Physician-assisted suicide-a clean bill of health?

Background: Physician-assisted suicide (PAS) laws have been enacted in five US States and, along with physician-administered euthanasia, in Canada and the Netherlands.

Sources of data: Annual reports of the Oregon Health Authority and published research papers.

Areas of agreement: Not all recipients of lethal drugs use them to end their lives. Improvements in palliative care provision.

Areas of controversy: Rising numbers of deaths from PAS. Emergence of 'doctor shopping' and multiple-prescribing. Absence of qualitative scrutiny of assessment process. No re-assessment or oversight when prescribed drugs are ingested. Recent pressures to extend Oregon's PAS law.

Growing points: Reasons given for seeking PAS indicate this is a societal rather than a clinical issue and raise the question whether adjudicating on requests for legalized PAS is an appropriate role for doctors.

Areas for timely research: Research into quality of decision-making in requests for PAS and into potential role of doctors as expert witnesses rather than judges in requests for PAS.