Who Uses Medical Aid to Die in Oregon and Washington?

The researchers compared demographics of users in the states with the longest-running programs.

There are many similarities among those utilizing medical aid-in-dying programs in Oregon and Washington, researchers have found.

By Katelyn Newman

The outcomes of medical aid-in-dying laws in the two states with the longest-running programs in the U.S. show many similarities in who is using the option, a new study finds.

With more states implementing laws to assist terminally ill patients in taking their lives, researchers from across the United States examined empirical data of Oregon and Washington to find out if there were similarities in who’s asking for and taking medical aid-in-dying prescriptions. The data came from published annual reports from the Oregon Health Authority and Washington State Department of Health that ranged from 1998 to 2017 in Oregon and from 2009 to 2017 in Washington.

They found that 2,558 – 76% – of the 3,368 written prescriptions resulted in patients’ deaths, with patients more likely to be non-Hispanic white (94.8%) and 65 years or older (72.4%). The most common underlying illnesses were cancer (76.4%), neurologic illness (10.2%), lung disease (5.6%) and heart disease (4.6%), with loss of autonomy, impaired quality of life and loss of dignity the most common reasons reported by clinicians for patients who pursue medical aid-in-dying. Ages of all participants over the time periods ranged from 20 to 102, and participation was nearly equally split between males and females.

“Among patients who ingested the lethal drugs and were evaluable for complications, only 4% experienced complications, the most common being difficulty ingesting or regurgitation of the lethal drug,” according to the study, published Friday in JAMA Network Open. “Short median times to unconsciousness and death prevent undue and lengthy suffering and reflect the efficacy of drugs used in (medical aid-in-dying).”

Further, the majority of patients who received the prescription had some college education (71.5%), had medical insurance (88.5%) and were enrolled in hospice care at the time of their deaths (76%). A total of 2,075 (81%) of the patients died at home, the study said.

So far, nine jurisdictions – eight states and the District of Columbia – have implemented medical aid-in-dying laws since Oregon’s went into effect in 1997, with New Jersey becoming the most recent on Aug. 1. Maine will join the group on Sept. 15, when its law goes into effect.

But using empirical data to show the demographics behind these longstanding laws portrays that the standard is inherently ethically good when data “cannot tell a society or a profession what ought to be done,” Dr. Daniel Sulmasy, acting director of the Kennedy Institute of Ethics and professor of biomedical ethics at Georgetown University and critic of the practice, wrote in an invited commentary that accompanied the study.

“Whether just 1 person or 100 000 persons legally avail themselves of lethal prescriptions cannot tell us whether the practice is right or wrong,” Sulmasy wrote. “Despite public arguments that (physician-assisted suicide) is needed to avoid excruciating pain and other symptoms, the reasons attributed to patients who seek PAS are not uncontrolled symptoms but lost autonomy, independence, and control.”

“About one-third of patients die without taking the drugs, which may suggest that patients only wanted the security of having a way out, but it could equally indicate that they died before using the drugs or changed their minds about using them,” he added.

Among its limitations, the study notes that the underlying reasons patients requested medical aid in dying were not collected from the patients themselves but rather from the physicians in a follow-up questionnaire. Still, the results presented show no intentional targeting of “socially disadvantaged patients,” an often cited concern among critics, and “most patients who acquired lethal prescriptions had cancer or terminal illnesses that are difficult to palliate,” according to the study.

“There is significant room for further integration of palliative care, social support services and case management in end-of-life decision-making with the intent of increasing the options available to those facing a terminal disease,” the study said.

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