Do Euthanasia and Physician-Assisted Suicide Ensure a Good Death?

General Reference (not clearly pro or con)
Ezekiel Emanuel, MD, PhD, Chair of the Department of Bioethics at the Clinical Center of the National Institutes of Health, and Linda L. Emanuel, MD, PhD, Director of the Buehler Center on Aging, Health & Society at the Feinberg School of Medicine at Northwestern University, wrote in a May 1998 The Lancet article titled "The Promise of a Good Death":

"For more than three decades, interest in improving the care of dying patients has progressed from being the concern of a few health-care professionals to being a widespread social concern… Despite this attention, a 'good death' remains more a hope than standard medical practice for all patients…

Over the past few years there has been growing interest in the possibility that euthanasia and physician-assisted suicide might provide a 'good death.'"

May 1998 - Ezekiel Emanuel, MD, PhD 
Linda Emanuel, MD, PhD 

The Oregon Department of Human Services (DHS) wrote in its Mar. 9, 2006 "Eighth Annual Report on Oregon's Death with Dignity Act":

"In 2005, 39 physicians wrote a total of 64 prescriptions for lethal doses of medication... Thirty-two of the 2005 prescription recipients died after ingesting the medication... In addition, six patients who received prescriptions during 2004 died in 2005 as a result of ingesting the prescribed medication, giving a total of 38 PAS [physician-assisted suicide] deaths during 2005. One 2004 prescription recipient, who ingested the prescribed medication in 2005, became unconscious 25 minutes after ingestion, then regained consciousness 65 hours later. This person did not obtain a subsequent prescription and died 14 days later of the underlying illness (17 days after ingesting the medication)...

Complications were reported for three patients during 2005; two involved regurgitation, and, as noted above, one patient regained consciousness after ingesting the prescribed medication. None involved seizures (see Complications, page 13). Fifty percent of patients became unconscious within five minutes of ingestion of the lethal medication and the same percentage died within 26 minutes of ingestion. The range of time from ingestion to death was from five minutes to 9.5 hours."

Mar. 9, 2006 - Oregon Department of Human Services (DHS) 
Eighth Annual Report on Oregon's Death with Dignity Act (184 KB)  

PRO (yes)

Dan Brock, PhD, Director of the University Program in Ethics and Health at the Harvard Medical School, wrote in an article titled "Voluntary Active Euthanasia" in the Mar.-Apr. 1992 issue of The Hastings Center Report:

"One last good consequence of legalizing euthanasia is that once death has been accepted, it is often more humane to end life quickly and peacefully, when that is what the patient wants. Such a death will often be seen as better than a more prolonged one. People who suffer a sudden and unexpected death, for example by dying quickly or in their sleep from a heart attack or stroke, are often considered lucky to have died this way."

Mar.-Apr. 1992 - Dan Brock, PhD 

The Royal Dutch Society for the Advancement of Pharmacy wrote in its 1994 report titled "Administration and Compounding of Euthanasic Agents":

"A clear general conclusion may be drawn as concerns the lethal action of the euthanasic agents recommended by the KNMP's [Royal Dutch Society for the Advancement of Pharmacy] Task Force: the administration of thiopental [a drug that causes unconsciousness] followed by a muscle relaxant--provided the latter is properly administered--causes immediate death without any problems...

Intravenous administration is the most reliable and rapid way to accomplish euthanasia and therefore can be safely recommended."

1994 - Royal Dutch Society for the Advancement of Pharmacy 

Gerrit Kimsma, MD, MPh, Associate Professor in Medical Philosophy at the Center for Ethics and Philosophy at Free University in Amsterdam, was quoted in an undated Willamette Week Online article by David Smigelski titled "Wonder Why You're Voting on Assisted Suicide Again? Sloppy Reporting in The Oregonian and Legislative Trickery" (accessed July 28, 2009):

"In the course of the on-going debate about physician-assisted suicide in the United States... a particular claim has been made by the opposition... that in cases of physician-assisted suicide in The Netherlands the established failure rate is 25 percent. This is implied to mean that in 25 percent of the cases... through orally applied means, the effect would not be death. Instead, there would be widespread reawakening of suffering patients or some form of continued coma...

This claim has no foundation whatsoever, is misleading and completely wrong... There are no scientific data nor hearsay to support it."

July 28, 2009 - Gerrit Kimsma, MD, MPh 

Pieter Admiraal, MD, PhD, a Dutch euthanasia activist and anesthesiologist, was quoted in an undated Willamette Week Online article by David Smigelski titled "Wonder Why You're Voting on Assisted Suicide Again? Sloppy Reporting in The Oregonian and Legislative Trickery" (accessed July 28, 2009):

"I realize that the article written by Mark O'Keefe in The Oregonian about an interview he had with me in the Netherlands in 1994 has been used to 'prove' that there should be a 25 percent failure rate in using oral lethal drugs... Let's face the facts... After an oral dose of 9 grams of barbiturate every patient will die.... A period of 24 hours or longer will be very exceptional."

July 28, 2009 - Pieter Admiraal, MD, PhD 

CON (no)

Bill Toffler, MD, National Director of the Physicians for Compassionate Care Education Foundation (PCCEF), is quoted in a June 18, 2006 San Francisco Chronicle article by Matthew Yi titled "California Looks to Replicate Oregon's Assisted Suicide Law":

"In many of the cases, the death lingers for hours. It's not a dignified death. It's not pretty to watch somebody struggle with breathing or having irregular, shallow breathing for hours and hours on end."

June 18, 2006 - William L. Toffler, MD 

Russel Ogden, MA, Criminology Instructor at the Kwantlen Polytechnic University, wrote in a Dec. 1997 Policy Options article "Oregon's Measure 16: A Bitter Pill":

"There is paucity of research into the dosages and types of drugs necessary to cause death and no pharmaceutical company has developed a sure-fire suicide pill... In the course of my own research I have heard horrific stories of patients taking massive quantities of drugs that have been fatal with other persons and yet they have either survived or suffered through lingering deaths. Risks include vomiting the drugs, coma, psychosis and even de-cerebration where the patient is brain dead but still breathing. Sometimes these protracted deaths elicit friends or partners to resort to smothering with pillows or asphyxiation with plastic bags. One physician reported to me that he took the recourse of holding shut the mouth and nostrils of a comatose patient."

Dec. 1997 - Russel Ogden, MA 

The BBC reported the following study results in a Feb. 24, 2000 BBC Health article titled "Euthanasia Deaths 'Not Easy'":

"Attempts by doctors to help people suffering from fatal illness take their own lives failed to give an 'easy' death in one in five cases, researchers say…

Research into euthanasia in the Netherlands claimed people awake from comas after taking supposedly fatal drug doses and suffer side effects such as vomiting and gasping.

The study showed that when patients tried to kill themselves using drugs prescribed by a doctor, the medication did not work as expected in 16% of cases.

In a further 7% of cases there were technical problems or unexpected side effects...

Patients either took longer to die than expected or woke from a drug-induced coma that was supposed to be fatal in 6% of cases."

Feb. 24, 2000 - BBC (British Broadcasting Corporation) 

Johanna Groenewoud, MD, PhD, Professor, and Agnes van der Heide, MD, PhD, Senior Researcher, both at the Department of Public Health at Erasmus University in Rotterdam, along with Bregje Onwuteaka-Philipsen, PhD, Associate Professor and Care and Prevention Program Leader at the Institute for Health and Care Research (EMGO) at the Free University Medical Centre in Amsterdam, and Dick Willems, MD, PhD, Senior Researcher in Ethics at the Department of General Practice in the Division of Public Health at the Academic Medical Centre in the University of Amsterdam, wrote in a Feb. 24, 2000 New England Journal of Medicine article titled "Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands":

"We analyzed data from two studies of euthanasia and physician-assisted suicide in the Netherlands... with a total of 649 cases...

Complications occurred in 7 percent of cases of assisted suicide, and problems with completion (a longer-than-expected time to death, failure to induce coma, or induction of coma followed by awakening of the patient) occurred in 16 percent of the cases; complications and problems with completion occurred in 3 percent and 6 percent of cases of euthanasia, respectively. The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in 12 cases) and the inability of the patient to take all the medications (in 5)...

We found that there were sometimes clinical problems with the performance of physician-assisted suicide and euthanasia. The problems reported by physicians frequently concerned a longer-than-expected interval between the administration of the lethal drug (or the first drug, if more than one was administered) and the patient's death."

Feb. 24, 2000 - Johanna Groenewoud, MD, PhD 
Bregje Onwuteaka-Philipsen, PhD 
Agnes van der Heide, MD, PhD 
Dick Willems, MD, PhD