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Elder Care News
Elderly and Disabled Not at Higher Risk of
Physician-Assisted Death
Terminal sedation, legal in the U.S. since 1997,
may account for up to 44% of deaths
 Sept. 28, 2007 - Claims that vulnerable groups,
such as the elderly and people with physical or mental disabilities, are
at an increased risk of physician assisted death are not supported by
evidence, says an expert in this weeks BMJ.
Physician assisted death (both voluntary active
euthanasia and physician assisted suicide) has been openly practiced in
the Netherlands for more than 25 years and was formally legalized in
2002. Physician assisted suicide was also legalized in Oregon in 1997,
writes Professor Timothy Quill of the University of Rochester, N.Y.
Many concerns still surround the practice, but
evidence now exists to answer questions about the risks and benefits of
legalization.
For example, a study published in this weeks
Journal of Medical Ethics analyzed data from Oregon and the Netherlands
and found no increased incidence of physician assisted death in elderly
people, women, people with low socioeconomic status, minors, people with
physical disabilities or mental illness.
These findings call into question the claim that
the risks associated with legalization will fall most heavily on
potentially vulnerable populations, says Quill.
Further evidence dispels the concern that these
practices become more common over time. In Oregon, physician assisted
death accounts for around one in 1000 deaths each year, with no
significant change in frequency over nine years. The Dutch practices of
physician assisted death have also remained stable over the duration of
four studies, and hospice and palliative care have become more prevalent
in recent years.
Evidence from the US also shows higher rates of
assisted death in areas where these practices are prohibited than in
Oregon after legalization. Although the data are not directly
comparable, none the less, it raises the possibility that legalization
and regulation with safeguards may protect rather than facilitate the
practice, says Quill.
The argument that legalization is a slippery slope
is also not supported by the evidence, he adds. A recent study found
that four out of six Western European countries where assisted death is
illegal had a much higher incidence of unreported cases than is seen in
the Netherlands.
Finally, limited data suggests that the practice of
terminal sedation, which has been legal in the US since 1997, accounts
for up to 44% of deaths, while in the Netherlands, it accounted for 5.6%
of deaths in 2001 and 7.1% in 2005.
Terminal sedation (also known as palliative
sedation, or sedation for intractable distress in the dying/of a dying
patient) is the practice of relieving distress in a terminally ill
person in the last hours or days of a patient's life, usually by means
of a continuous intravenous or subcutaneous infusion of a sedative
drug, according to
Wikipedia.
These days, patients who are dying are faced with a
wide array of uncertainties and choices, and the physical and
psychological challenges they experience are more complex, says Quill.
Studies help clarify the risks and benefits of
controversial practices like physician assisted death or terminal
sedation and suggest that outcomes are more favorable when practitioners
work together with patients and families in an open and accountable
environment.
Patients who are dying and their families need us
to be as objective and honest as possible in these deliberations, he
concludes.
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