Oregon law paved way for dialogue on end-of-life care

OB/GYN News, March 1, 2002 by Betsy Bates

ASHLAND, ORE. -- Fewer than 1 in 1,000 deaths in Oregon has been the result of physician-assisted suicide since 1997, when a controversial law approving the practice was passed in the state legislature, said Dr. Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health Sciences University in Portland.

Most people who contemplate physician-assisted suicide receive treatment for depression, find that hospice is adequate to quell their fears of a painful death, or simply change their minds, Dr. Tolle added during the annual meeting of the Pacific Coast Obstetrical and Gynecological Society where she was a special guest speaker.

The controversy has left its mark on Oregon, but in a surprising and refreshing way, she said. The constant media coverage and political debate about physician-assisted suicide appears to have made people more comfortable discussing their own end-of-life decisions, whether or not they would ever contemplate suicide.

By the time they die, 67% of all Oregonians have a living will. In nursing homes, 91% of residents have "Do not resuscitate" orders. Almost one-third of dying people in Oregon now take advantage of hospice services.

And, at 31% in 1998, Oregon now ranks 50th in the nation in terms of percentage of deaths that occur in the hospital.

"I consider that the bigger impact" of the new law, Dr. Tolle said.

In a random sampling of 475 families listed on Oregon death certificates since passage of the law, 87% said that their relative received the "right amount" of life-sustaining treatment in the last month of his or her life.

About 5% believed that an excessive amount of life-sustaining care was given, down from 15% in a similar survey conducted 15 years ago.

In the first 3 years of the physician-assisted suicide law, 70 people of 30,000 who died took advantage of the law's provisions, which allow a physician to prescribe medications that would end a patient's life.

To take these steps, two physicians must be consulted, a psychiatric evaluation must be made, and the patient's life expectancy must be less than 6 months. Some hospitals additionally require that the patient be seen by a physician who is board certified in pain medicine and palliative care.

Among those patients who opted to die with a physician's assistance, 68 of 70 were white, 52 had cancer, 36 were male, and 30 had more than a high school education.

In fact, people who held advanced degrees were eight times as likely to choose physician-assisted suicide than were people who did not have a high school degree.