Euthanasia and physician-assisted suicide in Scandinavia — with a conceptual suggestion regarding international research in relation to the phenomena

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Abstract
This article analyses and compares recent research on Scandinavian physicians' attitudes towards, as well as their practice of, euthanasia and physician-assisted suicide. The studies discussed are quite dissimilar in their design, resulting in considerable difficulties as far as comparability is concerned. Such difficulties are common in these fields of research. As an intended contribution to the amendment of future research, we suggest what we take to be detailed and precise definitions of the terms euthanasia and physician-assisted suicide for use internationally. Our definitions, or interpretations, basically draw on the Dutch experience and understanding of these terms. The Dutch approach implies that acts of abstention from life-prolonging treatment, i.e., withholding and withdrawing treatment, and pain and symptom treatment that theoretically could shorten life (including terminal sedation) are to be considered ‘normal medical practice’. Furthermore, death is seen as having natural causes in all of these acts. That, however, is not the case with euthanasia and physician-assisted suicide. When a physician performs either of these acts, he or she is required to state ‘unnatural death’ in the patient's death certificate. Our conceptual suggestions do not address the ethical status of the various medical decisions that are made with regard to the death of patients; our aim is conceptual clarity only. As far as euthanasia and physician-assisted suicide in Scandinavia is concerned, even though comparisons prove difficult, we do think some observations may be made: physicians from Norway, Denmark and Sweden display differences in both attitude and practice concerning these phenomena. Norwegian physicians are most restrictive with regard to attitude. Danish and Swedish physicians display a more liberal attitude, the latter being the most liberal. These findings did not fit the physicians' practice. Danish physicians have performed euthanasia and physician-assisted suicide more often than Norwegian physicians. Swedish physicians, even though they are the most liberal when it comes to attitude, appear never to have performed euthanasia and very seldom physician-assisted suicide.