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The Oregon Experience -- The First Six Months

August 1998

Compassion in Dying of Oregon began to serve clients January 1, 1998.

During our first six months of service to Oregonians we responded to over 200 requests for information from patients, family members, physicians, other healthcare professionals, interested volunteers, press and the general public.

We have provided evaluation and case management services for approximately 50 of those individuals. Upon evaluation, approximately 50% of these patients met the requirement under Oregon law of being terminally ill, with an estimated prognosis of 6 months or less.

Of these patients, eight began or completed the procedures for making a request under the Death with Dignity Act, yet died of natural causes. For a number of patients, we were able to facilitate greatly improved palliative care and as a result they achieved greater physical and emotional comfort during their final days. Several patients did not complete the request process because they were found to not meet the eligibility criteria of the law.

Two Compassion patients hastened their death by ingesting a lethal dose of medication. In both situations coma occurred within 5 minutes; death occurred for one of the patients within 30 minutes for the other patient within 45 minutes.

At this writing sixteen patients are in various stages of a request and currently have their options pending.

We have received 12 requests for help and information from individuals who are suffering in some way, yet are not considered "terminal" under the Oregon Death with Dignity Act. We have referred these patients to other organizations that provide services better suited to meeting their needs at this time. We are working with ten individuals as they explore their options aside from physician aid-in-dying. We are able to discuss other options with these individuals and provide them with information, support and referrals on improving quality of life such as palliative care, home health aides, group and individual therapy, as appropriate.

Four individuals who are not currently ill have called us for help locating a physician who shares their beliefs and values regarding assisted death.

Community outreach is a large part of Compassion's work in Oregon. We have met with 6 major health plans within the state, including the two largest health plans in order to understand their policies regarding aid in dying and to offer them our services as an adjunct to their case management program. Five of these six plans are paying the costs associated with aid-in-dying consistent with the individual's plan benefits.

We are very gratified over the collaborative and supportive relationship that has developed between Oregon hospices and Compassion in Dying of Oregon. The Oregon Hospice Association has adopted a policy that, "... no dying Oregonian should suffer and no dying Oregonian should have to choose between hospice and physician-assisted [death]. A dying Oregonian can choose both from among the options on the end-of-life continuum of care."

We work closely with the Oregon Hospice Association and with their member organizations to ensure that no patient is discharged or rejected because their personal values may conflict with the values or policies of the hospice providing care. We encourage our clients to seek hospice care and facilitate referral to an appropriate hospice whenever we are able. Hospice workers frequently direct their patients who inquire about assisted dying to Compassion.

In our view, implementation of Oregon's Death with Dignity Act is proceeding in a careful manner. Patients at the end of life are able to obtain the assurance of a humane and peaceful death and those whose suffering is not amenable to the best palliative care can choose to hasten their death if they wish. Yet few find themselves in such anguish that they actually exercise that choice.

Meanwhile, end-of-life care in Oregon has greatly improved in a number of measurable ways. The proportion of patients who die under hospice care rose sharply following passage of the new law and now stands at 32% of all deaths. This compares very favorably with a national average of 17%.

Similarly, morphine prescriptions increased dramatically here in the last 3 years. Oregon went from number 11 in the nation to number 1 in medical morphine use immediately after patients realized their new options under the law. Deaths in acute care hospitals have fallen dramatically, with more than 60 percent of people who die doing so at home or in nursing facilities. Health care experts across the country are watching the Oregon experience closely, as it seems to indicate how patient choice and control at the end of life can impact the quality of care in a way that everyone applauds.

Judith Fleming, Consulting Director, Compassion in Dying of Oregon.

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This article was provided by Compassion in Dying. It is a part of the publication Compassion in Dying.