Why Oregon patients request assisted death: Family members' views

BACKGROUND: Physician assisted death (PAD) was legalized through Oregon's Death with Dignity Act in 1994 and enacted in 1997. OBJECTIVE: The objective of this paper was to learn from family members why their loved ones requested PAD. DESIGN: This study used the cross-sectional survey. PARTICIPANTS: Participants of this study included family members of 83 Oregon decedents who made explicit requests for legalized PAD before their deaths, including 52 decedents who received prescriptions for a lethal medication and 32 who died of PAD. MEASUREMENTS: Family members rated the importance of 28 possible reasons their loved ones requested PAD on a 1-5 Likert scale, with higher scores representing greater importance. RESULTS: According to family members, the most important reasons that their loved ones requested PAD, all with a median score of 4.5 or greater, were wanting to control the circumstances of death and die at home, and worries about loss of dignity and future losses of independence, quality of life, and self-care ability. No physical symptoms at the time of the request were rated higher than a median of 2 in importance. Worries about symptoms and experiences in the future were, in general, more important reasons than symptoms or experiences at the time of the request. According to family members, the least important reasons their loved ones requested PAD included depression, financial concerns, and poor social support. CONCLUSIONS: Interventions that help patients maintain control, independence, and self-care in a home environment may be effective means of addressing serious requests for PAD.