A new survey published in the April 23 New England Journal of Medicine finds that few doctors have ever assisted a patient’s suicide — but that over a third would do so if the practice were legalized. “This is really not happening very often,” says survey co-author Dr. Diane Meier of New York’s Mount Sinai School of Medicine. “That’s the most important finding. It’s a rare event” [Associated Press, 4/23/98]. The survey was based on a questionnaire sent in 1996 to 3,102 physicians under the age of 65; 1,902 doctors responded anonymously.
In all, 11% of respondents said they had ever received a request for a lethal injection (euthanasia) and 18% said they had been asked for a prescription for an overdose of pills to end life (assisted suicide). Five percent said they had ever given such an injection, while 3 % had written a lethal prescription; since some doctors had done both, the cumulative total of doctors who had ever helped deliberately end a patient’s life was 6%.
While most of those who engaged in such behavior had done so only once or twice, one doctor claimed to have written 25 prescriptions and given 150 lethal injections. While responses were confidential and untraceable, the authors note that the survey may underreport these practices. On the other hand, the surveys were deliberately sent to doctors in ten specialties identified in previous surveys as “those in which physicians are likely to receive requests from patients for assistance in hastening death” [New England J. of Medicine, 4/23/98, p. 93].
Thus the survey may overestimate the percentage of all U. S. physicians who have assisted suicides or performed euthanasia. The survey found that these practices are most common on the West coast, where one state, Oregon, voted to legalize assisted suicide in 1994 [p. 4]. Earlier surveys, usually confined to a particular state or region, had produced higher estimates for the frequency of assisted suicide or euthanasia [e. g. , “1 in 5 Doctors Say They Assisted a Patient’s Death, Survey Finds,” Boston Globe, 2/28/92].
The new survey differed from these in having its questions tested beforehand with focus groups of physicians, to minimize confusion between these practices and medical actions which may indirectly or unintentionally hasten death. Noting that 36% of doctors in the survey said they might assist suicides if the practice were legal, the Hemlock Society declared that the results support its position favoring legalization. “The survey demonstrates that compassionate doctors want to help their patients but hesitate to do so under threat of legal and professional sanctions,” said Hemlock executive director Faye Girsh [News release, 4/23].
In fact Hemlock and other supporters of assisted suicide have generally claimed just the opposite: That legalization would not significantly increase the total number of assisted suicides, but simply bring a covert practice out into the open where it could be limited and regulated. The survey results contradict that claim. Simultaneously with the publication of the survey results, co-author Dr. Diane Meier published an opinion piece in the New York Times explaining her own change of heart on the assisted suicide issue.
She says that she once favored legalization, but “after caring for many patients myself, I now think that the risks of assisted suicide outweigh the benefits. ” Proposed safeguards in laws like Oregon’s, she argues, are “unrealistic and largely irrelevant to the reality faced by the dying” — for example, ensuring that a patient’s choice is not coerced is “an impossible task. ” She adds that “legalizing assisted suicide would become a cheap and easy way to avoid the costly and time-intensive care needed by the terminally ill” [Diane Meier, “A Change of Heart on Assisted Suicide,” The New York Times, 4/24].