Oregon, USA

A person can be ‘terminal’ even if curative treatment is available.

In Oregon it is legal for an adult to receive a lethal dose to self-administer if they have a terminal illness likely to cause death within six months.

However, the Oregon Health Authority confirmed that ‘death within six months’ is interpreted as ‘death within six months if not receiving medical treatment’.

According to the official 2019 data summary, eligible medical conditions included some that are usually not considered terminal when treated: diabetes, musculoskeletal system disorders, arthritis, arteritis, blood disease, complications from a fall, sclerosis and stenosis.

Eligibility criteria vs underlying reasons

There is a difference between the official eligibility criteria and the underlying reasons why some eligible people request a lethal dose.

Of the people who died under Oregon’s Act in 2019, 59% cited concern about being a burden as a reason to request a lethal dose (compared to 44% in the years up to 2017).

More than 90% cited concern about being less able to engage in activities making life enjoyable. Being “less able” may indicate physical disability and/or psychological disability such as depression.

Only 33% cited concerns about pain control, but this doesn’t mean that anyone was experiencing pain when requesting or receiving the lethal dose.

It’s mainly about existential reasons – not pain.

People who died under Oregon’s Death With Dignity Act were asked why they requested a lethal dose.[1]

The top five reasons given are existential, not physical, concerns. They are related to feelings of meaninglessness and concerns about being dependent on others.

In 2019 the most common reason given was concern about being ‘less able to engage in activities making life enjoyable’ (90.4 %), followed by concern about losing autonomy (86.7 %).

It’s worth noting that these responses reflect people’s feelings, and not necessarily their circumstances at the time. A person may have been concerned about the possibility of such issues in the future.

Find more research here.

Concern about ‘being a burden to family, friends and caregivers’ was cited by 59 % of people and was followed by concern about ‘losing control of bodily functions’ (37.1%). ‘Inadequate pain control or concern about it’ was cited by 33 % and concern about ‘financial implications of treatment’ resonated with 7.4 % of recipients.

Oregon’s law has been changed

Advocates often claim that Oregon’s law has not changed since it came into force. However, in July 2019 the 15-day waiting period before the second request was removed for people who are likely to die within this period. a bill to expand eligibility criteria has been introduced.

Safeguards cannot be enforced.

In the State of Oregon people are allowed to access assisted suicide by receiving lethal drugs from a doctor if they are diagnosed with a terminal illness that will lead to death within six months.[2]

However, during 2017 people took the drugs up to 20 months (603 days) after receiving them, with a record of three years and nine months (1009 days) in previous years.[3]

According to the Oregon Health Authority, 7.6% of people who received lethal drugs in 2017 had conditions that are usually considered chronic rather than terminal conditions [4], including diabetes, hepatitis, “benign and uncertain neoplasms” and HIV/AIDS which is no longer a terminal illness.[5] The 2018 report mentions that “arthritis, arteritis, sclerosis, stenosis, kidney failure, and musculoskeletal systems disorders” would also be eligible.[6]

Of those who received lethal drugs between 1998 and 2017, only 64.8% are known to have ingested it. That means that it’s possible that 692 lethal doses were left in the community like loaded guns.[8]

In all cases it is unknown whether the person was pressured leading up the request and the moment of ingestion.

In meetings with a British House of Lords Committee, Oregon officials conceded that “there’s no way to know if additional deaths went unreported” because the Oregon Health Authority “has no regulatory authority or resources to ensure compliance with the law”.[9] They rely on the word of doctors prescribing the drugs. The officials admitted: “For that matter the entire account [received from a prescribing doctor] could have been a cock-and-bull story.”[10]

A quick and dignified death is not guaranteed.

In 2019 it took people up to 47 hours to die after ingesting an overdose, since some drug combinations had become unavailable. However, in 32 % of cases the time to die was not recorded. 

During 2017 people it took people up to 240 minutes (10 hours) to become unconscious and up to 21 hours to die after ingesting the drugs. The time up to death was unknown in 73% of cases during 2017.[12]

It’s unknown whether there were complications in 68% of deaths during 2019. In 29% of cases there were none.

A dignified, pain-free death cannot be guaranteed since some have regained consciousness or experienced complications such as seizures and difficulties with ingesting the overdose.

During 2017 two people had seizures, one had difficulty ingesting or regurgitated the drugs, one person regained consciousness and another person had an unidentified complication. Whether there were complications was unknown in 70.6% of cases during 2017.[11]

Financial Concerns are becoming more common

Compared to previous years, a larger percentage of people who died under the Act were from economically disadvantaged groups. 70% of people who died under the Act in 2019 either had no medical insurance or had governmental medical insurance, which is cheaper than private insurance.

Assisted suicide is granted without assessing the person’s mental health.

In 2017, only 5 people who received assisted suicide were referred for a psychiatric evaluation. [13] 

Only a tiny percentage of terminally ill people die from assisted suicide.

 
In 2014, less than 1 % (0.91 %) of patients with terminal cancer died from assisted suicide [14] out of 7,862 deaths that year [15].
 
In the same year, only 13 % of patients with ALS died from assisted suicide [16] out of 129 deaths from ALS that year [17].
 

References:

 
1. Oregon Health Authority Public Health Division (2019, February 15). Oregon Death with Dignity Act 2018 Data Summary. p.11. Retrieved from http://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year20.pdf
2. Oregon Health Authority. About the Death With Dignity Act. Retrieved fromhttp://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/faqs.aspx#whatis 
3. Oregon Health Authority Public Health Division (2019, February 15). Oregon Death with Dignity Act 2018 Data Summary. p.11.
4. Oregon Health Authority Public Health Division (2017, February 21). Oregon Death with Dignity Act Data Summary 2016. p.9,11. 
http://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year19.pdf
5. Whitflield, R.G. in Bronner, A. (2007, July 12). The Doc is in: Is HIV a terminal illness? Retrieved from http://h2doc.com/uploads/File/AOL%207-12-07(1).pdf 
6. Oregon Health Authority Public Health Division (2019, February 15). Oregon Death with Dignity Act 2018 Data Summary. p.11.
7. Ibid. p.11.
8. Ibid. p.5.
9. Linda Prager, “Details emerge on Oregon’s first assisted suicides, ” American Medical News, 7, 1998. in Patients Rights Council. Ten Years of Assisted Suicide in Oregon. Retrieved from http://www.patientsrightscouncil.org/site/oregon-ten-years/ 
10. Oregon Health Division, CD Summary, vol. 48, no. 6 (March 16, 1999), p. 2. in Patients Rights Council. Ten Years of Assisted Suicide in Oregon. Retrieved from 
http://www.patientsrightscouncil.org/site/oregon-ten-years/
11. Oregon Health Authority Public Health Division (2018, February 9). Oregon Death with Dignity Act 2017 Data Summary. p.10
12. Ibid. p.11.
13. Ibid. p.10
14. Oregon Public Health Division (2015, February 2). Oregon’s Death with Dignity Act –2014. p.5. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf
15. Oregon Health Authority (2015, November). Leading causes of death by county of residence. Oregon vital statistics data 2014, Table 18. Retrieved from https://public.health.oregon.gov/BirthDeathCertificates/VitalStatistics/annualreports/CountyDataBook/Documents/2014/table18-2014.pdf
16. Oregon Public Health Division (2015, February 2). Oregon’s Death with Dignity Act –2014. p.5. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf
17. Oregon Health Authority (2015, November). Leading causes of death by county of residence. Oregon vital statistics data 2014, Table 18. Retrieved from https://public.health.oregon.gov/BirthDeathCertificates/VitalStatistics/annualreports/CountyDataBook/Documents/2014/table18-2014.pdf