Study: Assisted Suicide Safeguards Often Ignored In-Depth Report Challenges Assertions On Both Sides Of Debate

Doctors who hasten the death of dying patients often ignore the most widely accepted safeguards - some don’t even involve the patient in the decision - and a sizable fraction of doctors who have assisted a suicide deeply regret it afterward, a new study suggests.

For the study, researchers at Boston’s Dana-Farber Cancer Institute interviewed 355 randomly selected cancer specialists from all 50 states. They delved deeper with 38 of the doctors who were willing to provide detailed accounts of assisting a suicide or giving a lethal injection. The study appeared Wednesday’s Journal of the American Medical Association.

Dr. Ezekiel Emanuel and co-authors said some of their findings challenge the assertions of both advocates and opponents of assisted suicide and of euthanasia, in which a doctor actively administers a lethal agent.

In all but one case, doctors said they were willing to hasten death only when patients were experiencing “unremitting” pain or impaired physical functioning that limited the patients’ ability to take care of themselves.

In 20 percent of assisted-suicide cases, the patient never took the lethal medication, as advocates have often argued will be the case. But in 15 percent of cases, the attempted suicide failed, as opponents warned during the successful campaign in Oregon to legalize doctor-assisted suicide.

Having morphine-type pain medication and hospice care did not end some patients’ wish for hastened death. Dependency and the emotional burden on the patient’s family were the main motives just as frequently as pain, the surveyed doctors said.

While nearly 16 percent of all the oncologists said they had participated in assisted suicide, the researchers found that to be a significant over-statement of reality.

About one-fifth of these doctors revealed in the more in-depth interviews that they had withheld lifesustaining treatments or provided narcotics for pain that shortened a patient’s life - which are legal acts everywhere in the United States and not the same as assisted suicide. The researchers concluded that existing surveys of doctors may overstate by more than 20 percent the actual practice, including a widely reported 1994 study of Oregon doctors that concluded about 7 percent had taken part in assisted suicide.

At the same time, euthanasia may be underreported. The Boston researchers found seven cases in which the doctors had ordered lethal injections or other forms of euthanasia but believed they had participated in assisted suicide.

“These data warn that if (assisted suicide) is legalized, physicians may unintentionally and unknowingly commit many cases of euthanasia believing they are performing a legal act,” the researchers wrote.

Only one-third of cases were performed consistently with proposed safeguards, including having the patient initiate and repeat the request for hastened death, and consulting with another caregiver.

In just two of 38 cases did the patient get a psychiatric evaluation, and in another two cases the patient refused the doctor’s advice to get checked by a psychiatrist.

“Most worrisome,” the researchers wrote, “is that in 15.3 percent of cases, the patients were not involved in the decision but families wanted the patients’ lives ended.” This occurred even when patients were conscious and capable of making decisions, the study found.