Appendix
J
SIXTH
ANNUAL REPORT ON OREGON’S DEATH WITH DIGNITY ACT
Department
of Human Services Office of Disease Prevention and Epidemiology March
10, 2004
Table
1: Demographic
characteristics of 171 DWDA patients who died after ingesting a lethal
dose of medication, by year, Oregon, 1998-2003.
| Characteristics |
2003 |
1998-2002 |
Total |
| |
(N
= 42)* |
(N
= 129)* |
(N
= 171)* |
| Sex |
|
|
|
Male
(%)
|
19
(45) |
71
(55) |
90
(53) |
| Female
(%) |
23
(55) |
58
(45) |
81
(47) |
| Age |
|
|
|
18-34
(%)
|
0
(0) |
2
(2) |
2
(1) |
| 35-44
(%) |
2
(5) |
3
(2) |
5
(3) |
| 45-54
(%) |
4
(10) |
10
(8) |
14
(8) |
| 55-64
(%) |
8
(19) |
21
(16) |
29
(17) |
| 65-74
(%) |
9
(21) |
46
(36) |
55
(32) |
| 75-84
(%) |
14
(33) |
37
(29) |
51
(30) |
| 85+
(%) |
5
(12) |
10
(8) |
5
(9) |
| Median
years (Range) |
73
(40-93) |
69
(25-94) |
70
(25-94) |
| Race |
|
|
|
| White
(%) |
41
(98) |
125
(97) |
166
(97) |
| Asian
(%) |
1
(2) |
4
(3) |
5
(3) |
| Other
(%) |
0 |
0 |
0 |
| Marital
status |
|
|
|
Married
(%)
|
15
(36) |
60
(47) |
75
(44) |
| Widowed
(%) |
12
(29) |
29
(23) |
41
(24) |
| Divorced
(%) |
10
(24) |
32
(25) |
42
(25) |
| Never
married (%) |
5
(12) |
8
(6) |
13
(8) |
| Education |
|
|
|
Less
than high school (%)
|
2
(5) |
14
(11) |
16
(9) |
| HS
graduate (%) |
8
(19) |
43
(33) |
51
(30) |
| Some
college (%) |
12
(29) |
23
(18) |
35
(21) |
| Baccalaureate
or higher (%) |
20
(48) |
49
(38) |
69
(40) |
| Residence |
|
|
|
Metro
counties (%)**
|
19
(45) |
48
(37) |
67
(39) |
| Coastal
counties (%)*** |
3
(7) |
11
(9) |
14
(8) |
| Other
W. counties (%) |
19
(45) |
60
(47) |
79
(46) |
| E.
of the Cascades (%) |
1
(2) |
10
(8) |
11
(6) |
| Underlying
illness |
|
|
|
Malignant
neoplasms (%)
|
35
(83) |
100
(78) |
135
(79) |
| Lung
and bronchus (%) |
9
(21) |
24
(19) |
33
(19) |
| Breast
(%) |
6
(14) |
10
(8) |
16
(9) |
| Pancreas
(%) |
4
(10) |
2
(9) |
16
(9) |
| Colon
(%) |
3
(7) |
7
(5) |
0
(6) |
| Other
(%) |
13
(31) |
47
(36) |
60
(35) |
| Amyotrophic
lateral sclerosis (%) |
3
(7) |
10
(8) |
13
(8) |
| Chronic
lower respiratory dis. (%) |
1
(2) |
8
(6) |
9
(5) |
| HIV/AIDS
(%) |
2
(5) |
1
(1) |
3
(2) |
| Illnesses
listed below (%)# |
1
(1) |
10
(8) |
11
(6) |
*Unknowns
are excluded when calculating percentages.
** Clackamas, Multnomah, and Washington counties.
*** Excluding Douglas and Lane counties.
# Includes aortic stenosis, congestive heart failure, diabetes mellitus with
renal complications, gastrointestinal stromal tumor,
myelodysplastic syndrome, pulmonary disease with fibrosis, scleroderma, and
Shy-Drager syndrome.
Table
2: Demographic characteristics of 171 patients who died
during 1998-2003 after ingesting a lethal dose of medication compared
with 53,544 Oregonians dying from the same underlying diseases.
| Characteristics |
PAS
patients
1998-2003
(N
= 171)* |
Oregon
deaths,
same
diseases
(N
=53,544)* |
DWDA
deaths
per
10,000
Oregon
deaths |
Rate
ratio
(95%
CI**) |
| Sex |
|
|
|
|
Male
(%)
|
90
(53) |
26,972
(50) |
33.4 |
1.1
(0.8-1.5) |
| Female
(%) |
81
(47) |
26,572
(50) |
30.5 |
1.0 |
| Age |
|
|
|
|
18-34
(%)
|
2
(1) |
281
(1) |
71.2 |
5.3
(1.2-22.9)# |
| 35-44
(%) |
5
(3) |
985
(2) |
50.8 |
3.8
(1.4-10.3) |
| 45-54
(%) |
14
(8) |
3,235
(6) |
43.3 |
3.2
(1.6-6.6) |
| 55-64
(%) |
29
(17) |
6,674
(13) |
43.5 |
3.2
(1.7-6.0) |
| 65-74
(%) |
55
(32) |
13,309
(25) |
41.3 |
3.1
(1.7-5.4) |
| 75-84
(%) |
51
(30) |
17,969
(34) |
28.4 |
2.1
(1.2-3.7) |
| 85+
(%) |
15
(9) |
11,091
(21) |
13.5 |
1.0 |
| Median
years |
70 |
76 |
|
|
| Race |
|
|
|
|
White
(%)
|
166
(97) |
52,100
(97) |
31.9 |
1.0 |
| Asian
(%) |
5
(3) |
535
(1) |
93.5 |
2.9
(1.2-7.1)+ |
| Other
(%) |
0 |
898
(2) |
0 |
0 |
| Unknown |
0 |
11 |
|
|
| Marital
status |
|
|
|
|
| Married
(%) |
75
(44) |
26,003
(49) |
28.8 |
1.0 |
| Widowed
(%) |
41
(24) |
17,742
(33) |
23.1 |
0.8
(0.6-1.2) |
| Divorced
(%) |
42
(25) |
7,530
(14) |
55.8 |
1.9
(1.3-2.8)+ |
| Never
married (%) |
13
(8) |
2,168
(4) |
60.0 |
2.1
(1.2-3.7)+ |
| Unknown |
0 |
101 |
|
|
| Education |
|
|
|
|
Less
than high school (%)
|
16
(9) |
12,954
(25) |
12.4 |
1.0 |
| HS
graduate (%) |
51
(30) |
22,855
(43) |
22.3 |
1.8
(1.0-3.2) |
| Some
college (%) |
35
(21) |
9,598
(18) |
36.5 |
3.0
(1.6-5.3) |
| Baccalaureate
or higher (%) |
69
(40) |
7,392
(14) |
93.3 |
7.6(4.4-13.0)# |
| Unknown |
0 |
745 |
|
|
| Residence |
|
|
|
|
Metro
counties (%)
|
67
(39) |
19,333
(36) |
34.7 |
1.0 |
| Coastal
counties (%) |
14
(8) |
4,374
(8) |
32.0 |
0.9
(0.5-1.6) |
| Other
W. counties (%) |
79
(46) |
22,259
(42) |
35.5 |
1.0
(0.7-1.4) |
| E.
of the Cascades (%) |
11
(6) |
7,578
(14) |
14.5 |
0.4
(0.2-0.8)+ |
* Unknowns
are excluded when calculating percentages.
** Confidence interval.
#The ratio is statistically significant according to the chi-square test for
trend.
+ The ratio is statistically significant according to the chi-square test.
Table
3: Underlying illnesses of 171 patients who died during
1998-2003 after ingesting a lethal dose of medication compared with
53,544 Oregonians dying from the same underlying diseases.
| Underlying
illnesses |
PAS
patients
1998-2003
(N=171)
|
Oregon
deaths same
diseases
(N=53,544)
|
DWDA
deaths
per
10,000
Oregon
deaths
|
DWDA
Rate ratio
(95% CI*)
|
Malignant
neoplasms (%)
|
135
(79) |
35,906
(67) |
37.6 |
3.9
(2.0-7.6) + |
| Lung
and bronchus (%) |
33
(19) |
12,037
(23) |
27.4 |
2.8
(1.4-5.9) + |
| Breast
(%) |
16
(9) |
3,037
(6) |
52.7 |
5.4
(2.4-12.3) + |
| Pancreas
(%) |
16
(9) |
2,190
(4) |
73.1 |
7.5
(3.3-17.1) + |
| Colon
(%) |
10
(6) |
3,171
(6) |
31.5 |
3.3
(1.3-8.0) + |
| Prostate
(%) |
9
(5) |
2,670
(5) |
33.7 |
3.5
(1.4-8.8) + |
| Ovary
(%) |
9
(5) |
1,178
(2) |
76.4 |
7.9
(3.1-19.9) + |
| Skin
(%) |
6
(4) |
522
(1) |
114.9 |
11.9
(4.2-33.2) + |
| Other
(%) |
36
(21) |
11,101
(21) |
32.4 |
3.4
(1.6-7.0) + |
| Amyotrophic
lateral sclerosis (%) |
13
(8) |
522
(1) |
249.0 |
25.7
(11.1-59.9) + |
| Chronic
lower respiratory disease (%) |
9
(5) |
9,300
(17) |
9.7 |
1.0 |
| HIV/AIDS
(%) |
3
(2) |
175
(<1) |
171
4 |
17.7
(4.8-64.9) + |
| Illnesses
listed below ** |
11
(6) |
7,641
(14) |
14.4 |
1.5
(0.6-3.6) |
* Confidence
interval.
** Includes aortic stenosis, congestive heart failure, diabetes mellitus with
renal complications, gastrointestinal stromal tumor, myelodysplastic
syndrome, pulmonary disease with fibrosis, scleroderma, and Shy-Drager syndrome.
+ The ratio is statistically significant according to the chi-square test.
Table
4: Death With Dignity Act participant end of life care and
DWDA utilization. Based on physician interviews for 171 patients
who died
after ingesting a lethal dose of medication - Oregon, 1998-2003.
| |
2003 |
1998-2002 |
Total |
| Characteristics |
(N=42)* |
(N=129)* |
(N=171)* |
| End
of Life Care |
|
|
|
| Hospice
Enrolled (%) |
39
(93)
|
106
(83)
|
145
(86)
|
| Declined
by patient (%) |
3
(7)
|
21
(17)
|
24
(14)
|
| Insurance
Private (%) |
22
(52)
|
80
(63)
|
102
(61)
|
| Medicare
or Medicaid (%) |
20
(48)
|
44
(35)
|
64
(38)
|
| None
(%) |
|
2
(2)
|
2
(1)
|
| Unknown |
-
|
3
|
3
|
| End
of Life Concerns+ |
|
|
|
Losing
autonomy (%)
|
39
(93)
|
106
(85)
|
145
(87)
|
| Less
able to engage in activities making life enjoyable (%) |
39
(93)
|
99
(79)
|
138
(83)
|
| Loss
of dignity (%)++ |
31
(82)
|
–-
|
31
(82)
|
| Losing
control of bodily functions (%) |
24
(57)
|
73
(58)
|
97
(58)
|
| Burden
on family, friends/caregivers (%) |
16
(38)
|
44
(35)
|
60
(36)
|
| Inadequate
pain control (%)** |
9
(21)
|
28
(22)
|
37
(22)
|
| Financial
implications of treatment (%) |
1
(2)
|
3
(2)
|
4
(2)
|
| PAS
Process |
|
|
|
Referred
for psychiatric evaluation (%)
|
2
(5)
|
28
(23)
|
30
(18)
|
| Patient
died at home (patient, family or friend) (%) |
39
(93)
|
121
(94)
|
160
(94)
|
| Long
term care, assisted living or foster care facility (%) |
2
(5)
|
6
(5)
|
8
(5)
|
| Hospital
(%) |
0
|
1
(1)
|
1
(1)
|
| Other
(%) |
1
(2)
|
1
(1)
|
2
(1)
|
| Lethal
Medication Secobarbital (%) |
4
(10)
|
85
(66)
|
89
(52)
|
| Pentobarbital
(%) |
37
(88)
|
41
(32)
|
78
(46)
|
| Secobarbital/amobarbital
(%) |
1
(2)
|
2
(2)
|
3
(2)
|
| Other
(%) |
0
|
1
(1)
|
1
(1)
|
| Health-care
provider present when medication ingested# |
|
|
|
| Prescribing
physician (%) |
12
(29)
|
22
(39)
|
34
(34)
|
| Other
provider, prescribing physician not present (%) |
20
(48)
|
29
(51)
|
49
(49)
|
| No
provider (%) |
10
(24)
|
6
(11)
|
16
(16)
|
| Unknown |
0
|
2
|
2
|
| Regurgitation/seizures
after medication ingested |
|
|
|
| Regurgitated
(%) |
3
(7)
|
4
(3)
|
7
(4)
|
| Seizures
(%) |
0
|
0
|
0
|
| Neither
(%) |
39
(93)
|
121
(97)
|
160
(96)
|
| Unknown |
0
|
4
|
4
|
| Emergency
Medical Services |
|
|
|
| Called
for intervention after lethal medication ingested (%)*** |
0
|
0
|
0
|
| Not
called after lethal medication ingested (%) |
42
(100)
|
126
(100)
|
168
(100)
|
| Unknown |
0
|
3
|
3
|
| Timing
of PAS Event |
|
|
|
Duration
(weeks) of patient-physician relationship
|
|
|
|
Median
|
10
|
13
|
13
|
Range
|
0-405
|
0-851
|
0-851
|
Duration
(days) between 1st request and death
|
|
|
|
Median
|
36
|
43
|
39
|
Range
|
16-737
|
15-466
|
15-737
|
| Minutes
between ingestion and unconsciousness |
|
|
|
Median
|
4
|
5
|
5
|
Range
|
1-20
|
1-38
|
1-38
|
Unknown
|
2
|
18
|
20
|
| Minutes
between ingestion and death |
|
|
|
| Median |
20
|
30
|
25
|
Range
(minutes - hours)
|
5m-48h
|
4m-37h
|
4m-48h
|
| Unknown |
1
|
12
|
13
|
* Unknowns
are excluded when calculating percentages unless otherwise noted.
** Patients discussing concern about inadequate,pain control with their physicians
were not necessarily experiencing pain.
*** Excludes calls to pronounce death.
# The data shown are for 2001-2003. Information about the presence of a health
care provider/volunteer, in absence of the prescribing physician, was first
collected in 2001. Attendance by the prescribing physician has been recorded
since 1998. During 1998-2002 the prescribing physician was present when 47%
of the patients ingested the lethal medication.
+ Affirmative answers only (“Don't know” included in negative answers).
Available for 17patients in 2001.
++ First sked in 003.
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