Interest in physician-assisted suicide (PAS) among Oregon cancer patients

Abstract

8070 Background: Oregon remains the only U.S. state where PAS is legal. We sought to determine the level of interest in PAS among cancer patients in OR, how views changed over the course of their illness, psychosocial and medical correlates of interest in PAS, and the relationship between expressing an interest and actually requesting PAS from a physician. Methods: Patients with advanced cancer were recruited from oncology clinics at OHSU and PVAMC. Baseline medical and psychological factors were assessed using standardized instruments; patients were questioned about their attitudes towards and interest in PAS. Patients who expressed an interest in PAS at the initial survey were asked to participate in a longitudinal study. Results: 417 potential subjects were identified and 161 agreed to participate. 57% supported legalization of PAS, 38% might consider PAS for themselves, and 9% indicated a serious interest in obtaining a lethal prescription. Among 42 participants followed longitudinally for 3 to 27 months, 8 expressed interest in a lethal prescription at first evaluation but never subsequently, while 11 expressed interest at some point after the first evaluation. Interest in obtaining a lethal prescription was predicted by increasing hopelessness (p=0.03), decreasing satisfaction with medical care (p=0.002), and increasing suffering (p=0.01). Only 2 patients (1%) made an explicit request for a lethal prescription. 7% of subjects with an interest in PAS at first evaluation had discussed this with their physician, while 42% had on longitudinal follow-up. Conclusions: Interest in PAS among Oregon cancer patients is similar to that previously reported from areas where PAS is not legally sanctioned. Interest is highly variable over time, and few patients make a formal request for a lethal prescription. Less than half discussed this issue with their oncologist. Expressing an interest in PAS on a survey appears to be a marker of psychological and symptom distress, but may be neither sensitive nor specific for identifying patients who actually request PAS under legalized conditions. No significant financial relationships to disclose.