Oregon, USA

It’s about existential reasons – not pain

 

In Oregon people who died by lethal drugs were asked about the reasons they requested assisted suicide.[1]

The top five reasons are existential reasons, related to feelings of meaninglessness and concerns about being dependent on others.

Reasons for requesting assisted suicide in Oregon USA

The most common reason given is concern about losing autonomy (91%), followed by concern about being ‘less able to engage in activities making life enjoyable’ (90%). ‘Inadequate pain control or concern about it’ featured for only 26% of people. 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.

In 2017 the most common reason was concern about being ‘less able to engage in activities making life enjoyable’ (88.1%), followed by concern about ‘losing autonomy’ (87.4%) and concern about ‘loss of dignity’ (67.1%).

Concern about ‘being a burden to family, friends and caregivers’ rose to 55.2% and was followed by concern about ‘losing control of bodily functions’ (37.1%). ‘Inadequate pain control or concern about it’ fell to 21.0% and concern about ‘financial implications of treatment’ rose to 5.6%.

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 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]

The law requires that a doctor waits at least 15 days before issuing a prescription, but, some patients knew their prescribing physician for less than one week.[7]

Of those who received lethal drugs, 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

 

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 is unknown in 70.6% of cases during 2017.[11]

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 is unknown in 73% of cases during 2017.[12]

 

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 (2018, February 9). Oregon Death with Dignity Act 2017 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 (2018, February 9). Oregon Death with Dignity Act 2017 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 (2018, February 9). Oregon Death with Dignity Act 2017 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

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