SCCA’s Death with Dignity program was adapted from existing programs in Oregon. Significant internal debate took place before a policy was written and approved. Linda Ganzini, M.D., M.P.H., professor of psychiatry and medicine at Oregon Health & Science University and the country’s foremost expert on death with dignity programs, was brought in to consult.
Among the decisions made to address potentially controversial aspects:
• SCCA does not accept new patients solely for the purpose to access the Death with Dignity program.
• Information is not posted in public spaces of the clinic, effectively requiring patients to initiate requests with their doctor.
• Participants are required to sign an agreement not to take the lethal prescription in a public area or manner. This is more restrictive than the Death with Dignity state law, which only recommends this.
• No physicians or staff members are compelled to participate. A confidential survey asked about 200 SCCA physicians their willingness to act as prescribing or consulting clinicians as defined in the law. Eighty-one responded, with 50 physicians willing to participate in either role. Thirty-one physicians were unwilling or undecided.
According to Loggers, the decision to offer a Death with Dignity program to patients was a small part of offering a broad spectrum of high quality cancer care.
“Throughout history, cancer has been one of the paradigmatic diseases where we must prospectively deal with the knowledge of death,” she said. “You can’t ignore death if you are going to be a good medical oncologist or an organization that cares well for cancer patients and their families,” said Loggers, who is a medical oncologist and board-certified in hospice and palliative medicine. She is also an assistant member of the Clinical Research Division at Fred Hutchinson Cancer Research Center and an assistant investigator at Group Health Research Institute.
“In a pluralistic society where 58 percent of Washington voters affirmed that terminally ill individuals should have Death with Dignity as a legitimate choice at end of life, we felt compelled to honor that for patients and families,” she continued. “It’s also important to note that the vast majority of families, including those who also select Death with Dignity, opt for palliative and hospice care at end of life. The existence of Death with Dignity hasn’t changed that.”
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