Annual Medical Aid in Dying Requests Consistent in Oregon, Washington

A cohort analysis of medical aid in dying (MAID) in Oregon and Washington—the first 2 states to pass legislation allowing forms of the act—shows the rate of practice has only increased over time in 1 state.

In a new study of 3368 MAID prescriptions accumulated from 1998-2017, investigators from Oregon and Washington reported the annual rate of patients to receive a self-ingesting MAID medication prescription has increased in Washington, while remaining almost perfectly stagnant in Oregon.

That said, the presence of deaths due to MAID per 1000 total deaths has increased over time in both states.

Oregon’s Death With Dignity Act, which permits terminally ill state residents aged 18 years or older to make a voluntary informed choice to be prescribed life-ending oral drugs by a physician, was first passed 25 years ago. Washington followed 14 years later, in 2008. Since then, 6 more states and the District of Columbia have passed similar legislation—the most recent being New Jersey this year.

Both Oregon and Washington legislation requires the publication of annual statistical reports on the information of patients and physicians who participate in MAID. Investigators—led by Luai Al Rabadi, MD, and Michael LeBlanc, PhD, of the Oregon Health & Science University—conducted the first state-to-state comparative assessment of MAID use and demographic statistics, to their knowledge.

The team observed annual data from 1998-2017 in Oregon, and 2009-2017 in Washington. Among the 3368 combined prescriptions, 2558 (76%) of patient deaths came from lethal ingestion. The MAID ingestion patient population was nearly split among genders (51.3% male), and nearly all patients (94.8%) were non-Hispanic white.

A majority of patients older than 65 years (72.4%), college educated (71.5%), and insured (88.5%) at the time of their request. Just 2.5% of both state’s MAID patient population was between 18-44 years old.

Among patient illness which led to their MAID request, the majority had a cancer diagnosis (76.4%), while the remaining quarter of patients were diagnosed with a neurological condition (10.2%), lung disease (5.2%), heart disease (4.6%), or other illnesses (3%). Three-fourths (76%) of patients were enrolled in hospice at the time of their request.

The most common reasons for patients requesting MAID were loss of autonomy (87.4%), decreased ability to participate in pleasurable activity or impaired quality of life (86.1%), and loss of dignity (68.6%).

Most patients (81%) died at home, and a greater rate of Oregon physicians (14.7%) were present for their death than Washington physicians (4.7%). Median patient time from drug ingestion to coma was 5 minutes; time from ingestion to death was 25 minutes. In exactly half the drug recipients in Oregon, it is unknown whether a complication occurred—as a 2010 amendment to the physician follow-up questionnaire required a physician be present for the patient death in order to report any complications.

Just 8 patients, from Oregon, awoke after ingesting the drug.

The annual rate per year for percentage of patients to receive a prescription ingesting the prescribed medication ranged from 48% to 87%. The odds ratio (OR) per year in Oregon was insignificant (OR 1.01; 95% CI: .99 — 1.02; P= .59), but significant in Washington (OR 1.13; 95% CI: 1.08 — 1.19; P < .001).

Al Radabi, LeBlanc, and colleagues emphasized the importance of analyzing the 2 longest-practicing states in MAID, noting that proceeding states have modeled their own legislation based on those such as Oregon’s.

They noted the most significant difference among the observed states was their rate of patients in hospice care (Oregon reported a population 23.6 percentage points greater), though this may have been due to a similar difference between the states’ insured patient population rates.

Investigators concluded the findings support the overall safety and efficacy of lethal medication used in MAID. They also called for a more formal study into the underlying drivers of MAID requests, noting that most related data has been description-based. Improved research could lead to more informed implementation of palliative care, social support services, and case management among patients facing end-of-life decisions, they wrote.

In a column written for MD Magazine®, David R. Grube, MD, national medical director for Compassion and Choices and an Oregon-based family medicine physician with practice in MAID requests, detailed the request of a longtime patient with terminal cancer.

“Those of us who have participated in the practice of medical aid in dying have a different perspective than those who theorize about it,” Grube wrote. “All of them are sincere, all are compassionate, none of them take this action lightly, and none have reported instances of regret or depression.”

Grube opined the measured implementation and monitor of MAID in his state resulted in improved practices pertaining to palliative care.

“In point of fact, the practice of medical aid in dying in Oregon…has catalyzed improvement in end-of-life care, a much broader discussion of end-of-life care issues, more frequent conversations between physicians and patients about their end-of-life care wishes and goals, doctor-patient relationships, and the awareness of and participation in hospice and palliative care services,” he wrote.

The study, “Trends in Medical Aid in Dying in Oregon and Washington,” was published online in JAMA Network Open.