The Economist explains: How doctor-assisted dying works by N.L.

Courtesy of The Economist | 07.29.2015 | By N.L.


THOSE who are terminally ill have long sought help to end their lives from friends or doctors. When a doctor is involved, it is called physician- or doctor-assisted suicide. This is legal only in a few places: Belgium, the Netherlands and Switzerland have laws governing the practice, as do five American states. (Attempts to allow it in New Mexico remain stuck in legal limbo for now.) Belgium and the Netherlands also allow voluntary euthanasia, where the doctor administers the fatal medicine at the patient’s request, rather than leaving the patient to take it. Doctor-assisted dying is an umbrella term for both. (Physician-assisted dying and medically assisted dying are also used.) In California, a bill approving doctor-assisted suicide passed the senate earlier this month. If it is approved by the state assembly and signed by the governor before September 11th, a form of doctor-assisted dying will become legal in one of the most populous states, home to 40m people.

Oregon was the first state to legalise assisted suicide. The process begins when a patient with less than six months to live requests help to end his life. He must ask twice, at least 15 days apart, and then make a written, signed request to a second doctor. He is then referred to a consultant for a second opinion on whether his condition is indeed terminal and to verify that he is mentally competent to make decisions about his health. He must also be told about alternatives such as hospice care, advised to talk to his family and told that it is all right to change his mind at any time. Then his own doctor must write a prescription for a lethal dose of drugs and find a pharmacist willing to dispense it. Doctors and pharmacists may refuse to participate if they have religious or moral objections. Since the law came into effect in 1997, almost four-fifths of those who have used it have had a malignant cancer. They were overwhelmingly white and typically well-educated; most were concerned with loss of autonomy, an inability to engage in activities that make life enjoyable and loss of dignity. Only a fifth cited pain or the fear of it as their reason for wanting to die.

In Oregon, the most commonly prescribed drug is a barbiturate called secobarbital; pentobarbital is also used. Doctors also prescribe an anti-nausea drug, which is taken about an hour beforehand, to stop the patient vomiting the barbiturate before it takes effect. Sometimes morphine is used instead of barbiturates. In the Netherlands, a neuromuscular relaxant may also be given. In voluntary euthanasia, the doctor administers the drugs, usually intravenously. Where this is allowed, it accounts for the large majority of all doctor-assisted deaths.

Those who object to assisted suicide point to possible complications, and worries that the drugs will cause distress or panic, or that the patients might vomit and then choke. According to a Dutch study, the complication rate associated with using barbiturates is 7%. For voluntary euthanasia, it is lower: just 3%. The most common problem was that it took longer than expected for the patient to become comatose or to die. Oregon’s detailed data are also informative. Of 1,327 people who were prescribed lethal drugs over the years, only 859 actually took them. The state has no information about how 329 of them died; for 507 of the remaining 530, no complications were reported and 22 regurgitated the drugs. Though the median time between swallowing the dose and becoming unconscious was five minutes, and to dying 25 minutes, the longest a patient took to die was around four days. Even a death hastened at a patient’s wish does not always come as swiftly as desired.

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