Correspondence

Legalized Physician-Assisted Suicide in Oregon, 2001

N Engl J Med 2002; 346:450-452February 7, 2002

Article

To the Editor:

Although physician-assisted suicide has been a legal option for terminally ill residents of Oregon since 1997,1 it remains highly controversial. On November 6, 2001, U.S. Attorney General John Ashcroft issued a new interpretation of the Controlled Substances Act prohibiting the use of federally controlled substances to hasten death. The state of Oregon filed a lawsuit against the U.S. government to challenge Ashcroft's decision. Because of a temporary restraining order in U.S. district court, the law remains in effect pending a hearing by mid-April.

As follow-up to previous reports,2-4 we compared the number and characteristics of patients who died in 2001 after ingesting legally prescribed lethal medications in Oregon with those of patients who died between 1998 and 2000. Patients were identified through required reports filed by physicians on prescriptions for lethal medications. Data were obtained from these reports, from interviews with physicians, and from death certificates. We also compared patients who chose physician-assisted suicide in 2001 with Oregon residents who died in 2000 from similar underlying diseases without physician-assisted suicide.

In 2001, 33 physicians in Oregon wrote 44 prescriptions for lethal doses of medication (range, 1 to 4 prescriptions). This number of prescriptions represents an increase from 24 in 1998, 33 in 1999, and 39 in 2000. The number written each month ranged from three to eight, with no temporal trends noted over the course of the year. Of the 44 patients who received prescriptions, 19 died after ingesting the medications, 14 died from their underlying disease, and 11 were alive on December 31, 2001. During 1998, 1999, and 2000, 16, 27, and 27 patients, respectively, died after ingesting lethal medications. Two patients who received prescriptions during 2000 died after ingesting their medications in 2001.

The 21 patients who chose physician-assisted suicide during 2001 represent a rate of 7 per 10,000 deaths in Oregon — similar to the rates of 6 per 10,000 in 1998, 9 per 10,000 in 1999, and 9 per 10,000 in 2000. The demographic characteristics of patients who ingested lethal medications during 2001 resembled those of the patients who died during previous years (Table 1Table 1Characteristics of Patients in Oregon Who Died after Ingesting Legally Prescribed Lethal Medications and of All Patients Who Died from Similar Underlying Illnesses.). The exception was that a slightly higher percentage of the patients were women, although this difference was not statistically significant. As in previous years, those who chose physician-assisted suicide in 2001 were more likely to have a college education than other Oregon residents who died of similar underlying illnesses (38 percent vs. 13 percent).

The lethal medications ingested during 2001 differed from those used in previous years. Between 1998 and 2000, 67 of the 70 patients (96 percent) were given a prescription for secobarbital, 2 were given a prescription for pentobarbital, and 1 was given prescriptions for other medications. Eli Lilly (Indianapolis) stopped producing secobarbital in May of 2001. In 2001, 16 of the 21 patients (76 percent) were given a prescription for secobarbital, and 5 (24 percent) were given a prescription for pentobarbital; 4 of these 5 patients received their prescriptions during the last three months of the year.

One of the 33 physicians who wrote prescriptions during 2001 was reported to the Board of Medical Examiners for submitting incomplete written consent. Twenty patients died at home, and one died in an acute care hospital with the hospital's permission. Prescribing physicians were present while nine of the patients ingested the medication. One patient vomited after ingesting the medication and died 25 hours later; another patient lived for 37 hours after ingesting the medication. Neither patient regained consciousness, nor were emergency medical services called. No other complications were reported.

We conclude that in 2001, although the number of prescriptions written for use in physician-assisted suicide in Oregon was greater than in other years, the number of patients who ingested lethal medications remained small. The lack of availability of secobarbital has led physicians to prescribe other barbiturates.

Katrina Hedberg, M.D., M.P.H.
David Hopkins, M.S.
Karen Southwick, M.D., M.P.H.
Oregon Department of Human Services, Portland, OR 97232
katrina.hedberg@state.or.us

4 References

1. 1

   Oregon Death with Dignity Act, Oregon Revised Statute 127.800-127.995. (See http://www.ohd.hr.state.or.us/chs/pas/pas.htm.)
   

2. 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 | Medline

3. 3

   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 | Medline

4. 4

   Sullivan AD, Hedberg K, Hopkins D. Legalized physician-assisted suicide in Oregon, 1998-2000. N Engl J Med 2001;344:605-607
   Full Text | Web of Science | Medline

Citing Articles (10)

Citing Articles

1. 1

   MARIJKE C. JANSEN-VAN DER WEIDE,, BREGJE D. ONWUTEAKA-PHILIPSEN, GERRIT VAN DER WAL. (2006) Requests for euthanasia and physician-assisted suicide and the availability and application of palliative options. Palliative & Supportive Care 4:04,
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2. 2

   Javier Júdez. (2005) Suicidio médicamente asistido en el final de la vida. Medicina Clínica 125:13, 498-503
   CrossRef

3. 3

   H. Kessel. (2005) Eutanasia en el anciano: las cosas lo más claras posibles. Revista Española de Geriatría y Gerontología 40:4, 254-255
   CrossRef

4. 4

   Steven K. Dobscha, Ronald T. Heintz, Nancy Press, Linda Ganzini. (2004) Oregon Physicians' Responses to Requests for Assisted Suicide: A Qualitative Study. Journal of Palliative Medicine 7:3, 451-461
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5. 5

   Linda Ganzini, Steven K. Dobscha, Ronald T. Heintz, Nancy Press. (2003) Oregon Physicians' Perceptions of Patients Who Request Assisted Suicide and Their Families. Journal of Palliative Medicine 6:3, 381-390
   CrossRef

6. 6

   Hedberg, Katrina, Hopkins, David, Kohn, Melvin, . (2003) Five Years of Legal Physician-Assisted Suicide in Oregon. New England Journal of Medicine 348:10, 961-964
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7. 7

   (2002) Physician-Assisted Death. New England Journal of Medicine 347:13, 1041-1043
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8. 8

   Ganzini, Linda, Harvath, Theresa A., Jackson, Ann, Goy, Elizabeth R., Miller, Lois L., Delorit, Molly A., . (2002) Experiences of Oregon Nurses and Social Workers with Hospice Patients Who Requested Assistance with Suicide. New England Journal of Medicine 347:8, 582-588
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9. 9

   Roger Woodruff. (2002) Legalized Physician-Assisted Suicide in Oregon. Journal of Palliative Medicine 5:3, 445-445
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10. 10

    Steinbrook, Robert, . (2002) Physician-Assisted Suicide in Oregon — An Uncertain Future. New England Journal of Medicine 346:6, 460-464
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