End-of-life care
better after law,
Oregon reports

An annual review of its Death
With Dignity law shows doctors
improving treatment

Oregon’s Death With Dignity law, approved by voters in 1994, may have encouraged doctors to use more effective options for end-of-life care, according to the sixth annual report on the law.

“Often, once the provider has addressed a patient’s concerns, he or she may choose not to pursue physician-assisted suicide,” concluded the report by Oregon’s Department of Human Services. It was released yesterday.

A Death With Dignity bill, patterned after Oregon’s law, emerged again this session in Hawaii’s Legislature. The bill is similar to one in 2002 that missed passage by three votes.

The House Judiciary Committee recommended approval of the present measure, (House Bill 862, House Draft 1), but it was recommitted to the committee by the full chamber Tuesday.

In the six years since Oregon’s law was passed, including 2003, 171 patients used the provisions for assisted suicide out of 53,544 deaths from the same underlying illnesses, the annual report said.

Last year, 42 patients “hastened their death” under the law, compared with 38 in 2002.

“This is an increase but the number remains small in comparison to the average 31,000 Oregon deaths every year,” said Dr. Mel Kohn, epidemiologist in the state’s Department of Human Services. “Overall, about one-seventh of 1 percent of Oregonians die from taking legally prescribed medication.”

The law allows terminally ill Oregon residents to obtain and use prescriptions for lethal medications.

Of the 42 patients committing physician-assisted suicide last year, 39 received their prescription last year; two had prescriptions from 2002 and one had a prescription from 2001.

Cancer was involved in 83 percent of deaths occurring under the law.

Prescribing doctors were present when 12 of the 42 patients took their lives. Another health care provider or volunteer was present for 67 percent of the 30 other patients taking lethal medications.

One case was reported to the Oregon Board of Medical Examiners last year involving possible non-compliance with the law regarding witnessing of signatures, the report noted.

Patients last year averaged age 73, and mostly were highly educated, at least with a baccalaureate degree, the report said.

As in past years, loss of autonomy, dignity and the ability to participate in meaningful activities were major reasons cited for seeking a faster death.

The physician-patient relationship averaged about 10 weeks and the median period between the first request for medication and death was 36 days. The law imposes a 15-day mandatory waiting period between the first and second request.

Inadequate pain control continues to be one of the major concerns of patients, cited in 21 percent of cases. The patients weren’t necessarily in pain but were concerned about future pain, the report said.

It said 93 percent of patients were enrolled in hospice and died at home; 5 percent died in an institution. All had insurance.

The report concluded that, “The availability of physician-assisted suicide may have led to efforts to improve end-of-life care through other modalities.”

It noted one study showing Oregon physicians since 1994 have “made efforts to improve their knowledge of the use of pain medication in the terminally ill, to improve their recognition of psychiatric disorders such as depression and to refer patients more frequently to hospice.”


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