April 18, 2024

Major gaps persist in knowledge of the practice of assisted suicide and euthanasia

Even 25 years after legalisation in Oregon

On November 8, 1994, the citizens of Oregon voted in favour of a Death With Dignity Act. It took a couple of years for the initiative to be implemented, but since 1997, according to official statistics, prescriptions for lethal medications have been written for a total of 2,217 people; 1,459 people have actually died.

Even though assisted suicide has been legal in Oregon for 25 years, there are big gaps in our knowledge of how assisted suicide and euthanasia work.

An article in BMJ Supportive & Palliative Care by two Belgian physicians outlines the shortcomings in research. Here are some of its findings:

More than 180 million people now live in a jurisdiction where they can legally access some form of medical aid in dying – the Netherlands, Belgium, Luxembourg, Switzerland, Colombia, Canada, eight American states, and one Australian state.

In some jurisdictions, research is quite difficult as there are no legally required reporting procedures. In some of them mentioning “medical aid in dying” on a death certificate is forbidden.

“One major caveat of studying MAiD practice through the reported cases is that it suffers from an under- reporting bias. Studies have estimated that, even several years after legalisation, from 1/5 (the Netherlands) to 1/3 (Belgium) [of] cases is [sic] not reported.”

“More in-depth knowledge overall is needed into the MAiD decision- making process, especially concerning vulnerable population groups such as the oldest old and people suffering from severe mental illness … most research on MAiD practice has been limited to interviewing or surveying physicians. More research exploring the narratives from patients and patients’ relatives is particularly needed to gain a more complete picture.”

“Research on the link between MAiD practice and palliative care and quality of care remains … scarce. For instance, more research is needed on how legal MAiD practice influences palliative care practice on a daily basis and how palliative care professionals experience MAiD being practised in a palliative care context.”

“Concerns are also expressed regarding the possibility of people feeling pressured towards requesting euthanasia due to feeling a burden for their relatives and society in general and the fear that MAiD is seen too soon as a solution for suffering. Therefore, there is a knowledge-need about how MAiD legislation eventually affects societal discourses regarding palliative care, suffering, old age and dying.”

“The absence of an in-depth examination of the possible impact of involvement in MAiD procedures on relatives’ health, well-being and bereavement care needs remains an important gap in our understanding of the process and consequences of the practice.”

Michael Cook is editor of BioEdge   

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