BMJ  2003;327:E256 (22 November), doi:10.1136/bmj.327.7425.E256

BMJ USA: Commentary

Oregon update

¹ Oregon Health and Science University Portland, OR walshe{at}ohsu.edu, ² Whatcom Hospice Washington State End of Life Consensus Coalition Bellingham, WA ShHendrickson{at}peacehealth.org

In 1997, Oregon became the only US state to legalize physician assisted suicide (PAS). The Dutch experience may reassure those in the United States who fear an unchecked acceleration of PAS in Oregon and other states that may eventually choose to follow.

Two key differences distinguish the controversies in the Netherlands and Oregon. The Dutch authors pooled both euthanasia and PAS. In Holland, euthanasia is legal. In Oregon, it is not. In addition, the Dutch report tracks actual requests for both euthanasia and PAS, while Oregon officials report only lethal prescriptions written and taken.¹ The Oregon data both for deaths from PAS and for prescriptions seeking PAS are listed in the table.¹

View this table: [in this window] [in a new window]   Oregon official reports for deaths from physician assisted suicide (PAS) and for prescriptions written for PAS, 1998-20021

 

Other authors^2,3 report survey data suggesting that the requests for PAS in Oregon outnumber lethal prescriptions by ratios of 6:1 and 10:1, respectively. A ratio of 10:1 equals an average of 1.1 requests per 10 000 Oregonians per year. The Dutch data report an average of 2.6 requests per 10 000 persons per year, and current requests of 3.1 per 10 000 persons per year. In the Dutch report, requests for PAS increased over the first 15 years and have since leveled off. It is interesting to note the rise in prescriptions and deaths in Oregon in 2002, the year the law was challenged by the US Attorney General's office. Were more people compelled to seek this assistance when they feared losing the right to it? It may be too early to estimate the natural trends in PAS prescription requests and use in Oregon.

What is the meaning of the Oregon PAS experience? Is PAS part of, antithetical to, or perhaps even irrelevant to the delivery of good end of life care? Opponents of PAS point to the recent increase in PAS in Oregon as the beginning of the "slippery slope." Proponents of the Oregon law point to concurrent increases in morphine prescribing to relieve pain at the end of life, as well as increases in hospice enrollment and numbers of deaths out of hospital.⁴ How the availability of PAS has influenced doctors' and families' difficult conversations with patients about their fears and wishes concerning death is impossible to quantify. If PAS in Oregon is allowed to remain legal, future study may demonstrate whether the use of PAS will level off, as it has in Holland, and how PAS relates to other aspects of end of life care.

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Competing interests: None declared.

References

1. Oregon Department of Human Services. Physician-assisted suicide death with dignity annual report 2002. www.dhs.state.or.us/publichealth/chs/pas/ar-index.cfm. (accessed August 31, 2003).
2. Quill TE, Cassel CK. Professional organizations' position statements on physician-assisted suicide: a case for studied neutrality. Ann Intern Med 2003;138: 208-211.[Abstract/Free Full Text]
3. Bascom PB, Tolle SW. Responding to requests for physician-assisted suicide: "These are uncharted waters for both of us...". JAMA 2002;288: 91-98.[Abstract/Free Full Text]
4. Means to a better end: a report on dying in America today. November 2002. www.lastacts.org/files/misc/meansfull.pdf (accessed September 1, 2003).

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Aarti Sarwal
bmj.com, 5 Dec 2003 [Full text]