X-Message-Number: 13297
Date: Thu, 24 Feb 2000 22:22:02 -0500
From: Jan Coetzee <>
Subject: Complications Found With Doctor-Assisted Suicides

Complications Found With Doctor-Assisted Suicides

BOSTON (Reuters) - When a doctor hastens the death of a terminally ill
patient, the end is not
always easy or peaceful, researchers report in Thursday's New England
Journal of Medicine.

The scientists from the Netherlands, where euthanasia and
physician-assisted suicide have been
legal for years, found that such efforts frequently go awry.

When patients tried to kill themselves using drugs prescribed by a
doctor, the medication did not
work as expected in 16 percent of the cases. In addition, technical
problems or unexpected side
effects occurred 7 percent of the time.

Problems surfaced so often, doctors witnessing the attempted suicide
felt compelled to intervene
and ensure death in 18 percent of the cases, according to the report.

Even when the doctor was directly performing euthanasia, the researchers
found, complications
developed in 3 percent of the attempts. Patients either took longer to
die than expected or awoke
from a drug-induced coma that was supposed to be fatal in 6 percent of
the cases.

``This is information that will come as a shock to the many members of
the public -- including
legislators and even some physicians -- who have never considered that
the procedures involved
in physician-assisted suicide and euthanasia might sometimes add to the
suffering they are meant
to alleviate,'' Dr. Sherwin Nuland of Yale University School of Medicine
said in an
accompanying Journal editorial.

The new study, led by Dr. Johanna Groenewoud of Erasmus University in
``introduces a new element into the calculus'' of the U.S. debate over
physician-assisted suicide,
said Nuland, ``one that should have made its appearance long ago:
patients who wish to receive
help in dying face a small but nevertheless worrisome possibility that
some untoward event will
prevent the smooth accomplishment of their wish.''

Nuland said the underlying problem is that ``doctors are unprepared to
end life'' and those
practicing in areas where physician-assisted suicide is legal should
learn how to hasten death
without suffering.

``Once the decision to intervene has been made, the goal should be to
ensure that death is as
merciful and serene as possible,'' he said.

Groenewoud's group reviewed 649 cases: 535 cases where the doctors
intended to perform
euthanasia and 114 where they intended to provide assistance.

In the 114 cases, Groenewoud's group found two people awoke from their
coma and 14 either
did not become comatose from the fatal drug or took longer to die than
expected. In addition,
seven had difficulty swallowing the deadly drug prescribed by the
doctor, four vomited after
taking the drug, and three developed extreme gasping.

Complications were less common during the doctor-controlled euthanasia
attempts, but problems
still surfaced.

In five of the 535 attempts where a doctor was present, the patients
awoke from the coma and
death took longer than expected in 23 cases.

``In one case, that patient's eyes remained open, and in another case,
the patient sat up,'' the
researchers reported.

Nuland said the research demonstrated the wisdom of the Royal Dutch
Medical Association's
recommendation that a doctor be present when euthanasia is attempted.

Thursday's Journal also included two studies conducted in Oregon where
suicide became legal on Oct. 27, 1997.

Neither report mentioned complications arising from the attempts. But
Nuland said he suspected
the results of the Dutch study were typical, and similar problems in
Oregon either had not been
reported or will start to surface soon.

In 1998 and 1999, 57 terminally ill people in Oregon received
prescriptions for lethal doses of
medicine; 43 used the drugs to take their own lives.

When the Oregon law was being debated, critics fretted that it would
hasten the death of people
who were poor, ill-educated or lacked health insurance.

Those fears have not been borne out, said a team led by Amy Sullivan of
the Oregon Health
Division. ``Although concern about possible abuses persists, our data
indicate that poverty, lack
of education or health insurance, and poor care at the end of life were
not important factors in
patients' requests for assistance with suicide.''

Based on interviews with doctors and family members, the Sullivan team
found that the people
who sought the option of killing themselves feared losing their
autonomy, not being able to
participate in activities that made life enjoyable, and losing control
of bodily functions.

In another Journal study, which focused on the effects of the Oregon law
from the doctor's
perspective, Dr. Linda Ganzini and her colleagues at the Oregon Health
Sciences University
found that physicians granted only one in six requests for lethal
medication, and only one in 10
requests actually resulted in suicide.

They also found that many patients changed their mind about suicide
after doctors tried to
intervene to make their final days more comfortable.

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