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In Oregon, aid in dying has been legal since 1997. Here's how it works.

PORTLAND, Ore. — Terminally ill Oregon patients with less than six months to live have been able to request lethal medication to end their lives since 1997. Here's how the state legalized aid in dying and how the law works.

How did the law come about?

Sen. Frank Roberts introduced a bill for medical aid in dying in the state legislature three times: in 1989, 1991 and 1993. The bill never passed, but a group of citizens circulated an initiative petition, which allows residents to place legislation on the popular ballot if they gather enough signatures.

In 1994, Oregon voters passed the Death with Dignity Act with 51 per cent in favour. The law languished amid court challenges until 1997, when legislators placed a measure on the ballot asking residents to repeal the act. That time, citizens voted 60 per cent in favour of keeping the law.

How does the law work?

Two doctors must diagnose a patient with a terminal illness that would cause death within six months. The patient's request must be voluntary and confirmed by two witnesses, at least one of whom cannot be a family member. If doctors thinks a patient's judgment is impaired, such as by mental illness, they must refer them to a psychiatrist for approval.

The patient must make two oral requests 15 days apart, and one written request. Once this process is complete, a doctor writes a prescription for a lethal dose of medication. The patient must physically take the medication. No one else can administer it.

What kind of medication is it?

Doctors most frequently prescribe Seconal or secobarbital, a barbiturate originally developed as a sleeping medication. Patients must take 10 grams of the drug, or about 100 capsules. After Quebec-based Valeant Pharmaceuticals doubled the price last year to about $3,000 for 100 pills, some doctors have begun searching for alternative medications.

What happens when a patient takes the medication?

The person typically falls asleep within a few minutes and dies within hours. The median time between ingestion and death in 2015 was 25 minutes, but at least one death took 36 hours. Critics say complications such as vomiting or people waking up are more common than reported, but advocates and family members describe the deaths as peaceful and gentle.

Do doctors and pharmacists have to participate?

No, participation is voluntary for all health-care workers. Doctors can refuse requests and do not have to refer patients, while pharmacists can refuse to fill prescriptions.

How many people have used aid in dying?

A total of 1,545 people have received prescriptions, and 991 patients have died from ingesting the medication. The number of users remains low but has increased in recent years. During 2014 and 2015, the number of annual prescriptions increased by an average of 24.4 per cent. Still, the rate of deaths using aid in dying last year was 38.6 per 10,000 total deaths.

What kind of people use aid in dying?

Cancer patients are by far the most common users of the law, comprising 77 per cent of those who have taken the medications. Eight per cent of users are ALS patients. Nearly all patients — 96 per cent — are white. Most are over 65 and educated, with 45 per cent holding a bachelor's degree or higher. The split between men and women is about even.

What are the controversies surrounding the law?

The debate surrounding aid in dying is mostly settled in Oregon, but a vocal minority continues to oppose it. Dr. William Toffler argues the law has corrupted the medical profession. He says some patients fear "death doctors" who push assisted death, while doctors have lost touch with their roles as healers and seekers of medical advances.

Research by psychiatrist Linda Ganzini has also shown that some terminally ill patients suffering from depression have been able to get prescriptions, despite safeguards meant to prevent that from happening. Of 18 people who used aid in dying to end their lives during her study, three met the clinical definition of depression when they were prescribed the pills.

What has been the impact of the law?

Advocates say there have been no documented complaints about exploitation or coercion, and no referrals have been made to Oregon's Medical Board for failure to comply with the act. Opponents have catalogued a handful of cases where they allege people with early dementia or under financial pressure have used the law.

Former Oregon Hospice Association director Ann Jackson says the state had high-quality palliative care prior to the law and continues to rank highly among U.S. states. Ninety per cent of patients who use aid in dying are in hospice care and only 25 per cent report inadequate pain control.

Dr. Peter Reagan, a retired doctor and spokesman for advocacy group Compassion and Choices, says the law has resulted in more open communication with patients about all end-of-life options.

— Follow @ellekane on Twitter.

Laura Kane, The Canadian Press

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