Legalized Physician Assisted Death in Oregon—Eighteen Years’ Experience

  • Linda GanziniEmail author
Conference paper
Part of the Veröffentlichungen des Instituts für Deutsches, Europäisches und Internationales Medizinrecht, Gesundheitsrecht und Bioethik der Universitäten Heidelberg und Mannheim book series (IMGB, volume 46)


Five US states have defined a legal pathway for their residents to choose physician-assisted death (PAD). The Oregon Death with Dignity Act was passed by citizen’s initiative in 1994 and, after a series of legal challenges, enacted in 1997. In 2008, through a voter-initiated referendum, Washingtonians passed an almost identical law. In 2009, the Montana Supreme Court held that a terminally ill, mentally competent patient’s consent to physician aid-in-dying protected the physician against a charge of homicide. In 2013, Vermont legalized PAD, the first to use the traditional legislative process (Vermont Health Department). California’s legislature also passed a PAD law in 2015, which is likely to be enacted in 2016. No other form of PAD – that is physician prescription and patient consumption of medications for the sole purposes of causing death – is legal in the United States at this time, though studies support that in other states physicians rarely prescribe medications to hasten death outside the law.


Acknowledgement and Disclaimer

This material is the result of work supported with resources and the use of facilities at the Portland Veterans Affairs Medical Center. The views expressed in this chapter are those of the author and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.


  1. Back AL, Starks H, Hsu C, Gordon JR, Bharucha A, Pearlman RA (2002) Clinician-patient interactions about requests for physician-assisted suicide: a patient and family view. Arch Intern Med 162:1257–1265CrossRefGoogle Scholar
  2. Breitbart W, Rosenfeld B, Pessin H, Kaim M, Funesti-Esch J, Galietta M et al (2000) Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 284:2907–2911CrossRefGoogle Scholar
  3. Bruce ML, Have TR Ten, Reynolds CF III, Katz II, Schulberg HC, Mulsant BH et al (2004) Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA 291:1081–1091Google Scholar
  4. Campbell CS, Cox JC (2010) Hospice and physician-assisted death: collaboration, compliance, and complicity. Hastings Cent Rep 40:26–35CrossRefGoogle Scholar
  5. Campbell CS, Cox JC (2012) Hospice-assisted death? A study of Oregon hospices on death with dignity. Am J Hosp Palliat Care 29:227–235CrossRefGoogle Scholar
  6. Carlson B, Simopolous N, Goy ER, Jackson A, Ganzini L (2005) Oregon hospice chaplains’ experiences with patients requesting physician-assisted suicide. J Palliat Med 8:1160–1166CrossRefGoogle Scholar
  7. Dobscha SK, Heintz RT, Press N, Ganzini L (2004) Oregon physicians’ responses to requests for assisted suicide: a qualitative study. J Palliat Med 7:451–461CrossRefGoogle Scholar
  8. Emanuel EJ, Fairclough DL, Emanuel LL (2000) Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. JAMA 284:2460–2468CrossRefGoogle Scholar
  9. Foley K, Hendin H (2002) The Oregon experiment. In: Foley K, Hendin H (Hrsg) The case against assisted suicide. The Johns Hopkins University Press, Baltimore, pp 144–174Google Scholar
  10. Ganzini L (2010) Strange deathbedfellows. Hastings Cent Rep 40:3CrossRefGoogle Scholar
  11. Ganzini L, Beer TM, Brouns M, Mori M, Hsieh Y-C (2006) Interest in physician-assisted suicide among Oregon cancer patients. J Clin Ethics 17:27–38Google Scholar
  12. Ganzini L, Dobscha SK (2003) If it isn’t depression. J Palliat Med 6:927–930CrossRefGoogle Scholar
  13. Ganzini L, Dobscha SK (2004) Clarifying distinctions between contemplating and completing physician-assisted suicide. J Clin Ethics 15:119–122Google Scholar
  14. Ganzini L, Dobscha SK, Heintz RT, Press N (2003) Oregon physicians’ perceptions of patients who request assisted suicide and their families. J Palliat Med 6:381–390CrossRefGoogle Scholar
  15. Ganzini L, Fenn DS, Lee MA, Heintz RT, Bloom JD (1996) Attitudes of Oregon psychiatrists toward physician-assisted suicide. Am J Psychiatry 153:1469–1475CrossRefGoogle Scholar
  16. Ganzini L, Goy ER, Dobscha SK (2009) Oregonians’ reasons for requesting physician aid in dying. Arch Intern Med 169:489–492CrossRefGoogle Scholar
  17. Ganzini L, Goy ER, Dobscha SK (2008) Prevalence of depression and anxiety in patients requesting physicians’ aid in dying: cross sectional survey. Br Med J 337:a1682Google Scholar
  18. Ganzini L, Harvath TA, Jackson A, Goy ER, Miller LL, Delorit MA (2002) Experiences of Oregon nurses and social workers with hospice patients who requested assistance with suicide. N Engl J Med 347:582–588CrossRefGoogle Scholar
  19. Ganzini L, Lee MA, Heintz RT, Bloom JD, Fenn DS (1994) The effect of depression treatment on elderly patients’ preferences for life-sustaining medical therapy. Am J Psychiatry 151:1631–1636CrossRefGoogle Scholar
  20. Ganzini L, Leong GB, Fenn DS, Silva JA, Weinstock R (2000a) Evaluation of competence to consent to assisted suicide: views of forensic psychiatrists. Am J Psychiatry 157:595–600CrossRefGoogle Scholar
  21. Ganzini L, Nelson HD, Lee MA, Kraemer DF, Schmidt TA, Delorit MA (2001) Oregon physicians’ attitudes about and experiences with end-of-life care since passage of the Oregon Death with Dignity Act. JAMA 285:2363–2369CrossRefGoogle Scholar
  22. Ganzini L, Nelson HD, Schmidt TA, Kraemer DF, Delorit MA, Lee MA (2000b) Physicians’ experiences with the Oregon Death with Dignity Act. N Engl J Med 342:557–563CrossRefGoogle Scholar
  23. Goy ER, Jackson A, Harvath TA, Miller LL, Delorit MA, Ganzini L (2003) Oregon hospice nurses and social workers’ assessment of physician progress in palliative care over the past five years. Palliat Support Care 1:215–219Google Scholar
  24. Harvath TA, Miller LL, Smith KA, Clark LD, Jackson A, Ganzini L (2006) Dilemmas encountered by hospice workers when patients wish to hasten death. J Hosp Palliat Nurs 8:200–209CrossRefGoogle Scholar
  25. Henriksson MM, Isometsa ET, Hietanen PS, Aro HM, Lonnqvist JK (1995) Mental disorders in cancer suicides. J Affect Disord 36:11–20CrossRefGoogle Scholar
  26. Hotopf M, Chidgey J, Addington-Hall J, Ly KL (2002) Depression in advanced disease: a systematic review Part 1. Prevalence and case finding. Palliat Med 16:81–97CrossRefGoogle Scholar
  27. Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16:606–613CrossRefGoogle Scholar
  28. Loggers ET, Starks H, Shannon-Dudley M, Back AL, Appelbaum FR, Stewart FM (2013) Implementing a death with dignity program at a comprehensive cancer center. N Engl J Med 368:1417–1424CrossRefGoogle Scholar
  29. Mesler MA, Miller PJ (2000) Hospice and assisted suicide: the structure and process of an inherent dilemma. Death Stud 24:135–155CrossRefGoogle Scholar
  30. Miller LL, Harvath TA, Ganzini L, Goy ER, Delorit MA, Jackson A (2004) Attitudes and experiences of Oregon hospice nurses and social workers regarding assisted suicide. Palliat Med 18:685–691CrossRefGoogle Scholar
  31. Murphy E (1994) The course and outcome of depression in late life. In: Schneider LS, Reynolds CF III, Lebowitz BD, Friedhoff AJ (Hrsg) Diagnosis and treatment of depression in late life: results of the NIH consensus development conference. American Psychiatric Press, Washington, pp 81–98Google Scholar
  32. National Hospice and Palliative Care Organization (2012). NHPCO facts and figures: Hospice care in America. National Hospice and Palliative Care Organization, AlexandriaGoogle Scholar
  33. Ogden RD, Young MG (2003) Washington state social workers’ attitudes toward voluntary euthanasia and assisted suicide. Soc Work Health Care 37:43–70CrossRefGoogle Scholar
  34. Oregon Hospice Association (2014). Annual report 2014. Accessed 11 June 2015
  35. Oregon Public Health Division (2006). Eighth annual report on Oregon’s Death with Dignity Act. 9 March 2006. Accessed 31 Jan 2013
  36. Oregon Public Health Division (2016). Oregon’s Death with Dignity Act—2015. March 2016. Accessed 7 March 2016
  37. Pearlman RA, Hsu C, Starks H, Back AL, Gordon JR, Bharucha AJ et al (2005) Motivations for physician-assisted suicide. J Gen Intern Med 20:234–239CrossRefGoogle Scholar
  38. Pisto LA, Sanford ST (2010) Implementing Washington’s Death with Dignity Act: legal and policy issues. Two down, more to come? Or is this the end of the line?
  39. Rosenfeld B, Breitbart W, Gibson C, Kramer M, Tomarken A, Nelson C et al (2006) Desire for hastened death among patients with advanced AIDS. Psychosomatics 47:504–512CrossRefGoogle Scholar
  40. Silveira MJ, DiPiero A, Gerrity MS, Feudtner C (2000) Patients’ knowledge of options at the end of life: ignorance in the face of death. JAMA 284:2483–2488CrossRefGoogle Scholar
  41. Starks H, Back AL, Pearlman RA, Koenig BA, Hsu C, Gordon JR, Bharucha AJ (2007) Family member involvement in hastened death. Death Stud 31:105–130CrossRefGoogle Scholar
  42. Sullivan M, Ganzini L, Youngner SJ (1998) Should psychiatrists serve as gatekeepers for physician assisted suicide? Hastings Cent Rep 28:14–22CrossRefGoogle Scholar
  43. Supreme Court of the State of Montana, Baxter R, Speckart S MD, Loehnen CP MD, Autio L MD, Risi G Jr MD (2009) Compassion & choices v. state of Montana and Steve Bullock. In: DA 09-0051 2009 MT 449Google Scholar
  44. The Task Force to Improve the Care of Terminally-Ill Oregonians, Dunn P, Reagan B, Tolle SW, Foreman S (2008) The Oregon Death with Dignity Act: a guidebook for health care professionals. Accessed 26 Feb 2013
  45. Tolle SW, Tilden VP, Drach LL, Fromme EK, Perrin NA, Hedberg K (2004) Characteristics and proportion of dying Oregonians who personally consider physician-assisted suicide. J Clin Ethics 15:111–118Google Scholar
  46. Vermont Health Department: Patient choice and control at end of life. Accessed 11 June 2015

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© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of PsychiatryOregon Health and Science UniversityPortlandUSA

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