Trends in Medical Aid in Dying in Oregon and Washington

Luai Al Rabadi, Michael Leblanc, Taylor Bucy, Lee M. Ellis, Dawn L. Hershman, Frank L. Meyskens, Lynne Taylor, Charles Blanke

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Importance: The combined 28 years of data of medical aid in dying (MAID) between Oregon (OR) and Washington (WA) are the most comprehensive in North America. No reports to date have compared MAID use in different US states. Objective: To evaluate and compare patterns of MAID use between the states with the longest-running US death with dignity programs. Design, Setting, and Participants: A retrospective observational cohort study of OR and WA patients with terminal illness who received prescriptions as part of their states' legislation allowing MAID. All published annual reports, from 1998 to 2017 in OR and from 2009 to 2017 in WA, were reviewed. A total of 3368 prescriptions were included. Main Outcomes and Measures: Number of deaths from self-administration of lethal medication vs number of prescriptions written. Results: A combined 3368 prescriptions were written in OR and WA, with 2558 patient deaths from lethal ingestion (76.0%). Of the 2558 patients, most were male (1311 [51.3%]), older than 65 years (1851 [72.4%]), and non-Hispanic white (2426 [94.8%]). The most common underlying illnesses were cancer (1955 [76.4%]), neurologic illness (261 [10.2%]), lung disease (144 [5.6%]), and heart disease (117 [4.6%]). Loss of autonomy (2235 [87.4%]), impaired quality of life (2203 [86.1%]), and loss of dignity (1755 [68.6%]) were the most common reasons for pursuing MAID. Time between drug intake to coma ranged from 1 to 660 minutes and time from drug intake to death ranged from 1 to 6240 minutes. In the 1557 patients for whom rates of complications were reported, 1494 (96.0%) did not experience a complication (592 of 626 [94.6%] in OR and 902 of 931 [96.8%] in WA). Eight patients (<0.5%) regained consciousness after drug ingestion in OR. Annual rates per year for percentage of patients who received a prescription ingesting the prescribed medication ranged from 48% to 87%, with no significant time trend in OR (adjusted odds ratio per year, 1.01; 95% CI, 0.99-1.02; P =.59) but with an increase over time in WA (adjusted odds ratio per year, 1.13; 95% CI, 1.08-1.19; P <.001). In both OR and WA there were increases in the number of patient deaths due to MAID per 1000 deaths over time. Conclusions and Relevance: In this study, MAID results in Oregon and Washington were similar, although MAID use measured as a percentage of patients prescribed lethal medications and then self-administering them increased only in WA. Most patients who acquired lethal prescriptions had cancer or terminal illnesses that are difficult to palliate and lead to loss of autonomy, dignity, and quality of life.

Original languageEnglish (US)
JournalJAMA Network Open
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Prescriptions
Medical Legislation
Eating
Odds Ratio
Right to Die
Quality of Life
Pharmaceutical Preparations
Annual Reports
Self Administration
Coma
North America
Consciousness
Nervous System
Lung Diseases
Observational Studies
Heart Diseases
Neoplasms
Cohort Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Al Rabadi, L., Leblanc, M., Bucy, T., Ellis, L. M., Hershman, D. L., Meyskens, F. L., ... Blanke, C. (Accepted/In press). Trends in Medical Aid in Dying in Oregon and Washington. JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2019.8648

Trends in Medical Aid in Dying in Oregon and Washington. / Al Rabadi, Luai; Leblanc, Michael; Bucy, Taylor; Ellis, Lee M.; Hershman, Dawn L.; Meyskens, Frank L.; Taylor, Lynne; Blanke, Charles.

In: JAMA Network Open, 01.01.2019.

Research output: Contribution to journalArticle

Al Rabadi, L, Leblanc, M, Bucy, T, Ellis, LM, Hershman, DL, Meyskens, FL, Taylor, L & Blanke, C 2019, 'Trends in Medical Aid in Dying in Oregon and Washington', JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2019.8648
Al Rabadi L, Leblanc M, Bucy T, Ellis LM, Hershman DL, Meyskens FL et al. Trends in Medical Aid in Dying in Oregon and Washington. JAMA Network Open. 2019 Jan 1. https://doi.org/10.1001/jamanetworkopen.2019.8648
Al Rabadi, Luai ; Leblanc, Michael ; Bucy, Taylor ; Ellis, Lee M. ; Hershman, Dawn L. ; Meyskens, Frank L. ; Taylor, Lynne ; Blanke, Charles. / Trends in Medical Aid in Dying in Oregon and Washington. In: JAMA Network Open. 2019.
@article{8c24e26a5b0843ea87a4551d297c3a10,
title = "Trends in Medical Aid in Dying in Oregon and Washington",
abstract = "Importance: The combined 28 years of data of medical aid in dying (MAID) between Oregon (OR) and Washington (WA) are the most comprehensive in North America. No reports to date have compared MAID use in different US states. Objective: To evaluate and compare patterns of MAID use between the states with the longest-running US death with dignity programs. Design, Setting, and Participants: A retrospective observational cohort study of OR and WA patients with terminal illness who received prescriptions as part of their states' legislation allowing MAID. All published annual reports, from 1998 to 2017 in OR and from 2009 to 2017 in WA, were reviewed. A total of 3368 prescriptions were included. Main Outcomes and Measures: Number of deaths from self-administration of lethal medication vs number of prescriptions written. Results: A combined 3368 prescriptions were written in OR and WA, with 2558 patient deaths from lethal ingestion (76.0{\%}). Of the 2558 patients, most were male (1311 [51.3{\%}]), older than 65 years (1851 [72.4{\%}]), and non-Hispanic white (2426 [94.8{\%}]). The most common underlying illnesses were cancer (1955 [76.4{\%}]), neurologic illness (261 [10.2{\%}]), lung disease (144 [5.6{\%}]), and heart disease (117 [4.6{\%}]). Loss of autonomy (2235 [87.4{\%}]), impaired quality of life (2203 [86.1{\%}]), and loss of dignity (1755 [68.6{\%}]) were the most common reasons for pursuing MAID. Time between drug intake to coma ranged from 1 to 660 minutes and time from drug intake to death ranged from 1 to 6240 minutes. In the 1557 patients for whom rates of complications were reported, 1494 (96.0{\%}) did not experience a complication (592 of 626 [94.6{\%}] in OR and 902 of 931 [96.8{\%}] in WA). Eight patients (<0.5{\%}) regained consciousness after drug ingestion in OR. Annual rates per year for percentage of patients who received a prescription ingesting the prescribed medication ranged from 48{\%} to 87{\%}, with no significant time trend in OR (adjusted odds ratio per year, 1.01; 95{\%} CI, 0.99-1.02; P =.59) but with an increase over time in WA (adjusted odds ratio per year, 1.13; 95{\%} CI, 1.08-1.19; P <.001). In both OR and WA there were increases in the number of patient deaths due to MAID per 1000 deaths over time. Conclusions and Relevance: In this study, MAID results in Oregon and Washington were similar, although MAID use measured as a percentage of patients prescribed lethal medications and then self-administering them increased only in WA. Most patients who acquired lethal prescriptions had cancer or terminal illnesses that are difficult to palliate and lead to loss of autonomy, dignity, and quality of life.",
author = "{Al Rabadi}, Luai and Michael Leblanc and Taylor Bucy and Ellis, {Lee M.} and Hershman, {Dawn L.} and Meyskens, {Frank L.} and Lynne Taylor and Charles Blanke",
year = "2019",
month = "1",
day = "1",
doi = "10.1001/jamanetworkopen.2019.8648",
language = "English (US)",
journal = "JAMA network open",
issn = "2574-3805",
publisher = "American Medical Association",

}

TY - JOUR

T1 - Trends in Medical Aid in Dying in Oregon and Washington

AU - Al Rabadi, Luai

AU - Leblanc, Michael

AU - Bucy, Taylor

AU - Ellis, Lee M.

AU - Hershman, Dawn L.

AU - Meyskens, Frank L.

AU - Taylor, Lynne

AU - Blanke, Charles

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Importance: The combined 28 years of data of medical aid in dying (MAID) between Oregon (OR) and Washington (WA) are the most comprehensive in North America. No reports to date have compared MAID use in different US states. Objective: To evaluate and compare patterns of MAID use between the states with the longest-running US death with dignity programs. Design, Setting, and Participants: A retrospective observational cohort study of OR and WA patients with terminal illness who received prescriptions as part of their states' legislation allowing MAID. All published annual reports, from 1998 to 2017 in OR and from 2009 to 2017 in WA, were reviewed. A total of 3368 prescriptions were included. Main Outcomes and Measures: Number of deaths from self-administration of lethal medication vs number of prescriptions written. Results: A combined 3368 prescriptions were written in OR and WA, with 2558 patient deaths from lethal ingestion (76.0%). Of the 2558 patients, most were male (1311 [51.3%]), older than 65 years (1851 [72.4%]), and non-Hispanic white (2426 [94.8%]). The most common underlying illnesses were cancer (1955 [76.4%]), neurologic illness (261 [10.2%]), lung disease (144 [5.6%]), and heart disease (117 [4.6%]). Loss of autonomy (2235 [87.4%]), impaired quality of life (2203 [86.1%]), and loss of dignity (1755 [68.6%]) were the most common reasons for pursuing MAID. Time between drug intake to coma ranged from 1 to 660 minutes and time from drug intake to death ranged from 1 to 6240 minutes. In the 1557 patients for whom rates of complications were reported, 1494 (96.0%) did not experience a complication (592 of 626 [94.6%] in OR and 902 of 931 [96.8%] in WA). Eight patients (<0.5%) regained consciousness after drug ingestion in OR. Annual rates per year for percentage of patients who received a prescription ingesting the prescribed medication ranged from 48% to 87%, with no significant time trend in OR (adjusted odds ratio per year, 1.01; 95% CI, 0.99-1.02; P =.59) but with an increase over time in WA (adjusted odds ratio per year, 1.13; 95% CI, 1.08-1.19; P <.001). In both OR and WA there were increases in the number of patient deaths due to MAID per 1000 deaths over time. Conclusions and Relevance: In this study, MAID results in Oregon and Washington were similar, although MAID use measured as a percentage of patients prescribed lethal medications and then self-administering them increased only in WA. Most patients who acquired lethal prescriptions had cancer or terminal illnesses that are difficult to palliate and lead to loss of autonomy, dignity, and quality of life.

AB - Importance: The combined 28 years of data of medical aid in dying (MAID) between Oregon (OR) and Washington (WA) are the most comprehensive in North America. No reports to date have compared MAID use in different US states. Objective: To evaluate and compare patterns of MAID use between the states with the longest-running US death with dignity programs. Design, Setting, and Participants: A retrospective observational cohort study of OR and WA patients with terminal illness who received prescriptions as part of their states' legislation allowing MAID. All published annual reports, from 1998 to 2017 in OR and from 2009 to 2017 in WA, were reviewed. A total of 3368 prescriptions were included. Main Outcomes and Measures: Number of deaths from self-administration of lethal medication vs number of prescriptions written. Results: A combined 3368 prescriptions were written in OR and WA, with 2558 patient deaths from lethal ingestion (76.0%). Of the 2558 patients, most were male (1311 [51.3%]), older than 65 years (1851 [72.4%]), and non-Hispanic white (2426 [94.8%]). The most common underlying illnesses were cancer (1955 [76.4%]), neurologic illness (261 [10.2%]), lung disease (144 [5.6%]), and heart disease (117 [4.6%]). Loss of autonomy (2235 [87.4%]), impaired quality of life (2203 [86.1%]), and loss of dignity (1755 [68.6%]) were the most common reasons for pursuing MAID. Time between drug intake to coma ranged from 1 to 660 minutes and time from drug intake to death ranged from 1 to 6240 minutes. In the 1557 patients for whom rates of complications were reported, 1494 (96.0%) did not experience a complication (592 of 626 [94.6%] in OR and 902 of 931 [96.8%] in WA). Eight patients (<0.5%) regained consciousness after drug ingestion in OR. Annual rates per year for percentage of patients who received a prescription ingesting the prescribed medication ranged from 48% to 87%, with no significant time trend in OR (adjusted odds ratio per year, 1.01; 95% CI, 0.99-1.02; P =.59) but with an increase over time in WA (adjusted odds ratio per year, 1.13; 95% CI, 1.08-1.19; P <.001). In both OR and WA there were increases in the number of patient deaths due to MAID per 1000 deaths over time. Conclusions and Relevance: In this study, MAID results in Oregon and Washington were similar, although MAID use measured as a percentage of patients prescribed lethal medications and then self-administering them increased only in WA. Most patients who acquired lethal prescriptions had cancer or terminal illnesses that are difficult to palliate and lead to loss of autonomy, dignity, and quality of life.

UR - http://www.scopus.com/inward/record.url?scp=85070563838&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070563838&partnerID=8YFLogxK

U2 - 10.1001/jamanetworkopen.2019.8648

DO - 10.1001/jamanetworkopen.2019.8648

M3 - Article

C2 - 31397857

AN - SCOPUS:85070563838

JO - JAMA network open

JF - JAMA network open

SN - 2574-3805

ER -