Because legalized assisted suicide is unique to Oregon, the reporting system implemented under the Oregon Death with Dignity Act has no precedent. The reporting system will be subject to peer scrutiny in medical literature.
The OHD has two data-gathering methods - one based on physician reporting and documentation of compliance with the law, the other based on review of death certificates.
Under the new law, fifteen people died after taking lethal medications. The median age was 69; all individuals were Caucasian; eight were male; and thirteen had cancer at the time of death.
Despite its own neutral position, the OHD report included some policy-related information. OHD noted that no person who chose PAS expressed a concern to their physicians about the financial toll of their underlying illness. The proportion of patients with private insurance and with Medicaid were similar among those who chose PAS and those who did not. OHD noted that this may provide evidence that socioeconomic status was not a factor in the decisionmaking process. Only one of the fifteen patients expressed a concern to her physician about inadequate pain control at the end of life.
Instead, OHD found that autonomy and personal control were the predominant concerns of people who chose PAS. Patients who chose assisted suicide were seven times more likely than control group patients to be concerned about loss of autonomy, and nine times more likely to be concerned about loss of bodily functions.
OHD conceded that because the numbers of individuals involved in the study is so small, one cannot claim that its results are statistically significant. Authors of the report also pointed out that because physician reporting was a primary part of the methodology used for data-gathering, physician bias may affect the data. .
The concerns raised in the Center to Improve Care of the Dying’s amicus brief to the Supreme Court, under the aegis of the American Geriatrics Society, remain. The fact that patients expressed a concern about loss of bodily control and autonomy evidence that individuals may be prematurely choosing to end their lives. However, one can imagine a situation where in which a person with an illness that is mentally debilitating chooses an early death via PAS, despite a 10-year life expectancy.
The issue of what constitutes a "terminal illness" under the Oregon law is still under debate. Data from the SUPPORT study show that patients with cancer (the majority of these fifteen patients had cancer) often fit into the Medicare-hospice definition of "terminal illness." However, not all illnesses have trajectories with such obvious points of definitive and acute decline in physical health, and therefore may not fit as neatly into the constructs of the Oregon law.
Overall, Oregon’s report on its first year of legalized PAS did not describe any abuses of the law. And the rate at which people requested PAS is extremely low, when compared to Oregon’s 28,900 deaths in 1996. Oregon has proven to be efficient at reporting experiences from its "laboratory" to other states; we hope such open-reporting provides a useful guide as others grapple with the difficult issues surrounding PAS.