Death with Dignity: 'Well Accepted by Patients, Families, and Staff'

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Death with dignity: Should it be an option for patients with incurable cancer?
Death with dignity: Should it be an option for patients with incurable cancer?

Do patients with incurable illnesses, such as cancer, have the right to decide when to end their own lives?

That's the underlying message of the Death with Dignity movement, which originated in Oregon with the passing of legislation in 1994 (going into effect in 1997) that allowed physician-assisted death, a law ultimately upheld by the Supreme Court in 2006.1

“Physician-assisted suicide (PAS) is the subject of a national debate, the intensity of which obscures the essential problem that many patients do not receive optimal end-of-life care,” the American Society of Clinical Oncology wrote in a special article in 1998, in its most recent policy statement regarding end-of-life care.2 “ASCO believes that PAS is a complex issue which this Task Force will neither condone or condemn.”

The contentiousness of the topic—personified by Jacob “Jack” Kevorkian, MD, dubbed “Dr. Death,”—aside, what are the practical implications of implementing the Death with Dignity Act?

The Seattle Cancer Care Alliance, the site of care for the Fred Hutchinson–University of Washington Cancer Consortium, reported the first such institutional response to the law in the April 11, 2013, issue of the New England Journal of Medicine.

“Our Death with Dignity program has been well accepted by patients, families and staff,” lead author Elizabeth Trice Loggers, MD, PhD, reported.3 “We attribute this to the professionalism of our advocates, the great care taken by our prescribing and consultant clinicians when interacting with patients and families, the low profile of the Death with Dignity program overall, and the willingness of the Seattle Cancer Care Alliance leadership to allow considerable debate before the program was developed,” added Dr. Loggers, a medical oncologist and Medical Director of the Supportive and Palliative Care Service at the Seattle Cancer Care Alliance.

In fact, “a few clinicians who were initially strongly opposed to the Death with Dignity program subsequently expressed their willingness to participate as consulting or prescribing clinicians, which further supports acceptance of the program.”

To date, Washington is the only U.S. state besides Oregon with Death with Dignity legislation in place. “As more states consider legislation regarding physician-assisted death, the experience of a comprehensive cancer center may be informative,” Dr. Loggers wrote in explaining the impetus for the article.3 Hawaii, Kansas, Massachusetts, New Hampshire, New Jersey, and Vermont are currently considering bills in favor of physician-assisted death; a bill introduced in Connecticut has stalled and one in Montana was struck down by the Senate, according to the Death with Dignity National Center, a nonprofit organization behind the movement that legally defends such legislation.4]

The Death with Dignity Act in Washington was passed by the state legislature in November 2008. “Under the law, competent adults residing in Washington who have a life expectancy of 6 months or less because of a diagnosed medical condition may request and self-administer lethal medication prescribed by a physician,” Dr. Loggers and colleagues noted.

This is one of several essential elements and safeguards of the law; others include that both prescribing and consulting physicians must confirm the patient's diagnosis and competency and the voluntary nature of the request. Additionally, a pharmacist must dispense the medication directly to the patient or an identified agent. After making the initial request, both orally and in writing, a patient must wait 15 days before making a second oral request.

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