Characterizing 18 Years of the Death With Dignity Act in Oregon

Charles Blanke, Michael LeBlanc, Dawn Hershman, Lee Ellis, Frank Meyskens

Research output: Contribution to journalArticle

16 Citations (Scopus)

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 865 (90.5%) were in hospice care. Most (118, 92.2%) patients had insurance and 708 (71.9%) 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.

Original languageEnglish (US)
Pages (from-to)1403-1406
Number of pages4
JournalJAMA oncology
Volume3
Issue number10
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

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Right to Die
Prescriptions
Physicians
Legislation
Research
Hospice Care
Pain
Self Medication
Self Administration
Health
Activities of Daily Living
Coma
Insurance
Mental Competency
Lung Diseases
Observational Studies
Psychiatry
Heart Diseases
Neoplasms
Cohort Studies

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Characterizing 18 Years of the Death With Dignity Act in Oregon. / Blanke, Charles; LeBlanc, Michael; Hershman, Dawn; Ellis, Lee; Meyskens, Frank.

In: JAMA oncology, Vol. 3, No. 10, 01.10.2017, p. 1403-1406.

Research output: Contribution to journalArticle

Blanke, C, LeBlanc, M, Hershman, D, Ellis, L & Meyskens, F 2017, 'Characterizing 18 Years of the Death With Dignity Act in Oregon', JAMA oncology, vol. 3, no. 10, pp. 1403-1406. https://doi.org/10.1001/jamaoncol.2017.0243
Blanke, Charles ; LeBlanc, Michael ; Hershman, Dawn ; Ellis, Lee ; Meyskens, Frank. / Characterizing 18 Years of the Death With Dignity Act in Oregon. In: JAMA oncology. 2017 ; Vol. 3, No. 10. pp. 1403-1406.
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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 865 (90.5{\%}) were in hospice care. Most (118, 92.2{\%}) patients had insurance and 708 (71.9{\%}) 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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N2 - 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 865 (90.5%) were in hospice care. Most (118, 92.2%) patients had insurance and 708 (71.9%) 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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