What Most Often Leads to Voluntary Assisted Dying?

Euthanasia and Assisted Suicide

Assisted dying includes euthanasia and physician-assisted suicide (PAS). Over the past 20 years, the option to end one’s life in this way has expanded globally. Euthanasia refers to the deliberate ending of a patient’s life by a healthcare professional using medical means at the explicit request of the patient, while PAS involves a doctor providing or prescribing medication for the patient to end their own life.

Countries where voluntary medically assisted dying has been legal for some time include the Netherlands, Belgium, and Luxembourg. Euthanasia is also legal in New Zealand, Australia, and Colombia. Assisted suicide is permitted in Switzerland, Austria, Sweden, Albania, Canada, and several U.S. states. In Germany, the courts have ordered lawmakers to pass legislation permitting euthanasia, and in France, the relevant law was passed just weeks ago.

Different Countries, Different Rules

Legal regulations on voluntary assisted dying vary across countries. In places like Australia and New Zealand, voluntary assisted dying is available only to people with terminal illnesses. The patient must be in an advanced progressive stage of disease, with an estimated life expectancy of around six months.

The Netherlands, Spain, and Canada also allow voluntary death for people with non-terminal conditions. The patient must have a serious, incurable disease causing severe, chronic, or permanent and unbearable suffering.

Who may administer the life-ending substance also differs. In the United States and Switzerland, patients must self-administer it, usually by drinking a liquid. In some countries, it must be administered by doctors or nurses, typically intravenously. In other places, both self-administration and physician administration are permitted.

When Voluntary Death Is Most Common

The study aimed to determine the role of disease type in decisions to undergo voluntary assisted death. It examined data from 1999 to 2023 in 20 jurisdictions around the world where access to voluntary assisted dying exists. During those years, there were 184,695 voluntary assisted deaths recorded out of a total of 12.9 million deaths.

The majority of people who chose voluntary assisted dying had cancer (66.5% of cases). Neurological diseases ranked second (8.1%), followed by heart diseases (6.8%) and lung diseases (4.9%).

The study also assessed how often individuals with different illnesses opted for voluntary assisted death compared to other forms of dying. Although the rate of voluntary assisted dying and eligibility criteria varied by region, the prevalence of specific conditions was surprisingly consistent across regions and time periods.

For example, people with amyotrophic lateral sclerosis (ALS)—a rare, progressive, and fatal disease that damages the brain and spinal cord—had the highest rate of voluntary assisted death. People with ALS chose this option nearly 7 times more often than cancer patients, who themselves had 4 times higher odds of choosing assisted dying than those with lung diseases.

One Thing in Common

Although cancer and ALS are unrelated diseases, they share one feature: they more frequently lead to rapid health decline and loss of dignity. According to this study and others, people typically request voluntary assisted dying due to the loss of independence, dignity, or the ability to do things they find meaningful. That’s why it’s essential to explore new ways to support patients who are facing this profound challenge due to illness.

Editorial Team, Medscope.pro

Sources:

1. Heidinger B., Webber C., Chambaere K. et al.: International Comparison of Underlying Disease Among Recipients of Medical Assistance in Dying. Jama Intern Med. 2024 Dec 9;185(2):235–237, doi: www.theconversation.com/we-studied-20-places-around-the-world-and-found-the-most-common-diseases-linked-with-voluntary-assisted-dying-245664

2. Mroz S., Dierickx S., Deliens L. et al.: Assisted dying around the world: a status quaestionis. Ann Palliat Med. 2021 Mar;10(3):3540-3553, doi: 10.21037/apm-20-637. Epub 2020 Sep 4. Available at: www.apm.amegroups.org/article/view/50986/html

3. Waller K., Del Villar K., Willmott L. et al.: Voluntary assisted dying in Australia: A comparative and critical analysis of state laws. University of New South Wales Law Journal, 46(4), pp. 1421–1470.

4. Amyotrophic lateral sclerosis (ALS). Mayo Clinic. Available at: www.mayoclinic.org/diseases-conditions/amyotrophic-lateral-sclerosis/symptoms-causes/syc-20354022

5. Emanuel E. J., Onwuteaka-Philipsen B. D., Urwin J. W. et al.: Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe. Jama. 2016;316(1):79–90, doi: 10.1001/jama.2016.8499.