CHICAGO -- Doctors frequently ignore proposed guidelines for euthanasia and assisted suicide, even to the point of not consulting the patient, a new study found.
Researchers said the study, published in Wednesday's edition of The Journal of the American Medical Association, found that assisted-suicide cases appear to be rare: of 355 cancer specialists surveyed, 10.7 percent reported a case of either euthanasia or assisted suicide.
The study identified three main safeguards generally proposed by supporters of euthanasia and assisted suicide for terminally ill patients: the patient must initiate and repeat the request; the patient must be evaluated by another physician; the patient must be in extreme physical pain.
Of the doctors who reported a case, only 34.2 percent said they adhered to all three guidelines. Patients were not involved in the decision in 15.3 percent of the reports. In those cases, it was the families who asked to end the patients' lives, a finding the study called "most worrisome."
Rita Marker, executive director of the International Anti-Euthanasia Task Force, called it "obscene."
The study also found several doctors who did not actually administer a lethal dose of medication but left instructions for their nurses to do so.
One of the researchers, Brian Clarridge, said it was difficult to pin down the actual prevalence of euthanasia and assisted suicide. Oncologists in the survey were questioned only about their most recent case, not about how many cases they had seen. "But it is an important number, and the issues surrounding it are important," said Clarridge, of the Center for Survey Research at the University of Massachusetts.
Clarridge said the results show that doctors and patients need to communicate better about the end of life before crucial decisions need to be made. "People don't just go to bed one night and die in their sleep, usually," he said. "More often than not we're dealing with the medical establishment in one way or another and we could be doing a better job."
Further, Clarridge and others not involved in the study said, oncologists need to learn to treat pain better and to recognize when patients need psychiatric help.
"Oncologists often look at someone in severe pain and say 'There's nothing more I can do' when in fact if that doctor cannot do anything, he or she should find one who can," Marker said.
Karen Kaplan, executive director of Choice in Dying, said the study showed how few people are really interested in euthanasia or suicide, even when facing terminal illness. That number would shrink even more, she said, if society paid better attention to caring for people near the end of life.
"When we start talking to people about all the options, about pain management, about hospice, about home care, the request for Dr. Kevorkian's number disappears," said Kaplan, whose group that studies end-of-life issues.
"We cannot risk missing the forest for the trees, and physician-assisted suicide is the tree. The forest is end-of-life care."
The study also looked at the effect of euthanasia and assisted suicide on doctors, finding that many felt regret and 39.5 percent feared prosecution.
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