ABCD Exchange : February 1999 : Lunch Bunch - Legal Assisted Suicide in Oregon

Upfront - Barriers to Effective Pain Management
President's Letter - Turning a Corner
QuickScan - News in Brief
In the Sates - Media Briefing
Public Policy - Pain as a Fifth Vital Sign

Legal Assisted Suicide in Oregon - A Look at Oregon's Experience

The "Lunch Bunch" continues to attract forty to fifty participants each month to discuss and learn about a range of end-of-life issues. In January, participants enjoyed a program presented by the eventís co-host, Choice In Dying "Why Kevorkian is Not the Answer." Barbara Coombs Lee of Oregonís Compassion in Dying was the featured speaker. She presented data from the state of Oregon, where physician-assisted suicide (PAS) has now been legal (and free of court injunctions) since 1997.

Lee reported that in the first year, 56 qualified patients made a request for PAS. Of these, 22 are still alive and 34 have died; of the 34 deaths, 10 were the result of physician-assisted suicide. Of the 34 patients who have died, 27 were in hospice at the time of death. The majority of requests have come from cancer patients; 27 requests were from cancer patients, three from lung disease patients, two from heart disease patients, and one each from an ALS and an AIDS patient.

The mean age was 67, although patients ranged in age from 25 to 94. The time from a patientís first contact with Compassion in Dying ranged from 2 to 167 days, with a mean of 36 days.

Lee discussed the safeguards Oregon has established, such as the 15-day waiting period between the time of request and the prescription of lethal medications. Problems in the practice of PAS stem from issues of training and accountability for physicians.

Lee reported that some physicians have not responded appropriately to patient requests for PAS. She described a patient whose doctor advised her to stop eating, rather than to take a lethal dose of medication. After fasting for forty-four days, the woman contacted Compassion in Dying to ask what else she needed to do to hasten her deathóthe physician had not advised the patient that she needed to stop eating and drinking. Doctors who are not going to participate in PAS, Lee said, must let patients know this.

Since the advent of PAS in Oregon, the use of opioids has increased dramatically. The state has gone from being ranked eleventh in the nation in opioid use in 1994 to being fifth for the first quarter of 1998. As Lee explained, "In the wake of real patient choice, death in Oregon has improved."

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