Correspondence
Legalized Physician-Assisted Suicide in Oregon, 1998–2000
N Engl J Med 2001; 344:605-607February 22, 2001
- Article
To the Editor:
In 1997, Oregon legalized physician-assisted suicide.1 In a follow-up to our previous reports,2,3 we assessed whether the numbers and characteristics of patients who died after the ingestion of legally prescribed lethal medications in 2000 differed from those of patients who did so in 1998 and 1999.4 Patients who chose physician-assisted suicide were identified through required physician reporting of legally prescribed lethal medications. Data were obtained from these reports, interviews with physicians, and death certificates. We also compared patients who chose physician-assisted suicide in 2000 with a cohort assembled from 1999 death certificates of state residents who died of similar underlying diseases without physician-assisted suicide.
In 2000, Oregon physicians wrote 39 prescriptions for lethal doses of medication, as compared with 24 in 1998 and 33 in 1999. Twenty-six of the 39 patients who received prescriptions died after ingesting the medication, 8 died from their underlying disease, and 5 were still alive on December 31, 2000. During 1998 and 1999, 16 and 27 patients, respectively, died after ingesting the medication. One patient who received a prescription in 1999 died in 2000 after ingesting the medication; another patient who received a prescription in 1999 was still alive on December 31, 2000.
The 27 patients who ingested lethal medications in 2000 represent an estimated rate of 9 per 10,000 deaths in Oregon, as compared with a rate of 6 per 10,000 in 1998 and 9 per 10,000 in 1999. The demographic characteristics of the patients who chose physician-assisted suicide in 2000 resembled those of 6981 Oregon residents who died from similar underlying illnesses in 1999, with a single exception: as their level of education increased, their likelihood of choosing physician-assisted suicide increased. Patients with a college education were more likely to choose physician-assisted suicide than those without a high-school education (odds ratio, 8; 95 percent confidence interval, 2 to 44); patients with post-baccalaureate education were even more likely to choose physician-assisted suicide (odds ratio, 19; 95 percent confidence interval, 4 to 88). The patients in 2000 were demographically similar to those in previous years, except that they were more likely to be married (P=0.002 by the Cochran–Armitage test for trend) (Table 1Table 1
Characteristics of 70 Patients in Oregon Who Received Prescriptions for Lethal Medications and Who Died after Ingesting a Lethal Dose, 1998–2000.).We interviewed the 22 physicians who had prescribed the lethal medications for the 27 patients who died in 2000. One physician was reported to the Oregon Board of Medical Examiners for submitting an incomplete written-consent form. Physicians were present at 14 of the 27 deaths (52 percent). One patient who regurgitated approximately 10 ml of secobarbital suspension immediately after ingestion became unconscious within one minute after ingestion and died within seven minutes. Physicians continued to report that the patients who chose physician-assisted suicide in 2000 had multiple end-of-life concerns that contributed to the patients' requests for lethal medications. There was a significant increase in the number of patients who were concerned about being a burden to family, friends, and other caregivers in 2000 as compared with other years (test for trend, P<0.001).
We conclude that in 2000, the number of terminally ill patients in Oregon who chose physician-assisted suicide remained small. Such patients were better educated but otherwise demographically similar to other state residents who died from similar diseases. Among patients who choose physician-assisted suicide, the frequency of concern about being a burden to others has increased.
4 ReferencesAmy D. Sullivan, Ph.D., M.P.H.
Katrina Hedberg, M.D., M.P.H.
David Hopkins, M.S.
Oregon Health Division, Portland, OR 972321
Oregon Death with Dignity Act, Oregon Revised Statute 127.800-127.995. (See http://www.ohd.hr.state.or.us/cdpe/chs/pas/org.htm.)
2
Chin AE ,Hedberg K ,Higginson GK ,Fleming DW . Legalized physician-assisted suicide in Oregon -- the first year's experience. N Engl J Med 1999;340:577-583
Full Text | Web of Science | Medline3
Sullivan AD ,Hedberg K ,Fleming DW . Legalized physician-assisted suicide in Oregon -- the second year. N Engl J Med 2000;342:598-604
Full Text | Web of Science | Medline4
Oregon's Death with Dignity Act: the third year's experience. (See http://www.ohd.hr.state.or.us/chs/pas/pas.htm.)
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