ASSISTED SUICIDE: JAMA Study Investigates Practices
"Despite intense debates about legalization, there are few data examining the details of actual euthanasia and physician-assisted suicide (PAS) cases in the United States," according to researchers writing in today's Journal of the American Medical Association. To fill that gap, a research team led by Dr. Ezekiel Emanuel of the Dana-Farber Cancer Institute conducted comprehensive telephone interviews with 355 oncologists, of which 15.8% reported "participating in euthanasia or PAS." The researchers found that only 34.2% of those physicians adhered to "well-accepted safeguards" governing PAS: "having the patient initiate and repeat the request for euthanasia or PAS; ensuring the patient was experiencing extreme physical pain or suffering; and consulting with a colleague." The study team found that of the 38 oncologists willing to provide PAS services, 28 prescribed drugs "knowing the patient intended to use' them for suicide (PAS)," 2 reported euthanizing patients by injecting drugs, and 8 reported doing both. Perhaps the "most worrisome" finding was that in 15.3% of cases, family members initiated the decision to terminate the patients' lives, without input from the patient, even in situations where the patient was conscious. Furthermore, researchers found that only 40% of the oncologists discussed the case with colleagues, and "more important, there was very little use of psychiatric evaluations" before a decision to terminate life was reached. The authors warn that PAS should not be legalized without psychiatric evaluations. Depression "is one of the leading predictors of interest in PAS or euthanasia," but physicians often associate terminal illness with depression and fail to provide adequate evaluation and therapy, they note.
A Little Confusion?
The authors indicate that many of the oncologists preferred a "passive role" when assisting patients in terminating their lives, "believing that writing a prescription and letting the patient decide constitutes a passive role." The authors expressed some concern that in 7 cases, "physicians identified an action ending a patient's life as PAS, but in-depth interviews revealed it to be euthanasia. ... Thus, identifying their action as PAS rather than as euthanasia diminishes the importance of the physician's role, thereby decreasing physicians' psychological burden." The authors note that should PAS be legalized, "physicians may unintentionally and unknowingly commit many cases of euthanasia believing they are performing a legal act of PAS, thus creating potential enforcement problems." Developing appropriate procedures to deal with failed PAS attempts presents a dilemma in the U.S, they further write. Although in the Netherlands physicians can preform euthanasia in the event of a failed PAS, "[t]his approach is unlikely to work in the United States." Provided a legal consensus regarding this issue is reached in the U.S., it remains unlikely that euthanasia will be permitted and therefore the authors suggest that "[l]egalizing PAS but not euthanasia could create serious difficulties in addressing the failed PAS attempt" (Emanuel, 8/12 issue).
The Debate In Congress
Today's Christian Science Monitor looks at the congressional debate over physician-assisted suicide. The article focuses on House Judiciary Committee Chair Henry Hyde's (R-IL) effort to derail Oregon's Death with Dignity Act by making it illegal for doctors and pharmacists to prescribe "any federally regulated drug for the purpose of suicide." Hyde said, "I am worried about the culture of death that seems to have overtaken this country." But Sen. Ron Wyden (D- OR) defends Oregon's right to establish a physician-assisted suicide law. "Does this Congress ... believe it is better equipped than the citizens of my state to make moral decisions about acceptable medical practice in Oregon?" he asked (Knickerbocker, 8/12).
We're Working On It
In a letter to the Wall Street Journal, New York Attorney General Dennis Vacco (R) writes that the state's Commission on Quality Care at the End of Life is exploring "ways to improve standards of medical care for the dying." According to Vacco, "[t]he commission's report, due for release this fall," will recommend "changes in the laws and regulations that constrain the way physicians and other health professionals treat pain at the end of life." In addition, he notes that the commission "recommends methods to teach care-givers to identify and alleviate pain and related symptoms." Vacco's letter responded to a July 27 Journal editorial that urged more education for health professionals about pain management (8/12).