Oregon law (ORS 127.8) allows eligible adults to obtain medication from their doctor that will end their life. Samaritan offers unbiased information about your rights and protections under the Death with Dignity Act (DWD) through the Samaritan Death with Dignity Resource Center. Center personnel can answer questions and help you navigate the process by linking you to local resources. DWD is only one of many options for end of life care.
To someone who has struggled over time with a terminal illness, such as cancer, neurological disease, lung disease and others, having the option to end life on their own terms may bring a sense of comfort and control as disease progresses.
While Oregon’s Death with Dignity Act has made medical aid in dying legal since 1997, it isn’t for everyone.
To qualify for Death with Dignity, you must meet the following requirements:
Legal in nine states and the District of Columbia, medical aid in dying in Oregon is governed by a law that requires the patient to administer the terminal medication to themselves and it must be delivered into the digestive track. The current best practice includes prescriptions of four different medications in lethal doses taken as pills and liquid in a particular sequence.
Oregon statute specifies that participation under the Death with Dignity Act is not suicide and should not affect life insurance benefits by that definition.
Along with being of legal age and remaining in Oregon throughout the process to participate, patients must also be capable of making and communicating health care decisions for themselves, must be physically able to take the medications themselves, must be free of a mental illness that impairs their ability to make informed decisions, and must have a terminal diagnosis that will lead to death within six months.
Because the entire process depends on a patient meeting the criteria, a physician to write the prescription after determining a patient meets criteria, a second physician confirming the terminal diagnosis and recommendation, and a pharmacy to fill it, a patient must also find the medical personnel willing to participate in medical aid in dying. Participation by medical staff is voluntary; no one is required to provide the prescription. Also, some health care institutions may prohibit their staff from participating in the Death with Dignity Act. Even after you find willing physicians and pharmacists, there are detailed steps to obtain the prescription. Thus, the time it can take to clear all the needed hurdles can take up to a month or more. Since changes made to the law in 2020, a physician can request a reduction in the waiting periods, if the prescribing physician feels the person’s life expectancy is less than the waiting period. However, even if this reduction is allowed, all steps of the law must still be followed.
Despite the barriers, if you have a terminal condition or are nearing the end of your life, having the ability to hasten death in a more comfortable way than may otherwise be experienced can offer a sense of security. The top reasons people cite for participating in medical aid in dying has less to do with pain, and more about feeling a loss of autonomy or a loss of the ability to do the things that make life enjoyable. Others want it because they’ve had to live with an illness for a long time and have felt totally out of control because of it. As people anticipate disease getting worse, they say they want some control in the final act of their lives.
So far, in Oregon’s 22-year history, the diseases these patients most commonly have are cancer, neurological disease, lung disease and heart disease; however, it is the terminal diagnosis which is required and not the type of condition. Only 60 percent of those who collect the medication actually take it.
Once a patient decides to explore the process, they begin by asking their doctor for information.
Samaritan has a policy of neutrality, meaning that, if a patient asks about medical aid in dying, a Samaritan provider will give them the information as neutrally as possible. Samaritan’s goal is not to obstruct the process, but not to actively promote it. It is important patients understand all the available options at the end of life, such as ways to manage symptoms, hospice care and psycho/social supports Samaritan can offer. Throughout the entire process, patients can change their minds about any path they’ve chosen.
If, after obtaining information, the patient wants to continue with next steps, the average process takes a minimum of 15 days, if everything goes smoothly.
A patient will be required to make both verbal and written requests and will need two physicians to independently verify that the patient meets criteria to qualify for the medication. Additionally, a patient will need a pharmacy that agrees to fill the prescription, which may require going to a pharmacy outside their usual location. (For example, the nearest pharmacy to the Samaritan service area is in Portland.) Throughout the process of making requests and verification there are various waiting periods.
Every illness does not lend itself to this process because it is difficult to predict how long someone has to live. You could seem just fine and suddenly take a turn for the worse and quickly lose the physical or mental ability required to take the medication on your own. For example, in the case of dementia, by the time a person has six months to live, they no longer have the capacity required.
While every person is different, in most instances, the person is asleep and comatose within 45 minutes of ingesting the medication, and death can occur within an hour or two. The medication includes a number of sedatives to ensure comfort during the dying process.
Medical aid in dying is a decision that needs careful consideration. It is important to know your options and to have a serious discussion with a medical professional. Often you and your loved ones will have questions. For more information, contact your physician or call the Samaritan Death with Dignity Resource Center at 541-768-2187. Kelsey Terland, MD, is the medical director of Samaritan Palliative Care, a multidisciplinary team that supports patients with serious illness, and is the physician advisor for questions related to Death with Dignity.