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Oregon at 25: new highs, new lows

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20th March 2023

The assisted suicide law supposedly limited by a six-month prognosis now sees patients outlive this by five years, with individual doctors writing lethal prescriptions on a weekly basis.

Oregon at 25: new highs, new lows

The latest report on the functioning of Oregon's Dying With Dignity Act (DWDA), concerning legal assisted suicides in the state in 2022, has been published - the 25th annual report.

431 people - adult residents of Oregon deemed to have six months or less to live - received prescriptions in 2022, of whom 246 ingested the drugs and died, alongside 32 with drugs from previous years: 278 deaths in 2022, the highest level yet. For context, Oregon is a state of 4.2m people; the figure would extrapolate to around 4,388 based on a population the size of the UK's.

"Since the law was passed in 1997, a total of 3,712 people have received prescriptions under the DWDA and 2,454 people (66%) have died from ingesting the medications."

We are told that:

"A total of 146 physicians wrote 431 prescriptions during 2022 (1-51 prescriptions per physician; 78% of physicians wrote one or two prescriptions)."

51 prescriptions: at least one doctor in Oregon is approving patients for assisted suicide almost every week of the year. Many pages later, we find that once again, some patients were approved by doctors they had known for less than a week and moreover, where the median doctor-patient relationship between 1998 and 2020 was 12 weeks, in both 2021 and 2022, it was just five weeks. Taken together with the fact that only "three patients were referred for psychological or psychiatric evaluation", a picture emerges of doctors who barely know applicants approving them for assisted suicide without specialist support, on a regular basis. This is the system which is supposed to protect against coercion, depression and unsettled desires to die.

End of life concerns remain, as before, dominated by existential concerns: "less able to engage in activities making life enjoyable" (88.8%), "losing autonomy" (86.3%), and "loss of dignity" (61.9%). Almost half (46.4%) cited worries about being a "burden on family, friends/caregivers", while less than a third (31.3%) cited "inadequate pain control, or concern about it." 17 assisted suicides last year were influenced at least in part by concerns over the "financial implications of treatment."

Campaigners in the UK have often argued that Oregon's law is an example of a law which has not succumbed to the kind of mission creep seen so clearly in the Low Countries - an argument now in tatters.

"Since 2020, the DWDA provides an exemption to the statutory waiting periods for patients expected to live fewer than 15 days after the time of their first oral request for medication. In 2022, 109 patients (25% of DWDA prescription recipients) were granted exemptions."

"In October 2021, a lawsuit was filed against the State of Oregon in U.S. District Court for the District of Oregon, alleging that the residency requirement in the Act violated… [constitutional rights], in part because it bars Oregon health care providers from providing medical aid in dying to non-resident patients. In a settlement on March 28, 2022, the State agreed not to enforce the residency requirement [and the original DWDA is in the process of being amended to reflect this change.]"

The weakening and removal of so-called safeguards follows an earlier, important change. Oregon health officials freely admit that without amending the legislation, they have re-interpreted the terminal illness requirement of the law (six months) to include those who forego treatment for otherwise non-terminal conditions. It is a regular feature of the reports that patients demonstrate the unreliability of six-month prognoses: in 2021, one patient died by assisted suicide 1,095 days (three years) after first request and in earlier years, the gap had been as high as 1,503 days (more than four years). In 2022, one patient died 1,859 days - more than five years - after first request, and these figures do not reflect the possible lifespans of those who took the drugs earlier.

The proportion of assisted suicides referencing cancer was less than two thirds in 2022, with the report noting cases of "endocrine/metabolic disease (e.g. diabetes)", "infectious disease (e.g. HIV/AIDS) and "other illnesses". In past reports, a footnote has listed examples of these other illnesses, as for 2021:

"Includes deaths due to anorexia, arthritis, arteritis, blood disease, complications from a fall, hernia, kidney failure, medical care complications, musculoskeletal system disorders, sclerosis, and stenosis."

These are not conditions people would expect to qualify under the limited law Oregon is said to exemplify, and in fact, the 2022 report omits such a footnoted list entirely.

Unknowns have become an increasingly significant feature of the Oregon DWDA reports. Of 431 people who received prescriptions in 2022, the authorities don't know whether 43 who died subsequently had ingested the drugs, and don't know whether a further 58 are still alive.

We're told that five people had "difficulty ingesting/regurgitated" the drugs and another person had "other" complications, but they don't know either way for 206 out of the 278. Increasing attention has been given to complications in assisted suicide and euthanasia in both academic journals and the popular press, and it is noteworthy that the median time between ingestion and death has increased from 30 minutes between 998 and 2020, to 33 minutes in 2021, to 52 minutes, with death taking 68 hours in at least one instance last year. Of course, again, we don't know these times in more than 40% of cases.

The 2022 report makes still clearer that Oregon does not offer an example of a limited law, free from mission creep, but rather a warning not to replace clear, defensible boundaries with an opened door.

© Image copyright of Boracasli and licensed for reuse under Creative Commons License 4.0

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