More people opt to use assisted dying laws for greater variety of reasons

BMJ 2015; 351 doi: (Published 11 August 2015) Cite this as: BMJ 2015;351:h4332
  1. Ingrid Torjesen
  1. 1London

More people in Belgium and the Netherlands are ending their lives by voluntary euthanasia, and their reasons are widening, a series of papers published in JAMA Internal Medicine shows.

Belgium legalised voluntary euthanasia in 2000, and from 2007 to 2013 the proportion of people ending their lives in this way in Flanders, the Dutch speaking part of the country, increased from 1.9% to 4.6% (1 in 22) of all deaths.1 Meanwhile, 1 in 30 people who died in the Netherlands in 2012 died by euthanasia—roughly three times as many as in 2002, when the practice was made legal.2

In one study researchers surveyed a random sample of doctors who recorded deaths in Flanders in 2007 or 2013. Throughout those six years more people requested euthanasia, and the proportion successfully doing so increased from around half to three quarters.3

The most pronounced increases in requests were from people aged 80 or older (2.0% to 4.6%; relative risk 2.2 (95% confidence interval 1.5 to 3.3)), those with a college or university education (4.5% to 12.9%; 2.9 (1.4 to 6.1)), and those with a diagnosis of cardiovascular disease (0.8% to 3.0%; 3.9 (1.4 to 10.9)).

The authors said, “Although the prevalence of euthanasia remains highest in patients with cancer, those with a college or university education, and those who die before 80 years of age, there are increasing numbers of requests and granted requests in patients with diseases other than cancer, those who die after 80 years of age, and those who reside in nursing homes.”

Another study investigated the reasons why patients requested physician assisted suicide at the End of Life Clinic in the Netherlands, which was set up in 2012 to provide physician assisted suicide for patients who meet all legal requirements but whose regular physician had rejected their request.4

A total of 645 patient requests were considered during the year: 162 (25.1%) were granted, 300 (46.5%) were refused, 124 patients (19.2%) died before the request was assessed, and 59 patients (9.1%) withdrew their requests. The authors said that physicians were more willing to grant requests from patients with advanced cancer, so patients with other conditions and aged over 80 were over-represented in the groups who requested and received euthanasia.

Patients with somatic conditions (113 of 344 requests; 32.8%) or cognitive decline (21 of 56 requests; 37.5%) were most likely to have their request granted, while patients with a psychological condition were the least likely (6 of 121 requests; 5%).

“Requests characterized by psychological as opposed to physical suffering were more likely to be rejected, as were requests by individuals who lived alone,” said Barron Lerner and Arthur Caplan, of the division of medical ethics at New York University’s Langone Medical Center in New York City, USA, in an accompanying commentary.5 “Thus, fears were mitigated that solitary, depressed individuals with potentially reversible conditions might successfully end their lives.”

But they added, “Other findings are very worrisome. Most notably, 6.8% of those who successfully obtained euthanasia or physician assisted suicide were categorized as tired of living. A total of 3.7% reported only psychological suffering.”

Almost half of patients whose requests were granted had complained of loneliness. “Loneliness, even if accompanied by other symptoms, hardly seems a condition best addressed by offering death,” wrote Lerner and Caplan. “Finally, [the fact] that 53.7% of approved requests are among those 80 years and older raises red flags.”

The commentary also questioned whether the use of euthanasia or physician assisted suicide was appropriate for 1 in 20 to 25 dying patients. “Careful, independent studies are crucial to ensure that the safeguards put in place in the Netherlands and Belgium are working and that these end of life strategies remain ones of last resort for desperate individuals, not the wrong response to frailty and loneliness,” the authors concluded.

A private member’s bill to legalise physician assisted suicide for terminally ill people in England and Wales is due to go before the House of Commons on 11 September. The bill would allow someone who is judged to have no more than six months to live, who has a “clear and settled intention” to die, to be prescribed a lethal dose of drugs on the authority of two doctors. It includes amendments requiring the approval of a High Court judge.6


Cite this as: BMJ 2015;351:h4332


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