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Study Reveals While Few Oregonians Choose Physician-Assisted Suicide, Many Seriously Consider It

   Portland, Ore.

Study also details key demographics of patients more likely to choose physician-assisted suicide

Researchers at Oregon Health & Science University (OHSU) have published the first study of dying Oregonians' attitudes toward physician assisted suicide (PAS). The survey, which involved family members who had recently lost a loved one, found that while very few Oregonians use PAS to end their lives, a much greater number of patients seriously consider it. Prior to this study, research focused on patients who had ended their lives through PAS and on physician's and specific patient groups' attitudes about the practice. The results of the study are published in the current edition of the Journal of Clinical Ethics.

"One of the most surprising statistics this study generated was that approximately 17 percent of dying Oregonians consider PAS seriously enough to talk with their family about it," explained Susan Tolle, M.D., director of the Center for Ethics in Health Care at OHSU and first author of the study. "However, when it comes to actually taking part in PAS, the numbers differ greatly. Approximately 2 percent of dying patients formally request PAS and about one in 1,000 patients die through the use of a lethal prescription. We had no idea prior to our study how many Oregonians personally considered the option."

The study also provided some valuable information about dying Oregonians' overall attitudes regarding PAS. Researchers learned that 44 percent of dying patients were in favor of PAS, 15 percent were neutral on the issue and 41 percent were opposed. The researchers considered this data notable, indicating that after six years of legal existence, those Oregonians who were morally opposed to PAS appeared to remain morally opposed. In addition, the study revealed certain factors that relate to a person's feelings about PAS. Those factors include race, socio-economic status, religion, education and age.

"According to this study, patients more likely to personally consider PAS are younger, white, not very religious and battling cancer," added Tolle, also a professor of medicine (general internal medicine and geriatrics), OHSU School of Medicine. "However, patients at various levels of education considered PAS. The educational data really stands out here because previous reports have shown that those who ultimately take a lethal prescription tend to have a significantly higher level of education."

To obtain their data, researchers conducted phone interviews with 1,384 family caregivers who lost an adult loved one through natural causes between June 2000 and March 2002. The family caregivers were identified through a random sample of Oregon death certificates.

The current issue of the Journal of Clinical Ethics contains a commentary on the PAS study also written by two OHSU authors not involved in the original research. The commentary investigates the possible meanings of the data and its relevance.

"One major question raised by the study is why many consider PAS but decide not to take part in it," explained Linda Ganzini, M.D., a professor of psychiatry and medicine (general internal medicine and geriatrics) in the OHSU School of Medicine. "There are a number of possible explanations for this. For instance, patients who consider PAS may later dismiss the idea after speaking with their physician about treatment options which include better pain control or treatment of depression. Referral to hospice may also affect a person's wishes for PAS. However, on the other hand, those already in hospice care who make the request are more likely to persist, having found that palliative care does not satisfy their end-of-life expectations."

Another key question raised by the original article and addressed by the commentary authors is whether legalization of physician-assisted suicide may actually limit its use.

"When you compare Oregon's data to other states where PAS is illegal, you find, on average, other states appear to actually have more PAS cases," added Ganzini. "About one in 1,000 Oregon patients die through receiving a lethal prescription. In other states, the average rate is approximately four in 1,000 - despite the fact that doctors in those states are breaking the law. One possible reason for this is that Oregon doctors feel they are under greater scrutiny and are therefore less willing to act outside of a safe harbor. Another explanation is that Oregon's Death With Dignity Act has significant hurdles and many patients simply can't make it over them."

The Center for Ethics in Health Care at OHSU remains neutral on the Oregon Death with Dignity Act, neither supporting nor opposing the option. The center conducts research on all end-of-life issues, including PAS, in its long-term efforts to ensure the comfort of Oregonians near and at the time of death.

Additional authors for the PAS study include: Virginia Tilden, D.N.Sc., R.N., who is now with the University of Nebraska Medical Center; Katrina Hedberg, M.D., M.P.H.. , of the Oregon Department of Human Services; and Linda Drach, M.P.H., Erik Fromme, M.D., and Nancy Perrin, Ph.D., from OHSU. Funding for the research was provided by the National Institutes of Health and the Robert Wood Johnson Foundation.

Steven Dobscha, M.D., of OHSU, is co-author of the commentary.
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