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Previous Volume 348:961-964 March 6, 2003 Number 10 Next

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To the Editor: Physician-assisted suicide for terminally ill residents of Oregon has been legal since October 1997.¹ Although it has been challenged several times in court and by a referendum, the Oregon Death with Dignity Act remains in effect at this time. As the state public health agency with the mandate to monitor the use of physician-assisted suicide, we require physicians to file reports on patients for whom a prescription for a lethal medication is written. We analyzed data from these report forms, interviews with physicians, and death certificates. As part of follow-up to previous reports,^2,3,4,5 we characterized patients who died in 2002 after ingesting legally prescribed lethal medications and evaluated trends in the numbers of prescriptions written and in the numbers and characteristics of the patients who ingested lethal medications during the five years since implementation. We compared all patients who chose physician-assisted suicide during the first five years with other residents of Oregon who died of the same underlying diseases.

During 2002, 33 physicians wrote prescriptions for lethal medications for 58 Oregon residents. The number of prescriptions written has increased over the five-year period since implementation (24 in 1998, 33 in 1999, 39 in 2000, 44 in 2001, and 58 in 2002; P for trend <0.001 by the chi-square test). During 2002, 38 persons died from ingesting the prescribed lethal medications, and 8 who received prescriptions for lethal medications are still alive (6 of them received prescriptions in 2002, and 2 of them received prescriptions in 2001). The number of patients who died from ingesting prescribed lethal medications has increased since 1998 (16 in 1998, 27 in 1999, 27 in 2000, 21 in 2001, and 38 in 2002; P for trend <0.02 by the chi-square test).

In the five years during which the law has been in effect, a total of 129 people used physician-assisted suicide in Oregon. This corresponds to a rate of 8.8 per 10,000 deaths from any cause in Oregon. Table 1 shows the characteristics of patients who have ingested prescribed lethal medications since legalization. Among Oregon residents who died of the same underlying diseases as those who chose physician-assisted suicide, rates of use of physician-assisted suicide decreased with age and were higher among those who had been divorced and among those with higher levels of educational attainment. The rate of use of physician-assisted suicide was significantly higher among those who had amyotrophic lateral sclerosis (374.5 per 10,000) or cancer (61.0 per 10,000) than among those who had other terminal illnesses. Men and women were equally likely to choose physician-assisted suicide. Although the majority of patients were non-Hispanic whites, the rate of use of physician-assisted suicide among terminally ill Asian Americans was higher (91.7 per 10,000) (Table 1). Despite increases, the number of terminally ill Oregon residents using physician-assisted suicide remains small relative to the overall number of deaths.

View this table: [in this window] [in a new window]   Table 1. Characteristics of Patients in Oregon Who Died after Ingesting Legally Prescribed Lethal Medication and of All Patients Who Died from the Same Underlying Diseases.

 

Katrina Hedberg, M.D., M.P.H.
David Hopkins, M.S.
Melvin Kohn, M.D., M.P.H.
Oregon Public Health Services
Portland, OR 97232
katrina.hedberg{at}state.or.us

References

1. Oregon's Death with Dignity Act. Oregon revised statute 127.800-127.995. Portland: Oregon Public Health Services, 2003. (Accessed February 14, 2003, at http://www.healthoregon.org/chs/pas/pas.cfm.) 
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. [Free Full Text]
3. Sullivan AD, Hedberg K, Fleming DW. Legalized physician-assisted suicide in Oregon -- the second year. N Engl J Med 2000;342:598-604. [Free Full Text]
4. Sullivan AD, Hedberg K, Hopkins D. Legalized physician-assisted suicide in Oregon, 1998-2000. N Engl J Med 2001;344:605-607. [Free Full Text]
5. Hedberg K, Hopkins D, Southwick K. Legalized physician-assisted suicide in Oregon, 2001. N Engl J Med 2002;346:450-452. [Free Full Text]

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