Palliative Care 2016: Usage of Oregon’s Death With Dignity Act

Key Points

  • The prescribing rate for lethal medication increased 12% per year on average through 2013, with a 28% increase in 2014 and 40% in 2015 not explainable by growth in population.
  • Most of the of 991 patients who self-administered the medication had cancer (77%). Slightly more males than females self-administered; the median age of administration was 71 years; and the patients who self-administered were largely white.
  • The reasons for choosing death with dignity included finding activities of daily living not enjoyable (90%); loss of autonomy (92%), dignity (79%) or bodily functions (48%); inadequate pain control (25%); and financial reasons (3%). 

In 1997, Oregon enacted a voter initiative allowing terminally ill residents to self-administer physician-prescribed medication to end their lives called the Oregon Death With Dignity Act (ORDWDA). Statute requires prescriptions written for lethal medications be reported; the state also collects demographic and intended use data. Researchers led by Charles D. Blanke, MD, FACP, FASCO, Professor of Medicine at the Oregon Health & Sciences University Knight Cancer Institute, worked to evaluate and report participation trends in the initiative. The findings were presented at the 2016 Palliative Care in Oncology Symposium (Abstract 44).

Oregon’s Public Health Division gathers compliance forms from prescribing/consulting physicians, pharmacists, psychiatrists, prescribing physician follow-up forms, and death certificates. Data from 1998­ through early 2016 were reviewed, collated, and interpreted.

Findings

1,545 prescriptions were written, and 991 patients died from legally-prescribed lethal medication. The percentage of prescription recipients dying from drug use per year ranged from 48% to 82%, with no significant trend (logistic regression 2-sided P = .90).

The prescribing rate increased 12% per year on average through 2013, with a 28% increase in 2014 and 40% in 2015 not explainable by growth in population.

Most of the of 991 patients who self-administered the medication had cancer (77%); 8% had amyotrophic lateral sclerosis (ALS); 4.5% had lung disease; 2.6% had heart disease; and 0.9% had human immunodeficiency virus (HIV). 5.3% were sent for psychiatric evaluation. The male to female ratio was 51.4%:48.6%; the median age was 71 years (range, 25­­–102). The majority (97%) of patients were white, 0.1% were black, 1.3% were Asian, and 1% were Hispanic.

Patients who used hospice services were about 90.5% of initative participants, and 94% died at home. Estimated median time between intake and coma was 5 minutes (range, 1–38); the estimated median time between intake and death was 25 minutes (range, 1­–6240). Around 3% of patients experienced known complications.

The reasons for choosing death with dignity included finding activities of daily living not enjoyable (90%); loss of autonomy (92%), dignity (79%) or bodily functions (48%); inadequate pain control (25%); and financial reasons (3%).

Conclusions

The number of prescriptions written for ORDWDA medications increased annually since enactment. Very few patients are referred for psychiatric consultation prior to death with dignity. Most patients dying from lethal medications have cancer, and the overwhelming majority expire at home. Medications used are effective and rapidly acting. Patients use death with dignity for reasons related to quality of life, autonomy, and dignity; and relatively rarely due to inadequate pain palliation. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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