Euthanasia Research Papers - Academia.edu (original) (raw)

Background: Debates over legalisation of physician-assisted suicide (PAS) or euthanasia often warn of a ''slippery slope'', predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period. Methods: The data from Oregon (where PAS, now called death under the Oregon Death with Dignity Act, is legal) comprised all annual and cumulative Department of Human Services reports 1998-2006 and three independent studies; the data from the Netherlands (where both PAS and euthanasia are now legal) comprised all four government-commissioned nationwide studies of end-of-life decision making (1990, 1995, 2001 and 2005) and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought. Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups. 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. ''… no matter how carefully any guidelines are framed, assisted suicide and euthanasia will be practiced through the prism of social inequality and bias that characterizes the delivery of services in all segments of our society, including health care. The practices will pose the greatest risks to those who are poor, elderly, members of a minority group, or without access to good medical care.'' New York State Task Force on Life and the Law, 1994 1 ''… the State has an interest in protecting vulnerable groups-including the poor, the elderly, and disabled persons-from abuse, neglect, and mistakes. The Court of Appeals [Ninth Circuit] dismissed the State's concern that disadvantaged persons might be pressured into physician assisted suicide as ludicrous on its face.…We have recognized, however, the real risk of subtle coercion and undue influence in end of life situations …'' US Supreme Court, joint opinion in Washington v Glucksberg (1997) and Vacco v Quill (1997) 2 ''Euthanasia and assisted suicide are opposed by almost every national medical association and prohibited by the law codes of almost all countries. … If euthanasia or assisted suicide or both are permitted for competent, suffering, terminally ill patients, there may be legal challenges … to extend these practices to others who are not competent, suffering or terminally ill. Such extension is the ''slippery slope'' that many fear.'' Canadian Medical Association, 1998 3 ''Both society in general and the medical profession in particular have important duties to safeguard the value of human life. This duty applies especially to the most vulnerable members of society-the sick, the elderly, the poor, ethnic minorities, and other vulnerable persons. In the long run, such persons might come to be further discounted by society, or even to view themselves as unproductive and burdensome, and on that basis, ''appropriate'' candidates for assistance with suicide.'' ''… the ramifications [of legalization] are too disturbing for the … value our society places on life, especially on the lives of disabled, incompetent, and vulnerable persons.''