Trends in Medical Aid in Dying in Oregon and Washington

Luai Al Rabadi,Frank L Meyskens,Taylor Bucy,Lynne Taylor,Charles D Blanke,Lee M Ellis,Dawn L Hershman,Michael Leblanc

doi:10.1001/jamanetworkopen.2019.8648

Abstract

The combined 28 years of data of medical aid in dying (MAID) between Oregon (OR) and Washington (WA) are the most comprehensive in North America. No reports to date have compared MAID use in different US states. To evaluate and compare patterns of MAID use between the states with the longest-running US death with dignity programs. A retrospective observational cohort study of OR and WA patients with terminal illness who received prescriptions as part of their states' legislation allowing MAID. All published annual reports, from 1998 to 2017 in OR and from 2009 to 2017 in WA, were reviewed. A total of 3368 prescriptions were included. Number of deaths from self-administration of lethal medication vs number of prescriptions written. A combined 3368 prescriptions were written in OR and WA, with 2558 patient deaths from lethal ingestion (76.0%). Of the 2558 patients, most were male (1311 [51.3%]), older than 65 years (1851 [72.4%]), and non-Hispanic white (2426 [94.8%]). The most common underlying illnesses were cancer (1955 [76.4%]), neurologic illness (261 [10.2%]), lung disease (144 [5.6%]), and heart disease (117 [4.6%]). Loss of autonomy (2235 [87.4%]), impaired quality of life (2203 [86.1%]), and loss of dignity (1755 [68.6%]) were the most common reasons for pursuing MAID. Time between drug intake to coma ranged from 1 to 660 minutes and time from drug intake to death ranged from 1 to 6240 minutes. In the 1557 patients for whom rates of complications were reported, 1494 (96.0%) did not experience a complication (592 of 626 [94.6%] in OR and 902 of 931 [96.8%] in WA). Eight patients (<0.5%) regained consciousness after drug ingestion in OR. Annual rates per year for percentage of patients who received a prescription ingesting the prescribed medication ranged from 48% to 87%, with no significant time trend in OR (adjusted odds ratio per year, 1.01; 95% CI, 0.99-1.02; P = .59) but with an increase over time in WA (adjusted odds ratio per year, 1.13; 95% CI, 1.08-1.19; P < .001). In both OR and WA there were increases in the number of patient deaths due to MAID per 1000 deaths over time. In this study, MAID results in Oregon and Washington were similar, although MAID use measured as a percentage of patients prescribed lethal medications and then self-administering them increased only in WA. Most patients who acquired lethal prescriptions had cancer or terminal illnesses that are difficult to palliate and lead to loss of autonomy, dignity, and quality of life.

Highlights

The Oregon Death With Dignity Act, passed in 1994, legally permits terminally ill adults with legal Oregon (OR) residency to make the voluntary informed choice to obtain a physician’s prescription for oral drugs to end life.[1]
Annual rates per year for percentage of patients who received a prescription ingesting the prescribed medication ranged from 48% to 87%, with no significant time trend in OR but with an increase over time in Washington state (WA)
In this study, medical aid in dying (MAID) results in Oregon and Washington were similar, MAID use measured as a percentage of patients prescribed lethal medications and self-administering them increased only in WA

Summary

Introduction

The Oregon Death With Dignity Act, passed in 1994, legally permits terminally ill adults (age Ն18 years) with legal Oregon (OR) residency to make the voluntary informed choice to obtain a physician’s prescription for oral drugs to end life.[1]. Legislative processes inherent within the passage of the Death With Dignity Acts in both OR and WA ensure safeguards for patients seeking MAID, including guaranteeing procedural guidelines for oversight by local and state agencies.[3] Such precautionary measures include requiring the patient to place 3 separate oral and written requests with a built-in waiting period and a required assessment to assess decisional capacity in any case in which it is suspect.[1,2] differences in the framework of MAID legislation between each state may result in different outcomes, and, to our knowledge, data on the implementation and uniformity of this practice have never been compared between 2 US states. Policy researchers in Canada identified significant interprovincial differences in Canadian MAID program processes and practice.[4]

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