While euthanasia and physician-assisted suicide (PAS) remain rare, they are increasingly becoming legalized worldwide, so staying up to date on practices and attitudes is important.

Ezekiel Emanuel, MD, PhD, from the department of medical ethics and health policy from the University of Pennsylvania in Philadelphia, and colleagues, gathered polling data and surveys of physicians and the public official state and country databases, physician interview studies, and death certificate studies from 1947 to 2016 for review, which revealed interesting and changing trends.

Currently, euthanasia and PAS are legal in The Netherlands, Belgium, Luxembourg, Colombia, and Canada, while PAS, excluding euthanasia, is legal in 5 US states (California, Montana, Oregon, Vermont, and Washington) and Switzerland. Throughout the United States, Canada, and Luxembourg, patients must be at least 18 years old to request euthanasia or PAS. Since 2014, Belgium has allowed euthanasia and PAS regardless of age, as long as the patient is able to provide informed consent.  All US states require patients receiving PAS to have a survival prognosis of 6 months or less.

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Since the 1990s, public support for euthanasia and PAS in the United States has stagnated, with a range of 47% to 69% of Americans who support them, but physician support is consistently lower, and physicians are more likely to support PAS than euthanasia. Strong public support of euthanasia and PAS is found in Western Europe, while public support is decreasing in Central and Eastern Europe.

Just 18% of physicians in the United States have received requests for PAS or euthanasia, but 5% or less have agreed to fulfill them.  In Oregon and Washington, less than 1% of physicians write PAS prescriptions every year. However, in both The Netherlands and Belgium, there is a steady increase in cases of euthanasia and PAS, with more than 70% of all cases involving patients with cancer.  The most recent death certificate studies report an occurrence of 2.9% of deaths in The Netherlands (2010) and 4.6% of deaths in Belgium (2013) from euthanasia and PAS.

In their review, researchers did not find evidence supporting the concern that vulnerable patients have been encouraged to accept euthanasia or PAS at rates higher than the general population. In the United States, the typical demographics of patients requesting euthanasia or PAS include white race, older age, higher education, and being well-insured.

Requests for euthanasia or PAS are usually motivated by a loss of dignity or autonomy; difficulty enjoying regular activities; and other forms of mental distress, including depression. A psychiatric evaluation is suggested for patients requesting euthanasia or PAS.

“In most developed countries, there have been high levels of public support for euthanasia and PAS over the last 30 years, but more limited support among physicians,” remarked Dr Emanuel. Regardless, “euthanasia and physician-assisted suicide are increasingly being legalized.”


Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, Cohen J. Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. JAMA. 2016; 316(1): 79-90.

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