Battin et al’s article1 suggests vulnerable groups are no more likely to receive physician-assisted dying than other less vulnerable groups. This claim needs challenging based both on the figures presented and from experience in palliative medicine.

Palliative medicine frequently encounters patients wishing their lives were over. They may not explicitly request to have physician- assisted dying but clearly express that, at that moment, they feel they would be better off dead. The reasons for this include poor information and communication skills, lack of effective symptom control, misperceptions of what the last stages of life will be like, fear of being a burden and the impact on families. In Oregon it is necessary for the diagnosis of a terminal illness before a patient can be considered for physician-assisted suicide, while the Netherlands require that the patient be facing unbearable and hopeless suffering to be eligible for physician- assisted dying. We would consider that all people facing such serious concerns and conditions are vulnerable, and not just those who fall into pre-identified social groups.

According to the 2005 study2 used as the basis for much of the evidence in this paper, the reporting rate for physician-assisted dying in the Netherlands has improved, but 19.8% of cases (477 deaths) remain unreported. This study provides quantitative data on reasons for non- reporting in only 28 cases. We remain concerned that “vulnerable” groups may be receiving assisted dying in the Netherlands.

As a committee we are concerned that the early release of such information to the press, and the widespread reporting that followed, left professionals in a difficult position as without access to the article no clear response could be made to patients and colleagues. Data such as this may well be used to strengthen the argument to legalise assisted dying in this country. As a body representing palliative medicine physicians (who a recent survey demonstrated were against such legalisation) we would have welcomed this paper being made available to professionals for academic scrutiny before being released to the media.

References 1. Battin MP, van der Heide A, Ganzini L, et al. Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups. J Med Ethics 2007; 33: 591 – 597 2. van der Heide A, Onwuteaka-Philipsen BD, Rurup ML, et al. End-of-Life Practices in the Netherlands under the Euthanasia Act. NEJM 2007; 356 (9): 1957