Medscape reported 20 September 2016 on a Palliative Care in Oncology Symposium (PCOS) 2016
SAN FRANCISCO ― Oregon was the first state in the United States to enact a physician aid in dying law, known as Death With Dignity Act (DWD). Now, almost 20 years later, there is little evidence that it has been abused.
Since the passage of the law in 1997, a total of 1545 people have been written prescriptions under the DWD in Oregon, and 991 patients have died from ingesting the lethal medications.
A majority of the patients had cancer, said Charles Blanke, MD, professor of medicine, Knight Cancer Institute, at Oregon Health and Sciences University in Portland.
“Users are predominantly elderly, white, and well educated,” he added.
“Almost all patients are in hospice, and almost all take the medications at home after telling loved ones of their decision,” said Dr Blanke, who provided an update on Oregon’s experience here at the Palliative Care in Oncology Symposium (PCOS) 2016.
It is relatively rare for patients to use DWD because they were suffering from inadequate pain palliation, he explained. The most common reasons were related to quality of life, autonomy, and dignity.
DOSAGE QUESTIONS
The majority of patients took the medication at home (94%), with a “smattering doing it in a nursing home or equivalent (5%).
“Only one single patient was admitted to a hospital at the time of medication administration,” he pointed out.
As for the drugs used, pure pentabarbitol was at one time the drug of choice, but opposition to capital punishment by European suppliers adversely affected access, and secobarbitol has now taken its place.
The problem with secobarbitol is that it is expensive, costing about $3500 to $7000. “Insurance coverage is mixed,” Dr Blanke told Medscape Medical News. “Some patients have to pay the complete cost out of pocket.”
Use of secobarbitol is also complicated. About 100 capsules have to be opened and mixed with liquid, and many patients lack the dexterity to accomplish that. “As an alternative, a triple cocktail of morphine, chloral hydrate, and phenobarbital may be compounded,” he pointed out. “It is cheaper — about $400 — but it is acidic and, anecdotally, it takes longer for the patient to die.”
Only about two thirds of patients actually take the prescribed drugs once they fill the prescription. “It could be that just knowing that they have the option is enough,” said Dr Blanke. “It’s there if they need it, and it may relieve their fear of loss of control.”
The efficacy of the lethal medication is 99.4%, although, curiously, six patients have regained consciousness after taking it.
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A full report on this conference is at
http://www.medscape.com/viewarticle/869023
