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Too early to form reliable conclusions, but some worrying signs

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The 2011 annual report on physician-assisted suicide in Washington State has been published

The official report has now appeared of legal physician-assisted suicide (PAS) in Washington State in 2011. Washington State, along with neighbouring Oregon, is one of just two US States that have passed legislation licensing doctors to supply lethal drugs to terminally ill patients.

The report records that 103 terminally ill persons in Washington State received prescriptions for lethal drugs in 2011 and that 94 of these died. 70 of them died as a result of taking the drugs and 19 died without having taken them. Five other recipients of lethal drugs died, but it is not known whether or not their deaths resulted from taking the drugs. No information is available as to whether the remaining nine recipients have died.

The figure of 70 deaths from ingestion of lethal drugs may therefore be regarded as a minimum figure. At this level, it represents an increase of 38 per cent over the 2010 figure. Washington State's death rate from PAS in 2011 is equivalent to 813 such deaths in the UK.

It should be noted, however, that Washington's PAS law has been in force for only three years. Neighbouring Oregon's death rate after three years was significantly less than it is today. Oregon's experience suggests that the death rate from PAS in Washington will continue to rise. There have now been fourteen annual returns on the operation of Oregon's PAS law. Oregon's death rate from PAS at Year 14 (2011) was two and half times the rate at Year 3, and there is no sign of a steady state being reached.

Washington's detailed analysis of its PAS data focuses on recipients of lethal drugs who have died, whether from taking those drugs or not, whereas Oregon's data relate to those who have died after ingesting prescribed lethal drugs. However, as the great majority of Washington's recipients who died are recorded as having died as a result of taking the drugs supplied to them, it is probably fair to assume that they shared, more or less, the characteristics of the group as a whole.

As with Oregon, the main incidence of PAS in 2011 was among the elderly: 64 per cent of those who were supplied with lethal drugs in 2011 were aged 65 or over.

Referral for psychological assessment was the exception rather than the rule: 1 in 20 of those who received lethal drugs had been so assessed.

Again as with Oregon, there were more prescriptions for lethal drugs issued than there were prescribing physicians. It is not clear from the published data to what extent multiple prescribing is taking place - whether, for example, several physicians wrote two prescriptions or whether one or two wrote larger numbers.

The data recorded on the duration of doctor-patient relationships show that nearly half of those who received lethal drugs had been patients of the prescribing doctor for less than 24 weeks.

It is too early to form reliable conclusions on the operation of Washington's 2008 PAS law. The reports available, however, show much similarity with Oregon's experience. The most notable difference is in the death rate, which is higher than Oregon's at the same stage.

Click here to view the 2011 annual report.

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