Pulling the plug. The planned death of a cancer patient may help surviving friends and family cope.

Dealing With Death

Friends and family of cancer patients who die by euthanasia fare better than those of similar patients who die natural deaths, new research suggests.

Although euthanasia is outlawed in many countries, it is legal in the Netherlands, where several thousand people, the majority of whom are cancer patients, choose to die every year. Researchers at the University Medical Center Utrecht decided to find out if the kin of those patients who chose euthanasia suffered more or less grief than those who died naturally.

The researchers selected 78 cancer patients euthanized at the hospital between 1992 and 1999 and 156 cancer patients who died there naturally during the same time period. Friends and family of each person completed questionnaires assessing their personalities and levels of grief. Relatives and friends of patients who died by euthanasia experienced grief symptoms and posttraumatic stress reactions that rated 5% and 2% less, respectively, on a standardized scale than those of patients who died naturally, the team reports online in the British Medical Journal on 25 July.

Lead author Nikke Swarte and colleagues speculate that knowing when and how their loved one will die may encourage friends and family members to talk openly about death and prepare for it, easing the burden of grief down the road. The findings aren't an endorsement of euthanasia, Swarte says, but they show that--at least from the survivors' perspectives--"it's not worse" than other ways of dying. She also cautions that the results wouldn't necessarily apply in countries where euthanasia is not culturally acceptable.

Other researchers see shortcomings in the study's methods. "The bereaved family and friends of euthanized patients were more educated and had more distant relationships to their deceased," factors known to diminish grief after any death, points out Patricia Koop of the University of Alberta, Canada. The researchers also did not make clear how much time passed between diagnosis and death for patients in the two groups, says Ezekial Emanuel, a bioethicist and oncologist at the National Institutes of Health in Bethesda, Maryland. Perhaps the amount of grief depends more on having time to say goodbye than on how the patients died, he says.

Related site
National Institutes of Health MedlinePlus page on Death and Dying