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Death with Dignity is 11 years old

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This is the 11th anniversary of Oregon’s Death with Dignity Act, which allows terminally-ill adult residents to acquire and self-administer a lethal dose of medications from their physician. Every year Oregon publishes a summary statement with details on the prescriptions written and deaths which occurred this year. In today’s blog I offer some graphs and data to stimulate some thought about physician-assisted suicide.

This table, from the link provided above, shows the prescriptions received and the number of deaths over the history of the Oregon statute. One will immediately notice that the number of prescriptions written and the number of deaths differ significantly because some patients who acquire the medication do not take their own life. Many will eventually die of their disease. For example, in 2007, 85 prescriptions were written and 46 patients took the medications. Twenty-six died of their underlying disease and another 13 were still alive.

Loss of control is a common complaint of many dying patients. These losses are diffused through a persons’ entire existence: lost control of bodily functions, cognition, experience, family life, symptoms, etc. One argument for the Death with Dignity Act is that it enables dying people some measure of control if everything else is lost. I believe this rationale is supported by their data. An increasing number of DWD patients are dying from natural causes rather than the prescribed medication (see table 2 below). This supports that just having the ability to control the timing of their death is enough reassurance to continue living. I find the contradiction fascinating.

This graph, created by the folks at PalliMed, uses the published Oregon statistical data to show graphically the proportions of patients who acquire the medications but who go on to die from their disease or are still alive.

I think it’s also interesting to consider the disease represented in 2007. And to make note that cancer is the largest diagnostic group, but also the relative under-representation of other end-stage organ diseases. Perhaps the loss of control is a less powerful motivator in diseases other than cancer. Perhaps taking one's own life when he or she is dying with cancer is more acceptable to a patient and family than with other diseases. In any case, we have not seen any rapid changes in the use of PAS in Oregon as this "experiment" in a particular approach to end of life care is taking place in Oregon. I do expect that Death with Dignity Acts will continue to be proposed in state legislatures around the nation and the Oregon experience will be given great scrutiny as other states wrestle with this issue.