Since the first physician-assisted suicide (PAS) law took effect in 1997, euphemistically named the “Oregon Death with Dignity Act,” access to publicly available vital statistics on PAS deaths has raised questions on the ethical nature of these “assisted deaths.” Year after year, individuals who choose PAS increase at a near-exponential rate and provide increased access to data, yet the data is still ignored.
The Oregon Health Authority recently released its 2024 Data Summary on the Oregon Death with Dignity Act (DWDA), summarizing the outcomes of the 607 PAS prescriptions written throughout the reporting year. Of these prescriptions, only 376 prescriptions resulted in PAS deaths, while there was inadequate follow-up reporting about the remaining 274 prescriptions. The only reported information on these lost DWDA prescriptions is that 96 died from natural causes, not taking the prescribed drug, while another 91 had documented deaths, but the cause of death, whether by PAS drug or otherwise, was unknown. The remaining 87 patients were completely lost, death and prescriptions statuses unknown.
Lack of regulation on PAS drugs results in this dangerous non-reporting and underreporting, and insufficient oversight of patient safety. Only 16% of patients had their prescribing physician present at time of death, making it nearly impossible for every prescription to be followed. While Oregon law clearly delineates the prescribing and consulting physicians’ responsibilities from the time of the formal written DWDA request by the patient to when the prescription is dispensed, there are no legal guidelines for the reporting of deaths themselves.
Even with the 376 deaths reported, it is unknown whether there were complications for 68% – over two-thirds – of patients. While the Oregon Health Authority might assert a low complication rate, non-reporting at such high rates invalidates any such sweeping claims. This statistic holds for the entirety of the history of the Oregon DWDA, as 62% of all confirmed PAS deaths since 1997 have unknown complications. This is alarming because PAS physicians are using experimental drug compounds at lethal dosages directly on vulnerable patients. Many of these complications are the cause of “distressing deaths” – an outcome proponents of PAS aim to avoid. Leaving these complications as “unknowns” is epidemiologically irresponsible, and practitioners should follow these outcomes with far greater scrutiny.
Furthermore, the range of the physician-patient relationship was 0 to 1,272 weeks, showing some physicians are unfamiliar with the cases for which they are prescribing life-ending drugs. Though a range is not comprehensive in itself, the median physician-patient relationship only being 5 weeks demonstrates a heavy skew to the lower end of the range, suggesting a trend of “doctor shopping.” This is supported by the 6% of patients who traveled to Oregon from another state to be prescribed PAS drugs. Physicians must be able to intimately know a patient’s history to be able to judge the state of the patient’s condition, both the “terminal illness” and external screening factors such as mental state.
When the physician-patient relationship is as brief as has been reported, the PAS waiting periods are even more vital. But in 2024, 29% of patients—nearly a third—had their waiting periods waived, resulting in less time for the physician to seriously assess the request or for the patient to consider the weight of their decision, having serious implications on the issues of coercion and autonomy.
Ethical implications surrounding the lack of reporting extend far beyond the patient. The loss of 274 of the total 607 death-inducing prescriptions poses a risk to the community. When a patient dies of natural causes or travels across state lines and contact with the patient is lost altogether, the PAS prescription does not disappear. These relatively unregulated drugs have the potential to end up in the hands of children or other family members, some who may experience mental illness and attempt to use the drugs for themselves. Even partial ingestion of these drugs can cause a medical emergency since the drugs are at lethal dosages. If these drugs are improperly disposed of, there are unknown consequences of them entering our water systems and impacting the environment.
Looking back, not only over the past year of the Oregon DWDA report, but over the sum of data reported on PAS across the nation since 1997, it becomes increasingly difficult to justify such an ethically flawed and largely unregulated practice. The few loose patient “safeguards” that are in place are constantly under further attack from proponents of PAS without regard to the enormity of the lives affected by the law. Further stripping away safeguards to the already unethical practice of PAS will only increase the suffering and risks to autonomy that these patients are trying to avoid.
Physicians who want to aid the suffering of the terminally ill and elderly should be focused on a natural “death with dignity,” allowing physicians to uphold their ultimate purpose of treating the needs of their patients within the ethical and social bounds of “doing no harm.”
