"Comment on Ganzini and Dobscha regarding Comparing
Physician-Assisted Suicide in Oregon with that of
Kenneth R. Stevens, Jr., M.D., Professor and Chair,
Department of Radiation Oncology
William L. Toffler, M.D., Professor of Family Medicine
Oregon Health & Science University, Portland
The Journal of Clinical Ethics 15, No. 4 (2004):363-364
Copyright 2004, The Journal of Clinical Ethics.
This commentary article is in response to: L. Ganzini,
S.K. Dobscha. "Clarifying Distinctions between Contemplating and
Completing Physician-Assisted Suicide",
The Journal of Clinical Ethics 15, No. 2 (2004):
There is a very serious error regarding the rates of assisted suicide
in Oregon and in other states in an article by Ganzini and Dobscha, "Clarifying
Distinctions between Contemplating and Completing Physician-Assisted
Suicide" in the summer 2004 issue of this journal (volume 15, number
2). The authors imply that the rate of assisted suicide in other
states apart from Oregon is known, and they compound this error by
suggesting that the legalization of assisted suicide in Oregon has
decreased the rate of assisted suicide in that state.
Specifically, Ganzini and Dobscha write,
it is worth noting that this would represent a rate of
assisted suicide lower [in Oregon] than found in previous studies
done in other states. Emanuel and coauthors estimate a rate of physician-assisted
suicide (PAS) and euthanasia in other states in the United States
as approximately one in 250, as compared to Oregon's yearly rate
of one in 1,000 PAS deaths under the ODDA [Oregon Death with Dignity
Act]. If the rate in Oregon is similar to other states in the
United States, approximately three in 1,000 cases of PAS or euthanasia
in Oregon outside the law each year should be found. This raises
the interesting question of whether legalization of assisted suicide
can drive the rate of PAS down.
The authors' reported "rate" of four PAS deaths per 1,000 deaths
in other states is based on a single event, the PAS death of
one person, reported by E.J. Emanuel and colleagues.3 The Emanuel
article is based on a survey of patients with "a significant illness
and a survival time of 6 months or less." In that survey, 988 terminally
ill patients were interviewed; 256 had died, one patient died from
PAS. It is impossible, and completely unscientific, to claim a valid
PAS rate based on a single event taken from a survey of a non-representative
sampling of patients in six locations. Ganzini and Dobscha have clearly
gone far beyond what was stated in the Emanuel article and have misrepresented
Emanuel's data in claiming his survey established a rate of PAS of
four per 1,000 in states other than Oregon.
Even if it were possible to support the claimed rate of PAS in other
states from Emanuel's data, there are other serious problems with
Ganzini and Dobscha's attempt at making a comparison with Oregon's
PAS rate. Clearly, if PAS death rates among states are to be compared,
then the rates have to be based on a comparable population base.
Ganzini and Dobscha made no effort to ensure that the populations
were comparable before making their claim for a decrease in the rate
of PAS in Oregon.
While it is true that there is approximately one PAS death per 1,000
deaths in Oregon,4 this includes deaths from all causes (newborns,
children, sudden deaths and deaths from "non-terminal" conditions).
However, the Oregon PAS death rate compared to deaths from the same
underlying diseases is more than three times greater than 1/1000.
The sixth annual Oregon Department of Human Services report indicates
that, over the six years of legalized PAS in Oregon, there were 171
PAS deaths per 53,544 Oregonians dying from the same underlying diseases
as those who died from PAS: a 3.2 per 1,000 rate.5
In summary, Ganzini and Dobscha are wrong to imply that legalization
of PAS in Oregon has decreased the rate of PAS. The rate of illegal
PAS in other states cannot be established from Emanuel's article.
Most importantly, there is no evidence that legalization of assisted
suicide in Oregon has decreased the rate of PAS in Oregon.
We believe Ganzini and Dobscha should acknowledge their inappropriate
use of the Emanuel data to claim that the rate of PAS in other states
is known, and should acknowledge that the rates of PAS they stated
for Oregon and other states are not comparable.
- E.J. Emanuel, D.L. Fairclough, and L.L. Emanuel, "Attitudes and
Desires Related to Euthanasia and Physician-Assisted Suicide Among
Terminally Ill Patients and Their Caregivers", Journal of the
American Medical Association 284, no. 19 (2000): 2460-8.
- Oregon Department of Human Services, "Physician-Assisted Suicide,
Death with Dignity, Annual Report 2002," http://www.dhs.state.or.us/publichealth/chs/pas/year5/ar-index.cfm,
- See note 1 above.
- See note 2 above.
- Oregon Department of Human Services, Physician-Assisted Suicide,
Death with Dignity, Annual Report 2003, http://www.dhs.state.or.us/publichealth/chs/pas/ar-index.cfm,