Polling data and published surveys of the public and physicians, official state and country databases, interview studies with physicians, and death certificate studies (the Netherlands and Belgium) were reviewed for the period 1947 to 2016.
FINDINGS: Currently,
euthanasia or
physician-assisted suicide can be legally practiced in the Netherlands, Belgium, Luxembourg, Colombia, and Canada (Quebec since 2014, nationally as of June 2016).
Physician-assisted suicide, excluding
euthanasia, is legal in 5 US states (Oregon, Washington, Montana, Vermont, and California) and Switzerland. Public support for
euthanasia and
physician-assisted suicide in the United States has plateaued since the 1990s (range, 47%-69%). In Western Europe, an increasing and strong public support for
euthanasia and
physician-assisted suicide has been reported; in Central and Eastern Europe, support is decreasing. In the United States, less than 20% of physicians report having received requests for
euthanasia or
physician-assisted suicide, and 5% or less have complied. In Oregon and Washington state, less than 1% of licensed physicians write prescriptions for
physician-assisted suicide per year. In the Netherlands and Belgium, about half or more of physicians reported ever having received a request; 60% of Dutch physicians have ever granted such requests. Between 0.3% to 4.6% of all deaths are reported as
euthanasia or
physician-assisted suicide in jurisdictions where they are legal. The frequency of these deaths increased after legalization. More than 70% of cases involved patients with
cancer. Typical patients are older, white, and well-educated.
Pain is mostly not reported as the primary motivation. A large portion of patients receiving
physician-assisted suicide in Oregon and Washington reported being enrolled in hospice or
palliative care, as did patients in Belgium. In no jurisdiction was there evidence that vulnerable patients have been receiving
euthanasia or
physician-assisted suicide at rates higher than those in the general population.
CONCLUSIONS AND RELEVANCE: