Despite dire predictions, “vulnerable” populations including the elderly, the poor, disabled and minorities do not make up a disproportionate number of the deaths in areas where physician-assisted death is legal, according to international research led by a bioethics expert from the University of Utah.Margaret Battin, distinguished professor of philosophy and adjunct professor of internal medicine, and three colleagues from the Netherlands wanted to see if evidence existed to support the oft-used “slippery slope” claims regarding physician-assisted dying, she said. Those predictions have come from heavy hitters of all types, including medical associations in the United States, Canada and Britain, and have sparked concern even among proponents of assisted death.

The researchers looked at the experience in Oregon and the Netherlands, where people can receive help from a physician to die. They focused on 10 populations, including those with disabilities, low socioeconomic status, HIV/AIDS, low education levels or psychiatric issues — all factors believed by many to make one more vulnerable. Only in the case of AIDS did they see evidence of more deaths, Battin said. In the other nine categories, rates were actually lower.

The study was released Wednesday and is published in the October issue of the Journal of Medical Ethics.

In the nine years since the law took effect in Oregon, where a doctor can prescribe lethal drugs to patients diagnosed by two doctors as having a terminal illness and less than six months to live, 456 patients received lethal prescriptions and 292 used the drugs to kill themselves. That’s 0.15 percent of all deaths in Oregon during that time.

In the Netherlands, a physician can either administer a life-ending medication or prescribe one a patient can take himself. The law requires “intolerable suffering,” but not terminal illness. Of 136,000 deaths each year in the Netherlands, about 1.7 percent are by voluntary active euthanasia, 0.1 percent by physician-assisted suicide and 0.5 percent are “extralegal” because they involve patients with no current explicit request to die, but who made one before becoming incompetent or are perceived to be suffering intolerably, researchers said. The study centered on cases in the Netherlands between 1985 and 2005, while the Oregon data covers 1998-2006.

In both places, those most likely to choose a physician-assisted death had an average age of 70, and 80 percent of them had cancer. Slightly more men than women chose physician-assisted suicide.

During the nine years in Oregon, only six AIDS patients died with a physician’s assistance, 2 percent of all deaths under the law. But the researchers said that “persons with AIDS were 20 times more likely to use assisted dying” than a comparable group of patients without the disease who died of chronic respiratory disorders. In the Netherlands, of a group of 131 gay men in Amsterdam diagnosed with AIDS from 1985-1992 and who died by 1995, 22 percent chose physician-assisted suicide or euthanasia. The researchers said that rate might be lower now because of medicines that let many patients live with AIDS as a chronic illness.

“There’s no case in Oregon where someone with a disability but not also with a terminal illness chose this,” Battin said.

The analysis included data that was clear and some from which inferences were made, she said. For instance, data clearly provided gender, age and terminal diagnosis for Oregon. But for the Netherlands, socioeconomic status was inferred from a postal code. “Such data is recognized to be less strong,” Battin said, “but it is still informative.

“We recognized considerable differences in the strength of the data, but we did see a common picture in these two jurisdictions. This should put to rest some of the more florid concerns.”

The experience with physician-assisted suicide is important because other jurisdictions, including several U.S. states, are considering such laws, and the “slippery slope” argument is a regular in the debates, she said.

“This practice is reported everywhere, and it’s a heavily debated issue, particularly in countries with advanced health-care systems, where the average life expectancy is quite long and diseases with downhill courses are frequent,” Battin said.

The other researchers were Dr. Agnes van der Heide of Erasmus Medical Center, Rotterdam; psychiatrist Dr. Linda Agenizing at Oregon Health & Science University, Portland; and Dr. Gerrit van der Wal and health scientist Bregje Onwuteaka-Philipsen, of the VU University Medical Center, Amsterdam. Van der Wal is inspector general of The Netherlands Health Care Inspectorate, which advises that nation’s health minister.

By Lois Collins http://deseretnews.com/dn/view/0,5143,695213548,00.html