More people can ask for help in dying, but very few do

Anyone who feared that making physician-assisted suicide legal would lead to an onslaught of assisted deaths can relax.

A new study led by University of Pennsylvania bioethicist Ezekiel Emanuel finds that only a tiny fraction of the dying want help speeding up the process. However, Emanuel is concerned about the reasons people are choosing to die - horrible pain is sixth on the list - and says doctors remain less supportive of assisted suicide than the general public.

He said that the topic requires more study and that states that have legalized it should be keeping much better records of problems that patients encounter. Oregon, he said, does not consider it a complication if a patient regains consciousness after taking medication meant to kill him. While people die, on average, within 25 minutes after taking a lethal dose, the range extends to more than four days.

Emanuel has a long interest in physician-assisted suicide, and he opposes it. He said he purposely included researchers on his team from the Netherlands and Belgium who support it.

The subject is important now, he said, because the number of places with legal physician-assisted suicide is growing, though slowly.

Euthanasia or physician-assisted suicide are now legal in the Netherlands, Belgium, Luxembourg, Colombia, and Canada. Physician-assisted suicide alone is legal in five states - Oregon, Washington, Montana, Vermont, and California - as well as Switzerland.

In euthanasia, someone else actively causes the death. In physician-assisted suicide, a doctor prescribes lethal medications, but the patient must take them himself. Advocates prefer terms like medical aid in dying or death with dignity, but Emanuel said physician-assisted suicide is the term best understood by the international audience of the Journal of the American Medical Association, which published the study Tuesday.

Compassion and Choices, a group that advocates for medical aid in dying, said bills supporting the approach have been introduced in 26 states, including Pennsylvania and Delaware, in the last two years.

Emanuel said polls show that public support in the United States for euthanasia and physician-assisted suicide plateaued in the 1990s at 47 percent to 69 percent. Support has continued to grow in Western Europe, while it is decreasing in Central and Eastern Europe.

Data on physician beliefs are muddled because of poll quality, the study said, but the numbers are generally lower than those for the general public. Doctors are more supportive of physician-assisted suicide than euthanasia. "Doctors don't want to be the ones injecting, by and large," Emanuel said.

The study compared data on assisted-death cases reported in Oregon, Washington, and the Netherlands in 2015 and Belgium in 2013. Between 0.3 and 4.6 percent of deaths were reported as euthanasia or physician-assisted suicide. Both U.S. states were well under 1 percent.

Emanuel, who is chair of the department of medical ethics and health policy at Penn, said patients were similar across locations. More than 70 percent had cancer. Typically, they were older, white, and well-educated.

The process appeals to people who have been in "control of every part of their life," he said. "They want to control this, too."

In the U.S. states, more than half of those who chose physician-assisted suicide said they did so because of concerns about losing autonomy or dignity and being less able to do things that made life enjoyable. Losing control of bodily functions and being a burden to their family and friends came in above pain. About a fifth said pain was an issue.

Emanuel said he saw those numbers as a sign that cancer patients should be getting better care for emotional distress. "There are things we can do for these patients, and maybe we should try a little harder before throwing up our hands," he said.

In addition, he said, most people are less supportive of physician-assisted suicide for emotional disorders than they are for pain.

He thinks the more important issue is how care can be improved for dying patients. Physician-assisted suicide "doesn't address the whole issue of improving end-of-life care," Emanuel said, "and that, I think, should be the focus."

sburling@phillynews.com

215-854-4944 @StaceyABurling