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Trends in Medical Aid in Dying in Oregon and Washington

IMPORTANCE: The combined 28 years of data of medical aid in dying (MAID) between Oregon (OR) and Washington (WA) are the most comprehensive in North America. No reports to date have compared MAID use in different US states. OBJECTIVE: To evaluate and compare patterns of MAID use between the states w...

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Autores principales: Al Rabadi, Luai, LeBlanc, Michael, Bucy, Taylor, Ellis, Lee M., Hershman, Dawn L., Meyskens, Frank L., Taylor, Lynne, Blanke, Charles D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6692681/
https://www.ncbi.nlm.nih.gov/pubmed/31397857
http://dx.doi.org/10.1001/jamanetworkopen.2019.8648
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author Al Rabadi, Luai
LeBlanc, Michael
Bucy, Taylor
Ellis, Lee M.
Hershman, Dawn L.
Meyskens, Frank L.
Taylor, Lynne
Blanke, Charles D.
author_facet Al Rabadi, Luai
LeBlanc, Michael
Bucy, Taylor
Ellis, Lee M.
Hershman, Dawn L.
Meyskens, Frank L.
Taylor, Lynne
Blanke, Charles D.
author_sort Al Rabadi, Luai
collection PubMed
description IMPORTANCE: The combined 28 years of data of medical aid in dying (MAID) between Oregon (OR) and Washington (WA) are the most comprehensive in North America. No reports to date have compared MAID use in different US states. OBJECTIVE: To evaluate and compare patterns of MAID use between the states with the longest-running US death with dignity programs. DESIGN, SETTING, AND PARTICIPANTS: A retrospective observational cohort study of OR and WA patients with terminal illness who received prescriptions as part of their states’ legislation allowing MAID. All published annual reports, from 1998 to 2017 in OR and from 2009 to 2017 in WA, were reviewed. A total of 3368 prescriptions were included. MAIN OUTCOMES AND MEASURES: Number of deaths from self-administration of lethal medication vs number of prescriptions written. RESULTS: A combined 3368 prescriptions were written in OR and WA, with 2558 patient deaths from lethal ingestion (76.0%). Of the 2558 patients, most were male (1311 [51.3%]), older than 65 years (1851 [72.4%]), and non-Hispanic white (2426 [94.8%]). The most common underlying illnesses were cancer (1955 [76.4%]), neurologic illness (261 [10.2%]), lung disease (144 [5.6%]), and heart disease (117 [4.6%]). Loss of autonomy (2235 [87.4%]), impaired quality of life (2203 [86.1%]), and loss of dignity (1755 [68.6%]) were the most common reasons for pursuing MAID. Time between drug intake to coma ranged from 1 to 660 minutes and time from drug intake to death ranged from 1 to 6240 minutes. In the 1557 patients for whom rates of complications were reported, 1494 (96.0%) did not experience a complication (592 of 626 [94.6%] in OR and 902 of 931 [96.8%] in WA). Eight patients (<0.5%) regained consciousness after drug ingestion in OR. Annual rates per year for percentage of patients who received a prescription ingesting the prescribed medication ranged from 48% to 87%, with no significant time trend in OR (adjusted odds ratio per year, 1.01; 95% CI, 0.99-1.02; P = .59) but with an increase over time in WA (adjusted odds ratio per year, 1.13; 95% CI, 1.08-1.19; P < .001). In both OR and WA there were increases in the number of patient deaths due to MAID per 1000 deaths over time. CONCLUSIONS AND RELEVANCE: In this study, MAID results in Oregon and Washington were similar, although MAID use measured as a percentage of patients prescribed lethal medications and then self-administering them increased only in WA. Most patients who acquired lethal prescriptions had cancer or terminal illnesses that are difficult to palliate and lead to loss of autonomy, dignity, and quality of life.
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spelling pubmed-66926812019-08-27 Trends in Medical Aid in Dying in Oregon and Washington Al Rabadi, Luai LeBlanc, Michael Bucy, Taylor Ellis, Lee M. Hershman, Dawn L. Meyskens, Frank L. Taylor, Lynne Blanke, Charles D. JAMA Netw Open Original Investigation IMPORTANCE: The combined 28 years of data of medical aid in dying (MAID) between Oregon (OR) and Washington (WA) are the most comprehensive in North America. No reports to date have compared MAID use in different US states. OBJECTIVE: To evaluate and compare patterns of MAID use between the states with the longest-running US death with dignity programs. DESIGN, SETTING, AND PARTICIPANTS: A retrospective observational cohort study of OR and WA patients with terminal illness who received prescriptions as part of their states’ legislation allowing MAID. All published annual reports, from 1998 to 2017 in OR and from 2009 to 2017 in WA, were reviewed. A total of 3368 prescriptions were included. MAIN OUTCOMES AND MEASURES: Number of deaths from self-administration of lethal medication vs number of prescriptions written. RESULTS: A combined 3368 prescriptions were written in OR and WA, with 2558 patient deaths from lethal ingestion (76.0%). Of the 2558 patients, most were male (1311 [51.3%]), older than 65 years (1851 [72.4%]), and non-Hispanic white (2426 [94.8%]). The most common underlying illnesses were cancer (1955 [76.4%]), neurologic illness (261 [10.2%]), lung disease (144 [5.6%]), and heart disease (117 [4.6%]). Loss of autonomy (2235 [87.4%]), impaired quality of life (2203 [86.1%]), and loss of dignity (1755 [68.6%]) were the most common reasons for pursuing MAID. Time between drug intake to coma ranged from 1 to 660 minutes and time from drug intake to death ranged from 1 to 6240 minutes. In the 1557 patients for whom rates of complications were reported, 1494 (96.0%) did not experience a complication (592 of 626 [94.6%] in OR and 902 of 931 [96.8%] in WA). Eight patients (<0.5%) regained consciousness after drug ingestion in OR. Annual rates per year for percentage of patients who received a prescription ingesting the prescribed medication ranged from 48% to 87%, with no significant time trend in OR (adjusted odds ratio per year, 1.01; 95% CI, 0.99-1.02; P = .59) but with an increase over time in WA (adjusted odds ratio per year, 1.13; 95% CI, 1.08-1.19; P < .001). In both OR and WA there were increases in the number of patient deaths due to MAID per 1000 deaths over time. CONCLUSIONS AND RELEVANCE: In this study, MAID results in Oregon and Washington were similar, although MAID use measured as a percentage of patients prescribed lethal medications and then self-administering them increased only in WA. Most patients who acquired lethal prescriptions had cancer or terminal illnesses that are difficult to palliate and lead to loss of autonomy, dignity, and quality of life. American Medical Association 2019-08-09 /pmc/articles/PMC6692681/ /pubmed/31397857 http://dx.doi.org/10.1001/jamanetworkopen.2019.8648 Text en Copyright 2019 Al Rabadi L et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Al Rabadi, Luai
LeBlanc, Michael
Bucy, Taylor
Ellis, Lee M.
Hershman, Dawn L.
Meyskens, Frank L.
Taylor, Lynne
Blanke, Charles D.
Trends in Medical Aid in Dying in Oregon and Washington
title Trends in Medical Aid in Dying in Oregon and Washington
title_full Trends in Medical Aid in Dying in Oregon and Washington
title_fullStr Trends in Medical Aid in Dying in Oregon and Washington
title_full_unstemmed Trends in Medical Aid in Dying in Oregon and Washington
title_short Trends in Medical Aid in Dying in Oregon and Washington
title_sort trends in medical aid in dying in oregon and washington
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6692681/
https://www.ncbi.nlm.nih.gov/pubmed/31397857
http://dx.doi.org/10.1001/jamanetworkopen.2019.8648
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