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Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups
  1. Margaret P Battin1,
  2. Agnes van der Heide2,
  3. Linda Ganzini3,
  4. Gerrit van der Wal4,
  5. Bregje D Onwuteaka-Philipsen4
  1. 1
    Department of Philosophy and Division of Medical Ethics and Humanities, University of Utah, Salt Lake City, UT, USA
  2. 2
    Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
  3. 3
    Oregon Health & Science University, Portland, OR, USA
  4. 4
    Department of Social Medicine, EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands
  1. Margaret P Battin, Department of Philosophy, 260 South Central Campus Drive, Rm 341, University of Utah, Salt Lake City, UT 84112, USA; battin{at}


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.

  • physician-assisted dying
  • physician-assisted suicide
  • vulnerable patients
  • Oregon Death with Dignity Act
  • Netherlands

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  • Competing interests: None declared.

  • Abbreviations:
    amyotrophic lateral sclerosis
    Oregon Death with Dignity Act
    physician-assisted suicide

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