Western Carolina University Oregon Death with Dignity Act Discussion
Reflection involves critical thinking, which means rethinking your existing knowledge and previously held opinions in light of what we have learned about theories of ethics, logic, and reasoning. You will need to question your current knowledge and beliefs.
Discuss the main points of the debate, what stance you take, support that stance, and discuss the opposing argument. Also discuss an ethical theory that would apply to defend your view.
To complete each scenario assignment:
Compose your reflection in a Word document and be sure to address, at a minimum, the following questions:Why do you feel the way you do about the issue presented?Of the four responses offered in the scenario, which do you think is the most ethical and why?
Oregon Public Health Division
Oregon’s Death with Dignity Act–2014
Oregon’s Death with Dignity Act (DWDA), enacted in late 1997, allows terminally-ill adult Oregonians to
obtain and use prescriptions from their physicians for self-administered, lethal doses of medications.
The Oregon Public Health Division is required by the DWDA to collect compliance information and to
issue an annual report. The key findings from 2014 are presented below. The number of people for
whom DWDA prescriptions were written (DWDA prescription recipients) and the resulting deaths from
the ingestion of 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 February 2, 2015.
For more detail, please view the figures and tables on our web site: http://www.healthoregon.org/dwd.
Number
Figure 1: DWDA prescription recipients and deaths*,
by year, Oregon, 1998-2014
180
170
160
150
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
155
DWDA prescription recipients
DWDA deaths
121
114
116
105
97
95
88
85
71
68
65
44
38
33
27
24
65
60
46
42
37
73
65
60
58
39
85
59
49
38
27
21
16
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
*As of February 2, 2015
•
Year
As of February 2, 2015, prescriptions for lethal medications were written for 155 people during 2014
under the provisions of the DWDA, compared to 121 during 2013 (Figure 1). At the time of this
report, 105 people had died from ingesting the medications prescribed during 2014 under DWDA.
This corresponds to 31.0 DWDA deaths per 10,000 total deaths.1
1
Rate per 10,000 deaths calculated using the total number of Oregon resident deaths in 2013 (33,931), the most
recent year for which final death data are available.
http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/
DeathwithDignityAct/Documents/year17.pdf
Page 1 of 6
Oregon Public Health Division
•
Since the law was passed in 1997, a total of 1,327 people have had DWDA prescriptions written and
859 patients have died from ingesting medications prescribed under the DWDA.
•
Of the 155 patients for whom DWDA prescriptions were written during 2014, 94 (60.6%) ingested
the medication; all 94 patients died from ingesting the medication. No patients that ingested the
medication regained consciousness.
•
Eleven patients with prescriptions written during the previous years (2012 and 2013) died after
ingesting the medication during 2014.
•
Thirty-seven of the 155 patients who received DWDA prescriptions during 2014 did not take the
medications and subsequently died of other causes.
•
Ingestion status is unknown for 24 patients who were prescribed DWDA medications in 2014. For all
of the 24 patients, both death and ingestion status are pending (Figure 2).
•
Of the 105 DWDA deaths during 2014, most (67.6%) were aged 65 years or older. The median age at
death was 72 years. As in previous years, decedents were commonly white (95.2%) and welleducated (47.6% had a least a baccalaureate degree).
•
While most patients had cancer, the percent of patients with cancer in 2014 (68.6%) was lower than
in previous years (79.4%), and the percent with amyotrophic lateral sclerosis (ALS) was higher
(16.2% in 2014, compared to 7.2% in previous years).
•
While similar to previous years that most patients had cancer (68.6%), this percent was lower than
the average for previous years (79.4%); in contrast, the percent of patients with ALS was higher in
2014 (16.2%) than in previous years (7.2%).
•
Most (89.5%) patients died at home, and most (93.0%) were enrolled in hospice care either at the
time the DWDA prescription was written or at the time of death. Excluding unknown cases, all
(100.0%) had some form of health care insurance, although the number of patients who had private
insurance (39.8%) was lower in 2014 than in previous years (62.9%). The number of patients who
had only Medicare or Medicaid insurance was higher than in previous years (60.2% compared to
35.5%).
•
As in previous years, the three most frequently mentioned end-of-life concerns were: loss of
autonomy (91.4%), decreasing ability to participate in activities that made life enjoyable (86.7%),
and loss of dignity (71.4%).
•
Three of the 105 DWDA patients who died during 2014 were referred for formal psychiatric or
psychological evaluation. Prescribing physicians were present at the time of death for 14 patients
(13.9%) during 2014 compared to 15.9% in previous years.
http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/
DeathwithDignityAct/Documents/year17.pdf
Page 2 of 6
Oregon Public Health Division
•
A procedure revision was made in 2010 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 20 of the 105 DWDA deaths
during 2014. Among those 20 patients, time from ingestion until death ranged from eleven minutes
to one hour.
•
Eighty-three physicians wrote 155 prescriptions during 2014 (1-12 prescriptions per physician).
•
During 2014, no referrals were made to the Oregon Medical Board for failure to comply with DWDA
requirements.
Figure 2: Summary of DWDA prescriptions written and medications ingested in 2014,
as of February 2, 2015
155 people had prescriptions
written during 2014
11 people with
prescriptions written
in previous years
ingested medication
during 2014
94 ingested
medication
37 did not ingest
medication and
subsequently died
from other causes
24 ingestion and
death status
unknown
105 ingested
medication
105 died from
ingesting
medication
0 regained
consciousness after
ingesting medication;
died of underlying
illness
http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/
DeathwithDignityAct/Documents/year17.pdf
Page 3 of 6
Oregon Public Health Division
Table 1. Characteristics and end‐of‐life care of 857 DWDA patients who have died from ingesting a lethal
dose of medication as of February 2, 2015, by year, Oregon, 1998‐2014
Characteristics
Sex
Male (%)
Female (%)
Age at death (years)
18‐34 (%)
35‐44 (%)
45‐54 (%)
55‐64 (%)
65‐74 (%)
75‐84 (%)
85+ (%)
Median years (range)
Race
White (%)
African American (%)
American Indian (%)
Asian (%)
Pacific Islander (%)
Other (%)
Two or more races (%)
Hispanic (%)
Unknown
Marital Status
Married (%)2
Widowed (%)
Never married (%)
Divorced (%)
Unknown
Education
Less than high school (%)
High school graduate (%)
Some college (%)
Baccalaureate or higher (%)
Unknown
Residence
Metro counties (%)3
Coastal counties (%)
Other western counties (%)
East of the Cascades (%)
Unknown
End of life care
Hospice
Enrolled (%)4
Not enrolled (%)
Unknown
Insurance
Private (%)5
Medicare, Medicaid or Other Governmental (%)
None (%)
Unknown
2014
(N=105)
1998‐2013
(N=754)
Total
(N=859)
1
N (%)
56 (53.3)
49 (46.7)
1
N (%)
397 (52.7)
357 (47.3)
1
N (%)
453 (52.7)
406 (47.3)
1
2
3
28
29
23
19
72
6
16
58
156
218
206
94
71
7
18
61
184
247
229
113
71
(1.0)
(1.9)
(2.9)
(26.7)
(27.6)
(21.9)
(18.1)
(29‐96)
(0.8)
(2.1)
(7.7)
(20.7)
(28.9)
(27.3)
(12.5)
(25‐96)
(0.8)
(2.1)
(7.1)
(21.4)
(28.8)
(26.7)
(13.2)
(25‐96)
100 (95.2)
0 (0.0)
0 (0.0)
1 (1.0)
0 (0.0)
2 (1.9)
1 (1.0)
1 (1.0)
0
731 (97.3)
1 (0.1)
2 (0.3)
8 (1.1)
1 (0.1)
1 (0.1)
2 (0.3)
5 (0.7)
3
831 (97.1)
1 (0.1)
2 (0.2)
9 (1.1)
1 (0.1)
3 (0.4)
3 (0.4)
6 (0.7)
3
48 (45.7)
26 (24.8)
6 (5.7)
25 (23.8)
0
347 (46.2)
172 (22.9)
63 (8.4)
169 (22.5)
3
395 (46.1)
198 (23.1)
69 (8.1)
194 (22.7)
3
6 (5.7)
23 (21.9)
26 (24.8)
50 (47.6)
0
45 (6.0)
164 (21.9)
198 (26.4)
342 (45.7)
5
51 (6.0)
187 (21.9)
224 (26.2)
392 (45.9)
5
46 (44.7)
6 (5.8)
40 (38.8)
11 (10.7)
2
315 (41.9)
57 (7.6)
325 (43.3)
54 (7.2)
3
361 (42.3)
63 (7.4)
365 (42.7)
65 (7.6)
5
93 (93.0)
7 (7.0)
5
654 (90.0)
73 (10.0)
27
747 (90.3)
80 (9.7)
32
37 (39.8)
56 (60.2)
0 (0.0)
12
452 (62.9)
255 (35.5)
12 (1.7)
35
489 (60.2)
311 (38.3)
12 (1.5)
47
http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf
Page 4 of 6
Oregon Public Health Division
Characteristics
Underlying illness
Malignant neoplasms (%)
Lung and bronchus (%)
Breast (%)
Colon (%)
Pancreas (%)
Prostate (%)
Ovary (%)
Other (%)
Amyotrophic lateral sclerosis (%)
Chronic lower respiratory disease (%)
Heart Disease (%)
HIV/AIDS (%)
Other illnesses (%)6
Unknown
DWDA process
Referred for psychiatric evaluation (%)
Patient informed family of decision (%)7
Patient died at
Home (patient, family or friend) (%)
Long term care, assisted living or foster care facility (%)
Hospital (%)
Other (%)
Unknown
Lethal medication
Secobarbital (%)
Pentobarbital (%)
Other (%)8
End of life concerns9
Losing autonomy (%)
Less able to engage in activities making life enjoyable (%)
Loss of dignity (%)10
Losing control of bodily functions (%)
Burden on family, friends/caregivers (%)
Inadequate pain control or concern about it (%)
Financial implications of treatment (%)
Health‐care provider present11
When medication was ingested12
Prescribing physician
Other provider, prescribing physician not present
No provider
Unknown
At time of death
Prescribing physician (%)
Other provider, prescribing physician not present (%)
No provider (%)
Unknown
Complications12
Regurgitated
Seizures
Other
None
Unknown
Other outcomes
Regained consciousness after ingesting DWDA medications13
2014
(N=105)
1998‐2013
(N=754)
Total
(N=859)
72 (68.6)
16 (15.2)
7 (6.7)
5 (4.8)
9 (8.6)
2 (1.9)
5 (4.8)
28 (26.7)
17 (16.2)
4 (3.8)
3 (2.9)
0 (0.0)
9 (8.6)
0
596 (79.4)
139 (18.5)
57 (7.6)
49 (6.5)
47 (6.3)
33 (4.4)
28 (3.7)
243 (32.4)
54 (7.2)
34 (4.5)
14 (1.9)
9 (1.2)
44 (5.9)
3
668 (78.0)
155 (18.1)
64 (7.5)
54 (6.3)
56 (6.5)
35 (4.1)
33 (3.9)
271 (31.7)
71 (8.3)
38 (4.4)
17 (2.0)
9 (1.1)
53 (6.2)
3
3 (2.9)
95 (90.5)
44 (5.9)
634 (93.6)
47 (5.5)
729 (93.2)
94 (89.5)
8 (7.6)
0 (0.0)
3 (2.9)
0
716 (95.3)
29 (3.9)
1 (0.1)
5 (0.7)
3
810 (94.6)
37 (4.3)
1 (0.1)
8 (0.9)
3
63 (60.0)
41 (39.0)
1 (1.0)
(N=105)
96 (91.4)
91 (86.7)
75 (71.4)
52 (49.5)
42 (40.0)
33 (31.4)
5 (4.8)
(N=105)
403 (53.4)
344 (45.6)
7 (0.9)
(N=754)
686 (91.5)
667 (88.9)
504 (80.6)
376 (50.1)
300 (40.0)
178 (23.7)
22 (2.9)
(N=684)
466 (54.2)
385 (44.8)
8 (0.9)
(N=859)
782 (91.5)
758 (88.7)
579 (79.3)
428 (50.1)
342 (40.0)
211 (24.7)
27 (3.2)
(N=789)
14
6
4
81
14 (13.9)
6 (5.9)
81 (80.2)
4
(N=105)
0
0
0
20
85
0
119
238
76
251
107 (15.9)
263 (39.2)
301 (44.9)
13
(N=754)
22
0
1
487
244
6
http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf
133
244
80
332
121 (15.7)
269 (34.8)
382 (49.5)
17
(N=859)
22
0
1
507
329
6
Page 5 of 6
Oregon Public Health Division
Characteristics
Timing of DWDA event
Duration (weeks) of patient‐physician relationship14
Median
Range
Number of patients with information available
Number of patients with information unknown
Duration (days) between 1st request and death
Median
Range
Number of patients with information available
Number of patients with information unknown
Minutes between ingestion and unconsciousness11, 12
Median
Range
Number of patients with information available
Number of patients with information unknown
Minutes between ingestion and death11, 12
Median
Range (minutes ‐ hours)
Number of patients with information available
Number of patients with information unknown
2014
(N=105)
1998‐2013
(N=754)
Total
(N=859)
19
1‐1312
105
0
12
0‐1905
752
2
13
0‐1905
857
2
43
15‐439
105
0
48
15‐1009
754
0
47
15‐1009
859
0
5
2‐15
20
85
5
1‐38
487
267
5
1‐38
507
352
27
11mins‐1hr
20
85
25
1min‐104hrs
492
262
25
1min‐104hrs
512
347
1
Unknowns are excluded when calculating percentages.
2
Includes Oregon Registered Domestic Partnerships.
3
Clackamas, Multnomah, and Washington counties.
4
Includes patients that were enrolled in hospice at the time the prescription was written or at time of death.
5
Private insurance category includes those with private insurance alone or in combination with other insurance.
6
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, cerebrovascular disease, other
vascular diseases, diabetes mellitus, gastrointestinal diseases, and liver disease.
First recorded beginning in 2001. Since then, 37 patients (4.7%) have chosen not to inform their families, and 16 patients (2.0%) have
had no family to inform. There was one unknown case in 2002, two in 2005, one in 2009, and 3 in 2013.
Other includes combinations of secobarbital, pentobarbital, phenobarbital, and/or morphine.
7
8
9
10
11
12
13
14
Affirmative answers only (“Don’t know” included in negative answers). Categories are not mutually exclusive. Data unavailable for four
patients in 2001.
First asked in 2003. Data available for all 105 patients in 2014, 625 patients between 1998‐2013, and 730 patients for all years.
The data shown are for 2001‐2014 since information about the presence of a health care provider/volunteer, in the absence of the
prescribing physician, was first collected in 2001.
A procedure revision was made mid‐year in 2010 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 2010.
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 2005 (1 death), 2010 (2 deaths), 2011 (2 deaths) and 2012 (1
death). Please refer to the appropriate years’ annual reports on our website (http://www.healthoregon.org/dwd) for more detail on
these deaths.
Previous reports listed 20 records missing the date care began with the attending physician. Further research with these cases has
reduced the number of unknowns.
http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf
Page 6 of 6
