"Death With Dignity" Program Is Rarely Used

Date: Apr-11-2013Doctors, patients, and their families have been okay with a "death with dignity" physician-assisted suicide program that is available to patients with fatal cancer at a Seattle clinic, a study suggests.

In the final months of 2011, the majority of 255 Washington residents who had a prescription for lethal medication to terminate their lives under the state's Death with Dignity Act had been diagnosed with terminal cancer. Among those patients, 40 were being treated at Seattle Cancer Care Alliance - a branch of the Pacific Northwest's only National Cancer Institute-designated Comprehensive Cancer Center.

The current study, published in The New England Journal of Medicine, revealed that overall, SCCA's Death Dignity program was hardly ever used. However, when it was, the program was widely known and accepted by patients and doctors.

The authors wrote, "Qualitatively, patients and families were grateful to receive the lethal prescription whether or not it was used."

Researchers found that the most common reasons for taking part in the program included:
an inability to participate in enjoyable activities and loss of dignity
loss of autonomy
Elizabeth Trice Loggers, M.D., Ph.D., corresponding author and medical director of SCCA's Supportive and Palliative Care Service said, "People who pursue Death with Dignity tend to be individuals who want to be independent and want to have control over the conditions and timing of their final moments of life."

After Oregon, Washington was the second state to put into action the Death with Dignity law, it was approved in November 2008 after a voter-approved referendum and went into effect in March 2009.

Informed adults who live in the state, under the Washington law, who have a life expectancy of six months or less because of a diagnosed medical issue, can ask for and self-administer lethal medicine. Doctors who prescribe the medicine do not help patients in taking the medicine.

A group of 114 patients asked for information about the institution's Death with Dignity program between March 2009 and December 2011. Among those patients, 44 did not participate in the program, and 30 others started the process but chose not to continue or passed away before finishing the steps required to get a prescription for lethal medicine.

Forty people got the prescription and 24 passed away after taking the medication - secobarbital, a barbiturate. The average time from taking the medication to death was 35 minutes. The other 16 patients did not use the medication and eventually passed away.

The participants were mostly Caucasian men with more than a high school education, were married and ranged in age from 42 to 91 years.

The authors logged that there were no unexpected problems for a patient except for one who died a day after taking the lethal medication - giving the caregiver and clinician stress.

The authors explained:

"Anecdotally, families describe the death as peaceful (even when death has taken longer than the average of approximately 35 minutes). We have not received complaints from family members or caregivers regarding our process or the manner of death of any patients."

Patients who acquired a prescription were found to have present or historical depression or a problem with decision making. No patients needed a mental health analysis, which the law necessitates if doctors think the patient could be suffering from a psychological or psychiatric disorder or depression resulting in distracted judgement.

The authors suggest the acceptance of the Death with Dignity program was due to:
the professionalism of the advocates of the patients
the care given by the doctors when conversing with patients and families
the low profile of the program
the willingness by SCAA leadership to permit significant debate
Furthering the program's acceptance, some doctors who were originally opposed to the policy ended up joining the program.

The Death with Dignity program in Oregon reported that patients had better end of life control and were more ready for death.

Written by Kelly Fitzgerald

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