Research / Studies


Early experience with medical assistance in dying in Ontario, Canada: a cohort study

Study by James Downar MDMC MHSc, Robert A. Fowler MDCM MS(Epi), Roxanne Halko RN MPH, Larkin Davenport Huyer MPH, Andrea D. Hill PhD, Jennifer L. Gibson PhD; in: The Canadian Medical Association Journal CMAJ, February 2020 (Link to Article)

Medical assistance in dying (MAiD) was legalized across Canada in June 2016. Some have expressed concern that patient requests for MAiD might be driven by poor access to palliative care and that social and economic vulnerability of patients may influence access to or receipt of MAiD. To examine these concerns, the authors describe Ontario’s early experience with MAiD and compare MAiD decedents with the general population of decedents in Ontario. Result: Recipients of MAiD were younger, had higher income, were substantially less likely to reside in an institution and were more likely to be married than decedents from the general population, suggesting that MAiD is unlikely to be driven by social or economic vulnerability.

Experience With the California End of Life Option Act in the First Year of Implementation

Study by Huong Q. Nguyen, PhD, RN1 Eduard J. Gelman; Tracey A. Bush, MSW, LCSW; et al, 2018 (Link)

The California End of Life Option Act (EOLOA)took effect on June 9, 2016. In response to recommendations for more comprehensive documentation of EOLOA implementation to improve end-of-life care, this study describes the experience of a large integrated health system and provides in-depth descriptions of individuals who initiated the EOLOA process.

Euthanasia embedded in palliative care. Responses to essentialistic criticisms of the Belgian model of integral end-of-life care

Article by Jan Bernheim and Kasper Raus, in: Journal of Medical Ethics, July 2017 (Link to Abstract)

The Belgian model of ‘integral’ end-of-life care consists of universal access to palliative care (PC) and legally regulated euthanasia. The empirical evidence from the euthanasia-permissive Benelux countries shows that since legalisation, carefulness (of decision making) at the end of life has improved and there have been no significant adverse ‘slippery slope’ effects.

Trajectories to seeking demedicalised assistance in suicide: a qualitative in-depth interview study

Study by Martijn Hagens, Bregje D. Onwuteaka-Philipsen, H. Roeline and W. Pasman, in: Journal of Medical Ethics doi:10.1136/medethics-2016-103660 (Link to Abstract)

In the Netherlands, people can receive (limited) demedicalised assistance in suicide (DAS) – an option less well known than physician-assisted dying (PAD). The study explores which trajectories people take to seek DAS. The study concludes that while PAD is the preferred option of people in two trajectories, obtaining PAD is uncertain and not always possible. Dissatisfaction with physician–patient communication can result in the physician not being involved in DAS, being unable to diagnose diseases and offer treatment nor offer reassurance that people seem to seek. It closes with a plea for more mutual understanding, respect and empathy for the limitations and possibilities of the position of the physician and the patient in discussing assistance in dying.

Attitudes of New Zealand doctors and nurses towards legalising assisted dying – Report to New Zealand medical and nursing associations

Report by Phillipa Malpas, Michael Wilson and Pam Oliver, University of Auckland, New Zealand (Link / PDF)

Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt and What Questions Remain?

Judith A. C. Rietjens , Paul J. van der Maas, Bregje D. Onwuteaka-Philipsen, Johannes J. M. van Delden, Agnes van der Heide in: Journal of Bioethical Inquiry, September 2009, Volume 6, Issue 3, pp 271-283 (Link)

A research into 387 files of members of DIGNITAS shows that of those members who actually completed their formal request for an accompanied suicide and who actually received a “provisional green light”, only some 14 % actually made use of an accompanied suicide with DIGNITAS.

Excerpt of the diploma thesis (PDF, in German)

Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in ‘vulnerable’ groups

Margaret P Battin, Agnes van der Heide, Linda Ganzini, Gerrit van der Wal, Bregje D Onwuteaka-Philipsen, in: Journal of Medical Ethics 2007; 33 :591–597. doi: 10.1136 / jme.2007.022335 (Link)

Research by a student of the Otto von Guericke University in Magdeburg, Germany, into 138 accompanied suicides at DIGNITAS, shows that the preparation and assessment time between becoming a member of DIGNITAS and the actual accompanied suicide is around 3 to 6 months. The study disproves claims that it is possible to travel to DIGNITAS one day and receive access to an accompanied suicide right away.

Study (PDF, in German)

Effects of euthanasia on the bereaved family and friends: a cross sectional study

Nikkie B Swarte, Marije L van der Lee, Johanna G van der Bom, Jan van den Bout, A Peter M Heintz. In: British Medica Journal, July 2003; 327:189

This study by Nikkie B Swarte et al of the University of Utrecht shows that bereaved family and friends of cancer patients who died by euthanasia had less traumatic grief symptoms, less current feeling of grief; and less post-traumatic stress reactions than the family and friends of patients who died of natural causes. (Link)

The 'window of opportunity' for death after severe brain injury: family experiences (PDF)

This article by Professors Celia and Jenny Kitzinger explores the problems associated with the right to die for people who lack the capacity to make that choice (because they are in a coma, vegetative, minimally conscious etc). It builds on and develops the emerging bioethics literature on the 'window of opportunity' for allowing death by withholding or withdrawing treatment.

What are the social and economic costs deriving from suicides in Switzerland? What is the price of desperation which has to be paid due to some 1300 suicides and ten-thousands of suicide attempts?

Study "The Price of Desperation" (PDF, in German)

The article "Legal, political and ethical aspects of the assisted dying debate in Germany“, published in the journal “Aufklärung und Kritik”, special edition 11/2006 (ISSN 0945-6627) provides many references to studies, numbers and facts regarding suicides in Germany and Switzerland.

Article (PDF, in German)


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