Patients, families 'grateful' for physician-assisted suicide program

Patients, families 'grateful' for physician-assisted suicide program
Patients, families 'grateful' for physician-assisted suicide program

HealthDay News -- Patients and families are satisfied with a "Death with Dignity" physician-assisted suicide program made available to terminal cancer patients at a Seattle clinic, study results show.

Among 114 patients who inquired about the program offered at the Seattle Cancer Care Alliance, 40 passed screening examinations and ultimately received lethal prescriptions for secobarbital, Elizabeth Trice Loggers, MD, PhD, of the Fred Hutchinson Cancer Research Center in Seattle and colleagues, reported in New England Journal of Medicine.

However, only 24 patients actually took the drug.

"Patients, caregivers and family members have frequently expressed gratitude after the patient obtained the prescription, regardless of whether it was ever filled or ingested, typically referencing an important sense of control in an uncertain situation," the researchers wrote.

The program was instituted after Washington state enacted legislation in 2008 allowing physician-assisted suicide. The law specifies that patients must make two oral requests, with an interval of at least 15 days between, plus a written request before they can participate in such programs.



Two physicians -- a prescribing physician and a consulting physician -- must confirm that a patient has a life expectancy of six months or less, and that he or she is competent and able to voluntarily request the prescription. The programs also require an informed consent process and must offer the patient the option to rescind the request.

Prescriptions for lethal doses of secobarbital must be given directly to a pharmacist, who then administers the drug directly to the patient or an authorized agent.

In addition to the conditions outlined in the law, Seattle Cancer Care Alliance adopted additional requirements when developing it's program. The outpatient clinic does not accept patients who come with the sole purpose of obtaining a lethal drug dose and does not advertise or promote the program in public spaces. Although state legislation recommends that physicians advise patients against taking the prescription in public, the clinic requires patients to sign a statement promising not to do so. Staff and faculty are able to opt out of participating.

Among 81 clinicians surveyed at the clinic, nearly 40% were unwilling or undecided about serving as prescribing or consulting physician, whereas 26% indicated they were willing to act as consulting physicians but would not write prescriptions themselves.

Between March 5, 2009 and Dec. 31, 2011, 114 patients at Seattle Cancer Care Alliance inquired about the program. These patients were then assigned to a social worker to assist them and their families in the process and ensure compliance with state regulations. Social workers were also responsible for matching patients who meet eligibility requirements with physicians willing to write lethal prescriptions.

A total of 44 of patients chose not to pursue the program or did not meet eligibility requirements (38.6%); 30  started the process but chose not to continue or died before completion (26.3%); and 40 underwent counseling and received a prescription for a lethal dose of secobarbital upon request (35.1%). All of these 40 patients died; 24 after medication ingestion. Eleven participants lived for more than six months after receipt of the prescription.

Program participants were usually white, male, and well educated and most commonly cited loss of autonomy (97.2%), inability to engage in enjoyable activities (88.9%), and loss of dignity (75%) as the reasons for participation. 

"Our Death with Dignity program both allows patients with cancer who wish to consider this option to do so within the context of their ongoing care and accommodates variation in clinicians' willingness to participate," the researchers wrote.

Fred Hutchinson Center participants accounted for 15.7% of all participants in Washington State's Death with Dignity program. Statewide 255 patients have received lethal prescriptions since the 2008 law was adopted, including the 40 at the Seattle Cancer Care Alliance.


References

  1. Loggers E et al. New Engl J Med 2013; 368: 1417-1424.
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