The Oregonian
August 20, 2004

Study revisits assisted suicide: Researchers say legalization in Oregon has not increased the practice and may have caused a decline in requests to doctors

By Don Colburn

One in six dying Oregonians considers doctor-assisted suicide, although far fewer die that way, an Oregon Health & Science University study shows.

"That's surprisingly high," said Dr. Susan Tolle, director of OHSU's Center for Ethics in Health Care, who led the study.

The study, published today in the Journal of Clinical Ethics, is the first to examine who considers doctor-assisted suicide, not just who carries it out. During the six years since assisted suicide became legal in Oregon, attention has focused on the 171 terminally ill adults who have died by taking a lethal prescription.

The OHSU study found no evidence of an increase in the assisted-suicide rate since Oregon's Death With Dignity Act took effect in 1997, Tolle said.

An accompanying commentary by two OHSU psychiatrists suggests legalization of doctor-assisted suicide in Oregon paradoxically may have led to a decline in the practice.

In Oregon, the rate of assisted suicide has hovered around 1 in 1,000 deaths -- lower than predicted by proponents and opponents during the debate over the law. A study of terminally ill patients in six states where doctor-assisted suicide remains against the law found that about 1 in 250 deaths occurred by assisted suicide outside the law.

"This raises the interesting question of whether legalization of assisted suicide can drive the rate of (doctor-assisted suicide) down," wrote Dr. Linda Ganzini and Dr. Steven Dobscha in their commentary. They suggested several possible explanations.

Among them: Doctors may be less willing to act outside the law when a specific law exists, and the law's safeguards may become "hurdles that patients simply don't make it over." Also, the customary referral to hospice may lessen the need for assisted suicide.

"Whatever the reason," the commentary concluded, "these data do not support a slippery slope of increasing death-hastening acts -- within or outside the law."

Tolle's study turned up no unreported -- and therefore illegal -- cases of doctor-assisted suicide through its interviews with family members of deceased patients.

In a survey before the Death With Dignity Act took effect, 187 Oregon doctors said they had complied with at least one patient's request for an assisted suicide.

Patients who consider but do not use doctor-assisted suicide are "remarkably similar" to those who hasten their deaths by taking a lethal drug under the law, the new study found. They tend to be younger and white, with incomes of more than $30,000 a year. But unlike the 171 who have ended their lives by doctor-assisted suicide, they do not tend to be highly educated.

Oregonians remain sharply divided over assisted suicide, Tolle said. More than 40 percent of families in her study said their dying relatives rejected assisted suicide not only for themselves but also for others.

"Nothing here suggests that moral opposition has given an inch," Tolle said. "People opposed remain opposed and appear not to be changed by legalization." Protestants and Roman Catholics are about half as likely, compared with people with no religious affiliation, to favor assisted suicide.

None of the 62 dying African Americans in the study was reported to have considered assisted suicide. Twenty percent of white patients did.

The study is based on a random sample of 8 percent of death certificates filed in Oregon between mid-2000 and early 2002. It excluded people younger than 18, those who died suddenly and those reported to the state as doctor-assisted suicides. Researchers tracked down willing family caregivers and interviewed them by telephone -- 1,384 in all.

Oregon is the only state in which doctor-assisted suicide is legal. Under the Death With Dignity Act, a doctor can legally prescribe a lethal dose of medication to a terminally ill patient of sound mind who makes the request in writing. A second doctor must evaluate the patient, who must be notified of alternatives, including hospice care. The request must be repeated after 15 days.

The Bush administration has tried to quash the Oregon Death With Dignity Act as a violation of federal drug laws. A three-judge panel of the 9th U.S. Circuit Court of Appeals upheld the Oregon law in May, and the Bush administration has not decided whether to appeal to the Supreme Court.

Don Colburn: 503-294-5124; doncolburn@news.oregonian.com.