From the March 2011 issue of HealthCare Business News magazine


How you say the thing
Also curious is the role language plays in this issue. What do you call the action of terminally ill patients taking lethal drugs prescribed by their doctors? Physician-assisted suicide? Physician-assisted death? Aid in dying? When contacted by DOTmed News, Compassion & Choices provided a fact sheet, “Language Matters,” which said that DWDA deaths were not “suicide” as the patients were dying anyway, and that the label “suicide” is hurtful and pejorative.

“They want to use the more neutral language because they do not view this as a choice that should be subjected to moral scrutiny, let alone government oversight,” Campbell says. “It’s a matter of patient self-determination and basically others ought to stay out.”
In fact, where a hospice fell in participation could be predicted by what they chose to call the act, Campbell says. A good portion of the hospices use the language of assisted suicide, not assisted death, which, Campbell says, moves it into a realm of moral and even legal judgment – as technically, assisted suicide, as opposed to what takes place under the DWDA, is still against the law in Oregon and other states.

“Here semantics really do make a difference in terms of people’s actions,” Campbell says.

Doctors’ (lack of?) involvement
When most patients take their lethal drugs and die, the prescribing physician is not around. “In only one out of every four assisted deaths, the physician will actually attend the ingestion of the medication,” Campbell says. Nonetheless, at the time of death, for the majority of cases (around 57 percent), another provider – possibly a nurse, although it’s not clear from the published data – is present. But this could be changing. From 1998 to 2009, a provider was present at death in about one-fifth of all cases. But last year, most patients – a full 60 percent – had no provider with them at the end.

“There are not many medical procedures where physicians are prescribing medication to patients of fairly significant dosage and level and so forth, in which there isn’t follow-up to see what happens,” Campbell says.

Still, because of confidentiality laws that make it hard to know what’s happening – a problem that bedevils most research in this area – it’s not clear whether this change reflects the wishes of the patients, many of whom might prefer to spend their final moments surrounded by those they love, and not a doctor.

But this could be an issue, in the rare event of side effects. Typically, before taking the barbiturates, patients need to consume an anti-emetic to make sure they hold them down. But in about 4 percent of cases, patients have vomited up the drugs. Also, in even rarer instances, patients have survived the dosage. Since the program started, three patients have awakened after ingesting the medication between 24 and 88 hours later. All three later died of their illnesses, between five days and three months later, according to Oregon’s health department.

March 2011 Magazine

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