Oregon And Washington State: What’s The Situation?

Assisted suicide is currently legal in 11 US states, however euthanasia remains a federal offence. Assisted suicide is when lethal drugs are prescribed to a patient who must self-administer the cocktail, usually via oral ingestion. Euthanasia would allow a third party, such as a doctor, to administer the lethal drugs to the patient, usually via injection.

Despite 11 states legalising the practice, only three publish good quality, detailed annual reports: California, Oregon, and Washington State.

Of these three, Oregon and Washington provide arguably the best data sets for assisted suicide anywhere in the world. However, it must be noted that the bar is low – ‘assisted dying’ is notoriously poorly recorded around the world, and despite Oregon and Washington being the best, they still have significant issues and gaps in their data.

Oregon and Washington’s data both reveal three significant issues: frequent complications; changing reasons people are applying for assisted suicide; and extremely long deaths resulting from the prescription of unapproved, unstudied lethal drugs.

Regarding complications, between 2010-2022 there was an average recorded complication rate of over 11% in Oregon. These complications include regurgitation and seizures. At least 9 people have even regained consciousness and survived the lethal drugs, only to later pass away of their original illness. It is noteworthy that of these 9 individuals, none opted to try assisted suicide again.

However, as previously mentioned, data collection is poor, and particularly so in Oregon. In recent years most post-death forms have been left partially blank by the reporting physicians. This is especially true when reporting complications. In 2023, the section pertaining to recording complications was left blank in 72% of cases and listed as “unknown”. Clinicians are under no legal obligation to fully fill out the forms or even be present with the patient when they take the lethal drugs.

The US State of Washington has seen similar issues. Complications including regurgitation, seizures and regaining consciousness have all been recorded since its implementation in 2009. For example, in 2018, there were 8 recorded complications, all of which were regurgitation as a result of the ingestion of lethal drugs. 179 cases reported no issues, however, similar to Oregon, not all documents are filled out, with 16 further cases as being left as “unknown”.

Between 2009-2018 of the known data, there was an average 3.34% complication rate, with a peak of 5% in 2016. However, on average during the same period, complications for almost 8% of cases were listed as ‘unknown’ each year, also peaking in 2016 with 11% ‘unknown’. After 2018, Washington stopped publishing data relating to complications altogether.

Moving on to the reasons people are applying for assisted suicide, both Oregon and Washington present applicants with a short questionnaire asking them for their reasons. In 1997, the first year of implementation in Oregon, just 13% of respondents said they applied because they felt like a burden on their family, friends and caregivers. However, since 2017, some 52.2% of applicants have said they applied because they felt like a burden. So much so, feeling like a burden on their family consistently ranks above pain control as a reason to apply.

Washington has seen a very similar trend. In 2009, just 23% of applicants cited feeling like a burden on their family as a reason for applying for assisted suicide. In 2022, the most recent year of data available, 59% of people said they felt like a burden.

These very similar trends suggest that once assisted suicide is an option, people who qualify feel pressure (either from those around them or, more likely, from themselves) to use it. That pain control remains a relatively low-ranking reason suggests this is less about unbearable physical suffering than is being presented.

Further evidence of this is the increasing proportion of people in both Oregon and Washington who are applying for financial reasons. In Washington in 2009, 2% of applicants applied because continuing treatment for their condition was too expensive. This had increased to 10% in 2022. Similarly in Oregon, between 1998-2021, 5% of applicants applied because continuing treatment was too expensive. In 2023, it was 8.2%. The fact that this figure climbed in both Washington and Oregon should be a cause for concern and shows assisted suicide has a much wider and deeper societal impact than many assume. It has gone from an option to a suggestion, to an expectation.

An area often neglected in the debate surrounding assisted suicide is the lethal drugs themselves. None of the drugs used in assisted suicide have been approved by any independent regulatory body anywhere in the world for the purposes of assisted suicide. Oregon and Washington are not unique in this respect – every jurisdiction uses their own cocktails with varying degrees of effectiveness. However, the lack of research into these lethal concoctions means we ultimately don’t know how they kill people and if it is indeed a peaceful death. In Oregon in 2023, at least 5 different mixtures of lethal drugs were prescribed for assisted suicide.

Also in Oregon, on top of their 11% complication rate, there have been a series of extremely long deaths by assisted suicide. In 2023, they tragically broke their own record, with one assisted suicide taking 137 hours between the ingestion of lethal drugs and death. The previous longest death had taken 104 hours. The median time between ingestion and death has also been increasing. Between 1998-2021, the median was 30 minutes. However, in 2022, it increased to 51 minutes and in 2023 to 53 minutes.

Finally, according to Oregon’s Death with Dignity Act, one can only apply for assisted suicide if diagnosed with a terminal illness with six months or less to live. However, by refusing treatment, people can effectively ‘make themselves terminal’. For example, diabetes is a highly treatable condition today and we would not conventionally consider it a terminal illness. Yet last year, in 2023, 8 people had assisted suicide because a “Endocrine/metabolic disease [e.g., diabetes]”. Over the last few years, at least 38 people have had assisted suicide in Oregon on the same grounds. This shows just how tightly definitions must be made within any law, as assisted suicide for diabetes was not what lawmakers had in mind when they first passed the legislation.