A POLICY ANALYSIS OF OREGON’S DEATH WITH
DIGNITY ACT OF 1997
AND COMPARISON TO CALIFORNIA’S
END OF LIFE OPTIONS ACT OF 2015
JACOB SERMENO
SCHOOL OF SOCIAL WORK
CALIFORNIA STATE UNIVERSITY, LONG BEACH
MAY, 2015
Policy overview

Oregon's Death with Dignity Act, 1997 (DWDA).

This act allows qualified Oregon residents to request prescriptions for
medications to cause death.

This action is called Physician Assisted Suicide, PAS.

PAS is not the same as euthanasia, murder, or suicide.

California is currently trying to enact a similar policy known as the
End of Life Options Act, 2015 (ELOA). (California Legislative Information “Leginfo”, 2015).
Relevance to Social Work

“Social workers respect the inherent dignity and worth of the person”

Terminally-ill individuals must be treated with dignity, even up to their
time of death.

“Social workers seek to enhance clients’ capacity and opportunity to
change and to address their own needs” (Code of Ethics, 2008 p 1).

Social workers are obliged to respect self-determination of individuals

Engage clients in informed decision making at every possible
opportunity

These values are consistent with the NASW code of ethics; however the
NASW takes no official opinion on the morality of PAS (NASW Standards for Social
(Code of Ethics of the National Association of Social Workers “(Code of Ethics)”, 2008 pp. 7 - 8).
Work Practice “NASW”, 2004 p. 13)
Literature Review

Countries that explicitly allow PAS or voluntary active euthanasia
(VAE) include: Albania, Belgium, Germany Luxemburg, The
Netherlands, Sweden (Anonymous, 2014, Humphry, 2010; ProCon.org).

On average less than 3% of deaths were a direct result of VAE
(Onwuteaka-Philipsen, et al., 2012).

Beginning in1992, Oregon became the first state to allow PAS,
implementing the DWDA in 1997.

Currently PAS is allowed in Oregon, Montana, New Mexico Vermont,
and Washington (Anonymous, 2014, Humphry, 2010; ProCon.org).

California has attempted to enact PAS legislation 6 times, and is
currently on their 7th attempt, with the ELOA (Compassion and Choices “CC”,
2014; Economou, 2008 Robinson, 2007).
Methodology

Secondary data from: academic journals, publications, government
documents, and media pulled from the internet, were examined.

For comparison similar bills were examined to the DWDA, and ELOA.

Documents were chosen based on availability, containing at least
one of the following search terms:

“Death with Dignity”
“Oregon Suicide Law”
“Physician’s Assisted
Death”
“Physician’s Assisted
Suicide”
“Voluntary Active
Euthanasia”
“Voluntary Passive
Euthanasia”
A content analysis of the articles, and documents was used to
scrutinize the effects of the Oregon’s DWDA, and California’s ELOA.
Methodology cont.

Oregon’s Death with Dignity Act of 1997 was analyzed utilizing the
framework developed by Gil, (1992), and supplemented by Jimenez,
Pasztor, Chambers, and Fujii, (2015).

The analysis contains five parts, with subsections focusing the discussion

The five main components are as follows:

I. The Social Problem Addressed by the Policy

II. The Policy Objectives, Value Premises, Expectations and Target
Populations

III. Effect of the Policy

IV. Implications of the Policy

V. Alternative Policies and Relationship to the NASW Code of Ethics
Policy Analysis

I. The Social Problem Addressed by the Policy

The DWDA set out to allow terminally-ill individuals the right to choose when and how they
die (Altmann & Collins, 2007; Chin, Hedberg, Higginson, Fleming, 1999; Humphry, 2010).

In California, Bill Monning (D-District 17), said “The core of this, is respecting the dignity and
the self-determination, and I believe a civil right and a human right, of a patient with a
terminal diagnosis, who faces a death sentence not of their own choosing“ (Bartolone, 2015. par.
8).

II. The Policy Objectives, Value Premises, Expectations and Target Populations

The objective, and inherent value of the policy is to provide qualified, terminally-ill,
individuals the opportunity of a dignified death.

DWDA was expected to provide a small number of qualified individuals a dignified death
founded by self-determination (Boyle, 2004; O'Brien, Madek, & Ferrera, 2000; Miller, 2000; Robinson, 2007).

Qualified persons are mentally competent terminally-ill individuals, with a less than 6 months
prognosis. Who are physically capable of taking their own medication, and have requested,
a prescription twice verbally 15 days apart and submitted one written request (Chin, Hedberg,
Higginson, Fleming, 1999).
Policy Analysis Cont.



III. Effect of the Policy

As of January 2015, 155 prescriptions were written for 2014; a 22% increase from 2013. 105
known deaths have resulted. Accounting for 0.3% of Oregon’s total deaths (Oregon Data, 2015).

To date in Oregon, 1,327 prescriptions have been written; with 859 deaths (Oregon Data, 2015).

Statistical information is collected, however is very general because of privacy laws.

In California a 0.3% of total deaths is 745 deaths (Centers for Disease Control and Prevention , 2014).
IV. Implications of the Policy

There are no changes in financial, or material resources. There are protections for both
patients, and doctors for participating in this or choosing not to (ORS 127.800, 2013).

If enacted, California could follow the same trends as Oregon
V. Alternative Policies and Relationship to the NASW Code of Ethics

Currently there are no alternative policies for Oregonians, or Californians to allow for medical
access to a death with dignity.

Even though the NASW does not have an official stance on PAS, it does affirms the right for
individuals to choose for themselves what medical practices they want (NASW, 2004).
Strengths and Limitations

Where PAS is legal, there is an increase in hospice care, counseling, and mental
health services (2013 DWDA Report, 2014).

With ELOA the secretive, practice of assisting people to take their own life can
be regulated, as it has been in Oregon.

One limitation is that the DWDA also does not have specific language for Nurses,
or protections of nurses or counselors who see the PAS patients.

As a protective measure individuals with disabilities are explicitly excluded

Licensed social workers are excluded from being listed as qualified mental health
care professionals that can assess patients.
References

Anonymous. (2014). Where to go to die; assisted suicide. The Economist, 412(8896), 54-107. Retrieved from:
http://search.proquest.com.mcc1.library.csulb.edu/docview/1546424580?pq-origsite=summon.

Altmann, T.K., & Collins, S.E. (2007). Oregon's death with dignity act (ORS 127.800-897): a health policy analysis. Journal of Nursing Law, 11(1), 43-52. Retrieved from:
EBSCO host.

Bartolone, P. (2015). california law makers: time is right for “end of life option” law. Capitol Public Radio. January 22. Retrieved from:
http://www.capradio.org/articles/2015/01/22/california-lawmakers-pushing-for-right-to-die-legislation/

Centers for Disease Control and Prevention (2014). Deaths and mortality. Retrieved from: http://www.cdc.gov/nchs/fastats/deaths.htm

Chin, A.E., Hedberg, K., Higginson, G.K., Fleming, D.W. (1999) Oregon.gov Public Health. Oregon Death Data, Year 1 Retrieved from:
https://public.health.oregon.gov/ProviderPartnerResources/Evaluationresearch/oregondeath data/Pages/index.aspx.

Code of Ethics of the National Association of Social Workers (Code of Ethics) (2008). Retrieved http://www.socialworkers.org/pubs/code/code.asp.

Compassion and Choices (CC) (2014). Timeline Retrieved from https://www.compassionandchoices.org/who-we-are/timeline/

Economou, E.R. (2008). What about families? a different perspective on physician assisted suicide in california. Whittier Journal of Child and Family Advocacy, 7,
253-327 Retrieved from: LexisNexis.

Humphry, D. (2010). Euthanasia Research & Guidance Organization, World Laws on Assisted Suicide Retrieved from:
http://www.finalexit.org/assisted_suicide_world_laws_page2.html

Jimenez, J., Pasztor, E.M., Chamers R.M., & Fujii C.P. (2015). Social Policy and Social Change: Toward the Creation of Social and Economic Justice. Thousand Oaks,
CA: Sage Publications.

NASW Standards for Social Work Practice in Palliative and End of Life Care (NASW) (2004). National Association of Social Workers. Retrieved from:
https://www.socialworkers.org/practice/bereavement/standards/default.asp

Onwuteaka-Philipsen, B., Brinkman-Stoppelenburg, A., Penning, C., de Jong-Krul, G., van Delden, J. et al. (2012). Trends in end-of-life practices before and after
the enactment of the euthanasia law in the netherlands from 1990 to 2010: a repeated cross-sectional survey. Lancet, 380(9845), 908-915. doi: 10.1016/S01406736(12)61034-4.

Oregon’s Death with Dignity Act – 2013 (2013 DWDA Report). (2014). Oregon.gov, Public Health Oregon Death Data, Year 16 Retrieved from:
https://public.health.oregon.gov/ProviderPartnerResources/Evaluationresearch/oregondeath data/Pages/index.aspx

Oregon’s Death with Dignity Act – 2014 (Oregon Data). (2015). Oregon.gov. Public Health. Oregon Death Data, Year 17 Retrieved from:
https://public.health.oregon.gov/ProviderPartnerResources/Evaluationresearch/oregondeath data/Pages/index.aspx

ProCon.org. (2014) Euthinasia Pro Con. Retireved from: http://euthanasia.procon.org/view.answers.php?questionID=000146

Robinson, B. A. (2007) Physician Assisted Suicide (PAS) activity in California Past legislative activity. Retrieved from: http://www.religioustolerance.org/euthca1.htm