Hospice-Assisted Death? A Study of Oregon Hospices on Death with Dignity

Abstract

Nearly 90% of terminally ill patients who have used Oregon's distinctive death with dignity law to receive a medication to end their lives are enrolled in hospice care programs. In 2009-2010, we conducted a study of the policies developed by Oregon hospices to address patient inquiries and requests for death with dignity. The study examined the stated hospice values and positions and identified the boundaries to participation drawn by the hospice programs to protect personal and programmatic integrity. The boundaries were drawn around 6 key caregiving considerations: (1) language regarding physician-assisted death (PAD); (2) informed decision making by patients; (3) collaboration with physicians; (4) provision of lethal medication; (5) assistance in the patient's act of taking the medication; and (6) staff presence at the time of medication ingestion.

Health Care Providers’ Experiences with Implementing Medical Aid-in-Dying in Vermont: a Qualitative Study

“…[5][6][7][8][9][10] Several reports have also provided data about the utilization of AID in clinical contexts [11][12][13] and the development of institutional policies. 12,[14][15][16][17] However, more information is needed about how individual health care providers have worked within the constraints of institutional policies and navigated practical challenges relating to interpreting and implementing these new laws. Such challenges may include gaps in relevant clinical knowledge or details of the law, concerns about privacy or the potential for legal or social ramifications, and other process-based issues.…”

When a Patient Discusses Assisted Dying

“…Furthermore, if patients were discharged from a hospital environment after bringing up interest in physician-assisted dying, it would also be appropriate to share this information with hospice or other service organizations involved in follow-up care. 31 However, there are implications relative to this sharing of information with hospice organizations involved in follow-up care. With respect for patient autonomy and self-determination, it is essential that communication is transparent and that options for care given legal and situational constraints are open.…”

“…Nurses may feel conflicted given the historic pledge of hospice to not hasten death and to avoid patient and family abandonment and the need to respect the physician-patient relationship. 31 20,21 Statespecific nursing organizations can also be accessed for their position on appropriate management of patients who request information on assisted dying. It is also essential for nurses to utilize self-care resources such as stress reduction, finding workspace for relaxation, finding mentors, and seeking mental health support as needed for professional role stressors that contribute to distress and ambivalence.…”

“…For example, it has been shown that many patients who receive lethal medications in the state of Oregon do not ultimately use the prescribed medications to end their life, 24 although nearly 90% of patients with terminal illness who have used the law to receive lethal prescriptions are enrolled in hospice care. 31 Psychiatric factors such as depression, anger, cognitive avoidance, and grief need to be evaluated as potential contributors to the patient's request for assisted dying. Of paramount importance, any time a patient is actively suicidal, it is ethically appropriate that responsible medical providers and family members are notified immediately and that a thorough mental health evaluation is provided.…”

Attitudes of Chinese Oncology Physicians Toward Death with Dignity

“… 6 Joseph indicated that the essence of the DWDA is indeed physician-assisted suicide. 7 , 8 Some countries consider the DWDA as euthanasia and not DWD. 4 , 8 …”