(Reuters Health) - Even when physician-assisted suicide is legal, doctors often have reservations about helping patients die, two European studies suggest.
In one study, researchers reviewed euthanasia requests made to the End-of-Life Clinic, established in The Netherlands in 2012 to provide the option of physician-assisted suicide to people who met legal requirements for this possibility but couldn’t convince their regular physicians to approve it.
The clinic granted just 25 percent of the 645 requests received from March 2012 to March 2013. Many of the remaining cases were rejected, though in some instances patients died or withdrew their request before their situation was assessed, according to the study in JAMA Internal Medicine.
“Some physicians may reject requests based on personal considerations, but the physician might also reject requests because he/she is not sure a case will meet the due care criteria that are laid down by the law,” lead study author Marianne Snijdewind of the University of Amsterdam said by email.
To legally assist with suicide in The Netherlands doctors must, among other things, verify that the patient is making the request voluntarily, has unbearable suffering without any prospects for improvement, and fully understands his or her situation, Snijdewind said.
These requirements may explain why doctors in the study were more willing to approve euthanasia requests from patients with physical suffering, tied to conditions such as cancer and cardiovascular disease, than from people seeking suicide help only for psychological problems, she added.
A related study in the same journal surveyed doctors in Flanders, Belgium, and found the prevalence of physician-assisted suicides increased from 1.9 percent of all deaths in 2007 to 4.6 percent in 2013.
The prevalence of euthanasia increased across all patient groups and all healthcare settings, the researchers found. Among suicide requests, and among those granted by physicians, cancer was the most common affliction.
The most pronounced gains in the frequency of requests came from people who were age 80 and older, college-educated, or with cardiovascular disease.
Granted requests increased most dramatically among women, people 80 and up, less-educated patients, and nursing home residents.
The increased use of euthanasia was expected, said lead study author Sigrid Dierickx, an end-of-life care researcher at Vrije Universiteit Brussel and Ghent University.
“During the first years after legalization physicians may have been more hesitant to grant and perform euthanasia,” Dierickx said in an email.
In both Belgium and The Netherlands, physician-assisted suicide has been legal since 2002.
Some of the gains in granted requests in both countries suggest that, ethically, doctors may be treading a slippery slope, Dr. Barron Lerner and Arthur Caplan of New York University Langone Medical Center write in an editorial accompanying the studies.
Most troubling is the roughly 7 percent of people in the Dutch study who obtained euthanasia and were categorized as tired of living, as well as the almost 4 percent who reported only psychological suffering, they wrote. The fact that half of granted requests included loneliness as part of the suffering is also cause for concern.
In the Belgian study, the rising number of requests from potentially vulnerable populations such as nursing home residents and those with limited education also merit ethical scrutiny, they note.
“As the number of overall deaths like this becomes more frequent than 1 in 20, say, I think red flags really need to be raised,” Lerner said by email.
“Most of us were trained to never condone speeding death at all,” he added. “To the degree that some physicians are comfortable doing so, they will be in cases in which someone has an intractable physical suffering that will only persist or get worse; it is quite a leap for most of us to also see psychological suffering as a valid reason for speeding death.”