As a native Oregonian growing up amidst the controversy of the DWDA, I have witnessed many of the heated debates that this issue has inspired. But I also understand the outcomes of this legislation's passing. Based on this assessment, I see the DWDA as an effective tool for improving end-of-life care. It gives patients another option for writing the script of the final pages of their lives.
First, however, I would like to dispel a common misconception about how physician-assisted suicide has been utilized in Oregon. Some critics claim that PAS will eventually lead to the euthanasia of vulnerable, uninformed or mentally ill citizens. However, this has not been the case by any means in Oregon. The Oregon Health Division's latest annual report on the DWDA showed the complete opposite: The patients who used PAS tend to be younger, well-educated terminally ill people who expressed "losing autonomy" as their primary end-of-life concern and reason for choosing PAS.
Furthermore, of the patients who initially requested PAS, relatively few have actually gone through with it. For doctors, a patient's request for PAS can be seen as a "wake-up call" to address concerns with their end-of-life care. Oftentimes, doctors can find other ways to accommodate patients' concerns with end-of-life care in a personal and private way.
The implementation of the DWDA has also been a wake-up call for health providers statewide to make a stronger commitment to end-of-life care. The U.S. currently spends exorbitant amounts of money to little avail on end-of-life care. According to the "Dartmouth Atlas of Health Care," more than 80 percent of patients say that they wish to avoid hospitalization and intensive care during the terminal phase of illness, but those wishes are often overridden by other factors.
In Oregon, health providers statewide have taken steps to reverse this trend. Today, Portland-area health systems have among the highest percentage of patients in the nation dying at home, among the lowest percentage of Medicare patients on intensive care and spend among the least amount of money nationwide on inpatient end-of-life care. This is not, of course, entirely due to the implementation of the DWDA, but its existence has been a catalyst for systematic change statewide.
Take Providence Health Systems, for example, a Christian HMO that is among the largest in the Pacific Northwest. Although they publicly denounced the DWDA before it passed, they saw its passage as a sign from Oregonians that they were unhappy with the end-of-life care in their state. Providence poured resources not into legal challenges or political battles to undo the DWDA but into reevaluating the ways that patients were spending their final days of life.
This reevaluation led to an overhaul of the end-of-life care system, increasing funding for hospice care and other ways for patients to end their lives peacefully and comfortably. Providence's efforts led them to win the prestigious Circle of Life Award for comprehensive end-of-life care. Because organizations like Providence opted to take a constructive approach to the introduction of PAS, Oregonians in their final months of life have benefited enormously.
The biggest danger in the debate over physician-assisted suicide, however, is the abstraction of the issue to distract the public from the reality of the issue: quality of care for dying patients across the country. This danger has already reared its ugly head in Florida, where the husband and parents of Terri Schiavo, a 26-year-old terminally ill patient, are fighting over whether or not she, in her permanently-vegetated state, should have her feeding tube removed.
The problem with this case is that since so many people with causes outside the care of Schiavo have attached themselves to it, she is no longer a terminally ill patient with a certain set of human needs but a political symbol. If the physician-assisted suicide debate veers down this dangerous road, many of the positive outcomes from Oregon's DWDA will have been in vain. It is my sincere hope that this is an issue that can avoid the poison of divisive ideological politics and serve as a catalyst for a nationwide move toward improvement in the quality of American lives.
Rodriguez can be reached at awrodriguez@amherst.edu