In Reply Drs Stevens and Toffler raise concerns about the lack of data on complications and abuse with the performance of PAS in Oregon and Washington. We agree there is a dearth of data, and we advocated for more research on problems and complications of euthanasia and PAS. Two types of research studies should be conducted. One would enhance official reporting forms requiring information on specific types of complications, such as vomiting of medications, prolonged time to death (>1 hour), and regaining consciousness. It is true that in completing these forms, physicians would be reporting on their own practices and may be reluctant to disclose complications. However, they may still be willing to provide information about unanticipated problems, and such reporting provides a minimum frequency of complications. All jurisdictions also should routinely conduct death certificate studies in which death certificates are randomly selected and the signing physicians contacted to complete a survey about the circumstances of the death. Such surveys have been performed in Belgium1,2 and the Netherlands.3 Although rarely used, surveys of bereaved family members identified from death certificates could also uncover practices that physicians might not know about or disclose.4
Emanuel EJ, Onwuteaka-Philipsen BD, Cohen J. Euthanasia and Physician-Assisted Suicide—In Reply. JAMA. 2016;316(15):1600–1601. doi:10.1001/jama.2016.14080
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