Trends in Reported End-of-Life Concerns after the Legalization of Physician-Assisted Suicide

Understanding the concerns that motivate requests for assisted dying (euthanasia or assisted suicide) is essential for understanding these practices. Our objective was to determine whether there are significant trends in end-of-life concerns cited in requests for physician-assisted suicide (PAS) in Oregon and Washington.

We estimated regressions using data on reported end-of-life concerns (autonomy, enjoyment, dignity, control, burden, pain, and finance) taken from annual state reports and which covered 6853 deaths. We pooled the data for our two states and estimated the trend for each end-of-life concern. We added controls for demographic variables, separated time trends for each state, and added other tests for robustness.

Our estimates suggested no significant trend for autonomy or enjoyment. The common trend was negative and statistically significant for dignity and control, but control was not significant for Washington. Trends were significantly positive for burden, pain, and finance, but finance was not significant for Washington.

There have been significant trends in reported end-of-life concerns that motivate requests for PAS in Oregon and Washington. The increase in perceived burdensomeness as a motivation for PAS adds weight to the argument that changing the law can have an adverse effect on the self-perception of those who receive care. Qualitative research has identified adverse impacts of assisted dying on pain management. Our findings suggest a significant increase in concerns about inadequate pain control since the legalization of PAS. We found no evidence that the Patient Protection and Affordable Care Act has reduced the proportion of people seeking death because of concerns about the cost of their care.