37 J. Med. Ethics: Legal Physician-Assisted Suicide in Oregon and the Netherlands: Evidence concerning the Impact on Patients in Vulnerable Groups

Article excerpt

Battin et al examined data on deaths from physician-assisted suicide (PAS) in Oregon and on PAS and voluntary euthanasia (VE) in The Netherlands. This article reviews the methodology used in their examination and questions their conclusions, namely, that there is for the most part "no evidence of heightened risk" to vulnerable people from the legalization of PAS or VE. This critique focuses on the evidence about PAS in Oregon. It suggests that vulnerability to PAS cannot be categorized simply by reference to race, gender or other socioeconomic status and that the impetus to seek PAS derives from factors, including emotional state, reactions to loss, personality type and situation and possibly to PAS contagion, all factors that apply across the social spectrum. It also argues, on the basis of official reports from the Oregon Health Department on the working of the Oregon Death with Dignity Act (ODDA) since 2008, that, contrary to the conclusions drawn by Bat-tin et al, the highest resort to PAS in Oregon is among the elderly and, on the basis of research published since Battin et al reported, that there is reason to believe that some terminally ill patients in Oregon are taking their own lives with legal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS.

Some of Battin et al's observations appear to blur the distinction between terminal and chronic illness. They state that "virtually all patients who are seriously or terminally ill are to some extent physically disabled and chronically ill"; that "patients who are dying lose functional capacities and may be bedridden toward the end"; that "in this sense, most patients who received assistance in dying in either Oregon or The Netherlands were chronically ill and (recently) disabled"; and that "cancer, the diagnosis in about 80% of all cases of assisted dying in both Oregon and The Netherlands, is often identified as a chronic illness." This begs the question: what definition of chronic illness is being used? The term is normally employed to designate an illness that persists for some considerable time and that may--but will not necessarily--be the eventual cause of death. Therefore, illnesses such as multiple sclerosis, Parkinson's disease and cardiopulmonary disease pretty well universally have a chronic and disabling prelude before they become predictably terminal as defined by less than six months to live. …