Wednesday February 23 5:23 PM ET
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 Rotterdam, "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 physician-assisted 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.