In the two years since Washington’s “Death with Dignity” law was enacted, Asian Pacific Islander use of physician-assisted dying continues to be negligible according to a new report by the state Department of Health.
Only five percent of the 87 terminally ill patients who requested lethal doses of medication in 2010 were non-white or Hispanic. The 2011 report notes only a slight rise in the minority utilization rate from two percent in 2009.
The Death with Dignity law, which took effect on March 5, 2009, allows adult residents in the state with six months or less to live to request and self-administer lethal doses of medication from physicians.
The exact cause for the low participation rate of minorities, particularly API terminally ill individuals in physician-assisted dying remains a matter of conjecture by health experts. Some theorize that cultural differences in end-of-life decisions among minorities is a significant factor.
Hospice and palliative care participation remains low among minority families, said Robb Miller, executive director of Compassion and Choices of Washington, which advises patients and doctors about the Death with Dignity law.
“Overall, minorities have been underrepresented in the utilization of the end-of-life law,” said Miller, who attributes the low participation to suspicion of the medical system by some ethnic minority communities.
It is not unusual for African American families, for example, to delay such end-of-life decisions as securing advanced directives, he said. Lengthier hospital stays are normal, which lead to less enhanced quality of life. Minority use of palliative care is equally low.
Under-utilization rates among minority patients are not unusual according to Stuart Farber, University of Washington associate professor of family medicine. “In many minorities, family-based decision-making and an acceptance of having your community helping care for you is the norm rather than an extreme desire for autonomy and control.”
The data from Oregon suggests that patients who participate in Death with Dignity tend to be educated, upper income and have an extreme desire to be personally in control, he said.
In 2010, for Washington patients who received the prescriptions, 94 percent of the 72 individuals who died lived west of the Cascades. Ninety percent were concerned about loss of autonomy. Sixty four percent isted loss of dignity and 87 percent listed losing the ability to participate in activities that made life enjoyable.
Most of the patients, 78 percent, had terminal cancer, while ten percent had neuro-degenerative diseases like Lou Gehrig’s Disease, and 12 percent had heart disease. According to the 2011 Department of Health report, 88 percent had private, Medicare, Medicaid, or a combination of health insurance.
Of the 51 participants last year who ingested lethal doses of medication, 90 percent were at home and 84 percent were enrolled in hospice care. Emergency Medical Services were not called for intervention after ingestion of the medication by any participant, according to the Health Department report.
Data for 2010, the second year of the new law, reflects a full 12 months since the law began while the survey results for the 2009 only represents nine months in the preceding year.
Of the 87 participants last year, 51 percent died after self-administering medication prescribed by physicians. Prescriptions were written by 68 different physicians and medications dispensed by 40 different pharmacies.
Washington’s Death with Dignity law was adopted following the successful passage of Initiative 1000 in 2008. The state’s new law is the second in the nation after Oregon, to allow physicians to legally prescribe lethal doses of medication if requested by terminally ill patients.
The campaign to pass the controversial initiative was headed by former Washington governor Booth Gardner, who has Parkinson’s Disease. A similar initiative in 1991 was rejected by Washington voters by a margin of 54 percent to 46 percent.
Voters approved the new Death with Dignity law in the Nov. 4, 2008 general election by over 57 percent. Initiative 1000 is based on Oregon Measure 16, which was passed in 1994. Oregon voters reapproved it after the Oregon State Legislature referred a repeal of it to voters in 1997.
Passage of Washington’s Initiative 1000 in 2008 followed a contentious campaign and was opposed by such groups as the Coalition Against Assisted Suicide and faith-based organizations, including the Roman Catholic Church.