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Assisted suicide vulnerability
scores
AIDS patients —
In Oregon, AIDS patients represented 2% of PASs.
AIDS patients were more likely to use assisted
suicide than "a comparable group of non-AIDS patients
who died of chronic respiratory disorders." On
top of this, among 131 Dutch homosexual men diagnosed
with AIDS between 1985 and 1992 and dying by 1995,
22% of deaths were by PAS or euthanasia. "We suspect
that this is a phenomenon of the era prior to
the development of effective AIDS therapies, which
has changed since 1995," says Dr Battin.
Women — Data from
Oregon and the Netherlands found that women were
slightly less likely than men to die by PAS.
Elderly — In Oregon,
PAS more common among people aged 18-64 than over-65s.
Likewise, Dutch rates were higher for under-80s.
Poor — PAS rates
were were more common among affluent Oregonians,
the authors conclude. Rough Dutch measures, based
on postal codes, suggest the poor use PAS as much
as the rich.
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Society's most vulnerable don't
die disproportionately when physician-assisted suicide
(PAS) is legal, according to a study in the October
Journal of Medical Ethics.
The 'slippery slope' theory is
widely accepted by opponents and supporters of PAS alike.
The idea is that physicians, family and health insurers
may be able to bully vulnerable patients to request
PAS, even if they don't want it. "If it were to be the
case, it would require some serious rethinking. But
nobody's looked at the data," says study co-author and
philosophy professor Margaret Battin, PhD, of the University
of Utah. "There may be pressures on all people with
terminal illnesses. The question is if there's more
in certain people."
The study looked at data from Oregon,
where PAS is legal, and from the Netherlands, where
both PAS and euthanasia by physicians are legal. Oregon
data consisted of annual reports on 292 PASs from the
Department of Human Services issued since the Oregon
Death with Dignity Act (ODDA) came into effect in 1997,
as well as three surveys of physicians. Dutch data are
from government-commissioned studies dating back to
1990, covering 2,400 PASs and euthanasias.
Of the 10 groups identified as
vulnerable, PAS rates looked suspicious in only one:
AIDS patients (see Assisted suicide vulnerability scores,
above, for details).
FINDINGS
OPPOSED
The study quickly drew fire from PAS opponents. Criticism
was levelled at Dr Battin for not disclosing her organizational
affiliations as conflicts of interest, including her
role as advisor to the Death with Dignity National Center,
a non-profit organization which defends the ODDA.
Dr Battin admits she probably should
have disclosed her position, but insists she has nothing
to hide. "Conflict of interest disclosures are usually
for financial interests, and this was a grant-free project.
There were five scrupulous authors, and people are aware
of my work, too." She suggests that if no one performed
studies in which they had interests, nothing would ever
get done.
Further critiques point to soft
data, suggesting that physician reports are vulnerable
to creative editing by reporting doctors. "For many
of the variables, like age, race and gender, it seems
improbable that doctors lied," says Dr Battin.
Dr Battin defends her methods,
noting that where the data set overlapped, findings
were largely consistent between the Oregon and Dutch
data.
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