Cancer patients and physicians support assisted dying program
By Kirsty Oswald, medwireNews Reporter
17 April 2013
New Engl J Med 2013; Advance online publication

medwireNews: A Death with Dignity program, in which physicians can assist cancer patients with a prognosis of less than 6 months to end their lives, has been well-accepted by patients and their families, and received growing support from the physicians involved.

"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," authors, Elizabeth Loggers (University of Washington, Seattle, USA) and colleagues write in the New England Journal of Medicine.

Since November 2008, legislation was introduced in Washington State allowing adults with a life expectancy of 6 months or less to request and self-administer lethal medication prescribed by a physician.

Between March 2009 and December 2011, 114 patients at the Seattle Cancer Care Alliance expressed interest in the institution's program.

"The program ensures that patients (and families) are aware of all the options for high-quality end-of-life care, with the opportunity to have any concerns or fears addressed, while also meeting state requirements," the authors say.

The authors found that, in keeping with previous reports, only a small subset of patients who initially expressed interest in the Death with Dignity program went on to pursue it. Overall, 30 (26.3%) made an oral request but did not ultimately pursue the process or died before it was completed,

40 (35.1%) patients received a prescription, and 24 (60% of those receiving a prescription) died after ingesting the medication.

Nevertheless, many patients and their families expressed gratitude after receiving the prescription whether or not it was used, reporting that it gave them a sense of control in an uncertain situation. There was one case in which a patient died a day after taking the medication, causing distress to the family and clinicians. Otherwise, they received reports that patients' deaths were peaceful and had no complaints about the program.

Prior to the program's inception, 31 (38.3%) of 81 physicians at the cancer center who responded to a questionnaire said they would be unwilling to participate as either a consulting or prescribing clinician, or were undecided about participation. However, the authors report that during the course of the program, several clinicians subsequently expressed willingness to be a part of it.

Loggers and colleagues say that they hope by documenting their experience among cancer patients, who account for around four-fifths of Death with Dignity requests in Washington, it will help other health institutions to respond to requests for assisted dying.

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

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