Patients choosing assisted suicide defied predictions
Patients choosing assisted suicide defied predictions
Critics expected patients to be poor, in pain
Epidemiologists at the Oregon Health Division in Portland collected information on patients who received prescriptions for lethal medications during the first year of the state’s Death with Dignity Act. The researchers compared the group that chose assisted suicide and took the lethal medications with a group that died from similar illnesses but did not receive a lethal medication. Physicians treating both groups were interviewed.
"Our findings revealed that finances and fear of pain did not appear to be critical considerations in the choice of assisted suicide. Instead, persons who chose assisted suicide were primarily concerned about personal autonomy and control over the manner in which they died," says Katrina Hedberg, MD, medical epidemiologist at Oregon Health Division and author of the report.
Critics of Oregon’s law predicted it would prey on the state’s indigent population and patients experiencing extreme pain. That’s not been the case, says Barbara Coombs Lee, FNP, JD, executive director of Compassion in Dying Federation in Portland and co-author of Oregon’s Death with Dignity Act. "I believe Oregon’s law reflects the right balance between safeguards and access. By that I mean there are sufficient safeguards to protect society and vulnerable populations from potential abuse, yet not so many safeguards that terminally ill patients cannot surmount the barriers to access," Coombs Lee explains.
This information was collected between Jan. 1, 1998, and Dec. 31, 1998:
• Prescriptions for lethal medications were filled for 23 persons. Fifteen died after taking medications, six died from their illnesses, and two were alive as of Jan. 1, 1999.
• Assisted suicide accounted for five of every 10,000 deaths in Oregon.
• The average age of the 15 patients who took the medication was 69. All were Caucasian. Eight were male. Thirteen were diagnosed with cancer. Seven were from the Portland metropolitan area. Twelve were high school graduates.
• Assisted suicide was not disproportionately chosen by terminally ill patients who were poor, uneducated, uninsured, fearful of the financial consequences of their illnesses, or lacking end-of-life care.
• The primary factor distinguishing persons in Oregon who chose assisted suicide was the importance of autonomy and personal control.
• Similar lethal medications were prescribed. The average time to unconsciousness was five minutes, ranging from three to 20 minutes. The average time to death was 26 minutes, ranging from 15 minutes to 11.5 hours.
• Physicians who took part in the suicide process represented multiple specialties and a wide range of age and years practicing. Interviews revealed that for some, the process exacted a large emotional tool.
The Oregon Health Division is legally required to collect information regarding compliance with the act and to make the information available annually, notes Hedberg. "Our reporting role is a neutral one. It is critical that we have accurate data so that informed ethical, legal, and medical decisions can be made."
One problem that will become less common as the law gets older is getting the physician to agree to assist the patient, Coombs Lee says. During the first year of Oregon’s law, six of the 15 patients who died from lethal medications did not receive the medication from the first physician they asked.
As a result, the patients changed physicians — in compliance with the law — to physicians who would assume responsibility for their care and participate in the Death with Dignity Act if deemed appropriate, she adds. "More physicians will come to feel comfortable with their responsibilities under the act, and more patients will inquire early in a relationship with a physician, so there is unlikely to be a mismatch between the values and beliefs of the physician and those of the patient," she explains.
"We tell people that following diagnosis of a terminal illness is no time to change physicians, so having a frank conversation about end-of-life options early in the relationship, while you are still healthy, is desirable."
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