What news from the Golden State?

California seems to be headed in a similar direction to Oregon

The report, issued this week by the California Department of Public Health (CDPH), on the initial outturn of that State’s 2016 End of Life Options Act shows much similarity with Oregon’s first-year report on its own 1997 Death with Dignity Act. For the uninitiated both these laws permit doctors to prescribe lethal drugs for self-administration to terminally-ill patients who are thought to meet certain conditions.  In other words, they are laws licensing physician-assisted suicide (PAS).

California’s report covers only a half year – from 9 June to 31 December 2016.  Future reports will cover whole calendar years.  It states that 173 “unique physicians” supplied prescriptions for lethal drugs to 191 applicants.  It is not clear what the phrase “unique physicians” means.  The mismatch between the numbers of physicians and patients suggests that there must have been some mutliple prescribing, though it is not clear by how many doctors or to what extent.

Of the 191 recipients of prescriptions for lethal drugs, 111 went on the take them and end their lives, while 21 died of natural causes.  However, there is a substantial number of recipients (59) for whom the CDPH is unable to account.  If the experience of Oregon is anything to go by, these will comprise people who have postponed taking the drugs and will either take them in succeeding years or will not take them at all.  It can be plausibly argued that some people seek lethal drugs not necessarily to take at once but as a form of ‘insurance policy’.  On the other hand, the question arises: would those who do resort to taking their own lives have done so if they had not been provided with the means?

The death rate reported from PAS in California is 6.06 per 10,000 deaths.  This is a little higher than Oregon’s reported death rate (5 per 10,000 deaths) in the first year (1998) of its own PAS law.  To date the Oregon death rate has increased to 37.2 per 10,000 deaths (the equivalent of just under 2,000 deaths per annum in England and Wales) and it is reasonable to expect that California’s will follow suit.  It is predictable that numbers will rise following the introduction of new legislation.  What is unknown is for how long the rising trend will continue.  In Oregon we have seen a pattern of ups and downs but after nearly 20 years the overall upward trend shows no sign of stabilising.  

The characteristics recorded of those who took their own lives by PAS in California in the second half of 2016 look similar those that have been seen in Oregon – predominantly elderly, white and higher-educated with, in the main, cancer or neuromuscular conditions.   The first report from California is interesting, though it could perhaps be a little more informative – for example, on the length of doctor-patient relationships for those supplied with prescriptions for lethal drugs.  These and other data will, it is to be hoped, be included in future reports as more information is gathered.