title: Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe.
abstract: OBJECTIVE
  The increasing legalization of euthanasia and physician-assisted suicide worldwide makes it important to understand related attitudes and practices.
  
  
  OBJECTIVE
  To review the legal status of euthanasia and physician-assisted suicide and the available data on attitudes and practices.
  
  
  METHODS
  Polling data and published surveys of the public and physicians, official state and country databases, interview studies with physicians, and death certificate studies (the Netherlands and Belgium) were reviewed for the period 1947 to 2016.
  
  
  RESULTS
  Currently, euthanasia or physician-assisted suicide can be legally practiced in the Netherlands, Belgium, Luxembourg, Colombia, and Canada (Quebec since 2014, nationally as of June 2016). Physician-assisted suicide, excluding euthanasia, is legal in 5 US states (Oregon, Washington, Montana, Vermont, and California) and Switzerland. Public support for euthanasia and physician-assisted suicide in the United States has plateaued since the 1990s (range, 47%-69%). In Western Europe, an increasing and strong public support for euthanasia and physician-assisted suicide has been reported; in Central and Eastern Europe, support is decreasing. In the United States, less than 20% of physicians report having received requests for euthanasia or physician-assisted suicide, and 5% or less have complied. In Oregon and Washington state, less than 1% of licensed physicians write prescriptions for physician-assisted suicide per year. In the Netherlands and Belgium, about half or more of physicians reported ever having received a request; 60% of Dutch physicians have ever granted such requests. Between 0.3% to 4.6% of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal. The frequency of these deaths increased after legalization. More than 70% of cases involved patients with cancer. Typical patients are older, white, and well-educated. Pain is mostly not reported as the primary motivation. A large portion of patients receiving physician-assisted suicide in Oregon and Washington reported being enrolled in hospice or palliative care, as did patients in Belgium. In no jurisdiction was there evidence that vulnerable patients have been receiving euthanasia or physician-assisted suicide at rates higher than those in the general population.
  
  
  CONCLUSIONS
  Euthanasia and physician-assisted suicide are increasingly being legalized, remain relatively rare, and primarily involve patients with cancer. Existing data do not indicate widespread abuse of these practices.
authors.affiliation: Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Ezekiel J
authors.initials: EJ
authors.lastname: Emanuel
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research and Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
authors.affiliation: Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: John W
authors.initials: JW
authors.lastname: Urwin
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussels (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002170:Canada; D003105:Colombia; D005060:Europe; D005065:Euthanasia / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011639:Public Opinion; D017236:Suicide, Assisted / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data* / Q000639:trends; D011795:Surveys and Questionnaires; D009626:Terminology as Topic; D014481:United States; D028761:Withholding Treatment / Q000941:ethics; D055815:Young Adult