No slippery slope: Physician-aided deaths are rare among those presumed vulnerable.

Over the past quarter-century, opponents of physician-assisted death have argued against the practice on the grounds that vulnerable groups--the very old, the poor, and the mentally ill, to name three--would turn to, or be pushed toward, such deaths in disproportionate numbers. A review of records from Oregon and the Netherlands undermines that argument.

Instead, people who receive help dying tend to be better educated and better off than the general population.

The review also finds that, in fact, few people in Oregon have died with a physician's help. Since the practice became legal in 1997, only 292 people--of whom 85 percent were in hospice care--have chosen to end their lives with a lethal prescription. That number amounts to 0.15 percent of all deaths in the state.

In the Netherlands, which has a more flexible euthanasia policy, about 2 percent of deaths annually are via self- or physician-administered lethal narcotics.

"It's something that only a very small fraction are choosing, but many people say the possibility is comforting to explore," says Margaret Battin, a philosophy professor at the University of Utah in Salt Lake City, who led the review. Battin advocates legalized physician-assisted suicide to allow people to "choose the death that is least worst for them." The report, from a team including researchers in Oregon and the Netherlands, appears in the October Journal of Medical Ethics.

The team reviewed government reports and independent studies of patient records. It also evaluated surveys of the practices of health care workers. Of 10 groups the researchers identified as vulnerable--including people older than 80, women, the uninsured, the poor, people with little education, people with physical disabilities, people with mental illnesses, minors, and racial and ethnic minorities--only people with HIV infections or MDS were over-represented in the physician-assisted death statistics.

"These findings call into question the claim that the risks associated with legalization [of physician-assisted death] will fall most heavily on potentially vulnerable populations" says Timothy Quill, a palliative care specialist at the University of Rochester (N.Y.) School of Medicine. Quill wasn't involved in the study.

Thirty-five U.S. states ban physician-assisted suicide, and Oregon is the only state to explicitly permit it. There, two doctors must certify that a patient wanting to end his or her life is mentally competent and has less than 6 months to live. A doctor then can write a prescription for a lethal dose of drugs but can't administer it. The Netherlands allows physicians to assist in the death of a patient who, even if not terminal, faces "unbearable and hopeless suffering."