Approximately every five years the New England Journal of Medicine publishes an update on the practice of voluntary euthanasia and physician-assisted suicide in the Netherlands. The latest update covers 2005, which, for the first time, covers now legal practices which were previously accepted though illegal in that country. The study had an impressive 78% response rate by physicians to mailed requests sent to physicians attending 6860 deaths.

Major findings were the absence of a ‘slippery slope’, less evidence of hastened death without explicit request, and the fact that opioids are not the medication of choice (with greater use of neuromuscular relaxants).

In 2005 voluntary euthanasia accounted for 1.7% of all deaths, and physician-assisted suicide 0.1%, which were significantly lower than earlier studies.

Reference: Agnes van der Heide, M.D., Ph.D., Bregje D. Onwuteaka-Philipsen, Ph.D.,et al ‘End-of-Life Practices in the Netherlands under the Euthanasia Act’, NEJM Vol 356 (19) 1957-1965 May 10th 2007.

In another study in the Netherlands, involving retrospective interviews with 87 relatives of patients who died by euthanasia or physician-assisted suicide, it was revealed that 85% suffered from cancer. Prior to making an explicit request for assistance to die 79% of patients had discussed their wishes concerning end-of-life decision making.

It was hopeless suffering, loss of dignity, and no prospect of recovery that were the main reasons for requests. Relatives reported that for 92% of patients, voluntary euthanasia or assisted suicide contributed positively to the quality of the end of life by preventing or ending suffering.

Research in Canada around voluntary euthanasia and physician-assisted suicide has focused on those who are themselves dying - a cohort often ignored in research. Sixty per cent of the 379 palliative care cancer patients who participated in a survey supported legalization of assisted death. Interviews had been held between 2001 and 2003 in St. John's, N.L., Quebec City, Ottawa, Winnipeg, Saskatoon, Edmonton, Kelowna, B.C., and Vancouver.

The survey was funded by the Canadian Institutes of Health Research and published in the U.S. journal Health Psychology. Forty per cent claimed that they would consider a future request if facing a ‘worst-case scenario’, with ten per cent stating that they would already have requested it, and 5.8% stating that they would have already have elected to access voluntary euthanasia or physician-assisted suicide if they had the option.

Reference: Anne Marie Tobin The Globe and Mail (Canada) June 6 2007

In an article commenting on the recent release of Dr Kevorkian, Dr Sidney Wanzer, a well known commentator on the rights of the hopelessly ill, states that ‘he brought this matter (voluntary euthanasia) to the acute attention of the public in a way that no one had done before’.

‘There are occasional instances in which comfort care is applied with the greatest skill possible, and yet the patient continues to suffer intolerably in spite of all measures. This happens in the practicing lifetime of a physician only rarely, but it does happen. In my experience, these situations are self-evident. They cry out that physician-aid in dying is the only humane and compassionate thing left in the spectrum of treatment at the end of life. Without fearing abuse, we should permit intolerably suffering patients the right to exert this ultimate autonomy in choosing the manner of their dying. Doctors shouldn't have to go to jail for acting compassionately’.

Reference: Wanzer, S. ‘Dr. Death' served us all with time in prison’, USA Today, 6 June 07

SAVES is not affiliated with Exit International / Dr Philip Nitschke and opposes the public availability of a 'peaceful pill'.

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