Physician-Assisted Suicide Program Wins Praise

A new study reports that patients, their families, and their physicians are satisfied with a “death with dignity” physician-assisted suicide program made available to terminal cancer patients.

The program was instituted following legislation in 2008 in the US states of Washington and Oregon allowing physician-assisted suicide. Patients must make two oral requests, with an interval of at least 15 days between, plus a written request in order to begin the process. Prescribing physicians as well as a different consulting physician must then confirm that the patient's disease is terminal and that the patient is competent and voluntarily requesting the prescription. An informed consent process is required, and when the prescription is being written, physicians must give the patient a chance to rescind.

The prescriptions must then be given directly to a pharmacist, who gives the lethal drug directly to the patient or an authorized agent. In all, 114 patients inquired about the program between March 5, 2009, and December 31, 2011. Of these, 44 (38.6%) did not pursue the program, and 30 (26.3%) initiated the process but either elected not to continue or died before completion. Forty participants went through the process of obtaining the prescription, but only 60% ultimately ingested it.

The most common reasons given by patients for participation in the program were loss of autonomy (97.2%), inability to engage in enjoyable activities (88.9%), and loss of dignity (75%). Eleven participants lived for more than six months after prescription receipt. Qualitatively, patients and families were grateful to receive the lethal prescription, whether it was used or not. The study describing the program and the results was published in the April 11, 2013, issue of the New England Journal of Medicine (NEJM).

“Our ‘Death with Dignity’ program both allows patients with cancer who wish to consider this option to do so within the context of their ongoing care and accommodates variation in clinicians' willingness to participate,” concluded lead author Elizabeth Trice Loggers, MD, PhD, and colleagues. “The program ensures that patients (and families) are aware of all the options for high-quality, end-of-life care, including palliative and hospice care, with the opportunity to have any concerns or fears addressed, while also meeting state requirements.”

The implementation of the “Death with Dignity” program was at undertaken at the Seattle Cancer Care Alliance (Washington, USA). For those patients who express interest in participating, a licensed social worker is assigned who acts as an advocate and performs an initial chart review and, if appropriate, links patients with physicians willing to write lethal prescriptions. The advocate helps the patients, family members, and physicians navigate the process and ensure compliance with the state's regulations. Staff and faculty physicians can opt out of participating in the program.

Related Links:
Seattle Cancer Care Alliance