Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Euthanasia and Assisted Suicide in Selected European Countries and US States

Systematic Literature Review

Steck, Nicole, MSc*; Egger, Matthias, MD, MSc, FFPHM*,†; Maessen, Maud, PhD*; Reisch, Thomas, MD; Zwahlen, Marcel, PhD*

doi: 10.1097/MLR.0b013e3182a0f427
Original Articles

Background: Legal in some European countries and US states, physician-assisted suicide and voluntary active euthanasia remain under debate in these and other countries.

Objectives: The aim of the study was to examine numbers, characteristics, and trends over time for assisted dying in regions where these practices are legal: Belgium, Luxembourg, the Netherlands, Switzerland, Oregon, Washington, and Montana.

Design: This was a systematic review of journal articles and official reports. Medline and Embase databases were searched for relevant studies, from inception to end of 2012. We searched the websites of the health authorities of all eligible countries and states for reports on physician-assisted suicide or euthanasia and included publications that reported on cases of physician-assisted suicide or euthanasia. We extracted information on the total number of assisted deaths, its proportion in relation to all deaths, and socio-demographic and clinical characteristics of individuals assisted to die.

Results: A total of 1043 publications were identified; 25 articles and reports were retained, including series of reported cases, physician surveys, and reviews of death certificates. The percentage of physician-assisted deaths among all deaths ranged from 0.1%–0.2% in the US states and Luxembourg to 1.8%–2.9% in the Netherlands. Percentages of cases reported to the authorities increased in most countries over time. The typical person who died with assistance was a well-educated male cancer patient, aged 60–85 years.

Conclusions: Despite some common characteristics between countries, we found wide variation in the extent and specific characteristics of those who died an assisted death.

*Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

School of Social and Community Medicine, University of Bristol, Bristol, UK

University Hospital of Psychiatry, Bern, Switzerland

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

N.S., M.E., and M.Z. conceived the study, N.S. coordinated the review and carried out the searches, N.S. and M.Z. screened titles and extracted data. All authors contributed to the interpretation and writing of the manuscript and approved the final manuscript.

Supported by the Swiss National Science Foundation (grants 325130_133139 ( and 33CSC0_134273 (, and T.R. is a co-investigator on grant number 406740_139240 (

The authors declare no conflict of interest.

Reprints: Marcel Zwahlen, PhD, Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, CH-3012 Bern, Switzerland. E-mail:

© 2013 by Lippincott Williams & Wilkins.