Physician-assisted suicide laws can raise controversy and concern with their
passage, but a new study from Washington state suggests many of those fears may
Washington's Death With Dignity Act hasn't lead to scores of terminally ill
people seeking lethal prescriptions, the researchers report: Almost three years
after the law was enacted, just 255 people had obtained a lethal prescription
from a physician.
Of those 255 prescriptions, 40 were written for terminal cancer patients at
the Seattle Cancer Care Alliance. And, in the new study, doctors there found
that only 60% (24 people) of their patients chose to use their prescription to
hasten their death.
"Most Americans say that they want to die at home with family members around,
not in pain and with their mental faculties as in tact as possible. But, not
everyone is achieving that kind of good death. For the rare number of people
using the Death With Dignity program, we are reassured by the high numbers of
people who use palliative or hospice care and who talk with their families about
this decision," said study author Dr Elizabeth Trice Loggers, medical director
of palliative care at the Seattle Cancer Care Alliance.
Physician-assisted death, also known as physician-assisted suicide, is
currently legal in Oregon, Washington and Montana. Other states, among them
Hawaii, Pennsylvania and Vermont, are considering legislation to allow
physician-assisted deaths for people with terminal illnesses.
No advertising of programme
Washington's law was passed in November 2008, and enacted in March 2009. The
Death With Dignity Act contains a number of safeguards. The illness must be
terminal, and the patient must be competent. The request must be voluntary, the
person making the request can't have a mental illness that might impair their
judgement and they must understand what treatment and palliative care options
Additional safeguards have been put in place at the Seattle Cancer Care
Alliance that include no advertising of the program, no new patients whose sole
purpose is to access the Death With Dignity program and voluntary participation
by physicians and other staff members.
From March 2009 through December 2011, 114 patients at Seattle Cancer Care
Alliance asked about the Death With Dignity program. Of these, 44 chose not to
pursue the program at all.
Another 30 people initiated the process, but either chose not to continue to
the next step, or died in the interim.
Forty patients received a prescription for a lethal dose of secobarbital, a
powerful sedative. Twenty-four patients died after ingesting the medication. On
average, the time from ingestion to death was 35 minutes. The remaining 16
patients chose not to use their prescription and eventually died from their
Those who participated were mostly married white males with more than a high
school education. Their ages ranged from 42 to 91, according to the study
authors. All had been diagnosed with terminal cancer.
The most common reasons people cited for participating in the program were
loss of autonomy, an inability to engage in enjoyable activities and a loss of
"Each year, there are over 50 000 deaths in Washington state, and cancer is
the second leading cause of death. The number who chose to participate in the
Death With Dignity program is miniscule. This study shows that people are not
making these decisions lightly," Trice Loggers said. She added that patients and
their families have expressed gratitude for the program.
'Concerns that law would be promoted'
Dr Gary Kennedy, director of geriatric psychiatry at Montefiore Medical
Center in New York City, said he thought the Seattle Cancer Care Alliance took
great care to be as neutral as they could, so that it was up to the patients to
pursue physician-assisted death.
"Before these laws were enacted, one of the concerns in the suicide
prevention community was that these laws would be promoted," Kennedy said. And,
while he was pleased to see that there was no such promotion, he still has
concerns about physician-assisted death programmes.
He noted that most of the people who participated in the program were older,
white males. As a group, older, white males tend to have higher than normal
suicide rates, even without a terminal diagnosis, according to Kennedy.
While one of the requirements of the law is that someone must be competent
and free of mental illness that could impair their judgement, Kennedy said it
can be difficult to diagnose depression in terminally ill patients. It wasn't
clear from the study if people only met with social workers, or if they were
referred to psychologists or psychiatrists, according to Kennedy.
The good news, he said, is that "this law has not led to a whole rush to
suicide in the terminally ill."
Trice Loggers reiterated: "Our job is to cure cancer. But, there are
situations where we just can't do that. Among those who opted for Death With
Dignity, the number using hospice was 80% or greater. They were able to include
their family and to die at home, which is consistent with how most people say
they want to die."
"It's important to remember that in Washington, this law was passed by
referendum. Approximately 60% of voters said this was an appropriate end-of-life
decision," she noted.
Learn more about Washington's Death
With Dignity Act.
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