Physician-Assisted Death Scanning the Landscape: Proceedings of a Workshop (2018) / Chapter Skim
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3 Experiences with and Reflections on Physician-Assisted Death in the United States
3 Experiences with and Reflections on Physician-Assisted Death in the United States
Pages 45-64
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From page 45... ...
• The Oregon Death with Dignity Act requires the state to collect data focused on monitoring compliance with specific provi sions of the law. The state does not collect information about the conversations between physicians and patients or about the decision-making process concerning physician-assisted death.
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From page 46... ...
state to have legalized physician aid-in-dying, and Linda Ganzini, a professor of psychiatry and medicine at Oregon Health & Science University and associate director of the Health Services Research and Development Center of Innovation in the Veterans Affairs (VA) Portland Health Care System,1 said she had thought the law would always be "one of these quirky Oregon things." That changed, however, when Washington State passed a nearly identical law in 2008, followed by Vermont in 2013, and 1The views expressed in these workshop proceedings are those of Dr.
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From page 47... ...
In addition, as a result of a judicial decision, Montana does not prosecute physician aid-in-dying for competent, terminally ill patients. Statistics and Research Results on Physician Assisted Death in Oregon Linda Ganzini Professor of Psychiatry and Medicine Oregon Health & Science University Katrina Hedberg Health Officer and State Epidemiologist Oregon Health Authority The Oregon law, as well as others modeled on it, allows a competent, terminally ill patient to receive a lethal prescription from a physician for self-administration.
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From page 48... ...
More than 75 percent said loss of dignity was a major concern, and almost half feared losing bodily control. More than 40 percent worried they would be a burden to their family, 26 percent were concerned about inadequate pain control, and under 4 percent had financial concerns (Oregon Health Authority, 2018)
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From page 49... ...
In Oregon, hospice nurses and caregivers of ALS patients and cancer patients had an average score of 6 to 7, but patients requesting physician aid-in-dying had an average score of 2.3, the lowest score of any group she and her team have measured. This finding, she said, may indicate that religiousness protects one from pursuing physician aid-in-dying and is likely one reason that Oregon was the first state to pass a physician-assisted death law, given that it is among the least religious of all states.
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From page 50... ...
Ganzini said that the results, in total, leave unanswered questions regarding the role of depression in requests for lethal prescriptions. Ganzini's research has shown that the desire to maintain control is among the strongest reasons that patients request physician aid-in-dying.
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From page 51... ...
Hedberg said that in Oregon, prescribing physicians are required to complete a patient follow-up form, on which they indicate whether the patient ingested the medications, and provide information about the circumstances surrounding the death. During the discussion period a workshop participant noted that physician-assisted death laws specify that it is illegal for physicians to note in the death certificate that the cause of death is physician-assisted death and questioned the intellectual integrity of this requirement.
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From page 52... ...
. Another early study of hospice nurses and social workers found that almost one-third of respondents had cared for a client who had received a lethal prescription (Ganzini et al., 2002)
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From page 53... ...
Her team's study of the attitudes of other health care practitioners found that only 3 percent of hospice nurses (Miller et al., 2004) and 14 percent of hospice chaplains would actively oppose a client's choice for physician aid-in-dying (Carlson et al., 2005)
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From page 54... ...
54 TABLE 3-1 Oregon Health Care Practitioners' Attitudes Toward the Oregon Death with Dignity Act or Physician-Assisted Death Hospice Attitude Toward Generalist Hospice Social Hospice Oregon Death with Physicians Nurses Workers Chaplains Psychiatrists Psychologists Dignity Act or N = 2,641 N = 306 N = 85 N = 50 N = 307 N = 423 Physician-Assisted (Ganzini et al., (Miller et al., (Miller et al., (Carlson et al., (Ganzini et al., (Fenn and Death 2001)
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From page 55... ...
That is not the dying process she would have experienced if that brain tumor would have continued to run its course." To Diaz, the term physician-assisted suicide is an insult to terminally ill pa tients. "My wife Brittany wanted to live.
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OTHER U.S. EXPERIENCES Washington Helene Starks Associate Professor of Bioethics and Humanities University of Washington More than 20 years ago, Helene Starks, an associate professor of bioethics and humanities and an adjunct associate professor of health services, family medicine, and pediatrics at the University of Washington, conducted a study in which she and her research team asked patients and families in Washington, where physician-assisted death was still illegal, and in Oregon, where physician-assisted death had recently been approved, about their experiences in helping family members with terminal illnesses hasten their deaths (Back et al., 1996, 2002; Starks et al., 2005, 2007)
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From page 57... ...
. She said that her personal stance toward physician aid-in-dying was originally neutral but that this study swayed her in the direction of legalization because it mandates that people have a protocol and are engaged.
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From page 58... ...
Offering lessons from California's experience, Starks said that the process takes time and that very few patients or health systems report that they are able to complete the request process in 15 days. The exceptions, she said, occur with what she has started calling the "destination doctors," practitioners who are providing physician-assisted death either as a specialty within a larger practice or as their sole practice.
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From page 59... ...
However, organizations can prohibit patients from taking the lethal medication on their premises in the same way that the state prohibits people from taking these medications in state parks. The provision for organizations stems from lessons that advocates learned from Oregon and other earlier adopters, which is that while allowing organizations to prohibit employees from participating in the program may be respectful of the notion of "organizational conscience," it creates an access barrier for patients.
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From page 60... ...
To answer those questions, Buchbinder conducted 144 semi-structured interviews of nurses, chaplains, social workers, terminally ill patients, lay caregivers, policy makers and activists, other Vermont residents, and physicians, many of whom had direct experience with Vermont's law either as a prescriber or as a secondary physician. Buchbinder said that because Vermont is so small, she was able to talk to a majority of the prescribers in the state.
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From page 61... ...
This type of timing issue came up repeatedly in her interviews with both providers and family members, Buchbinder said. In July 2016 a lawsuit was filed by the Vermont Alliance for Ethical Healthcare and the Christian Medical and Dental Association against the Vermont Board of Medical Practice and several other state agencies alleging that Vermont's law entailed an affirmative duty to inform terminally ill patients that the law was an option in their state and therefore that the law violated the constitutional rights of these physicians.
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From page 62... ...
2005. Oregon hospice chaplains' experiences with patients requesting physician-assisted suicide.
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From page 63... ...
2004. Atti tudes and experiences of Oregon hospice nurses and social workers regarding assisted suicide.
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