Decisionally impaired persons in clinical research

Here’s a recent talk I gave at the University of Minnesota.  I can say without false modesty that a talk given by Carl Elliott was a bit more compelling.


God, mammon, and euthanasia

What distinguishes those countries that have legalized euthanasia/assisted suicide (the official terms used in the Netherlands) or assisted death/aid-in-dying (terms preferred by others; I use ‘EAD’ for euthanasia and assisted death as a compromise here) from those that have not?

The following countries have either had or currently have jurisdictions that have legalized euthanasia and assisted death (EAS):

  • The Netherlands
  • Belgium
  • Luxembourg
  • Colombia
  • Australia (briefly)
  • United States (in a few states)
  • Switzerland
  • Canada

Except for Colombia, the rest are wealthy Western countries. In fact, 7 of the 14 (50%) wealthiest Western countries (per capita wealth) have legalized assisted death at some point.  The 15th wealthiest Western nation (depending on the source) is UK, a country with a strong assisted death movement.

The remaining 7 of top 15 wealthiest Western countries have not legalized assisted death, and they consist of Germany (not surprising given its history), heavily Catholic countries (Ireland, Austria), and the Scandinavian countries (despite their secular, progressive reputation, surprisingly conservative on this issue).

The strong relationship between per capita wealth and permissive policies regarding assisted death is striking.

Many frame this issue as one between the religious and the non-religious. At least from a demographic perspective, this seems not to be the case. The proportion of a population who believe there is a God does not seem to correlate well with EAD legal status.  The following are proportion of persons who believe there is a God in the EAD legal countries (% saying yes to “You believe there is a God” in a 2010 Eurobarometer survey–so I’m limiting my examples below to countries with data from the survey):

  • The Netherlands 28%
  • Belgium 37%
  • Luxembourg 46%
  • Switzerland 44%

The following are some countries that have not legalized EAD and their proportion of population who believe there is a God:

  • Czech Republic 16%
  • Estonia 18%
  • France 27%
  • Sweden 18%
  • Norway 22%