Oregon s Death with Dignity Act--2013

Transcription

1 Oregon s Death with Dignity Act--2 Oregon s Death with Dignity Act (DWDA), enacted in late 997, allows terminallyill adult Oregonians to obtain and use prescriptions from their physicians for selfadministered, lethal doses of medications. The Oregon Public Health Division is required by the Act to collect information on compliance and to issue an annual report. The key findings from 2 are listed below. The number of people for whom DWDA prescriptions were written (DWDA prescription recipients) and deaths that occurred as a result of ingesting prescribed DWDA medications (DWDA deaths) reported in this summary are based on paperwork and death certificates received by the Oregon Public Health Division as of January 22, 24. For more detail, please view the figures and tables on our web site: Figure : Oregon DWDA Prescription Recipients and Deaths*, Number DWDA prescription recipients 4 6 DWDA deaths * *As of January 22, 24 Year DeathwithDignityAct/Documents/year6.pdf Page of 7

2 Oregon Public Health Division 2 DWDA Report As of January 22, 24, prescriptions for lethal medications were written for 22 people during 2 under the provisions of the DWDA, compared to 6 during 22 (Figure ). At the time of this report, there were 7 known DWDA deaths during 2. This corresponds to 2.9 DWDA deaths per, total deaths. Since the law was passed in 997, a total of,7 people have had DWDA prescriptions written and 72 patients have died from ingesting medications prescribed under the DWDA. Of the 22 patients for whom DWDA prescriptions were written during 2, 6 (.6%) ingested and died from the medication. Eight (8) patients with prescriptions written during the previous years (2 and 22) died after ingesting the medication during 2, for a total of 7 DWDA deaths. Twenty-eight (28) of the 22 patients who received DWDA prescriptions during 2 did not take the medications and subsequently died of other causes. Ingestion status is unknown for patients who were prescribed DWDA medications in 2. Seven (7) of these patients died, but follow-up questionnaires indicating ingestion status have not yet been received. For the remaining 24 patients, both death and ingestion status are pending (Figure 2). Of the 7 DWDA deaths during 2, most (69.%) were aged 6 years or older; the median age was 7 years (42 years 96 years). As in previous years, most were white (94.4%), well-educated (.% had a least a baccalaureate degree), and had cancer (64.8%). In 2, fewer patients had cancer (64.8%) compared to previous years (8.4%), and more patients had chronic lower respiratory disease (9.9%), and other underlying illnesses (6.9%). Most (97.2%) DWDA patients died at home, and most (8.7%) were enrolled in hospice care either at the time the DWDA prescription was written or at the time of death. Excluding unknown cases, most (96.7%) had some form of The rate per, deaths is calculated using the total number of Oregon resident deaths in 22 (2,47), the most recent year for which final death data are available. DeathwithDignityAct/Documents/year6.pdf Page 2 of 7

3 Oregon Public Health Division 2 DWDA Report health care insurance. The number of patients who had private insurance (4.%) was lower in 2 than in previous years (64.7%), and the number of patients who had only Medicare or Medicaid insurance was higher than in previous years (.2% compared to.7%). As in previous years, the three most frequently mentioned end-of-life concerns were: loss of autonomy (9.%), decreasing ability to participate in activities that made life enjoyable (88.7%), and loss of dignity (7.2%). Two of the 7 DWDA patients who died during 2 were referred for formal psychiatric or psychological evaluation. Prescribing physicians were present at the time of death for eight patients (.4%) during 2 compared to 6.% in previous years. A procedure revision was made mid-year in 2 to standardize reporting on the follow-up questionnaire. The new procedure accepts information about the time of death and circumstances surrounding death only when the physician or another health care provider was present at the time of death. Due to this change, data on time from ingestion to death is available for of the 7 DWDA deaths during 2. Among those patients, time from ingestion until death ranged from minutes to.6 hours. Sixty-two (62) physicians wrote the 22 prescriptions provided during 2 (range - prescriptions per physician). During 2, no referrals were made to the Oregon Medical Board for failure to comply with DWDA requirements. DeathwithDignityAct/Documents/year6.pdf Page of 7

4 Oregon Public Health Division 2 DWDA Report Figure 2: Summary of DWDA Prescriptions Written and Medications Ingested in 2, as of January 22, 24 DeathwithDignityAct/Documents/year6.pdf Page 4 of 7

5 Oregon Public Health Division - 2 DWDA Report Table. Characteristics and End-of-life Care of 72 DWDA Patients who Died from Ingesting a Lethal Dose of Medication as of January 7, 24, Oregon, Characteristics Sex Male (%) Female (%) Age 8-4 (%) -44 (%) 4-4 (%) -64 (%) 6-74 (%) 7-84 (%) 8+ (%) years (range) Race White (%) African American (%) American Indian (%) Asian (%) Pacific Islander (%) Other (%) Two or more races (%) Hispanic (%) Marital Status Married (%) Total (N=72) N (%) N (%) N (%) 44 (62.) 2 (.7) 96 (2.7) 27 (8.) 29 (48.) 6 (47.) (.) 6 (.9) 6 (.8) (.4) (2.2) 6 (2.) 6 (8.) 2 (7.6) 8 (7.7) (2.) 4 (2.7) 6 (2.7) 2 (2.4) 94 (28.) 27 (28.9) 7 (2.9) 89 (27.8) 26 (27.4) 9 (2.7) 84 (2.) 9 (2.4) 7 (42-96) 7 (2-96) 7 (2-96) 67 (94.4) 662 (97.6) 729 (97.) (.) (.) (.) (.4) (.) 2 (.) (.) 8 (.2) 8 (.) (.) (.) (.) (.4) (.) (.) 2 (2.8) (.) 2 (.) (.) (.7) (.7) 6 (.7) (4.7) 46 (46.2) Widowed (%) (8.) 8 (2.) 7 (22.8) Never married (%) 8 (.) (8.) 6 (8.4) Divorced (%) 4 (9.7) (22.9) 69 (22.6) Education Less than high school (%) 2 (2.8) 42 (6.2) 44 (.9) High school graduate (%) (4.) 4 (22.8) 64 (22.) Some college (%) 2 (29.6) 77 (26.2) 98 (26.) Baccalaureate or higher (%) 8 (.) (44.8) 4 (4.6) Residence Metro counties (%) 2 (.2) 289 (42.6) 4 (4.9) Coastal counties (%) (7.) (7.) 6 (7.) Other western counties (%) (46.) 292 (4.) 2 (4.4) East of the Cascades (%) 8 (.) 46 (6.8) 4 (7.2) End of life care Hospice Enrolled (%) 4 6 (8.7) 9 (9.) 6 (9.) Not enrolled (%) (4.) 62 (9.) 72 (9.9) Insurance Private (%) 27 (4.) 424 (64.7) 4 (62.9) Medicare, Medicaid or Other Governmental (%) (.2) 22 (.7) 24 (.4) None (%) 2 (.2) (.) 2 (.7) 9 26 DeathwithDignityAct/Documents/year6.pdf Page of 7

6 Oregon Public Health Division - 2 DWDA Report Characteristics When medication was ingested 2 Prescribing physician Other provider, prescribing physician not present No provider At time of death Total (N=72) Underlying illness Malignant neoplasms (%) 46 (64.8) 4 (8.4) 9 (78.9) Lung and bronchus (%) (4.) 29 (9.) 9 (8.6) Breast (%) (.4) 6 (8.) 7 (7.6) Colon (%) 6 (8.) 4 (6.) 49 (6.) Pancreas (%) 2 (2.8) 4 (6.6) 47 (6.) Prostate (%) 2 (2.8) (4.6) (4.4) Ovary (%) (.4) 27 (4.) 28 (.7) Other (%) 24 (.8) 24 (.6) 28 (.8) Amyotrophic lateral sclerosis (%) (7.) 49 (7.2) 4 (7.2) Chronic lower respiratory disease (%) 7 (9.9) 27 (4.) 4 (4.) Heart Disease (%) (.4) (.9) 4 (.9) HIV/AIDS (%) (.) 9 (.) 9 (.2) Other illnesses (%) 6 2 (6.9) (.2) 47 (6.) DWDA process Referred for psychiatric evaluation (%) 2 (2.8) 42 (6.2) 44 (.9) Patient informed family of decision (%) 7 62 (9.2) 7 (9.9) 62 (9.8) Patient died at Home (patient, family or friend) (%) 69 (97.2) 64 (9.) 74 (9.) Long term care, assisted living or foster care facility (%) 2 (2.8) 27 (4.) 29 (.9) Hospital (%) (.) (.) (.) Other (%) (.) (.7) (.7) Lethal medication Secobarbital (%) 7 (9.9) 96 (8.) 4 (.6) Pentobarbital (%) 64 (9.) 278 (4.8) 42 (4.) Other (%) 8 (.) 7 (.) 7 (.9) End of life concerns 9 Losing autonomy (%) Less able to engage in activities making life enjoyable (%) Loss of dignity (%) Losing control of bodily functions (%) Burden on family, friends/caregivers (%) Inadequate pain control or concern about it (%) Financial implications of treatment (%) Health-care provider present (N=677) (N=748) 66 (9.) 68 (9.) 684 (9.4) 6 (88.7) 62 (88.9) 66 (88.9) 2 (7.2) 42 (8.9) 4 (8.9) 26 (6.6) (.7) 76 (.) (49.) 264 (9.) 299 (4.) 2 (28.2) 7 (2.2) 77 (2.7) 4 (.6) 8 (2.7) 22 (2.9) Prescribing physician (%) 8 (.4) 99 (6.) 7 (6.) Other provider, prescribing physician not present (%) (7.) 28 (4.) 26 (9.) No provider (%) 7 (8.4) 242 (4.4) 299 (44.7) Complications 2 2 (N=72) Regurgitated Seizures Other None Other outcomes Regained consciousness after ingesting DWDA medications DeathwithDignityAct/Documents/year6.pdf Page 6 of (N=6) (N=682)

7 Oregon Public Health Division - 2 DWDA Report Characteristics Timing of DWDA event Duration (weeks) of patient-physician relationship 4 Range Duration (days) between st request and death Range Minutes between ingestion and unconsciousness Range Minutes between ingestion and death Range (minutes - hours) Total (N=72) min-.6hrs min-4hrs min-4hrs s are excluded when calculating percentages. Includes Oregon Registered Domestic Partnerships. Clackamas, Multnomah, and Washington counties. Includes patients that were enrolled in hospice at the time the prescription was written or at time of death. Private insurance category includes those with private insurance alone or in combination with other insurance. Includes deaths due to benign and uncertain neoplasms, other respiratory diseases, diseases of the nervous system (including multiple sclerosis, Parkinson's disease and Huntington's disease), musculoskeletal and connective tissue diseases, viral hepatitis, diabetes mellitus, cerebrovascular disease, and alcoholic liver disease. First recorded beginning in 2. Since then, patients (4.6%) have chosen not to inform their families, and 2 patients (.8%) have had no family to inform. There was one unknown case in 22, two in 2, one in 29, and three in 2. Other includes combinations of secobarbital, pentobarbital, and/or morphine. Affirmative answers only ("Don't know" included in negative answers). Categories are not mutually exclusive. Data unavailable for four patients in 2. First asked in 2. Data available for all 7 patients in 2, 2 patients between , and 62 patients for all years. The data shown are for 2-2 since information about the presence of a health care provider/volunteer, in the absence of the prescribing physician, was first collected in 2. A procedure revision was made mid-year in 2 to standardize reporting on the follow-up questionnaire. The new procedure accepts information about time of death and circumstances surrounding death only when the physician or another health care provider is present at the time of death. This resulted in a larger number of unknowns beginning in 2. There have been a total of six patients who regained consciousness after ingesting prescribed lethal medications. These patients are not included in the total number of DWDA deaths. These deaths occurred in 2 ( death), 2 (2 deaths), 2 (2 deaths) and 22 ( death). Please refer to the appropriate years annual reports on our website ( for more detail on these deaths. Previous reports listed 2 records missing the date care began with the attending physician. Further research with these cases has reduced the number of unknowns. DeathwithDignityAct/Documents/year6.pdf Page 7 of 7