Around the world, lobbyists for legalising physician-assisted suicide (PAS) use Oregon as an example of safe, successful, and carefully drafted legislation. Every year the state publishes what appears to be a comprehensive annual report.
Nonetheless, the statistics are still foggy. It is impossible to verify them, since all source records are destroyed after each annual report.
This is why a comprehensive and critical review of how Oregon’s Death With Dignity Act works is needed. Three British researchers, including Ilora Finlay, a well-known expert in palliative medicine, have published a review in the journal BMJ Supportive & Palliative Care.
An excellent summary of the research has been published in the UK Right to Life News.
It turns out that after 25 years, the number of people accessing assisted death and their characteristics have changed significantly. The authors highlighted problems with reporting complications, an increasing proportion of people who are concerned about being a burden, a reduction in the length of the doctor-patient relationship before an assisted suicide, and a collapse in psychiatric evaluation ahead of an assisted suicide.
The study found that while the average age of those ending their lives by assisted suicide has remained more or less constant at 72.5 years old, the number of prescriptions for lethal drugs has increased by 13% each year, and the number of patients who have died through their ingestion has increased 16% each year.
The proportion of those who ended their lives by assisted suicide who held private medical insurance fell from 65% over the first decade of its legalisation, to just over 20% in 2022. The majority now had health insurance through their government, either Medicare or Medicaid.
There was also a significant increase in the proportion of people who cited concerns about being a burden. In the first 5 years, an average of 30% of participants were concerned about being a burden. Since 2017, this concern has been cited by around half of those who die by PAS (46% in 2022).
While cancer remains the primary qualifying diagnosis, the researchers found that since 2010, patients with a range of non-cancer diagnoses have received PAS including non-terminal illnesses such as arthritis, arteritis, complications from a fall, hernia, sclerosis, ‘stenosis’ and anorexia nervosa.
The researchers commented that it was “concerning that there is a lack of data on why [a patient] refused treatment and how they were advised and counselled”.
Furthermore, the researchers found that the duration of the doctor-patient relationship in instances of assisted suicide had decreased radically from 1998 to 2022. In 2010 the median physician–patient duration was 18 weeks, dropping to 5 weeks in 2022. The time from the first request to death had reduced from 9.1 weeks in 2010 to 4.3 weeks in 2022.
The review also found significant gaps in the recording of complications that can arise in cases of assisted suicide. Complications associated with PAS drugs were reported in an average of 11% between 2010 and 2022, with a peak of 14.8% in 2015. In 2022 complications were identified in 6% of patients, though data on complications was missing in 206 patients (74%). Over the last 25 years, nine patients have regained consciousness.
In addition to the difficulties with reporting complications, researchers found a sharp decline in the number of instances of individuals wanting to end their lives by assisted suicide being referred for psychiatric assessment. In the first 3 years after enactment (1998–2000), a psychiatric assessment was sought in an average of 28% of cases. By 2003 this had dropped to 5%, and in 2022, 1% of patients who died from PAS underwent psychiatric evaluation.
“Despite Oregon producing detailed and regular post-death reports of value, there are considerable gaps in the data across US states. Most importantly, there is no monitoring in any form of the quality of the consultation in which the decision was made to prescribe lethal drugs,” the authors conclude. “Detailed, prospective studies that include socioeconomic and clinical information are essential to understand fully the changes seen in Oregon [PAS] data”.