Guest column: Why Oregon's Death with Dignity law is working

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Nov 5, 2014

Dr. Jeffrey Menashe, Guest columnist, Portland Business Journal

Brittany Maynard's recent move to Oregon in order to legally hasten death because of a malignant brain tumor has rekindled general interest in Oregon's Death with Dignity law, initially passed by popular vote in Oregon in 17 years ago, in 1994.

Since that time, physicians have written 1,173 prescriptions to hasten death, and 752 citizens have chosen to do so using the law, representing approximately 0.2 percent of deaths in Oregon. Four other states have adopted Oregon-like laws allowing physicians to assist patients in hastening death.

So is the law working to advance optimal end of life care for the people of our state?

Using objective measures, we in Oregon are in the forefront of states utilizing hospice support and opiate analgesics for our patients at the end of life.

Though our Death with Dignity law may be but one of many influences leading to this outcome, it has fostered a vital, important principle in the doctor-patient relationship as patients near the end of life: Each patient's journey to death is unique and demands the physician, nurse, or other caregiver listen to their individual patient's goals and hopes for the end of life without automatically imposing a particular medical or religious paradigm on that path.

On a more subjective level, my experience as an oncologist in Oregon in the era of our Death with Dignity law has been humbling and enlightening.

In 1997, though a supporter of the law at the ballot box, I was slow to agree to use the law as a physician. It was only after several difficult deaths experienced by patients who had hoped to hasten death according to the new law, but encountered resistance from their physician (me) , that I was pressed to reconsider my position vis a vis the law.

My faith in medical therapies as an infallible means to ease pain and anxiety and obviate a patient's desire to hasten death was shaken.

In subsequent years, even as medical therapy for the treatment of cancer and the supportive medical treatments for those at the end of life has improved dramatically, the existence of Oregon's law to give relief from suffering to patients (and their loved ones) at the end of life has been continually evident, as much for those who have merely contemplated using the law as for those who have used the law to hasten death.

In a time frame nearing two decades, the fears of the opponents of Oregon's law have not been realized. Medically vulnerable populations have not been coerced into hastening death. Improvements in palliative care have not been undermined by the law, and in fact, continue to develop.

Brittany Maynard was distinctly different than most when confronted with terminal illness. She was decades younger than most of her peers in that group. The next patient of mine facing the end of life will likely be older chronologically but will certainly be unique in other ways.

Whether they choose to use the law, or consider it all, we will be more likely to have an open conversation regarding their goals for the end of life than might occur elsewhere. And the existence of our Death with Dignity will be a significant balm for many.

I have commonly heard patients conclude these conversations with the exclamation, "Thank God I live Oregon." In my estimation, these conversations, and exclamations such as that tell me that our law is indeed working.

To read the article online, click here.

Dr. Jeffrey Menashe's practice at Compass Oncology East is focused on lymphoma, leukemia and myeloma. He is also on the Advisory Board for Compassion & Choices in Oregon.