On October 27, 1997 Oregon
enacted the Death with Dignity Act (the Act) which allows terminally ill
individuals who meet specific qualifications to end their lives through the
voluntary self-administration of a lethal dose of medications, expressly
prescribed by a physician for that purpose. The Act requires the Oregon Health
Authority (OHA), Public Health Division, to collect information about the
patients and physicians who participate in the Act and to publish an annual
statistical report. While OHA is neutral about the Act itself, we believe these
data are important to parties on both sides of the debate.
The Act outlines specific
patient requirements to participate. A patient must be: 1) 18 years of age or
older, 2) capable of making and communicating health
care decisions for him/herself, and 3) diagnosed with a terminal illness that
will lead to death within six months. It is up to the attending and
consulting physicians to determine whether these criteria have been met, and
report that fact to OHA at the time a prescription is written. If any issues of
non-compliance with the statutory requirements are identified, OHA reports that
fact to the appropriate licensing board.
The Death with Dignity Act is a
permissive law that allows qualified patients to request a prescription and
allows a physician to write the prescription. The Act as written requires that two physicians agree that the patient
is suffering from a terminal disease, the patient is capable of making a
decision to request life-ending medication, and the patient has made an
informed decision. The Act does not specify whether or not all
treatment options must be exhausted prior to a prescription being written, nor
does it specify health insurance payment requirements for disease treatment.
OHA does not interpret the statute, other than the portion related to the
To monitor compliance with the
Act, OHA has incorporated a basic reporting process into our administrative rules.
When a prescription is written under the Act, the prescribing doctor must
either submit Death with Dignity forms to OHA or make available relevant
portions of the medical record. Either method must clearly show that the doctor
and patient have followed the requirements of the Act. After the patient has
died, the death certificate will be matched with the Death with Dignity forms
or copies of the medical record, and then reviewed by OHA staff. The physician is
then contacted to confirm whether their patient died from a lethal prescription
or from the terminal illness.
To identify possible reasons for
the request and assess circumstances surrounding the time of death, OHA developed
a follow-up questionnaire to be completed by the physician or licensed health
care provider who was present at the time of death. The interview questions
were developed with help from the Oregon Task Force to Improve the Care of
Terminally Ill Oregonians. Information collected includes patient characteristics,
motivations for requesting a prescription, end-of-life care issues (e.g.,
whether the patient was enrolled in hospice), events surrounding the patient's
death (e.g., the time it took for the patient to die after taking the lethal
medications), and characteristics of physicians who participate in the Act.
OHA is responsible for providing
the public with accurate information about the Death with Dignity Act. We
believe that our reporting system, follow-up questionnaires filled out by
providers, and information policy will protect the privacy of patients who
choose DWDA, their families, and their providers. At the same time, it will
provide important information on the impact of Oregon's Death with Dignity Act.