Proponents for the legalisation of PAS in the UK claim that it works well in Oregon in the US. About 30 patients have used PAS each year since it was legalised in Oregon in 1997. This paper reports the result of a visit to Portland in Oregon to listen to the views of healthcare professionals, hospice association leaders and proponents of PAS.
‘Palliative care’ and ‘hospice’ mean different things in the US and the UK. ‘Hospice’ in the US means end-of-life care at home, and many of those ‘eligible’ patients receive this only for the last two or three weeks of life. ‘Palliative care’ tends to be delivered by hospital support teams and is largely concerned with the last days of life in the acute hospital setting. There are no specialist palliative care inpatient units in Oregon. It is commonly assumed that those patients who carry out PAS must be suffering terrible pain or are depressed. However, the experience in Oregon suggests that the small number of patients who carry out PAS are not depressed, nor are they in pain. They all share an overpowering need for control and they simply want to be able to choose when they should die.
Although PAS is legal in Oregon, only a small number of doctors take part in the process. No hospitals permit PAS to be carried out on their premises. Hospice home care programs adopt an ambivalent moral stance, distancing themselves from the act of PAS whilst continuing to support the patient and their family. The implications of these findings for notions of autonomy and moral agency are
discussed here.
