Five states in the United States have successfully legalized physician-assisted suicide for patients who are terminally ill: California, Oregon, Vermont, Montana and the state of Washington.

While support for the law has plateaued, a new study discovered that the practice did not increase the way some critics had feared.

Rare Cases

Physician-assisted death occurs when a doctor prescribes lethal drugs, which patients choose to take themselves.

On the other hand, euthanasia, which is illegal in the United States, happens when the doctor or someone else administers the lethal medication instead of the patient.

In the new study, researchers from the University of Pennsylvania found that in places where doctor-assisted deaths are legal, the practice still remains rare.

To better understand the attitudes toward physician-assisted suicide, researchers reviewed previous studies, surveys and other data from 1947 to 2016 published in the United States and Europe.

The study found that doctor-assisted deaths were mostly confined to patients diagnosed with cancer who are well-educated, white and wealthy.

In fact, the vast majority of dying patients do not "even think about" physician-assisted suicide or euthanasia, says Dr. Ezekiel Emanuel, a bioethicist and the lead author of the report. He says it appears that doctors remain less supportive of the practice than the general population.

Furthermore, the report found that worries that doctors will be swamped with requests for physician-assisted suicide are unfounded.

Less than 20 percent of doctors in the United States say they have been asked to assist in physician-assisted death or euthanasia, the study found. Only 5 percent agreed.

Support

Twenty states in the country are considering the legalization of physician-assisted suicide, including Colorado, Arizona, New York, Massachusetts and New Jersey, according to an assisted dying advocacy group called Death with Dignity.

Public support for the advocacy has constantly swayed from 47 percent to 69 percent since the 1990s.

And if the cases in Washington state and Oregon are an indication, most terminally ill patients that opt to hasten their mortality are in hospice or palliative care. The latter is designed to support and improve the lives of patients with life-threatening diseases.

Indeed, Emanuel says less than 0.5 percent of deaths in the state of Washington are from doctor-assisted suicide.

He says the topic requires more study and that states that have legalized it should keep much better records of the problems that patients encounter.

Reasons

Meanwhile, Emanuel, who opposes doctor-assisted suicide, says he is concerned about the reasons patients choose to die.

Many patients choose the practice because of several reasons: the fear of losing autonomy, the fear of losing control over bodily functions, the fear of being a burden to the family, the fear of no longer being able to enjoy activities and other psychological concerns.

Excruciating pain is only the sixth main reason on the list, Emanuel says.

This should be an indication that terminally ill patients should receive more treatment and care for emotional distress, Emanuel says. He believes that more can be done for patients.

"[A]nd maybe we should try a little harder before throwing up our hands," adds Emanuel.

Details of the study are published in the Journal of the American Medical Association.

Photo: Jess Pohlman | Flickr