Study of those who don't use assisted suicide law

A new study by two Oregon doctors concludes that the vast majority of dying Oregonians are either not interested in or medically ineligible to participate in Oregon's doctor-assisted suicide option.

In 1997, Oregon became the first state to legalize such an option.

From 1998 through 2007, about 296,000 Oregonians died of all causes. About 99,000 died of the same diseases as afflicted the 341 people who ended their lives with a legally prescribed overdose.

"This is a very small number at the end of life," said Dr. Katrina Hedberg, lead author and interim state epidemiologist. "It's not surprising. It takes a pretty assertive individual."

Those unlikely to use the Death with Dignity Act include: the very old (85 or older); those dying of causes other than cancer, AIDS or amyotrophic lateral sclerosis; those with less than a high school education; and those who are not white or Asian.

The study shows 82 percent of the deaths under the law were people with terminal cancer. Cancer patients are more likely than others to face a prognosis with a life expectancy that can be estimated as less than six months, as required under the law.

The analysis appears in the Journal of Clinical Ethics, along with a companion article exploring medical and social trends in the first 10 years of the Oregon law. Hedberg is the lead author for both.

Heart disease accounts for about one-third of Oregon deaths. But it often leads to a sudden attack, such as a cardiac arrest or stroke, from which patients either die or survive for a long time. In such cases, the less-than-six-months prognosis often is impossible or irrelevant.

Patients are ineligible for assisted suicide if they are incapable of making and communicating health care decisions. An estimated one-third to one-half of Oregonians older than 85 have some form of dementia.

All but three of the 341 Oregonians who ended their lives with a lethal prescription during the first decade of the Oregon law were white or Asian. Two were Hispanic Americans, and one an American Indian. No African American has chosen to die this way.

Do we know why? "I think we should be very careful suggesting we know the reasons, because we don't," said Dr. Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health & Science University and a co-author of the study on Oregonians who don't participate in the option.

The reason why such a high percentage of assisted suicide participants are terminal cancer patients is less surprising, Tolle said. Advanced cancer is more likely than traumatic injuries, cardiac arrests and strokes to lead to a less than six months prognosis - and less likely to be immediately fatal.

Oregon in 1997 became the first state to make it legal for a doctor to prescribe a life-ending drug to a terminally ill patient of sound mind who requested it orally and in writing. Washington voters approved an assisted suicide law last November.

Under both the Oregon and Washington laws, it is illegal for a doctor to administer the life-ending drug - for example, by injecting it. That would constitute euthanasia, which remains illegal. The patient must swallow the drug without help.

The study notes several worrisome trends in use of the Oregon law: an increase in participants' reported concern about inadequate pain control; an increase in their concern about being a burden on caregivers; and a decrease in the number of patients who go through a formal psychiatric evaluation.

A patient requesting a life-ending prescription must undergo psychiatric testing if either of the two approving doctors calls for it.

Hedberg's study notes there was considerable debate when the Oregon law was enacted about whether vulnerable populations, such as persons of color or patients who were poor or uneducated, would be coerced into participating. The Oregon data show that has not proven to be an issue.

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Information from: The Oregonian, http://www.oregonlive.com