The Washington PostDemocracy Dies in Darkness

Beyond Brittany Maynard: Who is choosing to die with dignity

Brittany Maynard, a 29-year-old terminally ill woman, took her own life under Oregon’s Death with Dignity law earlier this month. (AP Photo/Maynard Family, FILE)

Advocates are hoping Brittany Maynard's story will help their efforts to pass so-called "Death with Dignity" laws in more states around the country this coming year. A bill is advancing in New Jersey, though Gov. Chris Christie has said he'll veto it, while lawmakers in several other states, including Pennsylvania and Wyoming, are weighing similar bills. The Oregonian newspaper this week started running a series of readers' end-of-life stories in the first state to legalize physician-assisted suicide. Here's a story last month, days before Maynard took her own life, on the history of Death with Dignity laws.

Brittany Maynard's decision of whether to end her own life, before an aggressive and deadly form of brain cancer destroys the quality of her life, isn't made lightly. The 29-year-old knows she doesn't have long to live, and her final days may be filled with suffering — losing her ability to speak and control her own body.

Yet Maynard revealed this Wednesday evening she may extend her life beyond Nov. 1, when she originally planned to take a lethal dose of medication at home. As she explained in a new video, she feels better than she expected to, but she knows she still has the option to end her life if she's suffering.

Maynard can choose death on her own terms because she moved this year to Oregon, one of three states with laws letting physicians prescribe terminally ill patients with medications allowing them to die when they choose. Maynard's confidence in her choice, and her public defense of it, has re-opened a conversation about the ethics behind these Death With Dignity laws, as they're known.

These laws place strict limits on who can be prescribed life-ending medication. The patient must be an adult resident of the state, competent to make health-care decisions and be diagnosed with a terminal illness expected to kill the patient within six months — and two doctors must certify these conditions were met. The patient must make the request for the lethal dose of medication twice within a span of time no shorter than 15 days before the doctor can write the prescription.

Oregon's law has been in place since 1997, the state of Washington's law took effect in March 2009, and Vermont approved one last year. Oregon and Washington health departments have been reported on these programs every year, so we have a good idea of who's choosing this medical option and why.

In Oregon, the number of prescriptions written for lethal doses of medication, as well as the number of deaths resulting from those prescriptions, have generally increased each year. In all, 752 patients have ended their lives with drugs legally prescribed by a physician.

The experience has been similar in Washington State, where the law took effect in March 2009.

Not everyone who receives a prescription will choose to take it. For example, in 2013, Oregon reported that out of the 122 prescriptions written in 2013, just 63 patients ended up taking their own lives; another eight used prescriptions they had received in 2012.Twenty-eight patients died from other causes, and the status of 31 patients was still unknown at the time of the report.

The number of prescriptions and deaths this past year were higher in Washington. Of the 173 patients receiving lethal doses of medication last year, 119 ingested the medication, another 26 patients died of other causes, and the status was unknown for 28 patients at the time of the state's annual report.

The median age of patients in Oregon choosing physician-assisted suicide is 71. If Maynard does end her own life, she will be among just a few patients in Oregon under 35 who made that decision in the program's 15-year-history.

These patients also tend to be predominately white (about 97 percent in Oregon and Washington), have insurance (about 95 percent in Washington) and are more educated. About 45 percent receiving prescriptions in Oregon have at least a bachelor's degree, and about another 27 percent have some college. About nine in 10 patients from both states were enrolled in hospice care when they took the medication ending their lives.

About three-quarters of patients receiving prescriptions were diagnosed with cancer. About 7 percent of patients in the history of Oregon's program suffered from Amyotrophic lateral sclerosis, or ALS, a fatal neurodegenerative disease with no cure.

Their reasons for seeking a physician's help to end their lives are overwhelmingly similar. In Oregon, at least eight in 10 say they made the choice to end their lives because they fear losing autonomy, losing dignity, or that they'll be less able to participate in activities that make life enjoyable. Less than 3 percent in Oregon said they were concerned about the financial implications of treatment, though the rate was higher in Washington last year (13 percent).

A 2013 New England Journal of Medicine study of patients at a Washington cancer center concluded that Washington's law was rarely used and implemented properly. Advocates, including Maynard herself, are pushing for a broader adoption of the Death With Dignity laws. According to a national organization advocacy group, similar legislation over the past two years has been introduced in seven states — Connecticut, Hawaii, Kansas, Massachusetts, New Hampshire, New Jersey and Pennsylvania.

“I didn’t launch this campaign because I wanted attention; in fact, it’s hard for me to process it all,” Maynard wrote earlier this month. “I did this because I want to see a world where everyone has access to death with dignity, as I have had. My journey is easier because of this choice.”