Microsoft Word - DWDA_2015_narrative

http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/

DeathwithDignityAct/Documents/year18.pdf

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OREGONDEATHWITHDIGNITYACT:

2015DATASUMMARY



Formoreinformation:

http://www.healthoregon.org/dwd

Contact:[email protected]







OregonPublicHealthDivision

February4,2016

http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/

DeathwithDignityAct/Documents/year18.pdf

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Introduction

Oregon’sDeathwithDignityAct(DWDA),enactedinlate1997,allowsterminally‐illadultOregoniansto

obtainanduseprescriptionsfromtheirphysiciansforself‐administered,lethaldosesofmedications.

TheOregonPublicHealthDivisionisrequiredbytheDWDAtocollectcomplianceinformationandto

issueanannualreport.Data

presentedinthissummary,includingthenumberofpeopleforwhom

DWDAprescriptionswerewritten(DWDAprescriptionrecipients)andtheresultingdeathsfromthe

ingestionofthemedications(DWDAdeaths),arebasedonrequiredreportingformsanddeath

certificatesreceivedbytheOregonPublicHealthDivisionasofJanuary27,

2016.Moreinformationon

thereportingprocess,requiredforms,andannualreportsisavailableat:

http://www.healthoregon.org/dwd.



ParticipationSummaryandTrends

During2015,218peoplereceivedprescriptionsforlethalmedicationsundertheprovisionsofthe

OregonDWDA,comparedto155during2014(Figure 1,above).AsofJanuary27,2016,theOregon

PublicHealthDivisionhadreceivedreportsof132peoplewhohaddiedduring2015fromingestingthe

medicationsprescribedunder

DWDA.

Sincethelawwaspassedin1997,atotalof1,545peoplehavehadprescriptionswrittenunderthe

DWDA,and991patientshavediedfromingestingthemedications.From1998through2013,the

numberofprescriptionswrittenannuallyincreasedatanaverageof12.1%;however,during2014and

65 65

114

116

121

155

218

27 27

105

132

100

120

140

160

180

200

220

240

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Number

Year

Figure1:DWDAprescriptionrecipientsanddeaths*,

byyear,Oregon,1998‐2015

DWDAprescriptionrecipients

DWDAdeaths

*As ofJanuary27,2016

http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/

DeathwithDignityAct/Documents/year18.pdf

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2015,thenumberofprescriptionswrittenincreasedbyanaverageof24.4%.During2015,therateof

DWDAdeathswas38.6per10,000totaldeaths.



AsummaryofDWDAprescriptionswrittenandmedicationsingestedareshowninFigure2.Ofthe218

patientsforwhomprescriptionswerewrittenduring2015,125(57.3%)ingestedthemedication;all125

patientsdiedfromingestingthemedicationwithoutregainingconsciousness.Fifty ofthe218patients

whoreceivedDWDAprescriptions

during2015didnottakethemedicationsandsubsequentlydiedof

othercauses.

Ingestionstatusisunknownfor43patientsprescribedDWDAmedicationsin2015.Fiveofthese

patientsdied,buttheywerelosttofollow‐uporthefollow‐upque stionnaireshavenotyetbeen

received.Fortheremaining38

patients,bothdeathandingestionstatusarepending(Figure 2).







Rateper10,000deathscalculatedusingthetotalnumberofOregonresidentdeathsin2014(34,160),themost

recentyearforwhichfinaldeathdataareavailable.

Figure2:SummaryofDWDAprescriptionswrittenandmedicationsingestedin2015,

asofJanuary27,2016



7peoplewith

prescriptions

writteninprevious

yearsingested

medicationduring

2015

218peoplehadprescriptions

writtenduring2015

125ingested

medication

132ingested

medication

132diedfrom

ingesting

medication

0regained

consciousnessafter

ingesting

medication;diedof

underlyingillness

50didnotingest

medicationand

subsequentlydied

fromothercauses

43ingestion

status

unknown

5died,ingestion

statusisunknown

orlosttofollow

38deathand

ingestionstatus

pending

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DeathwithDignityAct/Documents/year18.pdf

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PatientCharacteristics

Ofthe132DWDAdeathsduring2015,mostpatients(78.0%)wereaged65yearsorolder.Themedian

ageatdeathwas73years.Asinpreviousyears,decedentswerecommonlywhite(93.1%)andwell‐

educated(43.1%hadalea stabaccalaureatedegree).

Whilemostpatientshadcancer,

thepercentofpatientswithcancerin2015wasslightlylowerthanin

previousyears(72.0%and77.9%,respectively).Thepercentofpatientswithamyotrophiclateral

sclerosis(ALS)wasalsolower(6.1%in2015,comparedto8.3%inpreviousyears).Heartdisease

increasedfrom2.0%inprioryearsto6.8%in

2015.

Most(90.1%)patientsdiedathome,andmost(92.2%)wereenrolledinhospicecare.Excluding

unknowncases,most(99.2%)hadsomeformofhealthcareinsurance,althoughthepercentofpatients

whohadprivateinsurance(36.7%)waslowerin2015thaninprevious years(60.2%).Thenumberof

patients

whohadonlyMedicareorMedicaidinsurancewashigherthaninpreviousyears(62.5%

comparedto38.3%).

Similartopreviousyears,thethreemostfrequentlymentionedend‐of‐lifeconcernswere:decreasing

abilitytoparticipateinactivitiesthatmadelifeenjoyable(96.2%),lossofautonomy(92.4%),andlossof

dignity(75.4%).



DWDAProcess

Atotalof106physicianswrote218prescriptionsduring2015(1‐27prescriptionsperphysician).During

2015,noreferralsweremadetotheOregonMedicalBoardforfailuretocomplywithDWDA

requirements.During2015,fivepatientswerereferredforpsychological/psychiatricevaluation.

Aprocedurerevisionwasmade

in2010tostandardizereportingonthefollow‐upquestionnaire.The

newprocedureacceptsinformationaboutthetimeofdeathandcircumstancessurroundingdeathonly

whenthephysicianoranotherhealthcareproviderwaspresentatthetimeofdeath.For27patients,

eithertheprescribing physicianoranotherhealthcareprovider

waspresentatthetimeofdeath.

Prescribingphysicianswerepresentattimeofdeathfor14patients(10.8%)during2015comparedto

15.7%inpreviousyears;13additionalcaseshadotherhealthcareproviderspresent(e.g.hospice

nurse).Dataontimefromingestiontodeathisavailableforonly

25DWDAdeathsduring2015.Among

those25patients,timefro mingestionuntildeathrangedfromfiveminutesto34hours.Forthe

remainingtwopatients,thelengthoftimebetweeningestionanddeathwasunknown.



OregonPublicHealthDivision

(%)

56 (42.4) 453 (52.7) 509 (51.4)

76 (57.6) 406 (47.3) 482 (48.6)

1 (0.8) 7 (0.8) 8 (0.8)

5 (3.8) 18 (2.1) 23 (2.3)

2 (1.5) 61 (7.1) 63 (6.4)

21 (15.9) 184 (21.4) 205 (20.7)

41 (31.1) 247 (28.8) 288 (29.1)

30 (22.7) 229 (26.7) 259 (26.1)

32 (24.2) 113 (13.2) 145 (14.6)

73 (30‐102) 71 (25‐96) 71 (25‐102)

122 (93.1) 831 (97.1) 953 (96.6)

0 (0.0) 1 (0.1) 1 (0.1)

0 (0.0) 2 (0.2) 2 (0.2)

4 (3.1) 9 (1.1) 13 (1.3)

0 (0.0) 1 (0.1) 1 (0.1)

0 (0.0) 3 (0.4) 3 (0.3)

1 (0.8) 3 (0.4) 4 (0.4)

4 (3.1) 6 (0.7) 10 (1.0)

52 (39.7) 395 (46.1) 447 (45.3)

34 (26.0) 198 (23.1) 232 (23.5)

Nevermarried(%) 9 (6.9) 69 (8.1) 78 (7.9)

Divorced(%) 36 (27.5) 194 (22.7) 230 (23.3)

7 (5.4) 51 (6.0) 58 (5.9)

31 (23.8) 187 (21.9) 218 (22.2)

36 (27.7) 224 (26.2) 260 (26.4)

56 (43.1) 392 (45.9) 448 (45.5)

64 (49.2) 361 (42.3) 425 (43.2)

7 (5.4) 63 (7.4) 70 (7.1)

48 (36.9) 365 (42.7) 413 (42.0)

11 (8.5) 65 (7.6) 76 (7.7)

Enrolled(%) 118 (92.2) 747 (90.2) 865 (90.5)

Notenrolled(%) 10 (7.8) 81 (9.8) 91 (9.5)

Unknown

Private(aloneorincombination)(%) 44 (36.7) 489 (60.2) 533 (57.2)

Medicare,Medicaidorothergovernmental(%) 75 (62.5) 311 (38.3) 386 (41.4)

None(%) 1 (0.8) 12 (1.5) 13 (1.4)

Unknown

752

47 59

AfricanAmerican(%)

AmericanIndian(%)

Twoormoreraces(%)

Asian(%)

Unknown

Marital

status

Married(includingRegisteredDomesticPartner)(%)

Widowed(%)

PacificIslander(%)

Other(%)

Hispanic(%)

Total

(N=991)

Table1.Characteristicsandend‐of‐lifecareof991DWDApatientswhohavediedfromingestingDWDA

medications,byyear,Oregon,1998‐2015

Male(%)

Female(%)

Sex

Ageatdeath(years)

18‐34(%)

2015

(N=132)

1998‐2014

(N=859)Characteristics

35‐44(%)

45‐54(%)

55‐64(%)

65‐74(%)

75‐84(%)

85+(%)

Medianyears(range)

Race

White(%)

Baccalaureateorhigher(%)

Unknown

EastoftheCascades(%)

Unknown

Lessthanhighschool(%)

Education

Hospice

Otherwesterncounties(%)

Coastalcounties(%)

Metrocounties(Clackamas,Multnomah,Washington)(%)

Residence

Highschoolgraduate(%)

31 35

Endoflifecare

Unknown

Somecollege(%)

Insurance

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OregonPublicHealthDivision

Total

(N=991)

2015

(N=132)

1998‐2014

(N=859)Characteristics

95 (72.0) 667 (77.9) 762 (77.1)

Lungandbronchus(%) 23 (17.4) 154 (18.0) 177 (17.9)

Breast(%) 9 (6.8) 64 (7.5) 73 (7.4)

Colon(%) 7 (5.3) 54 (6.3) 61 (6.2)

Pancreas(%) 7 (5.3) 56 (6.5) 63 (6.4)

Prostate(%) 5 (3.8) 35 (4.1) 40 (4.0)

Ovary(%) 3 (2.3) 33 (3.9) 36 (3.6)

Other(%) 41 (31.1) 271 (31.7) 312 (31.6)

8 (6.1) 71 (8.3) 79 (8.0)

6 (4.5) 38 (4.4) 44 (4.5)

9 (6.8) 17 (2.0) 26 (2.6)

0 (0.0) 9 (1.1) 9 (0.9)

14 (10.6) 54 (6.3) 68 (6.9)

5 (3.8) 47 (5.5) 52 (5.3)

Patientinformedfamilyofdecision(%)

126 (95.5) 729 (93.2) 855 (93.5)

Home(patient,familyorfriend)(%) 118 (90.1) 810 (94.6) 928 (94.0)

Longtermcare,assistedlivingorfostercarefacility(%) 9 (6.9) 37 (4.3) 46 (4.7)

Hospital(%) 0 (0.0) 1 (0.1) 1 (0.1)

Other(%) 4 (3.1) 8 (0.9) 12 (1.2)

Unknown

Secobarbital(%) 114 (86.4) 466 (54.2) 580 (58.5)

Pentobarbital(%) 1 (0.8) 385 (44.8) 386 (39.0)

Phenobarbital/chloralhydrate/morphinesulfatemix(%) 16 (12.1) 0 (0.0) 16 (1.6)

Other(combinationofaboveand/ormorphine)(%) 1 (0.8) 8 (0.9) 9 (0.9)

127 (96.2) 758 (88.7) 885 (89.7)

121 (92.4) 782 (91.5) 903 (91.6)

98 (75.4) 579 (79.3) 677 (78.7)

46 (35.7) 428 (50.1) 474 (48.2)

63 (48.1) 342 (40.0) 405 (41.1)

37 (28.7) 211 (24.7) 248 (25.2)

3 (2.3) 27 (3.2) 30 (3.1)

Prescribingphysician

Otherprovider,prescribingphysiciannotpresent

Noprovider

Unknown

Prescribingphysician(%) 14 (10.8) 121 (15.7) 135 (15.0)

Otherprovider,prescribingphysician

notpresent(%) 13 (10.0) 268 (34.7) 281 (31.2)

Noprovider(%) 103 (79.2) 383 (49.6) 486 (53.9)

Unknown

330

(N=132)

Endoflifeconcerns

Burdenonfamily,friends/caregivers(%)

(N=921)(N=789)(N=132)

Losingcontrolofbodilyfunctions(%)

Lossofdignity(%)

(N=991)(N=859)

332

243

133

430

256

148

Inadequatepaincontrolorconcernaboutit(%)

Attimeofdeath

Whenmedicationwasingested

Healthcareproviderpresent(collected2001‐present)

Financialimplicationsoftreatment(%)

Losingautonomy(%)

Patientdiedat

Referredforpsychiatricevaluation(%)

Unknown

Amyotrophiclateralsclerosis(%)

DWDAprocess

Chroniclowerrespiratorydisease(%)

Otherillnesses(%)

Lessabletoengageinactivitiesmakinglifeenjoyable(%)

Heartdisease(%)

Malignantneoplasms(%)

HIV/AIDS(%)

Underlyingillnes

Lethalmedication

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OregonPublicHealthDivision

Total

(N=991)

2015

(N=132)

1998‐2014

(N=859)Characteristics

Other

Median

Range

Numberofpatientswithinformationavailable

Numberofpatientswithinformationunknown

Median

Range

Numberofpatientswithinformationavailable

Numberofpatientswithinformationunknown

Median

Range

Numberofpatientswithinformationavailable

Numberofpatientswithinformationunknown

Median

Range(minutes‐hours)

Numberofpatientswithinformationavailable

Numberofpatientswithinformationunknown

506

330

(N=859)

529

Duration(days)between1strequestanddeath

Duration(weeks)ofpatient‐physicianrelationship

TimingofDWDAevent

Unknown

Complications

Otheroutcomes

RegainedconsciousnessafteringestingDWDAmedications

None

Regurgitated

(N=132)

435

(N=991)

47 46

132

105

13 12

0‐1905 0‐1905

1‐1004

25 25

989857

990859131

53150625

022

15‐517 15‐1009 15‐1009

101

1‐38 1‐38

Firstrecordedbeginningin2001.Sincethen,40patients(4.4%)havechosennottoinformtheirfamilies,and19patients(2.1%)havehad

nofamilytoinform.Therewasoneunknowncasein2002,twoin2005,onein2009,and3in2013.

Sixpatientshaveregainedconsciousnessafteringesting

prescribedmedications,andarenotincludedinthetotalnumberofDWDA

deaths.Thesedeathsoccurredin2005(1death),2010(2deaths),2011(2deaths)and2012(1death).Pleaserefertotheappropriate

years’annualreportsonourwebsite(http://www.healthoregon.org/dwd)formoredetailonthesedeaths.

Aprocedurerevision

wasmademid‐yearin2010tostandardizereportingonthefollow‐upquestionnaire.Thenewprocedureaccepts

informationabouttimeofdeathandcircumstancessurroundingdeathonlywhenthephysicianoranotherhealthcareprovideris

presentatthetimeofdeath.Thisresultedinalargernumberofunknowns

beginningin2010.

Minutesbetweeningestionanddeath

Minutesbetweeningestionandunconsciousness

53651125

107

Unknownsareexcludedwhencalculatingpercentages.

Includesdeathsduetobenignanduncertainneoplasms,otherrespiratorydiseases,diseasesofthenervoussystem(includingmultiple

sclerosis,Parkinson'sdiseaseandHuntington'sdisease),musculoskeletalandconnectivetissuediseases,cerebrovasculardisease,other

vasculardiseases,diabetesmellitus,gastrointestinaldiseases,andliverdisease.

353 460

Affirmativeanswersonly("Don'tknow"includedinnegativeanswers).Categoriesarenotmutuallyexclusive.Dataunavailableforfour

patientsin2001.

Firstaskedin2003.Dataavailablefor130patientsin2015,730patientsbetween1998‐2014,and860patientsforallyears.

2‐15

107

5mins‐34hrs 1min‐104hrs 1min‐104hrs

348 455

http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/

DeathwithDignityAct/Documents/year18.pdf

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