Academic journal article Social Work

Life after Death with Dignity: The Oregon Experience

Academic journal article Social Work

Life after Death with Dignity: The Oregon Experience

Article excerpt

This article offers a framework for examination and overview of Oregon's Death with Dignity Act after its first year of implementation. This law became public policy on October 27, 1997, when all legal barriers were lifted. The law allows a terminally ill person to request a prescription to end life if she or he qualifies under the law's requirements. According to records, 23 Oregonians have received such a prescription, and 15 have used it. The effect of physician-assisted suicide (PAS) on clients and families, professional health care providers and agencies, and society and culture is explored through two questions: (1) What is known about PAS? and (2) What needs discovery and exploration? The reality of this end-of-life option has forever changed care of terminally ill individuals, and social workers may benefit from the Oregon experience.

Key words: death with dignity; end of life; physician-assisted suicide; right to die; terminally ill people

Introduction to Legalization of PAS in Oregon

Physician-assisted suicide (PAS) became legal in Oregon on October 27, 1997. When the Oregon legislature sent the Death with Dignity Act back to the 1997 ballot, it passed by an even wider margin than the original ballot measure three years earlier. Legal barriers were cleared at about the same time, and this option is now available for terminally ill residents of the state of Oregon.

The original Death with Dignity Act (Ballot Measure 16) was voted on in November 1994 and passed by a 2 percent margin (51 percent to 49 percent). Many service providers and health care professionals were caught by surprise. During the next three years, the courts were the center of attention for PAS, as the Ninth Circuit Court, and later the Supreme Court, with different cases, did not prohibit PAS. The Supreme Court found that although PAS is not a constitutional right, states have the freedom to pursue this end-of-life option if they so choose.

In November 1997, Ballot Measure 51 was placed before Oregon voters to repeal the Death with Dignity Act. There was a deluge of newspaper, radio, and television coverage, making this ballot measure one of the most expensive in Oregon's history. Repeal was defeated by a 20 percent margin, and with the legal barriers gone, PAS became public policy.

The evolution of the Death with Dignity Act was almost like a living laboratory for social workers who appreciate the ebb and flow of policy, practice, and politics. Despite the ongoing controversy and continued debate with Oregon's legislature and Congress, terminally ill Oregonians can ask for drugs to end life when the law's requirements are met. The Oregon Health Division released to the public a required annual report in February 1999 that contained specific data on use of the law during the first year of availability.

Oregon is in a unique position as the only place in the world where PAS is legal. Although PAS and euthanasia are practiced openly in the Netherlands, these options are technically illegal. Social workers have an active role in many end-of-life settings such as hospice, long-term care, home care, and hospitals, and much has been learned in the first year since PAS became an option in Oregon. However, there are still many unknowns, and it may be of benefit to share Oregon's experiences and difficulties with PAS through a social work lens to assist practitioners and policymakers with end-of-life concerns that may emerge in their own communities.

What Is Known about Client and Family and PAS?

The guidelines to follow in the law are described here briefly. To qualify to receive a prescription for medication to end life, the person must be terminally ill with six months or less to live, and a second physician's opinion on diagnosis and prognosis is required. After the first oral request to start the process, a 15-day waiting period begins. A mental health consultation is not required, although either physician can request an evaluation by a psychiatrist or psychologist, and notification of family or friends is not required. …

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