Oregon's Death With Dignity Act: Two Decades of Data

Tara Haelle

September 18, 2017

Oregon's Death With Dignity Act (DWDA), passed through a voter-approved ballot initiative in 1997, lays out strict requirements for patients interested in requesting a prescription from their physician that would enable the patient to end to his or her life. In the 20 years since its passage, 0.2% of deaths in Oregon resulted from DWDA prescriptions but the number is increasing, researchers report in an article published online today in Annals of Internal Medicine.   

To obtain a DWDA prescription, patients must be adults of sound mind, have Oregon residency status, and have a terminal illness diagnosis. In addition, two physicians must confirm the patient's diagnosis and prognosis, the patient must be offered hospice care, and the patient must make one witnessed written request and two oral requests at least 15 days apart.

Among the 1857 Oregon residents who received DWDA prescriptions between 1998 and June 2017, 64% died from taking the prescribed drugs. These deaths represented a rate of 19 per 10,000 total deaths out of the 614,972 all-cause deaths of Oregon adults during that period.

Cancer was the diagnosis for 77% of DWDA patients, 8% had amyotrophic lateral sclerosis, 5% had chronic respiratory disease, and 2% had heart disease. Among adults with these same diagnoses who did not elect DWDA prescriptions, the rate of death was 54.6 per 10,000 deaths.

DWDA death rates showed relative increases of 14% each year from 1998 to 2013 and 36% annually from 2013 to 2015. Although DWDA deaths appeared to level off in 2016, it's unclear whether that decline represents a change in trends or a temporary drop, as occurred in 2013.

The increase over time, however, is real after accounting for population growth, lead author, Katrina Hedberg, MD, MPH, from the Oregon Public Health Division in Portland, told Medscape Medical News.

"I can't tell you why [the increase] is happening, whether it's that more people are aware of it, changes in social norms or something else," Dr Hedberg said, but "the people who have participated are pretty much the same as they were initially."

That is, nearly all (96%) of those requesting DWDA prescriptions were white, a majority (72%) had some college (DWDA rates increased with educational attainment), and just over half (52%) were men. Their median age was 72 years, compared with a median age of death at 76 years among Oregonians who died of the same underlying illnesses without DWDA prescription. The patients' primary reasons for seeking DWDA prescriptions were a loss of autonomy, cited by 91%, and a decreasing ability to participate in enjoyable activities, cited by 89%. Just over a quarter (26%) cited pain, and 4% cited finances.

The publication of the Oregon study accompanies a new policy statement from the American College of Physicians (ACP) that opposes physician-assisted dying. The simultaneous publication of these data contextualizes the overall issue.

"I think it's important to be aware of what the data show and be aware of what's happening," Dr Hedberg told Medscape Medical News. Less than 1% of physicians have written a DWDA prescription (0.2% in 2000, rising to 0.6% in 2016), according to the new study. "[ACP is] making a statement about something that a relatively narrow proportion of the population is participating in."

Physicians are required to report a patient's decision to the state only when the prescription is written.

"I do think there's this broader scope of people who are asking questions but aren't going through all the steps," Dr Hedberg said. "We didn't think every conversation needed to be reported. I am very cognizant as a government official of balancing the mandates in terms of reporting with the need for patient privacy."

The study used "DWDA" instead of "physician-assisted suicide" or "physician-assisted dying" because "the statute specifically stated that this is not suicide," Dr Hedberg noted, adding that "there is no neutral term to use."

The article did not note any external funding beyond the Oregon Public Health Division. The authors have disclosed no relevant financial relationships.

Ann Intern Med. Published online September 18, 2017. Abstract

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