79 Doctors in California Survey Admit to Euthanasia

In findings that appear to reflect a significant degree of physician involvement in euthanasia, 79 California doctors claim they deliberately took the lives of terminal patients who asked to die and 29 of them said they terminated the lives of at least three patients, according to a survey by the Hemlock Society, a national group that advocates euthanasia.

In addition, 20 of the doctors volunteered their names in the questionnaires, details of which were released in the wake of a growing national controversy over a medical journal essay in which an anonymous doctor claimed to have given a 20-year-old dying cancer patient a fatal shot of morphine.

That claim, whose veracity has been challenged by some experts, was published Jan. 8 in the Journal of the American Medical Assn. and resulted in the issuing of a subpoena to the AMA by a local prosecutor in Chicago demanding the identity of the author. The AMA, which officially opposes the practice of euthanasia, has said it will resist the subpoena under an Illinois law that permits reporters to keep secret the identities of their sources.

The Chicago legal proceedings, as well as the potential interest of California medical licensing officials and prosecutors, prompted the Hemlock Society to destroy the original questionnaires from which survey data were tabulated on Tuesday, the same day the society released the information on the voluntary identifications by some of the physicians. Some results of the survey had been initially released last week. Derek Humphry, the Venice-based society’s director, said he burned the questionnaires--starting with the 20 with names--after conferring with attorneys.

On Wednesday, Dr. Gary Krieger, president of the Los Angeles County Medical Assn., said the notion that 79 physicians in California had performed euthanasia was believable. “I have no doubt in my mind that incidents like this have occurred,” he said.

The euthanasia survey, which the California Medical Assn. believes is the first ever conducted among California doctors, was done in November and sent to 5,000 doctors, 588 of whom responded. The doctors, whose names were taken from physician mailing lists, practice in the fields of general medicine, cancer treatment or medicine for the aged and all are said to be AMA members.

Of the 79 physicians who said they had performed “active steps” to terminate the lives of patients, 15 said they had done so once, 35 had done so two or three times and 29 had done so more than three times. At the same time, a large sample of the 537 doctors who answered other questions on the survey found that 59.2% do not believe other physicians perform euthanasia and only 40.8% believe other doctors practice it.

The practice of euthanasia is illegal in every state, but a November ballot initiative, which is supported by the Hemlock Society but sponsored by an independent group, is in signature-gathering process in California.

“I think the significance of (the poll) is that it’s an indicator that active euthanasia is going on covertly in hospitals now,” Humphry said. “It’s another piece of evidence.”

The Hemlock survey differed radically from the results of a Louis Harris and Associates poll of 200 physicians and 1,250 lay people conducted for the Harvard Community Health Plan last year.

The Hemlock survey found that 62% of doctors believe it is “sometimes right” for a doctor to take steps to bring about the death of a terminally ill patient while 37.6% said the practice was wrong. In the Massachusetts survey, 66% of the responding doctors called the practice unacceptable and 30% said it was justified.

Less Divided

The surveys were less divided on the whether laws should be changed to permit physicians to offer euthanasia. In the Hemlock poll, 68% agreed a change in statutes was desirable; 31% disagreed. In the Harris poll, 50% of the doctors responding said no legal change should be enacted, 43% said the laws should be changed and 7% had no opinion.

The Hemlock Society specifically asked physicians if they had performed “active” euthanasia, generally defined by experts as requiring a deliberate act such as injecting a fatal dose of drugs. Active euthanasia is differentiated from “passive” euthanasia, generally perceived as the practice of disconnecting most life-support machinery or simply not intervening to try to reverse a patient’s fatal course.

The Hemlock poll also found that:

-- Protestant, Jewish and agnostic or atheistic doctors reported they had complied with patient requests for euthanasia with about equal frequency. But 10 Roman Catholic doctors also answered affirmatively even though euthanasia directly contravenes church doctrine, as well as all existing U.S. medical ethics codes.

-- Doctors in their 30s were more likely to believe their peers provide clandestine euthanasia services than physicians in their 40s and 50s. Male doctors were more likely to have performed euthanasia than women and family practitioners were more apt to have been involved in such activities than cancer specialists or doctors involved in care of the aged, specifically.

-- On the question of whether or not a patient asking to die could be rational in his or her request, 94.8% said yes; 5.2% said no. Asked whether doctors would perform euthanasia services if the practice was legal in California, 51% said yes; 48.9% of the 515 respondents said no.

However, a spokesman for the California Medical Assn. questioned whether California doctors who responded affirmatively to the question about their personal euthanasia practices understood the nuances of meaning between “active” and “passive” euthanasia. Neither the Hemlock Society nor Louis Harris surveys suggested a formal definition.

“I believe a majority of California physicians would interpret . . . ‘active’ euthanasia to mean picking up a syringe and injecting a patient with a fatal dose,” said Chuck McFadden, a spokesman for the CMA in San Francisco. “However, I don’t know that at least some doctors could have interpreted that question as (referring to) pulling the plug or withdrawing (feeding) tubes or something like that as being ‘active’ euthanasia.”

While McFadden said the CMA questions whether the doctors who responded to the questionnaire fully understood the meaning of “active” euthanasia and that the association also believes the response rate to the survey to be inordinately low, he said the medical group does not question the veracity of the figures released by the Hemlock Society.

“I have faith in his (Humphry’s) integrity and I believe he is being truthful” about the results, McFadden said.

McFadden added that the new survey and the intense controversy over the AMA journal’s publication of the euthanasia essay underscore what may be a new intensity of discussion in the United States of the issue.

“I suppose it’s good that everyone is beginning to talk about the issue,” McFadden said. “As technology goes on (developing), it’s going to be something that we’re are going to be confronted with. It is a real dilemma.”

However, Alexander Capron, a USC ethics professor and expert on euthanasia, criticized the Hemlock questionnaire as “one of the most confusing things I’ve ever seen.” He asserted that it was impossible to determine if doctors were aware of the differences between active and passive euthanasia in their answers to questions. “This doesn’t tell us a damned thing,” Capron said.

Dr. James Todd, the AMA’s deputy executive vice president, who reviewed the Hemlock Society poll’s results Tuesday afternoon, said the sample of physicians who responded was small compared with the 45,000 doctors in the state. But he added it would probably be appropriate to “suppose” that there could be 79 California doctors who would perform euthanasia acts.

“I believe those physicians who participate in active euthanasia are very, very, very few,” Todd said.

“On the other hand, there is an apparently increasing disparity between the beliefs of the (medical) profession and the beliefs of the society,” he said. “The discussion needs to be had but I think it’s nonproductive to go out and try to find out how many physicians do what to whom and under what circumstances. It is much more productive to find out how society (stands) on this and not expect physicians to become executioners.”