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Choosing Among Oregon's Legal End-of-Life Options

Hospice and physician assisted suicide.

PORTLAND, OREGON 6/1/2007 -- Jack Kevorkian's release from prison today puts end of life care back in the spotlight--and gives us an opportunity to remind dying Oregonians that it no longer matters, in our state, whether physician-assisted dying should or should not be permitted. It is a legal option in Oregon.

It's even more important to seize this opportunity to remind dying Oregonians that they need not choose between hospice and physician-aid in dying. Dying Oregonians can choose both from among the options on the end-of-life continuum of care. In the last ten years, 88% of those 292 individuals who used Oregon's Death With Dignity Act were enrolled in hospice.

A prescription for life-ending medication should not be the option of first choice for relieving fears or pain or symptoms of a terminal illness. A hospice should never deny a person its services because he or she has asked a doctor for a prescription, even when the hospice intends to exercise its right to not be involved. The Oregon Hospice Association supports patient choice.

Hospices are uniquely qualified to address the needs of the dying. When needs are met, fears addressed, and symptoms relieved, only 1 of 200 dying Oregonians who consider physician assisted dying will use a prescription to end his or her life.

The Oregon Hospice Association strongly recommends that a person be enrolled in hospice for comfort care during the required waiting period, if they are not already a hospice patient.

A right to ask for aid in dying.

Oregon's Death With Dignity Act allows competent adult Oregonians with a life expectancy of six months to ask their physician for a prescription of life-ending medication. The Act requires a second opinion, two oral and one written requests, and a 15-day waiting period. It requires that the person be fully informed about "feasible alternatives, including, but not limited to, comfort care, hospice, and pain control", as well as diagnosis, prognosis, risks, and results. A request can be canceled at any time. Any physician, or other health care provider, can refuse to participate. The law protects physicians from legal liability and professional disciplinary action. The law does not authorize lethal injection or euthanasia. (ORS127.800-127.897) Visit the OHSU Center for Ethics in Health Care website to learn more >>

<<Download ADVANCE DIRECTIVES for Oregon and Washington >>

A right to pain relief and comfort

Terminally-ill Oregonians have the right to medication to relieve pain and other distressing symptoms, even if death may be hastened as an effect. For most people, pain can be relieved without impairing alertness. Some may need sedation. Pain, breathlessness, nausea, and depression can all be relieved. No terminally-ill Oregonian should die, or live, in pain. (ORS 127.642)

A right to refuse and withdraw treatment.

Oregonians have the right to refuse or withdraw treatment, including artificial hydration and nutrition, even if doctors or others, such as family members, disagree. People are often reluctant to stop efforts to "beat" a disease, even when treatment or measures are futile and add nothing to quality of life. People do not know that they can refuse to eat or drink.

Refusing or withdrawing treatment may be appropriate for persons who cannot swallow, who are paralyzed, or who are unable to self administer medication, such as those with advanced ALS or Lou Gehrig's disease or MS. Provisions to refuse treatment for persons with incapacitating illnesses such as advanced Alzheimer's can be made in advance directives. (ORS127.505; ORS127.580-127.640)

A right to pto advance directives or POLST

Oregonians have the right to make health care decisions in advance and to appoint health care representatives. Every Oregonian should make their preferences about the end of life known to their families long before illness strikes and regardless of their age. They should ensure that their wishes are followed, if and when a crisis does occur, by completing advanced directives and by appointing a surrogate to make decisions on their behalf, when they are unable to do so themselves. Without advanced directives, the presumption is made that an person wants full treatment, even if that treatment may be futile. Preferences for hospice care and comfort measures can be indicated in advance directives, if a person becomes terminally ill. A lawyer is not needed to complete these documents. (ORS127.000-127.737)

Physician Orders for Life-Sustaining Treatment (POLST), do-not-resuscitate orders (DNRs), and/or allow natural death orders (AND) should be completed for Oregonians who are frail, elderly, or facing the end of life to further assure that their wishes are carried out. Emergency personnel have been authorized by the Oregon State Board of Medical Examiners to respect the POLST. (AR847-35-0001 ) Visit the OHSU POLST website to learn more >>

A right to hospice and palliative care.

All Oregonians, not only those who are terminally-ill, need to know about hospice and comfort care. Hospice addresses most fears people identify for politically supporting or personally considering physician-assisted dying: the fears of suffering, dying in pain, being kept alive hooked up to machines, being alone, being a burden, or losing control. Hospice addresses the symptoms that cause pain and suffering. Suicide in hospice patients is rare.

Hospice may not be for everyone, but polls confirm that eight of ten Americans would choose to have the services hospice offers, if they were dying. A significant number of those polled did not choose hospice by name, however, because they did not associate hospice with the list of services offered. Polls confirm, too, that more than eight out of ten Americans would want to know, if they had a terminal illness with a limited life expectancy .

Hospice addresses the medical, psychosocial, spiritual, and practical needs of the person and the family throughout the periods of illness and bereavement. Hospice is comfort care or palliative care, a good choice when curative or other more aggressive treatment is no longer effective or no longer wanted, and when life expectancy is limited. The earlier hospice is involved, the more it can help make the final months, weeks, and days as comfortable and satisfying as possible. The earlier hospice is involved, the more it can support the family in caring for their loved one and each other .

Hospice is provided at home or wherever the patient lives, such as a relative's home, a nursing or foster home, a residential care or assisted living facility, or a residential or inpatient hospice. Every Oregonian has access to hospice and comfort care. Hospices are operational in every county in Oregon. Comfort and palliative care is available throughout the state through hospices and through inpatient palliative care programs in hospitals and other facilities .

Paying for Hospice and Comfort Care.

The Oregon Hospice Association and Oregon's hospices support universal access to hospice care. While hospices will not turn dying Oregonians and their families away because they cannot pay for services, physicians sometimes are reluctant to refer persons when they do not have health care insurance or other resources. All Oregon health plans have hospice benefits. Terminally-ill Oregonians who are eligible for Medicare or for the Oregon Health Plan are entitled to hospice and comfort care, although the Oregon Health Plan is in jeopardy. No terminally-ill Oregonian should choose physician-assisted dying because they believe they have no other affordable choice. (ORS127.642; OAR410)

Dying With Dignity.

Dying is not undignified. Dignity is a notion of what society decides should be of value. What is considered "dignified" changes over time and is different from one society to another.

Dying can be a rich and meaningful process for persons and their families. The experience of dying is much more than avoiding pain and suffering. In truth, dying is simply a part of living: an important part. A person's dying may not be easy, but it is as important and valuable as any experience in life.