Euthanasia and physician-assisted suicide: focus on the data

I acknowledge Parker’s letter on my article.1 First, there are considerable data showing that the public support for euthanasia and physician-assisted suicide (PAS) is less well defined than the numbers cited by proponents. The support is very susceptible to the framing effect, that is, when the cases are described differently, support varies widely. Public support is highest for patients in pain — precisely those patients who do not want or use euthanasia. However, support drops below 50% when the cases involve patients who want euthanasia or PAS because of loss of dignity or autonomy or fear of being a burden2 — which are the reasons motivating most patients who request euthanasia or PAS. The proponents are the ones who manipulate the data, citing the strong public support statistics, but never acknowledging that this support is for the rare cases.

Second, if the justification for legalisation of euthanasia and PAS is to improve end-of-life care for patients, then the burden of proof is on the proponents not me. And proponents have never produced any such data. Data that legalising euthanasia or PAS increases the use of hospice or narcotics at the end of life is not proof that it improves the quality of care at that stage; these are merely proxies for good end-of-life care. Moreover, it is very hard to imagine how an intervention targeted at a small percentage of dying patients — in Oregon, about 0.3% — can improve care for the other 99.7% of patients.3 Where are the data showing that legalisation helps the majority of people to a good end-of-life experience?

Finally, the questions that are asked about public support do not ask about procedures by which people may not go into a coma or wake up from it. Instead, the public is asked some version of: “When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and their family request it?” Notice the total ambiguity of the question: we do not know the patient’s age, disease or symptoms. Indeed, the patient could be symptomless. But most importantly, the means of ending the patient’s life is described as “painless”, and there is not any suggestion there may be complications or that the procedure may take over 4 days. How many Australians would support the following proposition: “Should Australia change the law to permit physicians to end the life of a patient with cancer, who is not experiencing pain but fears the loss of dignity? In about one in ten cases, the means that the physician will use may not end the patient’s life and it may take up to 4 days to do so?” Most citizens would not support such a situation. And this is a much more accurate description of the actual practices.