From the Center for Outcomes and Policy Research, Division of Cancer Epidemiology and Control, Dana-Farber Cancer Institute, Boston, Mass (Dr Emanuel and Ms Daniels); Center for Research Methodology and Biometrics, Cancer Research Center, American Medical Center, Denver, Colo (Dr Fairclough); and the Center for Survey Research, University of Massachusetts, Boston (Dr Clarridge).
Context.— Despite intense debates about legalization, there are few data examining
the details of actual euthanasia and physician-assisted suicide (PAS) cases
in the United States.
Objective.— To determine whether the practices of euthanasia and PAS are consistent
with proposed safeguards and the effect on physicians of having performed
euthanasia or PAS.
Design.— Structured in-depth telephone interviews.
Setting and Participants.— Randomly selected oncologists in the United States.
Outcome Measures.— Adherence to primary and secondary safeguards for the practice of euthanasia
and PAS; regret, comfort, and fear of prosecution from performing euthanasia
Results.— A total of 355 oncologists (72.6% response rate) were interviewed on
euthanasia and PAS. On 2 screening questions, 56 oncologists (15.8%) reported
participating in euthanasia or PAS; 53 oncologists (94.6% response rate) participated
in in-depth interviews. Thirty-eight of 53 oncologists described clearly defined
cases of euthanasia or PAS. Twenty-three patients (60.5%) both initiated and
repeated their request for euthanasia or PAS, but 6 patients (15.8%) did not
participate in the decision for euthanasia or PAS. Thirty-seven patients (97.4%)
were experiencing unremitting pain or such poor physical functioning they
could not perform self-care. Physicians sought consultation in 15 cases (39.5%).
Overall, oncologists adhered to all 3 main safeguards in 13 cases (34.2%):
(1) having the patient initiate and repeat the request for euthanasia or PAS,
(2) ensuring the patient was experiencing extreme physical pain or suffering,
and (3) consulting with a colleague. Those who adhered to the safeguards had
known their patients longer and tended to be more religious. In 28 cases (73.7%),
the family supported the decision. In all cases of pain, patients were receiving
narcotic analgesia. Fifteen patients (39.5%) were enrolled in a hospice. While
19 oncologists (52.6%) received comfort from having helped a patient with
euthanasia or PAS, 9 (23.7%) regretted having performed euthanasia or PAS,
and 15 (39.5%) feared prosecution.
Conclusions.— Intractable pain or poor physical functioning seem to be nearly absolute
requirements for physicians to perform euthanasia or PAS. Only one third of
cases are performed consistently with proposed safeguards. For some patients,
end-of-life care that includes opioid analgesia and hospice care does not
obviate their desire for euthanasia or PAS. While the majority of physicians
seem comforted by their actions, some experience adverse consequences from
having performed euthanasia or PAS.
Emanuel EJ, Daniels ER, Fairclough DL, Clarridge BR. The Practice of Euthanasia and Physician-Assisted Suicide in the United States: Adherence to Proposed Safeguards and Effects on Physicians. JAMA. 1998;280(6):507–513. doi:10.1001/jama.280.6.507
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