Oregon Death with Dignity Act May Improve End-Of-Life Care

Am J Health Syst Pharm. 2001;58(12) 

Introduction

Oregon physicians report that they are more aware of their terminally ill patients' needs since the state's Death with Dignity Act was passed in 1994.

Newly published results [1] from a 1999 survey revealed that 76% of Oregon physicians whose charges included terminally ill patients tried to learn more about palliative care after the act was passed. Sixty-nine percent of these physicians said they had also worked since 1994 to improve their ability to identify depression and other psychiatric disorders.

Thirty percent of the responding physicians said they had referred more patients to hospice services after passage of the act. A third of the respondents incorrectly judged that the availability of hospice services in Oregon had risen since 1994, when in fact the availability was about the same. A possible explanation for this, said the report's authors, was that physicians had become more aware of hospice care in the wake of the act.

A total of 2641 practicing physicians responded to the survey, which was mailed to 3981 practitioners throughout the state. An earlier article [2] based on the same survey focused on the characteristics of people who requested a prescription for a lethal medication and physicians who cared for these patients. The new report examined physicians' attitudes and concerns about the Death with Dignity Act and discussions of the act between physicians and patients.

Thirty percent of the survey respondents concurred with the statement that writing a lethal prescription is "immoral" or "unethical," and about twice as many disagreed with this statement. Similarly, 51% of the responding physicians said they supported the Death with Dignity Act, and about a third opposed the law.

Twenty percent of the survey respondents said they had changed their opinion about the act between 1994 and 1999. Of those whose views changed, 13% were more in favor of the law than they had been, and 7% were more opposed.

Twenty-one percent of the physicians who discussed the act with patients said that at least one patient had become more comfortable after knowing the physician's views on the subject. Twenty-eight percent of physicians who discussed their opposition to the act with patients and 21% of physicians who talked about their support for the law said that at least one patient had been comforted by the conversation. But 4% of the physicians who opposed assisted suicide and 1% of those who favored the idea reported that a patient had left the physician's practice because of differences in opinion about assisted suicide.

Practical and legal concerns. Half of the physicians admitted that they were "only a little" or "not at all" confident of their ability to determine a patient's life expectancy, which, under the act, must be six months or less in order for a lethal prescription to be legal.

Thirty-four percent of the respondents said they were "willing" to prescribe a lethal dose of medication under the act's provisions. But 55% of the "willing" practitioners had not tried to obtain specific information about the law. Over a quarter of these physicians were "not at all" or "only a little" confident that they could find reliable information about which drug to use in a lethal prescription.

Some 82% percent of the physicians worried that writing a lethal prescription would be viewed as illegal by the Drug Enforcement Administration. Sixty-five percent feared that their hospital would "sanction" them for prescribing a lethal dose of medication. Almost 1 in 5 said their health system forbids writing lethal prescriptions.

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