PHYSICIAN-ASSISTED SUICIDE AND EUTHANASIA IN WASHINGTON-STATE - PATIENT REQUESTS AND PHYSICIAN RESPONSES

Objectives.-To estimate how often physicians receive requests for phys ician-assisted suicide and euthanasia and to describe a case series of patient requests for physician-assisted suicide and euthanasia, inclu ding physician responses to these requests. Design.-A mailed, anonymou s two-part questionnaire. Participants.-A total of 828 physicians retu rned questionnaires sent to 1453 potential respondents, for a response rate of 57%. Questionnaires were mailed to a random sample (25%) of p rimary care physicians and all physicians in selected medical subspeci alties in Washington State. Main Outcome Measures.-The frequency of ex plicit patient requests for physician-assisted suicide and euthanasia reported by physicians and individual case descriptions of patient cha racteristics, physician perceptions of patient concerns, and physician responses to patient requests. Results.-In the past year, 12% of resp onding physicians received one or more explicit requests for physician -assisted suicide, and 4% received one or more requests for euthanasia . These physicians provided 207 case descriptions. The diagnoses most often associated with requests were cancer, neurological disease, and the acquired immunodeficiency syndrome (AIDS). The patient concerns mo st often perceived by physicians were worries about loss of control, b eing a burden, being dependent on others for personal care, and loss o f dignity, Physicians provided assistance more often to patients with physical symptoms. Physicians infrequently sought advice from colleagu es, Of 156 patients who requested physician-assisted suicide, 38 (24%) received prescriptions, and 21 of these died as a result. Of 58 patie nts who requested euthanasia, 14 (24%) received parenteral medication and died. Conclusions.-Patient requests for physician-assisted suicide and euthanasia are not rare, As perceived by physicians, the most com mon patient concerns at the time these requests are made are nonphysic al, Physicians occasionally provide these practices, even though they are currently illegal in Washington State. Physicians do not consult c olleagues often about these requests. These findings raise the questio n of how to ensure quality in the evaluation of patient requests for p hysician-assisted death.