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Editor's Correspondence
January 9, 2006

“Agreed Boundaries”: Are We Asking the Right Question?

Arch Intern Med. 2006;166(1):126-127. doi:10.1001/archinte.166.1.126-c

As both Wolf1 and Jansen-van der Weide and colleagues2 underline, knowing whether legal euthanasia or assisted suicide can be kept “within agreed boundaries”1 is an important question. This, however, does not apply solely to countries where euthanasia or assisted suicide is permitted. In empirical studies, up to 3.7% of US physicians reported having practiced assisted suicide and up to 9.4% reported having practiced euthanasia.3 According to another study, intensive care unit physicians in France, where euthanasia is illegal, are more likely to report having practiced “deliberate administration of medication to speed death in patients with no chance of recovering a meaningful life” compared with their colleagues from 11 European countries including the Netherlands.4(p1630) In Switzerland, where assisted suicide is legal under certain circumstances but not euthanasia,5 an international study reported that 1.04% of deaths could be due to assisted suicide, 0.27% to euthanasia, and 0.42% to ending of life without the patient's explicit request.6 The same study found that these rates were 0.06%, 0.06%, and 0.76%, respectively, in Denmark, where neither euthanasia nor assisted suicide is legal. Which situation is closer to “agreed boundaries”? We may not be asking the right question: much needed attention has focused on how euthanasia and assisted suicide legislation is applied, but this may not be sufficient. Should we not be analyzing which option, forbidding euthanasia/assisted suicide or permitting it, can best keep this practice within the boundaries we want to see respected?

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