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Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups
Open accessAbstract
BACKGROUND: Debates over legalisation of physician-assisted suicide (PAS) or euthanasia often warn of a "slippery slope", predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period. METHODS: The data from Oregon (where PAS, now called death under the Oregon Death with Dignity Act, is legal) comprised all annual and cumulative Department of Human Services reports 1998-2006 and three independent studies; the data from the Netherlands (where both PAS and euthanasia are now legal) comprised all four government-commissioned nationwide studies of end-of-life decision making (1990, 1995, 2001 and 2005) and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought. RESULTS: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups. CONCLUSIONS: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges.
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“The idea that eligibility criteria in ADE regulations are gradually expanded, or that vulnerable populations are at greater risk is not substantiated by empirical studies [14–16].”
From Trends in assisted dying among patients with psychiatric disorders and dementia in Belgium: A health registry study (2025) · cites this paper as [15]
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Metadata
- Authors
- Battin, M. P., van der Heide, A., Ganzini, L., van der Wal, G., & Onwuteaka-Philipsen, B. D.
- Affiliations
- University of Utah (US)
- Oregon Health & Science University (US)
- Amsterdam Public Health (NL)
- Corresponding author
- Battin, Margaret P
- Venue
- Journal of Medical Ethics
- Publisher
- BMJ
- Published
- 2007-09-28
- Volume
- 33
- Issue
- 10
- Pages
- 591-597
- ISSN
- 0306-6800 (ISSN-L)
- 1473-4257
- PMC
- PMC2652799
- OpenAlex
- W2138074567
- Cited by
- 283
- References
- 27
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 9 · 2023: 14 · 2022: 10 · 2021: 16 · 2020: 7 · 2019: 12 · 2018: 47 · 2017: 22 · 2016: 12 · 2015: 16 · 2014: 11 · 2013: 20 · 2012: 15
- FWCI
- 14.13
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Medical Ethics (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- physician-assisted death, physician-assisted suicide, euthanasia, vulnerable populations, vulnerable patients, Oregon Death with Dignity Act, Netherlands, AIDS, end-of-life decisions, slippery slope
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Attitude of Health Personnel, Attitude to Death, Euthanasia, Female, Humans, Male, Middle Aged, Netherlands, Oregon, Practice Patterns, Physicians', Physicians, Right to Die, Risk Factors, Socioeconomic Factors, Suicide, Assisted, Terminally Ill, Vulnerable Populations
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