ORIGINAL CONTRIBUTION Oregon Physicians’ Attitudes About and Experiences With End-of-Life Care Since Passage of the Oregon Death with Dignity Act

THE OREGON DEATH WITH DIGnity Act was passed by ballot measure in 1994, and enacted in October 1997. This measure legalized physician-assisted suicide by allowing a physician to prescribe a lethal dose of medication for a mentally competent, terminally ill patient for the purpose of self-administration. Experts predicted that legalized assisted suicide would divert attention and resources from efforts to improve care for dying patients. Several lines of evidence, however, support the contention that care for terminally ill patients in Oregon has improved since the passage of the Death with Dignity Act. For example, more than one third of Oregonians who die are enrolled in a hospice program and two thirds have completed an advance directive before death. Since legalization, death from physician assisted suicide has been rare, but little is known about the broader effects of the Death with Dignity Act on clinical practice or the perspectives of Oregon physicians on care of the dying. In 1999, we surveyed all Oregon physicians who were eligible to prescribe under the Death with Dignity Act. Based on responses of 144 physicians (5% of respondents) who had received a request for physician-assisted suicide, we published information on the characteristics and outcomes of requesting patients and the interventions made by physicians other than assisted suicide. These data indicated that 1 in 10 requests for a lethal prescription resulted in assisted suicide. Physicians reported that as a result of palliative inAuthor Affiliations: Department of Veterans Affairs, Portland, Ore (Drs Ganzini and Nelson and Ms Delorit); Departments of Psychiatry (Dr Ganzini), Medicine (Drs Nelson and Lee), Emergency Medicine (Dr Schmidt), Division of Medical Informatics and Outcomes Research (Drs Nelson and Kraemer), and the Center for Ethics in Health Care (Drs Ganzini and Schmidt), Oregon Health Sciences University, Portland; and the Providence Health System (Dr Lee), Portland. Corresponding Author and Reprints: Linda Ganzini, MD, Mental Health Division, P31DMH, Portland VA Medical Center, PO Box 1034, Portland, OR 97207 (e-mail: [email protected]). Context The Oregon Death with Dignity Act, passed by ballot measure in 1994 and enacted in October 1997, legalized physician-assisted suicide for competent, terminally ill Oregonians, but little is known about the effects of the act on clinical practice or physician perspective.