No 'Slippery Slope' Found With Physician-Assisted Suicide

SALT LAKE CITY, Sept. 27 -- Forecasts that physician-assisted suicide and euthanasia would be practiced disproportionately on vulnerable groups, such as the poor, the elderly, and women, did not prove accurate, according to researchers here.

The finding came from a multi-year analysis of data from Oregon, where physician-assisted suicide became legal in 1997, and Holland, where both physician-assisted suicide and euthanasia are legal, said Margaret Battin, Ph.D., of the University of Utah, and colleagues in Oregon and The Netherlands.

The researchers found no evidence that people in nine of 10 vulnerable groups died more often as a result of either physician-assisted suicide or euthanasia, they reported in the October issue of the Journal of Medical Ethics.

The bottom line, they said, is that there is "no current factual support for so-called slippery-slope concerns about the risks of legalization of assisted dying -- concerns that death in this way would be practiced more frequently on persons in vulnerable groups."

AIDS patients were the only group that used doctor-assisted suicide at elevated rates, Dr. Battin and colleagues found.

"Fears about the impact on vulnerable people have dominated debate about physician-assisted suicide," Dr. Battin said. "We find no evidence to support those fears where this practice already is legal."

If anything, Dr. Battin and colleagues found, people taking advantage of doctor-assisted suicide and euthanasia tended to be slightly better off economically and better educated than average.

In Oregon, the Death with Dignity Act allows doctors to prescribe lethal drugs to patients who have been diagnosed by two physicians as having a terminal illness with less than six months to live.

In Holland, the law also allows a doctor to administer the medications in what is called "voluntary active euthanasia."

Dr. Battin and colleagues found that 292 people died under the provisions of the Oregon law in its first nine years, about 0.15% of those who died in the state during that time.

In Holland, fewer than 2% of all deaths are by voluntary active euthanasia and physician-assisted suicide combined, showed 2005 mortality data on 136,000 deaths in the country.

Compared with background populations, the researchers found the elderly, women, people with low educational status, the poor, the physically disabled or chronically ill, minors, those with psychiatric illnesses including depression, or racial or ethnic minorities did not have elevated rates of doctor-assisted dying.

In Oregon, for example, 21% of all deaths occurred among people 85 or older -- but only 10% of those who asked for a doctor's help were in that age category. In fact, those ages 18 through 64 were more than three times as likely to receive assisted dying as those older than 85.

Over the nine years, 46% of those who used the Oregon law were women. In The Netherlands, although the numbers fluctuated, men were generally in the majority.

The issue of health insurance doesn't apply to Holland, where all patients have coverage, but in Oregon, there was no sign that those without insurance were helped to die more often.

Of the 292 deaths, the researchers found, there was no documented health insurance in three and insurance status was unknown in four -- about 2.4%. In contrast, 16.9% of Oregon adults under the age of 65 were uninsured.

On the other hand, Dr. Battin and colleagues said, those with AIDS seemed to use the assisted suicide laws more often.

In Oregon, six patients with AIDS died under the act, or 2% of the total. That was 30 times the rate of those in a reference group of people with chronic respiratory disorders.

In Holland, few patients with AIDS have received a doctor's aid in dying, the researchers said. But in one Amsterdam cohort -- 131 men with AIDS who died before Jan. 1, 1995 -- 22% died by euthanasia or physician-assisted suicide.

The researchers cautioned that the data from the two countries are often difficult to compare. "Where they do overlap, however, the studies are largely consistent," Dr. Battin and colleagues said.