We conclude that the evidence suggests that individuals who receive assisted dying in the four jurisdictions examined do so on the basis of valid requests and third parties who assist death do not act unlawfully. However, further research on the elements that may undermine ...