Quotes

18: Oregon's Doctor Assisted Dying Law

In November 1994 an Oregon Citizens' Initiated Referendum on whether to legalise medically assisted dying under prescribed circumstances was narrowly won 51% to 49%. Oregon became the first government in the USA and the world to allow medically assisted dying as a clear legal option for the terminally ill. The Oregon Death with Dignity Act includes the following provisions:

Allows an attending doctor to prescribe medication to end life in a humane and dignified manner under prescribed conditions;
The medication is for self administration but the doctor is allowed to be present;
Requires a fully informed, voluntary decision by the patient;
Applies to the terminally ill with a prognosis of less than 6 months to live;
Requires a concurring second medical opinion;
Requires two oral requests with a 15 day waiting period from the first;
Requires a witnessed written request with a 48 hour waiting period from time of signing;
Allows cancellation of the request at any time;
Provides for penalties in the event of coercion of patients;
Provides for counselling as appropriate;
Promotes informing next of kin at patient's discretion;
Requires documentation and reporting to a monitoring authority.

The Act does not authorise the doctor to administer the medication.

Oregon's new law was due to come into effect on 8 December 1994 but was blocked by an appeal to the District Court from a National Right to Life Committee. The appeal claimed that the new law was unconstitutional and that vulnerable people could be disadvantaged. On 26 June 1997, in another context, the US Supreme Court ruled that there is no right to medically assisted dying under the US Constitution but that it is the jurisdiction of individual States. The Oregon Government put the issue again to the people of Oregon in November 1997 with 60% to 40% voting for the Act to stand. The Oregon Government issues an annual report on the Death with Dignity Act, with the 13th published in January 2011 (for 2010) reporting that:

Ninety six prescriptions for lethal medications were written during 2010, compared to 95 during 2009. Fifty nine of the 96 patients died from ingesting the medications. In addition, six patients with prescriptions written during previous years took the medications and died during 2010. The total of 65 known deaths corresponds to 20.9 DWDA deaths per 10,000 total deaths.
Fifty-five physicians wrote the 96 prescriptions.
Since the law was passed in 1997, 525 patients have died from ingesting medications prescribed under the Death with Dignity Act.
Of the 65 patients who died under DWDA in 2010, most (70.8%) were over age 65 years; the median age was 72 years. As in previous years, most were white (100%), well-educated (42.2% had a least a baccalaureate degree), and had cancer (78.5%).
Most patients died at home (96.9%); and most were enrolled in hospice care (92.6%) at time of death.
96.7% of patients had some form of health care insurance, although the number of patients who had private insurance (60.0%) was lower in 2010 than in previous years (69.1%), and the number of patients who had only Medicare or Medicaid insurance was higher than in pervious years (36.7% compared to 29.6%).
As in previous years, the most frequently mentioned end-of-life concerns were: loss of autonomy (93.8%), decreasing ability to participate in activities that made life enjoyable (93.8%), and loss of dignity (78.5%).
In 2010, none of the 65 patients were referred for formal psychiatric or psychological evaluation. Prescribing physicians were present at the time of ingestion for 6 (9.4%) patients, compared to 20.3% in previous years.
As part of reporting mechanisms, during 2010 one referral was made to the Oregon Medical Board for failure to wait 48 hours between the patient's written request and writing the prescription.

Oregon strengthened its Death with Dignity Act in June 1999 with a number of amendments to make it more effective. Residential requirements were clarified and protection offered to organisations and individuals not wishing to participate. The amendments made clear that the qualification for use of the Act was not to be based on age or disability, but on the requirements set out above.

Further details and archived annual reports are available on the Oregon Public Health Division web site:
http://www.oregon.gov/DHS/ph/pas/ar-index.shtml