EUTHANASIA AND PHYSICIAN-ASSISTED SUICIDE IN HOMOSEXUAL MEN WITH AIDS

Background In the Netherlands a nationwide study has shown that, in 38 % of deaths, there have been medical decisions concerning the end of l ife (MDEL); 2.1% of all deaths were brought about by euthanasia or phy sician-assisted suicide (PAS). We investigated the incidence of MDEL i n homosexual men with AIDS, suspecting that it might be higher, and st udied the effect of euthanasia/PAS on survival time. Methods The patie nts were 131 male homosexual participants in a cohort study in Amsterd am, diagnosed between 1985 and 1992 as having AIDS; all had died befor e Jan 1, 1995. Clinical and laboratory data and information on mode of death were obtained from their physicians and by review of hospital r ecords. Those who died by euthanasia/PAS or in whom there had been oth er MDEL were then compared with those who died naturally. Findings 29 men (22%) had died by euthanasia/PAS and in 17 (13%) another MDEL had been made; thus, more than one-third of these men had made medical dec isions concerning the end of life. The greatest difference between the groups was in age at time of diagnosis-72% aged 40 or more in the eut hanasia/PAS group compared with 38% in the natural death group. The li kelihood (relative risk) of euthanasia/PAS increased with duration of survival after AIDS diagnosis. Comparison of the groups in terms of th ree laboratory markers (CD4+ and CD8+ cells and phytohaemagglutinin re sponses) in the two years before death, and estimates of these markers at the time of death, did not indicate any substantial shortening of life by euthanasia/PAS; in the judgment of the physicians, most of the se patients would have died naturally within one month. Interpretation A possible reason for the high incidence of MDEL in this cohort was a good knowledge of the characteristics of AIDS acquired through long-t erm awareness of HIV infection. The higher rate of euthanasia in those with long survival from AIDS diagnosis could reflect either additiona l suffering or the greater opportunity to discuss this option with fri ends and physicians. Our findings indicate that euthanasia and other M DEL did little to shorten life; rather, they were an extreme form of p alliation, applied in the terminal phase of a lethal disease.