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Brief Report
April 6, 2017

Characterizing 18 Years of the Death With Dignity Act in Oregon

Author Affiliations
  • 1SWOG Group Chair’s Office, Portland, Oregon
  • 2SWOG Executive Advisory Committee, Portland, Oregon
JAMA Oncol. Published online April 6, 2017. doi:10.1001/jamaoncol.2017.0243
Key Points

Question  How is physician-aided dying being used in Oregon?

Findings  In this analysis of publicly available data, about two-thirds of patients prescribed lethal medication under Oregon’s Death with Dignity act consumed the medication and subsequently died. Cancer was the most common underlying disease.

Meaning  Physician aid-in-dying makes up only a small fraction of Oregon resident deaths, accounting for 38.6 deaths per 10 000 total deaths, but it offers considerable potential benefits to many patients who are near the end of their life.

Abstract

Importance  Numerous states have pending physician-aided dying (PAD) legislation. Little research has been done regarding use of PAD, or ways to improve the process and/or results.

Objectives  To evaluate results of Oregon PAD, the longest running US program; to disseminate results; and to determine promising PAD research areas.

Design, Setting, and Participants  A retrospective observational cohort study of 991 Oregon residents who had prescriptions written as part of the state’s Death with Dignity Act. We reviewed publicly available data from Oregon Health Authority reports from 1998 to 2015, and made a supplemental information request to the Oregon Health Authority.

Main Outcomes and Measures  Number of deaths from self-administration of lethal medication versus number of prescriptions written.

Results  A total of 1545 prescriptions were written, and 991 patients died by using legally prescribed lethal medication. Of the 991 patients, 509 (51.4%) were men and 482 (48.6%) were women. The median age was 71 years (range, 25-102 years). The number of prescriptions written increased annually (from 24 in 1998 to 218 in 2015), and the percentage of prescription recipients dying by this method per year averaged 64%. Of the 991 patients using lethal self-medication, 762 (77%) recipients had cancer, 79 (8%) had amyotrophic lateral sclerosis, 44 (4.5%) had lung disease, 26 (2.6%) had heart disease, and 9 (0.9%) had HIV. Of 991 patients, 52 (5.3%) were sent for psychiatric evaluation to assess competence. Most (953; 96.6%) patients were white and 92.2% were in hospice care. Most (118, 92.2%) patients had insurance and 92 (70.8%) had at least some college education. Most (94%) died at home. The estimated median time between medication intake and coma was 5 minutes (range, 1-38 minutes); to death it was 25 minutes (range, 1-6240 minutes). Thirty-three (3.3%) patients had known complications. The most common reasons cited for desiring PAD were activities of daily living were not enjoyable (89.7%) and losses of autonomy (91.6%) and dignity (78.7%); inadequate pain control contributed in 25.2% of cases.

Conclusions and Relevance  The number of PAD prescriptions written in Oregon has increased annually since legislation enactment. Patients use PAD for reasons related to quality of life, autonomy, and dignity, and rarely for uncontrolled pain. Many questions remain regarding usage and results, making this area suitable for cancer care delivery research.

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