Study Finds Majority Users of Oregon's Death With Dignity Act Had Cancer

To date, 4 states in the United States have enacted the Death With Dignity Act: Oregon, Washington, Vermont, and California. Oregon was the first state in 1997 to do so, following a voter initiative; California is the latest (2016). A new study, presented at the 2016 Palliative Care in Oncology Symposium hosted by the American Society of Clinical Oncology, provides an update on patient demographics and participation trends in the state of Oregon.

In this pioneer state, the Death With Dignity Act was initiated on October 27, 1997, to provide terminally-ill individuals to end their lives through voluntary self-administration of physician-prescribed lethal medications. The Oregon Health Authority is mandated to gather information on participating providers and patients—so for their study, the authors reviewed, collated, and interpreted data collected from prescribing/consulting physicians, pharmacists, and psychiatrists between 1998 and early 2016.

The authors report that 1545 prescriptions were written during the entire period that the Oregon Death With Dignity Act has been active. Less than a 1000 of those prescriptions were used—991 patient deaths from legally prescribed lethal drugs were reported. Growing awareness about the Act could be responsible for the rise in prescriptions, which increased at an average rate of 12% per year till 2013 and more than doubled to 28% in 2014 and to 40% in 2015. Of the 991 patients who died,

• 77% had cancer
• 8% had amyotrophic lateral sclerosis
• 4.5% had lung disease
• 2.6% had heart disease
• 0.9% had HIV

Only about 5% of the patients received psychiatric evaluation. According to provisions within the law, a referral is at the discretion of the attending or consulting physician.

While there was no gender bias in those who died (male/female: 51.4%/48.6%), patients who took the lethal dose tended to be older (median age 71 years) and white (97%), the authors found. Further, a majority of them chose hospice care (90.5%) and most died at home (94%).

The most common reasons reported for choosing death with dignity were not being able to enjoy daily activities (90%) and the loss of autonomy (92%). Only a quarter of the patients listed inadequate pain palliation as the reason for their choice to end life.

Reference

Blanke CD, LeBlanc ML, Hershman DL, Ellis LM, Meyskens FL. Usage of Oregon’s Death With Dignity Act (DWDA). J Clin Oncol. 2016;34(suppl 26S; abstract 44).