Journal Mobile

D Jeffrey
Journal Issue: 
Volume 37: Issue 3: 2007




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.