ASSISTED SUICIDE: Poll Finds Fraction Of Doctors Approve
Under current law, 11% of doctors surveyed said they would be willing to prescribe medication to assist a dying patient's death in some circumstances and 7% would provide a lethal injection, according to a nationwide poll published in today's New England Journal of Medicine (Meier et al, 4/23 issue). As lead author Dr. Diane Meier of Mt. Sinai Medical Center explains, "Fewer than 7% of doctors who frequently take care of patients with severe life-threatening illness have ever in their entire practice lifetime assisted a patient to die" ("World Today," CNN, 4/22). But if the practice were legalized, 36% said they would prescribe death-hastening medication and 24% would prescribe lethal injection, according to the poll. The poll, which surveyed 1,902 doctors across the country who were most likely to treat patients who would request assisted-suicides, found that nearly one in five (18.3%) have been asked by a patient "for medication to use with the primary intention of ending his or her own life" and that 3.3% of these doctors have prescribed the medication and 4.7% have prescribed a lethal injection. These findings led the researchers to conclude that about 6% of the doctors they surveyed have "complied" with a request for physician-assisted suicide or euthanasia "at least once."
The researchers looked at variables affecting the willingness of doctors to assist in patient suicides. Religious affiliation was a major predictor, with Catholic physicians the least likely to provide assistance and "Jewish physicians or those with no religious affiliation" the most likely to have done so. Doctors in the Western U.S., those older than 45 years of age and male practitioners were more likely to have received requests and have acted upon them, according to the poll. A doctor's specialty was also another major predictor, with pulmonologists, geriatricians and general internists the types of doctors "most likely to be willing" to assist (NEJM, 4/23 issue).
A Rare Event
The Boston Globe reports there was some "difference of opinion among the study's authors about what the numbers mean." Meier contended the results do not necessarily back calls for changing current law. "Had we found this a common underground event, I think there would be a powerful argument that we should get this out of the closet, regulate it and make sure it's only happening under carefully prescribed circumstances," she said. "If it's only a rare event, which is what our study shows, I don't think it makes sense to legalize a practice which carries significant risks to the most vulnerable members of our society, those who are sick and dying," continued Meier. But study co-author Dr. Timothy Quill of the University of Rochester said, "I think we need to worry about whether [the law is] the only reason they are not assisting patients. Are they turning their backs on their patients now because of legal constraints, because the legally safest thing to do is walk away?" (Knox, 4/23).
A Difficult Decision
CNN's Dr. Steve Salvatore reported that many of the surveyed doctors "said they had a difficult time distinguishing between giving pain medicine to relieve suffering and administering a lethal injection, suggesting more education is needed for physicians" ("World Today," 4/22). "[B]oth the authors and outside experts said that many of the doctors who acknowledged" having ended a patient's life "were probably confused about" doing so, the New York Times reports. Dr. Joann Lynn, director of George Washington University's Center for Care of the Dying, said, "This is a very murky, blurry situation when the family says to the doctor, 'Isn't there something you can do?'" "In 17% of the cases involving lethal injection, the medication used was potassium chloride, whose only purpose is to stop the heart from beating. The remaining 83% of the patients received opioids, which are used to relieve pain but may also speed the dying process." Responding to the survey, one doctor wrote, "I would not give a patient a lethal injection or prescription. I have, however, hastened a person's death while trying to relieve suffering at the end of life."
The New York Times notes that the "majority of doctors who granted the requests to hasten death said they had done so only once or twice in their careers." Dr. Kathleen Foley, director of the Project on Death in America, said these findings mean only "a very small number of patients" were ever affected. Foley "could not provide a precise figure but estimated that only a fraction of 1% of the 2.4 million Americans who die each year do so with help from their doctors" (Stolberg, 4/23). The Globe notes that the new findings are "relatively consistent with earlier physician polls ... which had found that between 3% and 13% of doctors reported they had assisted patients in suicide." In addition, American Society of Clinical Oncology President Dr. Robert Mayer notes that "findings of a new survey of 3,400 cancer specialists, scheduled for release next month, are 'in the same ballpark,'" as the NEJM survey (4/23).
Complicating matters further is depression. "Too often the patients are inadequately treated, which can affect their ability to make a competent decision," according to doctors. Dr. William Wood of Emory University Medical Center said the patients the doctors in the survey "described were patients that had inadequately treated pain and almost totally untreated depression. It betrays a willingness to not treat things we can treat, and leap to the patient's conclusion that there's not solution other than death." CNN's Salvatore reported that "doctors need to learn more about how to care for the terminally ill and dying, and patients need to be thoroughly counseled about all options" ("World Today," 4/22).