By Michael Cook, BioEdge, April 13, 2013
A cancer centre in Washington state has published in the New England Journal of Medicine a blueprint of how to implement a dying-with-dignity program, now that assisted suicide has been legalised.
The Seattle Cancer Care Alliance, which is associated with the Fred Hutchinson Cancer Research Center, says that the protocols it followed to help 40 of its patients die were designed to “adhere to legal regulations, maintain safety, and ensure the quality of patient care”. These include liaising with a social worker, identifying a doctor who will prescribe the lethal dose, helping with paperwork, and conducting a psychosocial assessment.
Of the 40, 24 died after taking secobarbital and 16 died later of their disease. Patients and families were “grateful” to receive the lethal prescription whether or not it was used. One of the 24 took more than a day to die, an outcome which distressed his family and the doctor. None of them were deemed to be depressed.
The main reasons why patients sought death with a lethal drug were loss of autonomy (97%), inability to engage in enjoyable activities (89%), and loss of dignity (75%). About 22% reported that they either had uncontrolled pain or were worried about having it in the future. "People who pursue Death with Dignity tend to be individuals who want to be independent and want to have control over the conditions and timing of their final moments of life," said Elizabeth Trice Loggers, one of the study’s authors. The participants were mostly white men with more than a high school education. They were married and ranged in age from 42 to 91.
The SCCA took some steps to dampen potential controversy. It does not accept new patients solely to access the DWD program. Information about it is not posted in public spaces of the clinic (although it is available on the centre’s blog). The patients must agree not to take the lethal dose in a public area. No doctors are required to participate.