California's End of Life Option Act took effect in June 2016. One of the biggest concerns from the bill’s opponents was that masses of people, particularly the disadvantaged, would be targeted and coerced into dying if physicians were allowed to prescribe a lethal dose of medicine for those who were terminally ill. But if we take a look at those states where the law has been in effect long enough to provide meaningful metrics (Oregon passed its law nearly 20 years ago), those fears have not been realized. A recent Los Angeles Times op-ed article by Ann Neumann discusses the realities of who is actually using this law.
Who will use the new law?
It’s been just a few months since the law went into effect here in California, so it’s too soon to know its full implications here at home, but in those states where aid in dying is legal--Oregon, Washington, Montana and Vermont--the number of people choosing to use this law is fewer than 1% of those who die each year. Based on 18 years of data from Oregon, whose Death with Dignity Act was the first such law in the nation, the majority of those who use the law are older, white and well-educated.
End of Life Option Act: a matter of insurance coverage and economics
When demographics such as education level and insurance type are analyzed along with race, Oregon's data tell us that it is the privileged who use aid in dying. Nearly 72% had at least some college and private insurance.
According to a National Public Radio report, the cost of a lethal dose of the most commonly prescribed aid-in-dying drug — the sleeping pill Seconal — rose from $1,500 to more than $3,000. Even a less expensive drug cocktail costs about $400. Insurance may cover at least some of the cost; it is up to each plan. State Medicaid funds are available in Oregon and California, but federal funds cannot be used for aid-in-dying drugs.
Aid in dying protocol a complex process
Given the nature of death with dignity laws, it isn't surprising that only a small number of people choose to make use of the right to die--it's a complex process. To get a prescription for lethal drugs, patients must be adults, and they must be deemed by two doctors to have six months or fewer to live. Patients must request a lethal prescription verbally and in writing, with a waiting period in between. If their mental competence is questioned, a psychiatrist must be consulted. Once patients obtain a prescription, they choose when to fill it and when to self-administer the drugs.
Oregon data provides a profile of who uses aid in dying
From 1998 through 2015, a total of 991 Oregonians died from ingesting DWDA drugs.
- A majority were over the age of 65 (nearly 70%).
- Slightly more were male (51%) than female.
- Most were diagnosed with terminal cancer (77%).
- Almost all were enrolled in hospice care (90%) and died at home (94%).
Racial and socioeconomic demographics of Oregon’s law
Nearly 97% of those who have exercised the right to die in Oregon were white. Keep in mind that Oregon has a relatively small minority population, but even where the percentages are higher, it's probable minorities will make use of the law in lower numbers. California’s population is much more diverse, so the numbers may be distributed more evenly across all demographic groups, though it’s too early to identify trends.
Data raises question whether aid in dying is working
If the premise of aid in dying is to prevent pain and suffering among terminally ill patients — something people of all races and from all walks of life experience — the narrow pattern of use that shows up in the data is a cause for concern. The availability of choice may be the primary factor behind the predominance of white, privileged patients seeking and using aid in dying.
Those with means always have more choices
Unfortunately, this law may represent another example of the growing disparity not just in American lives, but in the healthcare choices of its citizens.