Doctor-assisted suicide gaining acceptance in the US:

Jojy Cheriyan MD;MPH-April 10,2012

Oregon ( since 1997) and Washington (since 2008) are the two states in the United States where physician-assisted suicide is legalized. State of Montana has not legalized this type of suicide but a court decision in 2009 created a defense for a physician whether he or she should be charged for assisted suicide. Therefore prosecutions for assisted suicide remain possible in Montana and conviction also remains possible in Montana.

A special article published today (online before print) by the New England Journal of Medicinenarrates the experience of a comprehensive cancer center in Seattle ,Washington. This center named Seattle Cancer Care Alliance runs a program called 'Death With Dignity' for terminally ill patients ( with less than 6 months to live) who want to end life by receiving the prescription for a lethal dose of Secobarbital .

In this study the researchers reviewed the enquiries for 'Death With Dignity' program from March 5,2009 to December 3, 2011. Among 114 patients who asked about the program 40 passed screening examinations and ultimately received lethal prescriptions for Secobarbital. Although all died, only 24 actually died due to medication ingestion. The other 16 died of other causes. Among those 16, eleven lived for more than 6 months after prescription receipt. All the participants in the 'Death With Dignity' program were typically white, male, and well-educated.

The most common reasons for participation were loss of autonomy, inability to engage in enjoyable activities, and loss of dignity.

Qualitative analysis showed that patients, caregivers, and family members were grateful after the patient obtained the prescription, regardless of whether it was ever filled or ingested, typically referencing an important sense of control in an uncertain situation.

The study concludes saying, overall, the 'Death with Dignity' program has been well accepted by patients and clinicians.

How Physician -assisted suicide works:

In Washington this program was instituted following a legislation passed in 2008 allowing physician-assisted suicide. This law sets certain requirements and safeguards to be followed before a physician could write a lethal prescription.

First of all two physicians have to confirm that the patient has a sound mind when he or she make the request for a lethal dose of medication.

Prescribing physician as well as a different consulting physician (two doctors) must then confirm that the patient's disease is terminal (life expectancy 6 months or less), and also that the patient is competent and voluntarily requesting the prescription.

Patients must make two oral requests, with an interval of at least 15 days between two requests, plus a written request in order to begin the process. Two witnesses, one non-doctor unrelated to the patient, must confirm the patient's request.

An informed consent process is required, and, when the prescription is being written, physician must give the patient a chance to reconsider the request.

Washington State legislation requires physicians should ensure that patients should not take the lethal dose in a public area. Seattle Clinic which did this study requires that patients sign a statement promising not to do so.

Patients should be assigned a licensed social worker who acts as an advocate, helping patients, family members, and physicians navigate the process and also ensuring compliance with the state's regulations.

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