A group of Swiss and UK scientist have written a letter to the editor of The Lancet (Vol 384, issue 9938, page 127; 12 July 2014), suggesting a “solution” to decrease the rate of “euthanasia”.
In a review they found that data from countries that allow both practices show that euthanasia occurs more frequently: assisted suicide represents 7·8% of hastened death cases in the Netherlands and 2% in Belgium. Although euthanasia rates have risen substantially in the past years, assisted suicide remains a rare choice for Belgian and Dutch patients (see figure). In Oregon, the trend shows a limited growth. In Switzerland, where assisted suicide is tolerated but no specific federal legislation exists, the increase is similar to that of euthanasia in Belgium and the Netherlands, albeit at a lower incidence.
The overwhelming preponderance of euthanasia over assisted suicide cases in the Netherlands and Belgium suggests that if patients are given the choice, they prefer to have their doctors do the procedure. Since overall incidence rates of hastened death are much higher in these two countries than in regions where only assisted suicide is allowed, the availability of euthanasia done by a physician could lower the psychological threshold for requesting hastened death.
Comparing the regions that only allow assisted suicide, the absence of legislation specifying procedural aspects in Switzerland might be one of the reasons for the increasing incidence of assisted suicide in this country.
Thus, to legalise only assisted suicide (with clear procedural rules) but not euthanasia seems to limit the number of hastened deaths and their increase over time. This might be partly due to a higher psychological threshold towards assisted suicide and, with the exception of Switzerland, more stringent procedural rules excluding non-terminally ill patients. The reasons for this discrepancy need further investigation, and will be important to inform the ongoing political discussions.