Euthanasia in Victoria — Part Two:
The Oregon Model
This is the second in a three-part series exploring the Victorian voluntary assisted dying laws.
Premier Daniel Andrews has called Victoria’s proposed assisted dying law “the most conservative in the world”. This may or may not be true, but either way it doesn’t tell the average person much about the effect that the law will have if they come into force.
So, what will the Victorian system really look like if the assisted dying bill passes?
Health policy experts have pointed to the assisted dying laws in the US state of Oregon as being most similar to the Victorian legislation. ‘Assisted dying’ is a key term here.
Whereas laws in The Netherlands, Belgium and Luxembourg allow people in a wide range of circumstances to end their lives, Oregon has very strict criteria for people wishing to end their lives. The laws in the three European countries also allow a doctor to directly administer the lethal drugs to the patient. This is euthanasia, not assisted dying. Under an assisted dying model, the doctor prescribes the drugs, but the patient must take them him or herself.
Oregon’s Death With Dignity Act (DWDA) was enacted in 1997, so it has been around for 20 years now. The act allows terminally ill residents of Oregon to “end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose”. It also has many similar safeguards to the proposed Victorian law:
- The patient must make two voluntary oral requests to their doctor, as well as a witnessed written request;
- The patient must wait at least 15 days between their first and last oral request (a ‘cooling off’ period);
- The doctor must assess that the patient has decision-making capacity, and that they are likely to die within six months.
The Oregon Health Authority has been collecting data on the assisted dying process since the law was enacted, which gives some helpful insights into its impact.
The first thing that the data shows is that very few people actually access assisted dying in Oregon. In 2016 there were 35,799 deaths recorded in the state. Of those deaths, only 133, or 0.37 per cent, were due to assisted dying.
Interestingly, the number of people who died from ingesting assisted dying medication in 2016 was also much lower than the number of people who were prescribed the medication in that year. There were 204 prescriptions written under the law in 2016, and of those 204 people, 114 ingested the medication. The remaining 19 DWDA deaths were people who took medication they had been prescribed during the previous year. Of the 204 people, there were also 36 (17 per cent) who did not take the medication but died of other causes.
Generally around two thirds of the people prescribed medication under the DWDA choose to take it.
The number of people using the DWDA has grown steadily since its inception, with a yearly increase of 12.5 per cent. Dr Charles Blanke, an oncologist who led a recent study of the law, attributes this steady growth to an increasing awareness of the law amongst both patients and physicians.
It is overwhelmingly cancer sufferers who are accessing assisted dying. Almost 80 percent of patients receiving life-ending medication listed some form of cancer as their underlying illness. The next most common illness was amyotrophic lateral sclerosis, or motor neurone disease, at 6.8 per cent.
One of the most interesting pieces of data involves patients’ reasons for requesting assistance to die. Contrary to expectations, inadequate pain control was only a factor in one third of cases. On the other hand, the loss of autonomy and the inability to engage in activities that make life enjoyable were a concern for 89.5 percent of patients. Other major factors included the loss of dignity and the feeling of being a burden on family and friends.
While the law in Oregon stipulates that 15 days must elapse between a patient’s first request and a doctor writing a DWD prescription, most patients waited much longer to take the medication. In 2016 the average time between a patient’s first request and their ingesting the medication was 56 days, with at least one patient waiting only 15 days, and one waiting over a year and a half.
Over the 20 history of the DWDA, the medication used has been effective in 99.4 per cent of cases, with only six patients out of 1,127 regaining consciousness after taking the drugs. On average, the patient loses consciousness five minutes after ingestion, whilst death takes 25 minutes. The vast majority of patients (94 per cent) take the medication at home and only four patients in 20 years took it whilst in hospital.
In Oregon there were concerns, before the law was brought in, that it would be abused or otherwise taken advantage of. In his study, Dr Blanke found no evidence that the strict DWDA guidelines had been infringed. There hasn’t been a single report of coercion or abuse in the 20 years since the law came into force.
The other main concern for opponents of the law was the possibility that it would gradually become less strict over time. This ‘slippery slope’ scenario hasn’t materialised, mainly because any change in the law — which only passed by 1.3 per cent in 1997 — would need to be voted on by the people of Oregon.
Looking to Oregon as a guide, Victoria’s assisted dying law, if passed, is unlikely to make a huge difference to health care in the state. It is almost certain that it won’t open the floodgates of coercion and corruption, leaving the vulnerable at the mercy of avaricious friends and family. Only a very small group will be eligible to access assisted dying medication and it is likely that many won’t end up taking it.
What will change? In short, not much.