When a doctor hastens the death of a terminally ill patient, the end is not always easy or peaceful, says a report in the New England Journal of Medicine.

The scientists from the Netherlands, where euthanasia and physician-assisted suicide have been legal for years, found that such efforts frequently go awry.

When patients tried to kill themselves using drugs prescribed by a doctor, the medication did not work as expected in 16 percent of cases. In addiction, technical problems or unexpected side-effects occurred seven percent of the time.

Problems surfaced so often that doctors witnessing the attempted suicide felt compelled to intervene and ensure death in 18 percent of cases, says the report released today.

Even when the doctor was directly performing euthanasia, the researchers found complications developed in three percent of attempts. Patients either took longer to die than expected or awoke from a drug-induced coma that was supposed to be fatal in six percent of cases.

“This is information that will come as a shock to the many members of the public, including legislators and even some physicians, who have never considered that the procedures involved in physician-assisted suicide and euthanasia might sometimes add to the suffering they are meant to alleviate,” Dr. Sherwin Nuland of Yale University School of Medicine said in a Journal editorial.

The new study, led by Dr. Johanna Groenewoud of Erasmus University in Rotterdam, “introduces a new element into the calculus” of the U.S. debate over physician-assisted suicide, said Nuland, “one that should have made its appearance long ago: patients who wish to receive help in dying face a small but nevertheless worrisome possibility that some untoward event will prevent the smooth. accomplishment of their wish.”

Nuland said the underlying problem is that “doctors are unprepared to end life” and those practicing in areas where physician-assisted suicide is legal should learn how to hasten death without suffering.

“Once the decision to intervene has been made, the goal should be to ensure that death is as merciful and serene as possible.”

Groenewoud’s group reviewed 649 cases: 535 where the doctors intended to perform euthanasia and 114 where they intended to provide assistance.

In the 114 cases, Groenewoud’s group found two people awoke from their coma and 14 either did not become comatose from the fatal drug or took longer to die than expected. In addition, seven had difficulty swallowing the deadly drug prescribed by the doctor, four vomited after taking the drug, and three developed extreme gasping.

Complications were less common during the doctor-controlled euthanasia attempts, but problems still surfaced.

In five of the 535 attempts where a doctor was present, the patients awoke from the coma and death took longer than expected in 23 cases.

“In one case, that patient’s eyes remained open, and in another case, the patient sat up,” the researchers reported.