[Right_to_die] No big slippery slope in the Netherlands, study finds

[org.opn.lists.right-to-die at lists.opn.org]

CBC news in Canada reported:

Dutch Euthanasia Rates Steady After Legalization
Published: Wednesday, May 9, 2007
Canadian Press: AMANDA GARDNER, HEALTHDAY REPORTER

(HealthDay News) - Since euthanasia and physician-assisted suicide were 
legalized by the Dutch in 2002, use of the practices has dropped 
slightly and now has stabilized, a new report finds.

That marks an abrupt turnaround from trends during the last 10 years, 
say the authors of a study in the May 10 New England Journal of Medicine.

In the United States, physician-assisted suicide is legal only in the 
state of Oregon, while euthanasia is not legal in any state.

"One lesson is there's not a big slippery slope in this area, that the 
practice will be used relatively infrequently and that it's generally a 
good thing to have an open conversation," said Dr. Timothy Quill, 
director of the Center for Ethics, Humanities and Palliative Care at the 
University of Rochester Medical Center in Rochester, N.Y. He also wrote 
a related perspective article in the journal.

Dr. Nancy W. Dickey, president of the Texas A&M Health Science 
Center and vice chancellor for health affairs for the Texas A&M 
System, agreed. "Neither Oregon nor the Netherlands appear to have 
started down a slippery slope," she said. "Also, physicians have become 
better equipped to offer a wide variety of palliative care, leading them 
to become more effective at it and very rarely having to resort to 
assisted death," she said.

In the Netherlands, euthanasia is defined as death resulting from 
medication administered by a physician with the intention of hastening 
death at the request of the patient. In assisted suicide, the patient 
hastens death by giving him or herself medication prescribed by a 
physician.

Although neither procedure was legal in the Netherlands in the early 
1990s, physicians were generally not prosecuted if they had adhered to 
certain requirements.

"The passing of the law was a formalization of a practice that the 
Netherlands freely admitted occurred on a less-than-rare basis," Dickey 
said.

In 1990, the reporting rate for euthanasia and physician-assisted 
suicide was 18 percent. An official reporting procedure was established 
in 1993, after which the reporting rate climbed to almost 41 percent.

"An important goal of the euthanasia law in the Netherlands is to 
achieve public control of this practice," said study co-author Bregje 
Onwuteaka-Philipsen, associate professor at the VU University Medical 
Center in Amsterdam, EMGO Institute/Department of Public and 
Occupational Health. "The increase in the reporting of euthanasia and 
physician-assisted suicide to the review committees, from 18 percent in 
1990, through 41 percent in 1995 and 54 percent in 2001 to 80 percent in 
2005, shows that that goal of the law is met."

According to Onwuteaka-Philipsen, approximately 8,400 people per year 
explicitly request euthanasia or physician-assisted suicide, at which 
point physicians must determine whether or not to grant the request 
according to legal criteria. This results in approximately 2,300 cases 
of euthanasia and 100 cases of physician-assisted suicide per year 
which, together, make up 1.8 percent of all deaths in the Netherlands.

For this study, researchers mailed questionnaires to doctors who had 
attended 6,860 deaths. More than three-quarters (77.8 percent) of 
physicians responded.

In 2005, 1.7 percent of all deaths in the Netherlands were the result of 
euthanasia and 0.1 percent were the result of physician-assisted 
suicide. This a substantial decrease from 2001, when 2.6 percent of all 
deaths resulted from euthanasia and 0.2 percent from assisted suicide.

"The euthanasia law did not coincide with an increase of the practice," 
noted Onwuteaka-Philipsen.

In 2005, 0.4 percent of all deaths were the result of the ending of life 
without an explicit request by the patient.

In 7.1 percent of all deaths in 2005, continuous deep sedation was used 
in conjunction with a possible hastening of death. This was an increase 
from 5.6 percent in 2001.

Why the decrease in overall euthanasia and physician-assisted suicide?

"We have three likely explanations," Onwuteaka-Philipsen said. "The 
first one is a demographic one. The percentages of deaths of people of 
80 years and older was higher in 2005 than in 2001. Since euthanasia and 
assisted suicide relatively infrequently occur in this age group, this 
explains a small part of the decrease."

Other explanations include improvement in palliative care as well as 
changing opinions and knowledge as to the effects of opioids.

"There has been increasing evidence that the potentially life-shortening 
effects of opioids are often overestimated, making physicians less 
inclined to attribute life-shortening effects to opioids," 
Onwuteaka-Philipsen said.

According to the perspective piece, the palliative care movement has 
grown similarly robust in the United States, albeit with some disparities.

"Clearly, we're moving in a direction of widespread acceptance and 
growth of palliative care as the standard of care for people who are 
dying," Quill said. "In the last 10 years, there is a wider acceptance, 
but there's still going to be some tough cases, and we will have to 
figure out ways to respond to those cases."

And disparities remain, Dickey added.

"We have made substantial progress 1/8in end-of-life care 3/8, but we 
probably do not pay it enough attention in this country," she said. "One 
of the most troubling statements in the perspective paper was that this 
is still largely limited to people who are white, relatively educated, 
insured and enrolled in hospice. I can think of few disparities that are 
more troubling to my soul than the thought that we give 
less-than-satisfactory end-of-life care to the poor, to the less 
well-educated, to the newest immigrants. We're not there yet."