Nightingale Alliance® Euthanasia Opposition - Resources, End of Life Alternatives

Linda Ganzini, et al., Oregon Physicians' Attitudes About and Experiences With End-of-Life Care Since Passage of the Oregon Death With Dignity Act, 285 JAMA 2363 (2001)

In 1999, the authors 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, the authors published information on the characteristics and outcomes of requesting patients and the interventions made by physicians other than assisted suicide. These data indicated that one in ten requests for a lethal prescription resulted in assisted suicide. Physicians reported that as a result of palliative interventions, some patients changed their minds about assisted suicide.

This article is based on information submitted by the Oregon physicians who responded to the survey. It reports these physicians' attitudes toward the Death with Dignity Act and caring for dying patients, their efforts to improve their ability to care for dying patients, their attitudes, concerns, and sources of information about writing lethal prescriptions, and their discussions and experiences with patients regarding assisted suicide. It compares the characteristics of physicians who received requests for a lethal prescription with those who did not.

Of 4,544 physicians on the list from the Oregon Board of Medical Examiners, 212 were in training, 343 were retired or not in practice, and eight were deceased. Of the remaining 3981, 2641 (66%) returned a survey that was at least two-thirds complete. Thirty percent of all physician respondents agreed with a statement that writing a lethal prescription for a patient under the Death with Dignity Act was immoral and/or unethical, 59% disagreed, and 11% neither disagreed nor agreed. A total of 1349 respondents (51%) supported the Death with Dignity Act, 832 (32%) opposed it, and 449 (17%) neither supported nor opposed the law. Four out of five claimed they had not changed their views on the law since it passed in 1994. For those who did change their view, almost twice as many reported that they had become more supportive (13%) than more opposed (7%). Fourteen percent of physicians reported that they had become more willing to prescribe a lethal medication since 1994, but 8% were less willing. Overall, one third of respondents were willing to write a lethal prescription under the law, 20% were uncertain, and 46% were unwilling. Fifty-three percent of respondents would consider obtaining a physician's assistance to end their own lives if terminally ill, including 88% of those who were willing to prescribe a lethal medication for a patient.

Among the 1841 physicians who were not morally opposed to writing a lethal prescription, 82% were concerned that writing a lethal prescription might violate federal Drug Enforcement Agency law, and 65% were concerned that their hospital might sanction them. The Death with Dignity Act allows hospital systems to forbid writing prescriptions under the act on their premises or by physicians they directly employ. Eighteen percent of respondents practice in a hospital system that has a policy forbidding prescription of lethal medications in accordance with the Death with Dignity Act.

Among physicians who were willing to prescribe and who had received a request for a lethal prescription, one in seven had not obtained information about the Act from any of several credible resources, one in six were not confident about finding reliable lethal prescribing information, and one in four were not confident in determining six-month life expectancy. Patients who make requests of these physicians may receive a lethal prescription without the comprehensive evaluation currently recommended.

Posted on June 26, 2004.