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Death with Dignity improved end-of-life care

Victoria Worthington, the subject of today’s front-page story, is living — and ending — her life on her own terms. And she’s taking time to make sure Gi-gi, her canine companion of nine years, has an easy transition, too.

Worthington has heart and lung conditions that cause her excruciating pain and would inevitably take her life, but she has used Oregon’s Death With Dignity law to obtain a lethal dose of medication to die at a time and place of her choosing.

But before that happens, Worthington will take her emotional support dog to the beach — somewhere Gi-gi has never been because Worthington’s illnesses made it difficult for her to travel. On that one-night beach visit, she will hand over Gi-gi’s care to the close friend who bonded with her as a bedside volunteer at Celia’s House, the nonprofit hospice facility in Medford.

In many ways, Worthington is fortunate to live in Oregon, and not just because the Death with Dignity law gives her the option to choose how when and how her life will end, but because of the changes in end-of-life care that the law fostered.

Oregon was the first state in the nation to legalize physician-assisted suicide, now referred to as physician aid in dying. Voters approved it in 1994, by a margin of 51% to 49%. Three years later, opponents of the law placed a measure on the ballot to repeal it; that effort failed, 60% to 40%, and the law was implemented in 1998.

The Oregon law was carefully drafted to include safeguards against any coercion or abuse. The result has been that a very small proportion of people have used it to take their lives — barely more than half a percent of total deaths in the state last year. Of those who go through the process of obtaining the lethal prescription, one-third never take it.

But the greatest benefit of the law may be the changes it prompted. A 2017 report in the New England Journal of Medicine found more people die at home or in hospice in Oregon than in any other state. Oregonians are more likely to have their care wishes honored at the end of life and less likely to be hospitalized than anywhere else in the country.

A 2015 report in the Journal of Palliative Medicine suggested Oregon’s high quality of end-of-life care was connected to the Death with Dignity Act:

“It is possible that the Oregon Death with Dignity Act has resulted in or at least reflects more open conversation and careful evaluation of end-of-life options, more appropriate palliative care training of physicians, and more efforts to reduce barriers to access to hospice care and has thus increased hospice referrals,” the authors wrote.

Victoria Worthington’s story is evidence of that. She has obtained the prescription needed to end her life, but even if she winds up among the one-third of people who don’t use the drugs, she has already benefited from the law through the availability of hospice care and the freedom to plan her last days knowing she has control over them.