HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Thursday, March 10, 2005

Oregon Releases Its 7th Annual Report on PAS

AP reports (courtesy of FindLaw) that Oregon's Department of Human Services today released its 7th annual report on the use of its Death With Dignity Act.  As in the past, the report is an invaluable resource for supporters and opponents of PAS alike.

Some of the highlights (from the Summary):

  • In 2004, 40 physicians wrote a total of 60 prescriptions for lethal doses of medication, the first decrease in the annual total of prescriptions written since PAS became legal in Oregon. In 1998, 24 prescriptions were written, followed by 33 in 1999, 39 in 2000, 44 in 2001, 58 in 2002, 68 in 2003, and 60 in 2004.
  • Thirty-five of the 2004 prescription recipients died after ingesting the medication. Of the 25 recipients who did not ingest the prescribed medication in 2004, 13 died from their illnesses, and 12 were alive on December 31, 2004. In addition, two patients who received prescriptions during 2003 died in 2004, after ingesting their medication, giving a total of 37 PAS deaths during 2004.
  • Although five fewer patients ingested lethal medication in 2004 compared to 2003, the trend has been upward since legalization. In 1998, 16 Oregonians used PAS, followed by 27 in 1999, 27 in 2000, 21 in 2001, 38 in 2002, 42 in 2003, and 37 in 2004.
  • Paralleling the upward trend in the number of deaths are the ratios of PAS deaths to total deaths: in 1998 there were 5.5 PAS deaths per every 10,000 total deaths, followed by 9.2 in 1999, 9.1 in 2000, 7.0 in 2001, 12.2 in 2002, 13.6 in 2003, and an estimated 12/10,000 in 2004.
  • Compared to all Oregon decedents, PAS participants in 2004 were more likely to have malignant neoplasms (78%), to be younger (median age 64 years), and to have more formal education (51% had at least a baccalaureate degree). 
  • During the past seven years, the 208 patients who took lethal medications differed in several ways from the 64,706 Oregonians dying from the same underlying diseases. Rates of participation in PAS decreased with age, but were higher among those who were divorced or never married, those with more years of formal education, and those with amyotrophic lateral sclerosis, HIV/AIDS, or malignant neoplasms.
  • Physicians indicated that patient requests for lethal medications stemmed from multiple concerns with nine in 10 patients having at least three concerns. The most frequently mentioned end-of-life concerns during 2004 were: a decreasing ability to participate in activities that made life enjoyable, loss of autonomy, and a loss of dignity.
  • During 2004, 25 patients (68%) used pentobarbital as their lethal medication and 12 patients (32%) used secobarbital.  Complications were reported for three patients during 2004; all involved regurgitation and none involved seizures. One-half of patients became unconscious within five minutes of ingestion of the lethal medication and died within 25 minutes. The range of time from ingestion to death was five minutes to 31 hours. In no case were Emergency Medical Services called.
  • Although the number of Oregonians ingesting legally prescribed lethal medications has trended upward since 1998, the overall number of terminally ill patients using PAS has remained small, with about one of every 800 deaths among Oregonians in 2004 resulting from physician-assisted suicide.

Here's the Report's take on the Supreme Court litigation surrounding the Death With Dignity Act:

Although physician-assisted suicide has been legal in Oregon for seven years, it remains highly controversial. On November 6, 2001, U.S. Attorney General John Ashcroft issued a new interpretation of the Controlled Substances Act, which would prohibit doctors from prescribing controlled substances for use in physician-assisted suicide. All patients receiving medication under the Death with Dignity Act have used barbiturates, which are controlled substances and, therefore, would be prohibited by this ruling for use in PAS. In response to a lawsuit filed by the State of Oregon on November 20, 2001, a U.S. district court issued a temporary restraining order against Ashcroft’s ruling pending a new hearing. On April 17, 2002, U.S. District Court Judge Robert Jones upheld the Death with Dignity Act. On September 23, 2002, Attorney General Ashcroft filed an appeal, asking the Ninth U.S. Circuit Court of Appeals to overturn the District Court’s ruling, which was subsequently denied on May 26, 2004 by a three-judge panel.  On July 13, 2004, Ashcroft filed an appeal requesting that the Court rehear his previous motion with an 11-judge panel; on August 13, 2004, the request was denied. On November 9, 2004, Ashcroft asked the U.S. Supreme Court to review the Ninth Circuit Court’s decision and on February 22, 2005, the court agreed to hear the appeal.  Arguments will be held during the Supreme Court's next term, beginning in October 2005. At this time, Oregon's law remains in effect.

The Supreme Court's docket page for the case (No. 04-623) is here[tm]

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