Latest News:

For Researchers

Note: The listing on this page of any particular work does not constitute our endorsement thereof; these resources are provided strictly for information purposes.

Please email us any suggestions for journal articles or books (make sure you include all bibliographic information as you see on this page).

This list of peer-reviewed journal articles about physician-assisted dying and related issues is organized by topic:

For books on Death with Dignity and related end-of-life issues, click here.

Implementation of Death with Dignity Legislation

“Early Experience With the California End of Life Option Act: Balancing Institutional Participation and Physician Conscientious Objection.” May 2, 2017 (online). Stephanie M. Harman, MD; David Magnus, PhD. JAMA Internal Medicine.

“Characterizing 18 Years of the Death With Dignity Act in Oregon.” April 6, 2017 (online). Charles Blanke, MD; Michael LeBlanc, PhD; Dawn Hershman, MD; et al Lee Ellis, MD; Frank Meyskens, MD. JAMA Oncology.

“Lessons from Oregon in Embracing Complexity in End-of-Life Care.” March 2017. Susan W. Tolle, M.D., and Joan M. Teno, M.D. New England Journal of Medicine, No. 376. pp. 1078-1082.

The study finds that Oregon may be the best U.S. state in which to die. “Persons dying in Oregon are less likely to be hospitalized and more likely to use hospice services at home than are patients…in the rest of the United States,” the authors write. In 2013, nearly two-thirds of Oregonians who died did so at home; the same year, 97 percent of people who used the Death with Dignity Act died at home. In contrast, even though 85 percent of Americans want to die at home, fewer than 40 percent get to do so. Similarly, patients in Oregon are 61 percent more likely to be enrolled in hospice than other Americans.

Oregon was the second state in the nation to legalize advance directives and the first to both use POLST (Physician Orders for Life-Sustaining Treatment) and enact an assisted dying statute. All of these policies are supported with complementary policies. It is, however, not the mere presence of these tools that has improved the experience of dying in Oregon. Linking patients’ goals for end-of-life care to actionable care plans supported by both local healthcare systems and state regulations is key.

Education through the media and physicians raises Oregonians’ awareness about their end-of-life options. State regulation around POLST ensures forms are completed correctly, distributed among healthcare professionals at all levels, and honored. Change in culture supports healthcare professionals in collaborating with colleagues and conducting honest conversations with patients. Home hospice allows patients to die not at a hospital but in their own bed.

“Drug Price Inflation and the Cost of Assisted Death for Terminally Ill Patients—Death With Indignity.” October 6, 2016. Veena Shankaran, MD, MS; Richard J. LaFrance, PharmD; and Scott D. Ramsey, MD, PhD. JAMA Oncology.

Authors review the use of the Washington State Death with Dignity Act since 2009. The number of prescriptions dispensed in Washington State has steadily increased, and the majority of patients to whom the medications have been dispensed have ingested them. The law has generally been considered successful and patients have reported feeling grateful to have an option for physician-assisted death. However, patients and their families are raising new concerns about the high cost of medication and the unaffordability of ending their lives in this way.

“When a Patient Discusses Assisted Dying: Nursing Practice Implications.” July 2016. Rebecca H. Lehto; Douglas P. Olsen; Roxanne Raffin Chan. Journal of Hospice and Palliative Nursing, Vol. 18, No. 3, pp. 184-191.

“Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe.” July 2016. Ezekiel J. Emanuel, Bregje D. Onwuteaka-Philipsen, John W. Urwin, Joachim Cohen. JAMA, Vol. 316, No. 1 [Summary by Science Daily]

“Legalised Physician-Assisted Death in Oregon.” January 2016. Linda Ganzini. QUT Law Review, Vol. 16, No. 1, pp 76-83 [pdf]

Ganzini reviews the Oregon Death with Dignity Act by discussing what the collected data present. She concludes that legalization of physician-assisted dying has not decreased the use of or quality of palliative and hospice care. She also addresses other concerns about the law, including mental illness and depression, and shows that there is much support for greater psychiatric involvement to evaluate patients for depression. However, it is unclear whether mandatory psychiatric evaluations would benefit and protect vulnerable patients and psychiatrists. Overall, the data show a slight increase in use of aid in dying over time; that the large majority of patients using the life-ending medication have similar terminal illnesses; and that patients are educated, insured, and mentally competent.

“Clinical Criteria for Physician Assisted Aid in Dying.” November 2015. David Orentlicher, MD, JD, Thaddeus Mason Pope, JD, PhD, & Ben A. Rich, JD, PhD. Journal of Palliative Medicine, Vol. 18, No. X, pp. 1-4.

Authors discusse the main areas in which the Physician Aid-in-Dying Clinical Criteria Committee deemed most important for physicians to focus on when a patient requests aid-in-dying. First, they express the importance of determining if the request is voluntary, informed, and without influence of others or of mental illness. Secondly, they asses whether the patient thoroughly understands his/her options for end-of-life carem such as hospice, stopping eating/drinking, and palliative sedation. Third, they assert that physicians must make clear the results of ingesting the life-ending medication and must be thorough in documenting the patient’s understanding through the process of requesting. Lastly, the Committee urges patients to have family present and discusses the steps of how to ingest the medications for the safest possible death.

“Implementing a Death with Dignity Program at a Comprehensive Cancer Center.” April 11, 2013. Elizabeth Trice Loggers, Helene Starks, Moreen Shannon-Dudley, Anthony L. Back, Frederick R. Appelbaum, and F. Marc Stewart. New England Journal of Medicine, Vol. 368, No. 15, pp. 1417-1424.

This article provides an institutional response to Death with Dignity through the perspective of a Washington cancer center. The cancer center found that their Death with Dignity program showed data consistent with the overall physician-assisted dying data collected in Oregon and Washington. This institution’s Death with Dignity program has elicited positive responses from physicians, patients, and families. They attribute this acceptance to the professional leadership team at the cancer center which provides great care in prescribing for and consulting with patients in the end-of-life process.

“Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey.” July 11, 2012, published online. Bregje D. Onwuteaka-Philipsen, Arianne Brinkman-Stoppelenburg, Corine Penning, Gwen JF de Jong-Krul, Prof Johannes JM van Delden, Agnes van der Heide. The Lancet.

This article analyzes the data collected in the Netherlands from the time the euthanasia laws passed in 1990 to 2010. Based on the questionnaires, they found that the incidence of euthanasia and physician assisted suicide has been stable and is comparable with the incidence before the law was passed. Further, they found that the patient groups dying by euthanasia has not shifts over the years of the study.

“The Washington State Death With Dignity Act: A Survey of Nurses Knowledge and Implications for Practice Part 1.” January/February 2012. Anita Jablonski, Janine Clymin, Dana Jacobson, Karen Feldt. Journal of Hospice & Palliative Nursing, Vol. 14, No. 1, pp. 45–52.

 

“Quality of Death and Dying in Patients Who Request Physician-Assisted Death.” April 6, 2011. Kathryn A. Smith, Elizabeth R. Goy, Theresa A. Harvath and Linda Ganzini. Journal of Palliative Medicine, Vol. 14, No. 4, pp. 445-450.

“Mental Health Outcomes of Family Members of Oregonians Who Request Physician Aid in Dying.” December 2009. Linda Ganzini, Elizabeth R. Goy, Steven K. Dobscha, Holly Prigerson. Journal of Pain and Symptom Management, Vol. 38, No. 6, pp. 807-815.

This study shows that aid in dying does not have negative grief impacts on family members of the deceased and may lead to a more prepared death. In contrast, family members whose loved one did not pursue aid in dying expressed feelings of regret that the deceased did not fulfill their wishes. Family members of patients who used medications to hasten death also reported a higher quality of life rating in the last week of life than those who did not request aid in dying. Furthermore, this study shows that physician-assisted death does not result in prolonged mental health or severe grief symptoms among family members.

“The Inevitable Death: Oregon’s End-of-Life Choices.” November 18, 2008. Ann Jackson. Willamette Law Review, Vol. 45, No. 1, pp. 137-160.

Jackson provides an extensive overview of the Death with Dignity law in Oregon and its relationship to hospice. Use of hospice care has increased as the Death with Dignity law came into effect. This article shows that hospice staff members are generally in favor of the law because it gives Oregonians options and facilitates important end-of-life conversations.

“Prevalence of depression and anxiety in patients requesting physicians’ aid in dying: cross sectional survey.” 2008. Linda Ganzini, Elizabeth R Goy & Steven K Dobscha. The BMJ (British Medical Journal). Vol. 337, pp. 1-5.

This article aims to present the prevalence of depression among the people who request and get aid-in-dying medication from their physicians through Death with Dignity. They found that most people requesting physician-assisted death do not have a depressive disorder, but that a small portion do. They suggest that all patients go through depression tests similar to the ones used in this study to help physicians make better informed decisions about whether a patient has depression when requesting aid-in-dying.

“Why Oregon Patients Request Assisted Death: Family Members’ Views.” February, 2008. Linda Ganzini, Elizabeth R. Goy, and Steven K. Dobscha. Journal of General Internal Medicine, Vol. 23, No. 2, pp. 154-157.

This article focuses on the family members whose loved one requested physician-assisted death to gain more intimate insight into why they chose aid-in dying. They found that similar to other studies done similar to this one, that reasons related to autonomy were rated most important for why they chose physician-assisted death. The authors propose that when discussing fears with patients, physicians should focus on relieving any worries or anxieties about the future by talking with them about the dying process and by providing a concrete pain management plan that allows for the most autonomy possible.

“Legal Physician-Assisted Dying in Oregon and the Netherlands: Evidence Concerning the Impact on Patients in “Vulnerable” Groups.” October, 2007. Margaret P Battin, Agnes van der Heide, Linda Ganzini, Gerrit van der Wal, Bregje D Onwuteaka-Philipsen. Journal of Medical Ethics, Vol. 33, No. 10, pp. 591-597.

Authors discuss the impact of physician-assisted death on “vulnerable populations” in both Oregon and the Netherlands. The authors show the importance of looking into the impact on certain populations and discusses both the statistical information collected as well as the societal implications of Death with Dignity and people that fear abuse of the law. They found that none of the vulnerable groups they looked at were at risk of abuse in both places except for the AIDS population. They also note that their findings do not conclude whether their results show that the safeguards of the law are working effectively or if there is unequal access to assistance.

  • Response: “Legal physician-assisted suicide in Oregon and The Netherlands: evidence concerning the impact on patients in vulnerable groups—another perspective on Oregon’s data.” 2011. I G Finlay, R George. Journal of Medical Ethics, Vol. 37, No. 3.
  • Reply to response: “Legal physician-assisted dying in Oregon and the Netherlands: The question of “vulnerable” groups. A reply to I.G. Finlay and R. George.” July, 27 2011. Margaret P. Battin, Agnes van der Heide, Linda Ganzini, Gerrit van der Wal, Bregje D. Onwuteaka. Journal of Medical Ethics, Vol. 37, No. 3, pp. 171-174.This article defends the data the authors collected and refutes Finlay and George’s argument that being in the position to request physician assisted death makes one vulnerable by nature. The authors argue that the way opponents of physician-hastened dying define vulnerable groups is different than how they have in their studies because they recognize all types of “vulnerable” groups, not just the ten most common groups that Finlay and George identify. They argue that Finlay and George’s critique of their data merely reflects the limitations of their study.

Oregon Hospice Chaplains’ Experiences with Patients Requesting Physician-Assisted Suicide.” December 13, 2005. Bryant Carlson, Nicole Simopolous, Elizabeth R. Goy, Ann Jackson, Linda Ganzini. Journal of Palliative Medicine, Vol. 8, No. 6, pp. 1160-1166.

“Characteristics of Patients Requesting and Receiving Physician-Assisted Death.” July 14, 2003. Diane E. Meier, Carol-Ann Emmons, Ann Litke, Sylvan Wallenstein, and R. Sean Morrison. Archive of Internal Medicine, Vol. 163, No. 13, pp. 1537-1542.

This article aims to identify the characteristics of patients requesting physician-assisted death by getting surveys from physicians who have provided the life-ending medication. They found that overall patients requesting and receiving the medication are in a great deal of physical pain and have a very short amount of time left to live. Also that patients requesting assistance do not seem to be similar to the general population of dying people in the United States as far as demographics; meaning that the people using physician-assisted death are white, higher class, christian or jewish and educated individuals. They propose that physicians should have greater training in pain management to be more effective in relieving physical pain or discomfort and deciphering the difference between physical distress to the point of needing temporary sedation and the expressed want to die.

“Interest in Assisted Suicide Among Oregon Cancer Patients.” April 2003. Linda Ganzini, Tomasz M. Beer, and Matthew Brouns. Oregon Health Sciences University.

“Physicians’ Experiences with the Oregon Death with Dignity Act.” February 2000. Linda Ganzini et al. New England Journal of Medicine, Vol. 342, No. 8, pp. 557-563 [pdf]

Ganzini discusses the results of surveys given to physicians who have prescribed life-ending medication to terminally ill patients through the Death with Dignity law. The study covered the process that physicians go through when discussing physician-assisted death with a patient and provides thorough statistics for patient demographics and the reasons for requesting aid-in-death. They found no evidence that vulnerable populations are at risk and that alternative health plans presented to patients such as palliative and hospice care often gave patients an alternative route before continuing with the Death with Dignity request process.

“Legalized Physician-Assisted Suicide in Oregon, 1998-2000.” February 22, 2001. Amy D. Sullivan, Katrina Hedberg, and David Hopkins New England Journal of Medicine, Vol. 344, No. 8, pp. 605-607.

This article provides a brief overview of the characteristics of the people who died by physician-assisted death in the years 1998 to 2000. They found that a small number of people during these years died by aid-in-death and that as educational achievement increases, so does the likelihood of requesting physician assisted death. Overall the characteristics and numbers of people requesting and digesting the life-ending medication has remained similar over the time frame.

“Physician-Assisted Suicide and Patients with Human Immunodeficiency Virus Disease.” February 6, 1997. Lee R. Slome, Thomas F. Mitchell, Edwin Charlebois, Jeffrey Moulton Benevedes, and Donald I. Abrams. New England Journal of Medicine, Vol. 336, No. 6, pp. 417-421.

This article examines physicians responses to the use of aid-in-dying for AIDS patients between the years 1990-1995. The results of the study show that over the five year period, support for aid-in-dying for AIDS patients increased greatly. In 1990 28% of responding physicians said they would aid in the death of an AIDS patient that was terminal and mentally competent, and in 1995, 51% of physicians responded yes. 51% of the 117 physicians in 1995 also reported that they had performed aid-in-dying at least once for an AIDS patient.

Healthcare Professionals on Death with Dignity

Legal Challenges

End of Life Care

Palliative Sedation and Voluntary Refusal of Treatment or Food & Fluids

Physician-Assisted Death and People with Disabilities

  • “The Ethics of PAS: Morally Relevant Relationships Between Personal Assistance Services and Physician-Assisted Suicide.” 2001. Andrew I. Batavia. Archives of Physical Medicine and Rehabilitation, Vol. 12, Suppl. 2, pp. 25-31.
  • “So Far, So Good: Observations on the First Year of the Oregon Death with Dignity Act.” 2000. Andrew I. Batavia. In: Special Theme Issue: Hastened Death. G. Andrew H. Benjamin, James L. Werth, Jr, and Lawrence Gostin, eds. Psychology, Public Policy and Law, Vol. 6, No. 2, pp. 291-305.
  • “The Relevance of Physician and Disability Data on the Right to Physician-Assisted Suicide: Can Studies Resolve the Issue?” 2000. Andrew I. Batavia. In: Special Theme Issue: Hastened Death. G. Andrew H. Benjamin, James L. Werth, Jr, and Lawrence Gostin, eds. Psychology, Public Policy and Law, Vol. 6, No. 2, pp. 546-558.
  • “Disability and Physician-Assisted Suicide.” June 1997. Andrew I. Batavia. The New England Journal of Medicine, Vol. 336, No. 23, pp. 1671-73.
  • “A Disability Rights/Independent Living Perspective on Euthanasia.” May 1991. Andrew I. Batavia. The Western Journal of Medicine, Vol. 154, pp. 616-7.