More recently, those with no physical ailment but merely ‘tired of life’ also qualify for assisted suicide. ¼ of deaths in Belgium are instigated by those other than a physician with 1 out of 8 occurring in the home without consent of the individual. 3.8% of all euthanasia deaths in Belgium were not requested and involuntary. Nevertheless, no one has ever been prosecuted in Belgium or the Netherlands for any violation surrounding euthanasia or PAS.
In both Belgium and the Netherlands the clear trend has been away from usual PAS and Euthanasia practices towards sedating the individual into unconsciousness with sedatives or narcotics, then withdrawing food and fluids. The result is intentional dehydration, which, within a few days causes death, termed ‘slow euthanasia.’ This practice has gained ground within hospice in some quarters in the US as well. Palliative care in the Netherlands and Belgium, specialized care provided to patients with either chronic disabling or terminal illness is almost nonexistent.
A popular belief emerging in Belgium is the failure to provide euthanasia early is a form of ‘discrimination’ by causing individuals to ‘suffer’ longer putting pressure on families and individuals to agree to assisted suicide.
Oregon/Washington: Oregon legalized PAS in 1997; Washington in 2009. It is difficult to decipher the results of this law as the single sources of information currently are the Oregon and Washington Depts of Public Health, which, publish limited yearly reports. Death certificates in both states are labeled with the original diagnosis not as due to PAS precluding independent assessment. The most recent reports for both states in 2010 were incomplete. The number of patients requesting PAS referred for psychological evaluation decreased from 44% in 1999 to 1.5% in 2010. Depression in both states is not a contraindication to PAS.
Oregon Medicaid will pay for physician assisted suicide but refuses surgery, radiation and chemotherapy if they judge survival unlikely. Oregon QualMed HMO will pay for PAS but limits payment on hospice care.