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This article explores the topic of physician-assisted death and the recent changes to Oregon's Death with Dignity Act. It discusses the removal of the residency requirement for terminally ill patients seeking access to physician-assisted death in Oregon and the constitutional arguments raised in a federal lawsuit challenging this requirement. The article also examines the Supreme Court's rulings on the right to refuse medical treatment and the legality of physician-assisted death, as well as public policy arguments and public support for physician-assisted death in the United States. It concludes by discussing the future of physician-assisted death and the potential for legal challenges to residency requirements in other states. [Extracted from the article]

Family medicine physicians take care of patients and their families "from womb to tomb." This phrase is particularly apt in Oregon, where the Death with Dignity Act allows for terminally ill patients to end their lives with self-administered medications prescribed by a physician. This story chronicles my first experience caring for a patient under the Death with Dignity Act; that night of her death at home, surrounded by the warmth of her life and loved ones, opened my mind to the possibilities of what the patient-physician relationship entails, from the routine of meeting her family to the intimacy of assisting in her decision to die., (© 2023 Annals of Family Medicine, Inc.)

The article discusses the concept of litigating for the right to die in New Zealand as of 2015, and it mentions the legal rights of terminally-ill patients, as well as the nation's Crimes Act 1961 and criminal liability for aiding and abetting a person in the commission of suicide. The legal aspects of physician-assisted suicide are addressed, along with the attitudes of New Zealanders regarding the right to die. U.S. constitutional law cases and Oregon's Death with Dignity Act are examined.

With passage of the Death with Dignity Act in 1994, Oregon became the first jurisdiction to authorize and regulate aid in dying. Data from that experience are comprehensive and bountiful, and answer a multitude of questions and concerns about whether the benefits of recognizing the medical practice of aid in dying justify the risks. An exhaustive description of findings from Oregon's aid-in-dying experience is beyond the scope of this or any single article on the subject. This article provides a summary of data highlights, gleaned from scientific investigations and governmental reporting. It organizes highlighted reports along subjects so that readers may see what various sources have to teach on a number of questions important to policy makers. [ABSTRACT FROM AUTHOR]

Some form of assisted dying (voluntary euthanasia and/or assisted suicide) is lawful in the Netherlands, Belgium, Oregon, and Switzerland. In order to be lawful in these jurisdictions, a valid request must precede the provision of assistance to die. Non-adherence to the criteria for valid requests for assisted dying may be a trigger for civil and/or criminal liability, as well as disciplinary sanctions where the assistor is a medical professional. In this article, we review the criteria and evidence in respect of requests for assisted dying in the Netherlands, Belgium, Oregon, and Switzerland, with the aim of establishing whether individuals who receive assisted dying do so on the basis of valid requests. We conclude that the evidence suggests that individuals who receive assisted dying in the four jurisdictions examined do so on the basis of valid requests and third parties who assist death do not act unlawfully. However, further research on the elements that may undermine the validity of requests for assisted dying is warranted. More research on the reasons why requests for assisted dying are refused is also desirable. [ABSTRACT FROM AUTHOR]

Palliative care and hospice should be the standards of care for all terminally ill patients. The first place for clinicians to go when responding to a request for assisted death is to ensure the adequacy of palliative interventions. Although such interventions are generally effective, a small percentage of patients will suffer intolerably despite receiving state-of-the-art palliative care, and a few of these patients will request a physician-assisted death. Five potential 'last resort' interventions are available under these circumstances: (1) accelerating opioids for pain or dyspnea; (2) stopping potentially life-prolonging therapies; (3) voluntarily stopping eating and drinking; (4) palliative sedation (potentially to unconsciousness); and (5) physician-assisted death. Patient, family, and clinicians should search for the least harmful way to respond to intolerable end-of-life suffering in ways that are effective and also respect the values of the major participants. A system that allows an open response to such cases ultimately protects patients by ensuring a full clinical evaluation and search for alternative responses, while reinforcing the need to be responsive and to not abandon. [ABSTRACT FROM AUTHOR]

Battin et al examined data on deaths from physician assisted suicide (PAS) in Oregon and on PAS and voluntary euthanasia (VE) in The Netherlands. This paper reviews the methodology used in their examination and questions the conclusions drawn from it—namely, that there is for the most part 'no evidence of heightened risk' to vulnerable people from the legalisation of PAS or VE. This critique focuses on the evidence about PAS in Oregon. It suggests that vulnerability to PAS cannot be categorised simply by reference to race, gender or other socioeconomic status and that the impetus to seek PAS derives from factors, including emotional state, reactions to loss, personality type and situation and possibly to PAS contagion, all factors that apply across the social spectrum. It also argues, on the basis of official reports from the Oregon Health Department on the working of the Oregon Death with Dignity Act since 2008, that, contrary to the conclusions drawn by Battin et al, the highest resort to PAS in Oregon is among the elderly and, on the basis of research published since Battin et al reported, that there is reason to believe that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS. [ABSTRACT FROM AUTHOR]

Abstract: Expected-utility theory can explain why people who are terminally ill often feel a surge in wellbeing and hope to live longer when they have the option of legally ending their lives. Behavioral theories, however, may better answer larger questions such as why so few terminally-ill people bother to get that option. [Copyright &y& Elsevier]

Abstract: The Death with Dignity (DWD) Act, a physician-assisted suicide statute, was initially adopted in Oregon In November, 1994 and became operational in 1998. The purpose of this study is to: 1) determine the nature and form of the empirical literature on the Oregon DWD Act; 2) describe the effects of the DWD Act on Oregonians with disabilities according to the empirical literature; and 3) present opinions held by a group of Oregonians with disabilities about the DWD Act and its effects. A literature review and focus group were conducted for this study. Thirteen empirical studies and 11 state annual DWD reports werw included in the literature review. Review of the empirical literatuer on DWD in Oregon reveals a number of potential concerns, including inadequate demographic profiling of DWD requesting patients, inadequate mental health evaluations, insufficient duration of physician-patient relationships, potential inaccuracy of the six month prognosis, and inadequate exploration of alternative treatment. These concerns suggest that the DWD reporting system may be inadequate and lack sufficient safeguards. The focus group revealed that there are multiple facets to the DWD issue. Within the disability community, there does not seem to be unequivocal support for one viewpoint over another. [Copyright &y& Elsevier]

Two hundred six individuals were surveyed concerning their views about the Oregon Death with Dignity Act, which allows for physician-assisted suicide under certain conditions. Results indicated extensive heterogeneity and strong opinions concerning the act. Implications are discussed. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the reasons of terminally ill patients for requesting physician aid in dying (PAD). It discusses the Oregon Death with Dignity Act, which provides opportunity for Oregonian patients to have PAD. It explores the most important reasons for requesting PAD including the patients' wish to control the circumstances of death and die at home, loss of independence, and concerns about future pain, poor quality of life and inability to care for one's self. It states that health care providers should promote first the patient's sense of control, and educate and reassure the patient regarding management of future symptoms when confronted with a request for PAD.

Prior to passage of the Oregon Death with Dignity Act, opponents of assistance in dying argued that legalization would have serious harmful consequences. Specifically, they argued that the quality and availability of palliative care would decline, that the harms of legalization would affect certain vulnerable groups disproportionately, that legal assisted dying could not be confined to the competent terminally ill who voluntarily request assistance, and that the practice would result in frequent abuses. Data from Oregon's decade-long experience decisively refute the first three predictions. As to abuses, the record is not quite as clear, but if an appropriate framework for analysis is utilized, the most reasonable conclusion is that the risks of abuse do not outweigh the benefits of legalization. To the extent projected harmful consequences are relevant to the debate over legalization, Oregon's experience argues in favor of legalization of assistance in dying. [ABSTRACT FROM AUTHOR]

Background: Physician assisted death (PAD) was legalized through Oregon's Death with Dignity Act in 1994 and enacted in 1997.Objective: The objective of this paper was to learn from family members why their loved ones requested PAD.Design: This study used the cross-sectional survey.Participants: Participants of this study included family members of 83 Oregon decedents who made explicit requests for legalized PAD before their deaths, including 52 decedents who received prescriptions for a lethal medication and 32 who died of PAD.Measurements: Family members rated the importance of 28 possible reasons their loved ones requested PAD on a 1-5 Likert scale, with higher scores representing greater importance.Results: According to family members, the most important reasons that their loved ones requested PAD, all with a median score of 4.5 or greater, were wanting to control the circumstances of death and die at home, and worries about loss of dignity and future losses of independence, quality of life, and self-care ability. No physical symptoms at the time of the request were rated higher than a median of 2 in importance. Worries about symptoms and experiences in the future were, in general, more important reasons than symptoms or experiences at the time of the request. According to family members, the least important reasons their loved ones requested PAD included depression, financial concerns, and poor social support.Conclusions: Interventions that help patients maintain control, independence, and self-care in a home environment may be effective means of addressing serious requests for PAD. [ABSTRACT FROM AUTHOR]

The article presents views and insights over assisted suicide in Oregon. The author offers information about the reaction of right-to-die activists on the first assisted-suicide law, a law that transformed the crime of assisted suicide into a medical treatment. Assisted-suicide advocates concluded that, if they were going to break their twelve-year string of failure, the word suicide had to go.

In 1997, Oregon enacted the Oregon Death With Dignity Act, which legalized physician-assisted suicide. This article reports on a qualitative study of the ethical and clinical dilemmas experienced by hospice nurses and social workers when they encounter patients who wish to hasten death through physician-assisted suicide. The biggest dilemma arises from the conflict between two important hospice values: honoring patient autonomy versus promoting a death experience in which personal and spiritual transformation are possible. Hospice professionals report conflict between their advocacy for patients and for the family members who sometimes oppose physician-assisted suicide. Conversely, when patients choose to hasten death by voluntarily refusing all food and fluids, many of these dilemmas dissipate. As more patients request control of the circumstances of their deaths, a better understanding of the complex issues regarding hastening death is needed for patients, families, and the health professionals who provide care during this difficult transition. [ABSTRACT FROM AUTHOR]

Oregon's Death with Dignity Act (ODWDA) has been in effect for eight years. The United States Supreme Court recently decided that Oregon's law did not violate the Controlled Substances Act. Other states may consider a law similar to Oregon's through legislative process or ballot measures. Although social work is not mentioned in the law, our profession interfaces with the terminally ill, particularly in hospice. Eighty-seven percent of those who have used the law were enrolled in a hospice program. As a pilot project, this article explores conversations that the authors have had with patients, families, team members and health systems in hospices and oncology settings under Oregon's unique environment. The following four themes emerged from these conversations: (1) mental health, education, choice; (2) team concerns; (3) family issues; and (4) values, ethics, restricted conversations and professional struggles. [ABSTRACT FROM AUTHOR]

Discusses the article "Physician-Assisted Suicide (PAS) Among Oregon Cancer Patients." Aspects of the study that cast doubt on the soundness of the final conclusions; Explanation on longitudinal interest in PAS; Examination of the public perception that uncontrollable pain plays a pivotal role in a terminally ill patient's desire for PAS and is the primary justification for legalizing the prescription of lethal medications.

Provides information on a study that measured the level of interest in and actions around physician-assisted suicide (PAS) among cancer patients in Oregon. Association between psychosocial and medical factors and interest in PAS; Relationship between expressing an interest in PAS on a survey and actually requesting legalized PAS from a physician; Methodology and results of the study.

This article presents views on the enactment of the Death with Dignity Law in Oregon in 1994. Legal arguments involving the law is discussed. The controversy extends to the meticulous and precise language stipulated in the law. Challenges and concerns raised by disabled people about their rights and how the law serves as a step down toward euthanasia.

Purpose/Objectives: To inform readers about the Oregon Death With Dignity Act and present a compilation and summary of major arguments in debates regarding physician assistance in dying for the terminally ill. Data Sources: Experience, medical records, the patient's physician and family, books, periodicals, legislative documents, and publications. Data Synthesis: The Oregon Death With Dignity Act became a legal option for terminally ill Oregon residents in October 1997. Persuasive psychological, theological, philosophical, and pragmatic arguments protest the Act as being irrational, immoral, contrary to medical ethics, and dangerous. Equally persuasive arguments advocate the Act as rational, moral, consistent with the practice of healing, and safe. Conclusions: Physician assistance in dying is a legal option for terminally ill patients in the State of Oregon. For such a practice to be "out of the closet,o as well as legal, is novel. The debate about the appropriateness of this Act revolves around values and beliefs that are seasoned and cherished. Implications for Nursing Practice: As the practice of the terminally ill requesting physician assistance to die moves into the realm of a rational patient choice and legal physician action, nurses increasingly will be faced with having to deal with their own beliefs, attitudes, and emotions regarding this issue. Nurses cannot hide behind glib responses, quick referrals, institutional policies, or organizational standards to cover their own discomfort or confusion. They must discuss and formulate an understanding of healing and caring in situations that may challenge their core values. [ABSTRACT FROM AUTHOR]

Presents a psychiatric defense of the Oregon Death With Dignity Act including the role of mental health professionals in evaluating competence in compliance with the law. Physician aid-in-dying versus physician-assisted-suicide; Changes in the dying process; Public's support for aid-in-dying; American Medical Association and the American Psychiatric Association's opposition to aid in dying.

Focuses on the challenges experienced by health care professionals in Oregon, regarding the legal sanctioning of assisted suicide and the plans for the implementation of Oregon's Death with Dignity Act. Factors which influenced the enactment of the act; Views of physicians regarding physician-assisted suicide in Oregon; Details on a vote made by the Oregon Medical Association regarding physician-assisted suicide. INSET: Guidance for practitioners.

Background: Medical aid-in-dying (AID) is increasingly available in the United States. Despite their substantial role in the medication use process, pharmacists' involvement in medical AID has been overlooked.Objective: To describe pharmacist attitudes toward medical AID and experiences with Oregon's Death with Dignity Act (DWDA).Methods: Qualitative analysis of Oregon-licensed pharmacists with professional interactions involving Oregon's DWDA. Data were collected through semistructured focus groups and analyzed with immersion-crystallization methods.Results: Sixteen Oregon pharmacists participated in this study. The participants were almost evenly divided between males and females, who varied in age, years of pharmacy experience, and the number of DWDA encounters. Of these, 14 pharmacists agreed to participate in the DWDA process while 2 declined. Three themes emerged. First, pharmacists identified logistical challenges that negatively affected their ability to assist patients seeking medical AID. Second, pharmacists described the content and other patient counseling considerations for DWDA prescriptions. Third, pharmacists discussed how values and preferences informed their decisions related to medical AID requests.Conclusion: Pharmacists' involvement in medical AID has been largely focused on medication dispensing and patient counseling, and medical AID prescriptions raise unique challenges. Their decisions to participate were frequently tied to support for patient autonomy, although more research is needed to capture the diversity of attitudes, perspectives, and experiences related to their involvement with medical AID, particularly for those who decline to participate. There is a need to develop educational materials and other resources to assist pharmacists in navigating medical AID requests. [ABSTRACT FROM AUTHOR]

This article presents an editorial on the legal regulation of physician-assisted death. A report from the Netherlands where laws allow for legalized euthanasia and physician-assisted suicide shows a decrease in the number of cases since the law was enacted. A report from the Oregon Department of Human Services in its ninth year of legal physician-assisted death, also shows no increase of deaths as a result of the legislation.

Presents a response by Linda Ganzini to Colleen C. Denny and Ezekiel J. Emanuel's comments concerning their article "Physician-Assisted Suicide (PAS) Among Oregon Cancer Patients." Concern expressed by Denny and Emanuel to Ganzini and colleague's study results; Assertion of Denny and Emanuel on academic discussion of PAS; Ways to judge the importance of studying PAS.

A letter to the editor is presented in response to the article "A Comparison of Characteristics of Kevorkian Euthanasia Cases and Physician-Assisted Suicides in Oregon," by L. A. Roscoe, J. A. Malphurs, L. J. Dragovic, and D. Cohen from the August 2001 issue on physician-assisted suicide (PAS), euthanasia, the actions of Dr. Jack Kevorkian, and medical law in Oregon regarding the right to die.

This qualitative study explores bereavement experiences with an assisted death. Thematic analysis of data from interviews with 22 people who had a family member die under Oregon's Death with Dignity Act revealed the following five themes: (a) general grief reactions, (b) anticipating the death, (c) sense of control, (d) level of agreement with assisted death, and (e) grief expression and stigma. Grief from an assisted death is a varied experience, including aspects that are unique to this mode of death, and aspects that can both ease and bring challenges to the grieving process.

The article reports that permission granted for author's father to end his life as per the the Oregon law which states that a person can opt to end his when he has less than six months to live. Topics discussed include administration of lethal medication to her father, celebration of Thanksgiving and discusses relationship of author with her father.

The author argues that physicians should aid patients in ending or avoiding pain and suffering to the extent of supporting the legalization of physician-assisted suicide in U.S. states. Topics include the relation of religious beliefs to the issue of assisted suicide, the 1997 Oregon Death With Dignity Act, and the author's own decision to commit assisted suicide after a terminal illness diagnosis.

The article reports on a California bill aimed to legalize physician-assisted suicide. The bill is patterned after Oregon's Death with Dignity Ac. The California Medical Association is opposed to physicians assisting with the suicides of patients. The provisions under the proposed California PAS law are outlined.

The article reports on the debate between nurses and nursing groups on the merits of assisted-death measures. According to the article, nurses have a greater responsibility when it comes to helping patients deal with life-and-death issues. It also differentiates the physician-assisted suicide from patient-requested euthanasia. The article describes the U.S. Supreme Court ruling which prevents the Bush Administration from using a federal law regulating controlled substances to hold liable the Oregon physicians who prescribe lethal doses of prescription drugs under the state's physician-assisted suicide law.

A letter to the editor is presented in response to the article "A Comparison of Characteristics of Kevorkian Euthanasia Cases and Physician-Assisted Suicides in Oregon by L. A. Roscoe, J. E. Malphurs, L. J. Dragovic, and D. Cohen with a written reply from the authors regarding the characteristics of patients who died with the assistance of Dr. Jack Kevorkian, along with information on the definition of euthanasia, patient consent, laws in Oregon regarding the right to die, and bioethics.