Oregon’s Death with Dignity Act: The Second Year’s Experience

[Pages:21]Oregon's Death with Dignity Act:

The Second Year's Experience

Department of Human Services Oregon Health Division

Center for Disease Prevention and Epidemiology February 23, 2000

Oregon's Death with Dignity Act: The Second Year's Experience

Prepared by: Amy D. Sullivan, Ph.D., M.P.H. Katrina Hedberg, M.D., M.P.H.

David W. Fleming, M.D.

For more information contact: Katrina Hedberg, M.D., M.P.H.

Oregon Health Division 800 N. E. Oregon Street, Suite 772

Portland, OR 97232 E-mail: katrina.hedberg@state.or.us

Phone: 503-731-4273 Fax: 503-731-4798

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Summary In November 1997, approval of the Death with Dignity Act made Oregon the only state

allowing legal physician-assisted suicide (PAS). With passage of the Act came concerns that participation in the Death with Dignity Act might be forced onto poor, uneducated or uninsured patients, or that patients with inadequate end-of-life care might disproportionately seek to participate. We previously reported that during 1998, the first year of implementation, 23 Oregonians received prescriptions for lethal doses of medication; 15 of them died after ingesting these medications. Their participation was not associated with low educational level, lack of health insurance or poor access to hospice care. Physicians of terminally ill patients using PAS in 1998 reported patient concerns over loss of autonomy and control of bodily functions. Here we report results from 1999, summarizing information from physician reports, physician interviews, and death certificates. We also present information from interviews with families that were conducted to help us better understand patients' reasons for requesting PAS.

Patients participating in PAS were identified through mandatory physician reporting, and additional data were obtained from physician interviews and death certificates. We interviewed families of patients who participated between September 15, 1998 and October 15, 1999.

In 1999, 33 prescriptions were written for lethal doses of medication, and 27 patients participated in legal PAS (26 of the 33 1999 prescription recipients and one 1998 prescription recipient). Of the remaining seven 1999 prescription recipients, five died of their underlying illness and two were still alive at the end of the year. One additional 1998 death, from late in that year, also was included in this report, increasing the number of prescriptions in that year from 23 to 24, and the number of PAS deaths from 15 to 16.

The median age of the 27 patients who took lethal medication in 1999 was 71 years. Sixteen were male, 26 were white and 12 were married. Nine were from the Portland metropolitan area, and 13 were college graduates. The most frequent underlying diseases were end-stage cancer (17 patients), amyotrophic lateral sclerosis (4 patients), and chronic obstructive pulmonary disease (4 patients). All patients had health insurance and 21 were in hospice before death. These 27 patients using PAS in 1999 (9 PAS deaths /10,000 Oregon deaths) were demographically and medically similar to the 16 patients using PAS in 1998 (6 PAS deaths /10,000 Oregon deaths), though more likely married (44% vs. 13 %; P ................
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