Related Experiment Videos
Euthanasia and physician-assisted suicide in homosexual men with AIDS
P J Bindels1, A Krol, E van Ameijden
1Municipal Health Service, Department of Public Health, Amsterdam, Netherlands.
Background:
In the Netherlands a nationwide study has shown that, in 38% of deaths, there have been medical decisions concerning the end of life (MDEL); 2.1% of all deaths were brought about by euthanasia or physician- assisted suicide (PAS). We investigated the incidence of MDEL in homosexual men with AIDS, suspecting that it might be higher, and studied the effect of euthanasia/PAS on survival time.
Methods:
The patients were 131 male homosexual participants in a cohort study in Amsterdam, diagnosed between 1985 and 1992 as having AIDS; all had died before Jan 1, 1995. Clinical and laboratory data and information on mode of death were obtained from their physicians and by review of hospital records. Those who died by euthanasia/PAS or in whom there had been other MDEL were then compared with those who died naturally.
Findings:
29 men (22%) had died by euthanasia/PAS and in 17 (13%) another MDEL had been made; thus, more than one-third of these men had made medical decisions concerning the end of life. The greatest difference between the groups was in age at time of diagnosis-72% aged 40 or more in the euthanasia/PAS group compared with 38% in the natural death group. The likelihood (relative risk) of euthanasia/PAS increased with duration of survival after AIDS diagnosis. Comparison of the groups in terms of three laboratory markers (CD4+ and CD8+ cells and phytohaemagglutinin responses) in the two years before death, and estimates of these markers at the time of death, did not indicate any substantial shortening of life by euthanasia/PAS; in the judgment of the physicians, most of these patients would have died naturally within one month.
Interpretation:
A possible reason for the high incidence of MDEL in this cohort was a good knowledge of the characteristics of AIDS acquired through long-term awareness of HIV infection. The higher rate of euthanasia in those with long survival from AIDS diagnosis could reflect either additional suffering or the greater opportunity to discuss this option with friends and physicians. Our findings indicate that euthanasia and other MDEL did little to shorten life; rather, they were an extreme form of palliation, applied in the terminal phase of a lethal disease.
Insights
Medical decisions concerning the end of life (MDEL), including euthanasia and physician-assisted suicide (PAS), were common in homosexual men with AIDS. These end-of-life decisions did not significantly shorten survival, serving as palliation.
Area of Science:
- Medical Ethics
- Oncology
- Public Health
Background:
- Medical decisions concerning the end of life (MDEL) are prevalent in the Netherlands, with euthanasia or physician-assisted suicide (PAS) accounting for 2.1% of deaths.
- This study investigated the incidence of MDEL in homosexual men with Acquired Immunodeficiency Syndrome (AIDS) and its impact on survival.
Purpose of the Study:
- To determine the incidence of medical decisions concerning the end of life (MDEL) in homosexual men diagnosed with AIDS.
- To examine the effect of euthanasia or physician-assisted suicide (PAS) on the survival time of these patients.
Main Methods:
- A cohort of 131 homosexual men diagnosed with AIDS between 1985 and 1992 in Amsterdam were studied.
- Data on clinical status, laboratory markers, and mode of death were collected from physicians and hospital records.
- Patients who died by euthanasia/PAS or other MDEL were compared to those who died naturally.
Main Results:
- Over one-third of the cohort experienced MDEL, with 22% dying by euthanasia/PAS and 13% by other MDEL.
- Euthanasia/PAS was more common in older patients (≥40 years) and increased with longer survival after AIDS diagnosis.
- Laboratory markers did not suggest significant life shortening by euthanasia/PAS; physicians believed most patients would have died naturally within a month.
Conclusions:
- High MDEL incidence may stem from greater awareness of AIDS and HIV infection characteristics.
- Increased euthanasia rates with longer survival could be due to prolonged suffering or more opportunities for discussion.
- Euthanasia and other MDEL acted as extreme palliation in the terminal phase of AIDS, with minimal impact on overall survival.