Discussing their death wishes is paramount for most, not actually hastening their demise, expert says
THURSDAY, April 6, 2017 (HealthDay News) -- Oregon's Death with Dignity Act allows terminally ill patients to end their own lives. But over almost two decades, relatively few patients have done so, a new study reveals.
Less than 1,000 residents have followed through since Oregon became the first state to permit physician-aided dying in 1997, researchers found.
More people requested the lethal drugs than actually used them. And, more than three-quarters who used the drugs had cancer, said Dr. Charles Blanke, lead researcher of the new study.
"Oregon's Death with Dignity Act is being used only rarely, and by patients who are truly suffering," said Blanke, a professor of medicine at Oregon Health and Science University's Knight Cancer Institute.
Most patients who chose to die cited loss of independence and an inability to enjoy life, said Blanke, who is also chair of SWOG, a worldwide cancer study group.
Analyzing state records from 1998 through 2015, Blanke's team found that more than 1,500 prescriptions for lethal medication were written. But, less than two-thirds of these patients -- 991 in all -- used the drugs.
Blanke said the findings may predict outcomes in other places in the United States that have since legalized physician-aided death: California, Colorado, Montana, Vermont, Washington, D.C., and Washington state.
States with these laws enable very ill people to express their fears about dying with dignity, said Matt Whitaker, California state director of Compassion & Choices. The group advocates for right-to-die laws.
"Other studies have shown that for every prescription that is written, 25 people have an open and transparent conversation with their physician about their values, wishes and fears when it comes to the end of life," he said.
"For 24 of the 25 people, that's enough," Whitaker added.
In states without these laws, he said, "that conversation is not even a possibility, because it comes with a lot of liabilities."
Blanke's team used data from the Oregon Health Authority to determine how many lethal-drug prescriptions were written and how many were filled and used.
Of those who took their life, men slightly outnumbered women. Patients' ages in 2015 ranged from 25 to 102, with more than half older than 71.
While cancer accounted for the overwhelming majority of cases, ALS (Lou Gehrig's disease), lung disease, heart disease and HIV also led to physician-assisted death.
For 9 out of 10, losing autonomy and not enjoying activities of daily living were the primary reasons for wanting to die, the study found.
Loss of dignity led to about 80 percent of the overall deaths, while uncontrolled pain was cited by one-quarter of patients.
The researchers said 5 percent of the patients underwent a psychiatric evaluation to assess their competence in making end-of-life decisions.
Also, "contrary to claims that it might be pushed onto the poorly educated or disadvantaged -- mostly white, older, college-educated people used the law," Blanke said.
For example, nearly all were white. More than 9 out of 10 were receiving hospice care and had health insurance. And more than 70 percent had at least some college education, the researchers found.
Most patients died at home. On average, they fell into a coma 5 minutes after taking the drug and died within 25 minutes, Blanke said.
Acceptance of the law appears to have grown. "We found that use of the law has mostly increased over time," Blanke said.
Still, some critics of physician-assisted death say the emphasis should be on improving end-of-life care, not ending lives.
"The number of people who opt for a hastened death is less than 1 percent of people who die in Oregon," said Dr. R. Sean Morrison, a professor of geriatrics and palliative care medicine at Mount Sinai Hospital in New York City.
The overwhelming majority of people who are dying don't consider this [physician-aided death] an option, said Morrison, who wasn't involved in the study.
"We should be focusing on improving end-of-life care and making palliative care available to all, rather than focusing on the less than 1 percent of patients who choose to end their life," he said. Palliative care aims to relieve the symptoms and stress of a serious illness.
"It's the wrong choice and a false choice for many people," Morrison said.
The report was published online April 6 in the journal JAMA Oncology.
For more on physician-aided death, visit the organization Death with Dignity.