MAID By The Numbers

When MAID legislation was first proposed in the late 1990s, there were dire predictions that "physician assisted suicide" (as it was commonly called back in the day), would take off like a rocket, resulting in an obscene numbers of participants.  Justice Neil Gorsuch, in his pre-SCOTUS book The Future of Assisted Suicide and Euthanasia relied on the 1995 New York State Task Force on Life and the Law, appointed by Gov Mario Cuomo, which came out firmly against the legalization of assisted suicide based partly on its extrapolation of data from the Netherlands, a country then of 15 mio people, concluding ominously:

If euthanasia were practiced in a comparable percentage of cases in the US, voluntary euthanasia would account for about 36,000 deaths each year and euthanasia without the patients' consent would occur in an additional 16,000 deaths.

That dire prediction would have corresponded to euthanasia accounting for about 11% of the US population which succumbed in any given year  to a terminal illness (i.e. excluding accidents, homicides, accidents, heart attacks.)  The reality shows how ill-founded were those assumptions.

After 25 years of data-gathering with 10 US jurisdictions reporting, it is helpful to review the facts... and in doing so, to compare the situation in America with the worse-case predictions of MAID's opponents and with the reality in other countries which have also enacted MAID laws.  The discrepancies could not be more telling.

Let us start with Oregon, the state with the longest experience with MAID.  To date, since 1997, there has been a total of 2,159 patients who have died using Oregon's Death with Dignity Act (out of 3,280 prescriptions which have been filled), or an average of 90 a year, starting with 16 and rising to 238 in 2021.  The compound growth rate has been 12%.  As a percentage of all deaths in Oregon ascribable to a terminal illness (i.e. subtracting out accidents, contagious diseases etc.), it has averaged about 0.24%, and has never exceeded 0.65% (i.e. nowhere near the 11% the Cuomo commission cavalierly posited).

Let us next take the totality of reported deaths by MAID in the 10 US jurisdictions with MAID ( Montana is excluded as it has no statutory reporting requirements).  There have been a total of 5,171 deaths in that period (out of 8,213 prescriptions issues).   These numbers are trivial compared with the tens of millions of people who have died in that timespan of a terminal illness for which they would have been eligible under MAID.  The 11 jurisdictions where MAID is legally available represent 22% of the US population, in which states at least 150,000 people die every year from a disease which enters a terminal phase.  On average there are about 140 MAID prescriptions issued in the US each year, and 88 deaths, or about 0.06% of the eligible population.

Not let's compare the situation in the US with those in two other countries which have very granular data available: our neighbor to the north Canada and the Netherlands, one of the first countries to embrace euthanasia.

In Canada, with 38 mio inhabitants, and in the Netherlands with 17 mio inhabitants,  MAID is readily available nationwide.  In Canada each year about 250,000  people succumb  to a terminal illness;   In the Netherlands, it is around 85,000.  The most recent total number of MAID deaths annually in Canada is 7,600 and in he Netherlands 6,300. That corresponds to a participation rate of 3.0% and 7.4%... and those percentages have been relatively stable for the last few years.

One may ask why the participation rate is so much higher in Canada and the Netherlands.  Simply put, the laws are much more user friendly and accessible.  In the United States, a person must be terminally ill with 6 months to live.  In Canada and the Netherlands, a peson need only be suffering from an incurable illness causing intolerable suffering.  Furthermore, unlike in the US, where a person must be able to self administer (thereby excluding patients with Parkinsons or palsy or who are so handicapped they have no control of their arms), euthanasia is not only allowed, but widely preferred by patients.  In Canada and Holland by ratios of 10-1, patients themselves prefer that their doctors give them a quick-acting injection into the bloodstream, rather than having to imbibe an often bitter tasting (and occasionally nausea-inducing ) concoction.

In short, where MAID is most readily available and where the criteria do not impose an artificial 6 month prognosis, the most that a country will see is about 7.5%.  In the US as the laws are now written and with all the difficulties in even finding participation physicians and hospitals in a country where the Catholic Church controls half the hospital beds, the numbers are more like 0.05%.

In any event, the reality whether in America or in Canada/Holland, MAID is very rarely, only exceptionally used, even among a population group which is eligible. We who advocate for MAID in NC do not expect  see it become a commonplace because it will only appeal to a certain set of people.  But those people deserve the right to choose.



The Netherlands