Data - Events- Outside Canada

Data Bits

"Data Bit" is a feature that has appeared in Free To Go, the cooperatively-produced newsletter of Canada's anglophone right-to-die groups, since issue 6:1 (Jan.-Mar. 2004).

RTDSC Newsletter 3:4

The number: 0%

     What it is:

The degree of negative change in the quality and availability of palliative care, in places where aid in dying has been legalized.
Figures from Belgium, Switzerland and the Netherlands were compared with figures from France, Germany and Spain.

     Discussion:

The researchers found that no deterioration in palliative care had followed upon the establishment of formal policies permitting euthanasia and/or assisted suicide.
In some countries, notably Belgium, palliative care and assisted dying are quite closely linked. "In Belgium all palliative-care options must be disclosed to the patient, many institutions demand a palliative-care consultation when euthanasia is requested, and the highest prevalence of euthanasia or assisted suicide is found in palliative-care units."

Issue 9:3 (Jul.-Sep. 2007)

The number: 0

     What it is:

The amount of support found for the frequently made claim that legalizing euthanasia or assisted suicide (EAS) endangers the vulnerable – racial/ethnic minorities, women, the poor, people with little education, etc.

     Discussion:

Researchers examined reports from Oregon (back to 1998) and the Netherlands (back to 1990) to see if EAS use in 10 "vulnerable" population groups was out of proportion to the group's size. In all groups but one (AIDS patients) it was not.
Instead, EAS use by well-off and well-educated mature males was out of proportion to their numbers. This suggests that it is correct to view EAS as a benefit rather than a harm, since things that this group gets more of are usually benefits.

     When published:

September 2007 (in Journal of Medical Ethics vol. 33, no. 10, pages 591-597)

For more information:
http://www.euthanewsia.ca/archive/anno/en-sltribune-070927.html

Issue 8:4 (Oct.-Dec. 2006)

The number: 31 percentage points

     What it is:

The difference between (a) the percentage of doctors in Italy, Sweden and Denmark ("non-permissive" countries with respect to aid in dying) who consult patients about end-of-life decisions, and (b) the percentage of doctors in Belgium, Switzerland and the Netherlands ("permissive" countries) who consult patients. In the 3 non-permissive countries, about 50% of doctors consult patients (competent ones, of course); in the 3 permissive countries, 81% of doctors consult with patients. When patients are not competent, and only the patients' relatives are available for consultation, there is an even greater difference: 44% in the non-permissive countries, and 77% in the permissive countries.

     Discussion:

It does not seem likely that patients' interests are better served by non-consultation than by consultation. Policy-makers in non-permissive countries often claim to be "protecting the vulnerable", but this seems to mean protecting them from themselves.

     When published:

October 16, 2006 (in Palliative Medicine vol. 20, no. 7, pages 653-659)

For more information:
http://pmj.sagepub.com/cgi/content/abstract/20/7/653
The title of the article is "Characteristics of end-of-life decisions" and the author is Clive Seale.

Issue 8:3 (Jul.-Sep. 2006)

The number: 15 %

     What it is:

The percentage of Dutch doctor-assisted suicide cases, in 2005, which turned into euthanasia cases -- the patient-initiated dying was so slow that the attending physician intervened and provided euthanasia (in 25 of 168 cases)

     Discussion:

This can happen in the Netherlands because the doctor is always present, even when the patient tries to be the active party. In Oregon, by contrast, the patient's doctor was present in only 11 of the 25 assisted-suicide cases during 2005.
There are probably many factors involved in the Oregon situation:
• Oregon doctors know that whether or not they attend, their patients can call upon Compassion & Choices to provide a knowledgeable and understanding companion;
• Patients often choose to exit in the morning, when they are relatively strong after a night's sleep, but doctors may find it hard to attend at this time of day;
• Healthcare in Oregon is provided and funded through many different frameworks, and with some of these there is a financial disincentive for the doctor – a private-pay physician is not compensated for time spent supervising an exit, and health-insurance companies paying a claim count only the days up until the day the patient exits (however, Oregon doctors who are salaried or are part of an HMO do not have financial disincentives, being in much the same situation as Dutch doctors, most of whom are salaried);
• Finally, Oregon doctors know that even if the dying does not proceed as expected (and in one 2003 case the patient took 48 hours to die) there is nothing they can do about it, because the Oregon law prohibits lethal injections.

     When published:

The numbers cited are contained in a booklet entitled "Helping People to Die in Dignity in the Netherlands", written by Dutch doctor Aycke Smook and published in 2006 by ERGO .

     For more information:

Copies of the booklet were available free at the ERGO booth during the World Federation conference, and the Free To Go office has a supply; if you would like to receive one,
just ask (for our contact details, see box at bottom of last page in this newsletter).

Issue 8:1 (Jan.-Mar. 2006)

The data bit for this issue is actually a cluster of bits,
excerpted from the 2005 annual report of Compassion and Choice of Oregon. This is the nonprofit group that acts as steward of the Death With Dignity Act. By the details which it presents, the report does a good job of putting a face on Oregon's enlightened law:
• 25 clients chose to hasten their death by taking medication, 10 chose to stop eating and drinking, and 35 chose a referral to hospice
• Of the 25 who used medication (9 grams of secobarbital), 22 had cancer, 2 had ALS, and one had severe heart disease
• 14 of the 25 were men and 11 were women
• 24 had family members with them when they exited, 11 also had friends present, 13 had a CCO volunteer present, 11 had their doctor present, and 5 had a hospice person present (22 of the 25 were in hospice care at the time they took the medication)
• 22 were Caucasian, 1 was Asian, 1 was Latino, and 1 was Native American
• The youngest of the 25 was 42, and the oldest was 88
• 18 had some college or post-graduate education

When published:
13 Feb 2006
( in Derek Humphry's right-to-die news list)

Issue 6:2 (Apr.-Jun. 2004)

The number: 63%

What it is:

Among 1100 New Zealand doctors who had attended a death within the previous 12 months, and who were describing the last death attended within that period, this many had taken actions which they described as (a) having a "probability death would be hastened" or (b) being "partly or explicitly to hasten death".

The vast majority of the respondent doctors (88.9%) had access to an interdisciplinary pain-management or palliative-care team.

In 380 cases the physician-assisted death action was taken without consulting the patient.

What it suggests:

"Legal or not, physician-assisted death is an international reality and New Zealand is no exception, with such actions occurring in an apparently palliative rich environment." (Kay Mitchell and Glynn Owens, authors of the study)

When published:

June 18, 2004

For more information:

"End of life decision-making by New Zealand general practitioners: a national survey" (New Zealand Medical Journal, vol. 117 no. 1196)

Issue 6:1 (Jan.-Mar. 2004)

The number: 93%

What it is:

Among the Oregonians who chose assisted suicide during 2003, this many had been receiving hospice care.

What it suggests:

Hospice programs and assisted dying are team-mates, not adversaries. Help with dying is simply there as a possible ultimate level on the continuum of care.

When published:

March 10, 2004

For more information:

Sixth Annual Report on Oregon's Death With Dignity Act: