Abstract 1206
Background
Eight venues in the US allow terminally ill residents to self-administer prescribed oral drugs to end life. The Pacific Northwest states Oregon (OR) and Washington (WA) report number of prescriptions written, pt demographics, and motives underlying the requests. To study reasons for medical-aid-in-dying (MAID) requests and to assess patterns of use, we evaluated a combined 28 years of information from the most extensive database in North America.
Methods
OR and WA Health Authorities monitor MAID compliance. Website data from 1998 –2017 (OR) and 2009-2016 (WA) were collated. Characteristics of those dying from ingested drugs were calculated independently by state and then combined. Time trends for deaths vs. prescriptions written were analyzed using logistic regression.
Results
3368 prescriptions were writte; 2282 pts took drug and died. The percent ingesting medication per yr ranged from 48-87, with no significant time trend in OR but with an increase over time in WA (2-sided p = 0.59 and <0.01, respectively). 77% of pts had cancer; 10% neurologic illness; 5% lung disease (dz); 5% heart dz; 3% other. 4% were sent for psychiatric evaluation. M/F (%): 51/49. 31% were in the largest pt age group represented: 65-74 yrs (overall range 20-102). Race white/other/unknown (%): 95/4/0.8. Eighty-three percent died at home (93 OR, 71 WA); a prescriber was present in 10% of cases (16 OR: 5 WA). Time between drug intake and coma ranged from 1 to 660 min; to death: 1-6240 min. Fewer than 0.5% awoke in OR. Reasons for MAID (%): Poor QOL 87; loss of autonomy 88; loss of dignity 69; inadequate pain control 30 (OR 26; WA 36); financial concerns 6.
Conclusions
Unlike European countries allowing euthanasia, US MAID consists only of terminally ill pts self-administering lethal medication. Up to half the pts requesting prescriptions do not take the drugs. Pts must be legally competent but rarely are referred to psychiatrists for that assessment. Most MAID pts have cancer and most use MAID for conditions that are difficult to palliate (loss of autonomy/dignity/QOL). Of concern, some use it because of inadequate pain control or finances. MAID merits formal study, such as how to develop faster-acting medications, as well as comparing effectiveness and demographics (especially age) with assisted dying data from Canada and Europe.
Clinical trial identification
Legal entity responsible for the study
SWOG Cancer Research Network.
Funding
SWOG Cancer Research Network.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.