What Patterns Are Seen in Physician-Assisted Suicides?

The demographics of patients seeking medical aid in dying (MAID) seem to be similar in both Oregon and Washington, according to a study published in JAMA Network Open.

In a group of 3,368 prescriptions from 1998 to 2017 in Oregon and 2009 to 2017 in Washington, most patients in both states were insured, non-Hispanic white, and had some level of college education, the study showed. The most common diagnosis associated with MAID was cancer.

“Concerns that MAID would unintentionally target socially disadvantaged patients have not materialized, as evidenced by the data presented in this article,” wrote Luai Al Rabadi, MD, of Oregon Health & Science University in Portland, Oregon, and colleagues. “States considering MAID legalization may see similar results if they model their rules on those put into place in the US Pacific Northwest.”

Of the prescriptions given, 2,558 (76%) resulted in patient death from lethal ingestion. A little more than half of prescriptions were given to men (51.3%) and the majority were in patients older than age 65 years (76%) and white (94.8%).

Cancer was the most common underlying diagnoses associated with MAID (76.4%) followed by neurologic illness (10.2%), lung disease (5.6%) and heart disease (4.6%). Among the reasons given for MAID, loss of autonomy was the most common (87.4%). Only 4% of patients received referrals for psychiatric examinations.

The annual percentage of patients per year who were prescribed medication and ingested it did not change in Oregon, with annual rates per year for percentage of patients ranging from 48% to 87%. However, there was an increase over time in Washington (adjusted odds ratio per year=1.13; 95% CI, 1.08–1.19; P<.001). Both states had increases in the number of patient death due to MAID per 1,000 deaths over time.

In an accompanying editorial, Daniel P. Sulmasy, MD, PhD, of Georgetown University in Washington D.C., wrote that the similarity in trends seen between Washington and Oregon in the study were not surprising “given the similarity of the laws and demographic characteristics of these states,” but that limitations to the work exist.

“The appeal of the study by Al Rabadi et al is that it is empirical, and by comparing data from two states for the first time, it can be considered novel. Because there are new reports each year and the practice of physician-assisted suicide (PAS) is legal in only a few states, descriptive reports about PAS are published frequently,” Sulmasy wrote. “This means, however, that articles defending the ethical status quo (ie, against PAS) tend to be shut out of the medical literature because they are not reporting anything new and, therefore, cannot have any data. The result is an impression of growing acceptance of PAS, but it really represents an artifact of a scientific bias.”

In addition, Sulmasy pointed out that studies of PAS can show trends in use but cannot answer ethical questions.

“Whether just 1 person or 100,000 persons legally avail themselves of lethal prescriptions cannot tell us whether the practice is right or wrong,” he wrote.

The number of reported cases of PAS in the United States are increasing, he wrote, but more robust data and investigation into the practice are needed.

“In Belgium and the Netherlands, 5% of all deaths are by euthanasia and the indications have expanded to include psychiatric illness and life completion. Euthanized patients are now regular sources for organ donation,” Sulmasy wrote. “Although there is no empirical proof that the United States will follow these trends if PAS is more widely adopted, the logic that justifies PAS inexorably points in this direction. Studying these trends empirically will not prevent them from occurring. Are we willing to entertain a serious ethical debate, based on reasoned argument, or will we be content merely to file empirical reports on whatever fate befalls us?”