Researchers Explore Death with Dignity Law at Comprehensive Cancer Center

A paper in the New England Journal of Medicine is generating lots of media buzz as being the first of its kind to describe how a large cancer center implements a Death with Dignity law.

The paper, by researchers from the Seattle Cancer Care Alliance, looks at the implementation of Washington State's 'Death with Dignity law' at the Alliance itself, which is the site of care for the Fred Hutchinson–University of Washington Cancer Consortium, a national comprehensive cancer center that serves the Pacific Northwest.

The law, which took effect in March of 2009, works by giving patients with fewer than six months to live the opportunity to ask for a lethal, life-ending prescription from their doctor.

In the paper, investigators reported that 114 patients asked about the Death with Dignity program between 5 March 2009 and 31 December 2011. Forty-four patients (38.6 percent) decided against pursuing the program while 30 (26.3 percent) got the process underway but did not complete it.

A total of 40 patients asked for and did receive the prescription — which amounts to a lethal dose of secobarbital. All 40 patients died; however, only 24 of them did so after taking the lethal dose of medication.

Across the entirety of Washington state during that time frame, 255 people took part in the program, and the reasons most commonly cited by patients for participating were:

• - Loss of autonomy (97.2 percent)
• - Inability to engage in enjoyable activities (88.9 percent)
• - Loss of dignity (75 percent)

"Qualitatively, patients and families were grateful to receive the lethal prescription, whether it was used or not," the authors concluded.

One of the concerns tied to trying to introduce a Death with Dignity program at a major comprehensive cancer center is the seeming contradictory messages, namely that the cancer center functions with the stated goal of treating and curing patients, while the program does not.

Source: NEJM