Quality of Death and Dying in Patients who Request Physician-Assisted Death
Publication: Journal of Palliative Medicine
Volume 14, Issue Number 4
Abstract
Background: Physician-assisted death (PAD) was legalized in 1997 by Oregon's Death with Dignity Act (ODDA). Through 2009, 460 Oregonians have died by lethal prescription under the ODDA.
Objective: To determine whether there was a difference in the quality of the dying experience, from the perspective of family members, between 52 Oregonians who received lethal prescriptions, 34 who requested but did not receive lethal prescriptions, and 63 who did not pursue PAD.
Design: Cross-sectional survey.
Measurements: Family members retrospectively rated the dying experience of their loved one with the 33 item Quality of Death and Dying Questionnaire (QODD).
Results: There were differences reported in 9 of the 33 quality item indicators. Few significant differences were noted in items that measured domains of connectedness, transcendence, and overall quality of death. Those receiving PAD prescriptions had higher quality ratings on items measuring symptom control (e.g., control over surroundings and control of bowels/bladder) and higher ratings on items related to preparedness for death (saying goodbye to loved ones, and possession of a means to end life if desired) than those who did not pursue PAD or, in some cases, those who requested but did not receive a lethal prescription.
Conclusions: The quality of death experienced by those who received lethal prescriptions is no worse than those not pursuing PAD, and in some areas it is rated by family members as better.
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References
1.
Engelberg R. Measuring the quality of dying and death: Methodological considerations and recent findingsCurr Opin Crit Care200612381-387. 1. Engelberg R: Measuring the quality of dying and death: Methodological considerations and recent findings. Curr Opin Crit Care 2006;12:381–387.
2.
Steinhauser KClipp EMcNeilly MChristakis NMcIntyre LTulsky J. In search of a good death: Observations of patients, families, and providersAnn Intern Med2000132825-832. 2. Steinhauser K, Clipp E, McNeilly M, Christakis N, McIntyre L, Tulsky J: In search of a good death: Observations of patients, families, and providers. Ann Intern Med 2000;132:825–832.
3.
Oregon Department of Human Services 2009. Summary of Oregon's Death with Dignity Act 2009 Annual Reportwww.oregon.gov/DHS/ph/pas/index.shtmlMarch2010. 3. Oregon Department of Human Services 2009. Summary of Oregon's Death with Dignity Act 2009 Annual Report. www.oregon.gov/DHS/ph/pas/index.shtml (Last accessed March 2010).
4.
Abrahm J. Patient and family requests for hastened deathHematology2008475-480. 4. Abrahm J: Patient and family requests for hastened death. Hematology 2008;475–480.
5.
Breitbart WRosenfeld BPessin HKaim MFunesti-Esch JGalietta MNelson CJBrescia R. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancerJAMA20002842907-2911. 5. Breitbart W, Rosenfeld B, Pessin H, Kaim M, Funesti-Esch J, Galietta, M, Nelson CJ, Brescia R: Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 2000;284:2907–2911.
6.
Ganzini LGoy EDobscha S. Oregonians' reasons for requesting physician aid in dyingArch Intern Med2009169489-492. 6. Ganzini L, Goy E, Dobscha S: Oregonians' reasons for requesting physician aid in dying. Arch Intern Med 2009;169:489–492.
7.
Ganzini LNelson HSchmidt TKraemer DDelorit MLee M. Physicians experiences with the Oregon Death with Dignity ActN Engl J Med2000342557-563. 7. Ganzini L, Nelson H, Schmidt T, Kraemer D, Delorit M, Lee M: Physicians experiences with the Oregon Death with Dignity Act. N Engl J Med 2000;342:557–563.
8.
Schroepfer T. Social relationships and their role in the consideration to hasten deathGerontologist200848612-621. 8. Schroepfer T: Social relationships and their role in the consideration to hasten death Gerontologist 2008;48:612–621.
9.
Tolle STilden VDrach LFromme EPerrin NHedberg K. Characteristics and proportion of dying Oregonians who personally consider physician-assisted suicideJ Clin Ethics200415111-118. 9. Tolle S, Tilden V, Drach L, Fromme E, Perrin N, Hedberg K: Characteristics and proportion of dying Oregonians who personally consider physician-assisted suicide. J Clin Ethics 2004;15:111–118.
10.
Lindsay R. Oregon's experience: Evaluating the recordAm J Bioethics2009919-27. 10. Lindsay R: Oregon's experience: Evaluating the record. Am J Bioethics 2009;9:19–27.
11.
Meier DMeyers HMuskin P. When a patient requests help committing suicideGenerations1999Spring61-68. 11. Meier D, Meyers H, Muskin P: When a patient requests help committing suicide. Generations 1999;Spring:61–68.
12.
Ganzini LGoy EDobscha S. Why Oregon patients request assisted death: Family members' viewsJ Gen Intern Med200723154-157. 12. Ganzini L, Goy E, Dobscha S: Why Oregon patients request assisted death: Family members' views. J Gen Intern Med 2007;23:154–157.
13.
Ganzini LHarvath TJackson AGoy EMiller LDelorit M. Experiences of Oregon nurses and social workers with hospice patients who requested assistance with suicideN Engl J Med2002347582-588. 13. Ganzini L, Harvath T, Jackson A, Goy E, Miller L, Delorit M: Experiences of Oregon nurses and social workers with hospice patients who requested assistance with suicide. N Engl J Med 2002;347:582–588.
14.
Curtis JRPatrick DEngelberg RNorris KAsp CByock I. A measure of the quality of dying and death: Initial validation using after-death interviews with family membersJ Pain Symptom Manage20022417-31. 14. Curtis JR, Patrick D, Engelberg R, Norris K, Asp C, Byock I: A measure of the quality of dying and death: Initial validation using after-death interviews with family members. J Pain Symptom Manage 2002;24:17–31.
15.
Ganzini LGoy EDobscha SPrigerson H. Mental health outcomes of family members of Oregonians who request physician aid in dyingJ Pain Symptom Manage200938807-815. 15. Ganzini L, Goy E, Dobscha S, Prigerson H: Mental health outcomes of family members of Oregonians who request physician aid in dying. J Pain Symptom Manage 2009;38:807–815.
16.
Downey LCurtis JRLafferty WHerting JEngelberg R. The Quality of Dying and Death Questionnaire (QODD): Empirical domains and theoretical perspectivesJ Pain Symptom Manage2010399-22. 16. Downey L, Curtis JR, Lafferty W, Herting J, Engelberg R: The Quality of Dying and Death Questionnaire (QODD): Empirical domains and theoretical perspectives. J Pain Symptom Manage 2010;39:9–22.
17.
Patrick DLStarks HECain KCUhlmann RFPearlman RA. Measuring preferences for health states worse than deathMed Decis Making1994149-18. 17. Patrick DL, Starks HE, Cain KC, Uhlmann RF, Pearlman RA: Measuring preferences for health states worse than death. Med Decis Making 1994;14:9–18.
18.
McPherson CJAddington-Hall JM. Judging the quality of care at the end of life: Can proxies provide reliable information?Soc Sci Med20035695-109. 18. McPherson CJ, Addington-Hall JM: Judging the quality of care at the end of life: Can proxies provide reliable information? Soc Sci Med 2003;56:95–109.
19.
Steinhauser KEClipp ECTulsky JA. Evolution in measuring the quality of dyingJ Palliat Med20025407-414. 19. Steinhauser KE, Clipp EC, Tulsky JA: Evolution in measuring the quality of dying. J Palliat Med 2002;5:407–414.
20.
Foley K. Competent care for the dying instead of physician-assisted suicideN Engl J Med199733653-58. 20. Foley K: Competent care for the dying instead of physician-assisted suicide. N Engl J Med 1997;336:53–58.
Information & Authors
Information
Published In
Journal of Palliative Medicine
Volume 14 • Issue Number 4 • April 2011
Pages: 445 - 450
PubMed: 21417741
Copyright
Copyright 2011, Mary Ann Liebert, Inc.
History
Published online: 6 April 2011
Published in print: April 2011
Published ahead of print: 18 March 2011
Accepted: 16 November 2010
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No competing financial interests exist.
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