In the debate over physician-assisted suicide, opponents have long argued that legalizing it could lead to disproportionately high suicide rates in vulnerable patients. But a new study published in the October 2007 issue of the Journal of Medical Ethics suggests that this concern is more fear than fact: an analysis of reports of doctor-assisted deaths in Oregon and the Netherlands — two areas where the practice is legal — found that rates of assisted death were no higher than average in nine of 10 patient groups that could be at risk for coercion, such as the elderly or the poor. In fact, the one group that researchers found sought assisted suicide more frequently was younger white men — a generally more privileged few.
"People who tend to take advantage of this tend to be well educated when it comes to their options," says Russell Korobkin, a professor at UCLA School of Law. In the last 13 years in Oregon, only 292 have died under the law. "Mostly what this is good for is giving people peace of mind. They feel like they have control if they need it."
The 10 vulnerable groups identified in the study were women, the elderly, the uninsured, the less educated, the poor, racial and ethnic minorities, the physically disabled and chronically ill, people with psychiatric illness, minors and AIDS patients. With the exception of the AIDS patients, no group had a higher than normal risk of seeking or being administered lethal drugs. Margaret Battin, lead author of the study and a professor of philosophy at the University of Utah, says that although her study is the first of its kind, the results didn't surprise her. "It's not actually news to people who really pay attention," says Battin, who has worked with a pro-legalization group. "For proponents who favor legalization, it is important because it shows that [this question] that is a central concern for everyone — could this be damaging for a vulnerable group? — has no basis in fact." For opponents, she says, it should help alleviate their fears that health care systems put these groups at risk.
Though the patients who chose to end their lives had similar profiles in Oregon and the Netherlands, the legal terms of doctor-assisted suicide in the two places are quite different. In Oregon doctors can prescribe lethal doses of medication only to terminally ill patients 18 and older, and those patients then have to administer the medicine themselves. The Netherlands, where the practice has been officially sanctioned since 2002, has a more permissive code. The Dutch courts allow both self-administration and euthanasia, defined as when a doctor delivers the lethal dose — the more common patient choice. A patient does not have to be terminally ill to be treated in the Netherlands, but does have to be facing "unbearable suffering," and children as young as 12 can be considered for treatment, with both parents' consent.
Still, the Dutch and Oregon state laws share some similarities. Neither requires patients to undergo separate mental health assessments before being prescribed lethal medication. But doctors in both Oregon and the Netherlands have to report cases to the appropriate authorities (the Department of Human Services and the municipal coroner, respectively), and they must consult with at least one other physician to make their diagnoses. The latter requirements more directly address the fear highlighted in the University of Utah study: that counseling patients to take their own lives could be done without the patients' best interests in mind.
Indeed, the study was immediately met with rancor from some anti-euthanasia groups, including the Euthanasia Prevention Coalition, which called the study "propaganda" and said that the statistics could not offer any real insight into why patients made the decision to die. Opponents say answers to crucial questions, such as whether the patients' options were fully explained to them, whether it was cheaper for the medical company involved to offer death rather than more years of life, or whether the patient had a family member waiting to cash in on a life insurance policy, can't be found in numbers. "In a [health care] system that is so concerned about the bottom line, to legalize physician-assisted suicide would mean people would be denied life-sustaining treatments and pressured, indirectly, into choosing to end their life," says Paul Longmore, a professor at San Francisco State University and head of the school's Institute on Disability. He says he does not disagree with the ethics of assisted suicide, but doubts that in America it will get done right.
It's a common worry. In the U.S., many disability groups have mobilized to fight further legalization of physician-assisted dying, both because of concerns about the U.S. health care system, and because the practice strikes a deeper nerve. Longmore argues that the reasoning behind euthanasia and doctor-assisted suicide is built on a social prejudice against handicap and illness, which posits that it's better to die than to need physical assistance in life. "That's something that society has imbued many of us with — that if you require assistance, that's dehumanizing, and maybe you'd be better off dying," says Longmore. "We think the culture of dying ought to be changed, but it should be changed in such a way that [the terminally ill] are not abandoned by the community."
Battin, who has published prolifically on the subject in the last three decades, knows the new study will not end the emotional public debate. "I'm very clear about support for legalization, but that can be interpreted as support for suicide," Battin says of the criticism she's gotten over the years. "Some of this stuff looks as though you're a cheerleader for people offing themselves. That's absolutely not true. That is both disturbing and misleading."