Assisted dying in Oregon

In Oregon, USA, it has been legal for terminally ill, mentally competent adults to have an assisted death for 19 years. In those 19 years there have been no cases of abuse and the law has not been extended beyond terminally ill adults.

Assisted dying in Oregon works. It prevents unnecessary suffering at the end of life and provides dying adults with the choice to control their death, if that is their wish.

Evidence shows assisted dying legislation is working in Oregon

Evidence shows assisted dying legislation is working in Oregon. In the 19 years assisted dying has been legal in Oregon there have been no calls to extend the law beyond terminally ill, mentally competent adults.

The 2015 Oregon report showed:

  • 132 people had an assisted death. This accounts for around 0.39% of total deaths in Oregon
  • 218 people were eligible and received the prescription for life-ending medication in 2015. 50 did not take the medication, dying of their underlying terminal illness and taking comfort in knowing the option was there. The remaining people have either not taken the medication yet or the outcome is still being processed for the Oregon Health Authority.
  • 92% of people who had an assisted death were also enrolled in hospice care (average deaths under hospice care in the USA are 45%¹)
  • The majority of people who had an assisted death had terminal cancer and were aged 65+
  • 96% of requesting people cited being ‘less able to engage in activities making life enjoyable’ as their reason for request, followed by ‘losing autonomy’ (92%) and ‘loss of dignity’ (75%). Concerns about being a burden has been cited by around 40% of people over the years, with additional research showing that this reflects people’s worries, rather than caregivers feeling burdened.
  • Consistent across the years, time from taking medication to unconsciousness is 5 minutes and time till death is, on average, 25 minutes.

You can access the 2015 report in full here.

Life-ending medication is self-administered by the terminally ill patient

Under Oregon’s Death with Dignity Act the terminally ill patient must be able to self-administer and ingest the life-ending medication themselves and they can only be prescribed the medication after meeting a number of legal safeguards. These include:

  • The patient must be 18 years or older
  • The patient must be mentally competent
  • The patient must be diagnosed with a terminal illness that will lead to their death within 6 months

How people are protected in Oregon

Safeguards in Oregon’s law ensure potentially vulnerable people are protected and the option is only available to dying patients. The safeguards and the request process are designed to protect patients.

The terminally ill patient:

  • Must request life-ending medication twice, with 15 days separating each request (a ‘cooling off’ period).
  • Must make a written request to their doctor– witnessed by two individuals who are not primary care givers or family members
  • Can cancel the verbal and written requests at any time
  • Must be able to self-administer and ingest the life-ending medication themselves.

In addition:

  • The diagnosis of a terminal illness with less than six months to live must be certified by a consulting doctor, who must also certify the patient is mentally competent to make and communicate healthcare decisions
  • If either doctor determines the patient’s judgement is impaired the patient would either be deemed ineligible for assistance or they could be referred for psychological evaluation
  • The attending doctor must inform the patient of alternatives, including palliative care, hospice and pain management options

The impact on palliative care

Palliative care is delivered to a very high standard in Oregon. Overall, 93% of the people who have had an assisted death in Oregon were enrolled in hospice care. The national average for the USA as a whole is 45%¹.

The rate of use of assisted dying legislation has been described as ‘very low’ by researchers, who suggest that the reason for this may be the high quality of care provided by Oregon’s hospices.²

Assisted dying is not a replacement for palliative care. It is an option for terminally ill adults who wish to control the manner and timing of their death who would otherwise have to go through weeks of unnecessary suffering.

According to Ann Jackson, Executive Director/CEO of Oregon Hospice Association (1988 to 2008), assisted dying:

 

“…has been responsibly implemented with none of the predicted dire consequences”

“Physician-assisted dying is not used by people without access to hospice and palliative care: every Oregonian has access, even in the most remote and rural areas of the state. Oregon’s hospices strongly support a dying Oregonian’s right to choose from among all end-of-life options.”

“In fact, Oregon was declared a national leader in end-of-life care in 1998, before the Death With Dignity Act was implemented, and maintains its position as a leader today.”

Ann Jackson Executive Director/CEO Oregon Hospice Association.³

 

Assisted Dying Bills build on the Oregon model

Both Lord Falconer’s and Rob Marris’  Assisted Dying Bill were similar to Oregon’s Death with Dignity Act.

But there are some key differences that build on Oregon’s legislation:

  1. Under the Assisted Dying Bill the life-ending medication is stored at the pharmacy until the terminally ill person decides they want to use it – in Oregon it can be kept in the patient’s home.
  2. Under the Assisted Dying Bill a doctor or nurse must deliver the life-ending medication to the patient when they want to use it. The doctor or nurse would check that the patient did not want to change their mind and would stay with the patient and their family. In Oregon the patient can ask a healthcare professional to be with them when they take the medication, but it is not a requirement of the law.
  3. The Assisted Dying Bill includes a ‘sunset clause’ which states that Parliament must review the law after 10 years, and that Parliament could repeal the law at this point. This is a unique safeguard that has not been used in any previous assisted dying legislation. It ensures that there is a formal review of how the law works in practice.

 

1. http://www.nhpco.org/sites/default/files/public/Statistics_Research/2012_Facts_Figures.pdf

2. Ganzini L et al (2002) Experiences of Oregon nurses and social workers who requested assistance with suicide New England Journal of Medicine 347(8): 582-8

3. http://www.judiciary.senate.gov/hearings/testimony.cfm?id=e655f9e2809e5476862f735da1154c57&wit_id=e655f9e2809e5476862f735da1154c57-3-4