Assisted dying practices for individuals living with frailty: prevalence and eligibility

Abstract

Background Despite the high prevalence of frailty among individuals nearing the end of life, there is uncertainty around assisted dying practices (encompassing physician-assisted suicide and voluntary euthanasia) in this population. Aim We aimed to 1) describe the prevalence of frailty among individuals accessing AD, and to describe whether frailty was the main condition or a comorbidity, and 2) where prevalence data are not available, determine whether individuals are likely to be eligible for AD on the basis of their frailty. Methods We reviewed publicly available statistics on AD usage and the relevant legal provision from jurisdictions where AD is regulated. Results Only Canada and the Netherlands report the prevalence of frailty among individuals accessing AD. In Canada, 9.07% of deaths by AD in 2023 were associated with frailty (either as a main condition or as a comorbidity). In the Netherlands, 3.85% of deaths by AD involved multiple geriatric syndromes in 2023. We identified 11 jurisdictions in which it would be unlikely for frailty to be an eligible condition to access AD, 6 jurisdictions where severe frailty meets or would be likely to meet eligibility criteria to access AD and 14 jurisdictions where it is unclear. Conclusion There is a lack of detailed reporting and ongoing ambiguity about eligibility of frailty in AD across many jurisdictions. These findings support the need for improved data reporting and clarity in regulation to provide more certainty to people living with frailty and their healthcare providers.