Despite increasing legalization of euthanasia and physician-assisted suicide (PAS) worldwide, the practice remains relatively rare and, when carried out, is primarily motivated by psychological factors such as loss of autonomy or enjoyment of life, rather than physical pain.

A new comprehensive assessment of data from around the world shows that in areas where they are legal, only 0.3 to 4.6 percent of deaths result from euthanasia or PAS, with more than 70 percent of cases involving patients with cancer. The study also shows that the majority of patients requesting euthanasia or PAS are older, white and well-educated. The study, led by Ezekiel J. Emanuel, MD, PhD, chair of the department of Medical Ethics & Health Policy at the Perelman School of Medicine at the University of Pennsylvania, is published today in JAMA.

“There are perceptions that euthanasia and physician-assisted suicide are widespread regardless of its legal status, that it’s quick and painless, and flawless. But, the best data we have on these issues is about15 years old,” Emanuel said. “In the United States, there’s been an increase in legalization since Oregon legalized PAS, and several other states are considering passing legislation that would make these practices legal, but we don’t currently have a comprehensive understanding of the practices themselves, or how the public and health care providers view them. We need more data before turning to these practices as a solution for end-of-life care.”

Euthanasia – where a physician actively and intentionally ends a patient’s life by medical means such as an injection of a neuro-muscular relaxant – and PAS – which occurs when lethal drugs are prescribed or supplied by a physician but are self-administered by the patient – can be legally practiced in the Netherlands, Belgium, Luxembourg, Colombia and Canada. PAS, excluding euthanasia, is legal in Switzerland and five US states: Oregon, Washington, Montana, Vermont and California. Using data from 1947-2016 collected from polls, published surveys of the public and physicians, official state and country databases, interviews with physicians, and death certificates, the team sought to determine how legalization affects attitudes and practices of euthanasia and PAS, as well as prevalence and outcomes of the procedures.

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