Oregon’s Death with Dignity Act, 20 years later

Number of prescriptions and assisted deaths under the Oregon Death with Dignity Act. (Blanke et al. from Oregon Health Authority data)

In 1997, Oregon became the first state to make it legal for terminally ill patients to self-administer a prescription to hasten death.

A review of 991 cases of lethal self-medication through 2015 shows that the law’s impact has remained largely predictable. Three-fourths of the people were dying of cancer, nearly all were white and around 70 percent had attended college. More than 90 percent had health insurance, were receiving hospice care and died at home.

Still, some findings surprised first author Charles Blanke, M.D., a professor of medicine in the OHSU Knight Cancer Institute and chair of the SWOG research consortium.

  • Untreatable pain was not among the main reasons people gave for using the law. The most common reasons were loss of autonomy, inability to participate in enjoyable activities, and loss of dignity.
  • Only 1 in 20 people seeking to hasten death were referred for a psychiatric consultation.
  • Physicians were present with patients when they ingested the lethal prescription in only 16 percent of cases.

“My guess is that physicians aren’t asking what their patients would prefer, because when I’ve asked my patients if they would like me to be present when they take the medication, 100 percent say yes,” Blanke said in an interview with the ASCO Post published in March. (Blanke presented some of the Oregon Death with Dignity findings late last year at a palliative care in oncology symposium.)

Regardless of a physician’s position on assisted dying laws, Blanke said it’s important for oncologists to talk to their incurable patients early in the care process about what happens when active therapy is no longer effective:

I tell my patients that there is always something I can do to help them and that while I may not be able to treat their cancer any longer, I can help with symptoms they may be experiencing such as depression, insomnia, or pain. That said, we should never be afraid to talk to patients about their demise.

It shocks me to hear from terminally ill patients—referred to me for aid in dying—that they were never told by their oncologist that they had a terminal disease. It’s possible that a patient might not have heard that part, but it has happened to me often enough that I believe some patients who come to me to talk about ending their lives genuinely don’t know they have a fatal disease—and that is not acceptable.”

In addition, I would say that we need to use our palliative care teams much earlier in cancer care and more effectively. There are plenty of patients who would not consider death with dignity if they had better palliation, so we need to introduce palliative care medicine in the process much earlier.

You can read the full interview online. Blanke’s review article is accessible online at JAMA Oncology.



Characterizing 18 Years of the Death With Dignity Act in Oregon by Charles Blanke, Michael LeBlanc, Dawn Hershman, Lee Ellis and Frank Meyskens, JAMA Oncology (April 06, 2017)