Why Oregon is at the forefront of change on end-of-life care

The Terri Schiavo case and its emphasis on end-of-life care could put a spotlight on Oregon, where policies and practices point to a future most Americans apparently want and are working toward: personal decision-making, widely available hospice care, and the final act of human life played out at home and not in a hospital.

In all these areas, studies show, Oregon is ahead of the rest of the country.

Some of this has to do with its unique legislation. The country's only "Death With Dignity" assisted-suicide law is the most well-known and the most controversial. The number of people choosing this option is small - about 30 a year, or fewer than one in 1,000. But its availability has increased interest in how to alleviate the discomfort and despair that can feed a desire to end one's own life, as well as to more planning for such an eventuality.

When Oregon voters first considered physician-assisted suicide a decade ago, medical ethicist Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, predicted an "enormous long-term impact on American public life - how we live and how we die." Critics warned that a wave of suicides would follow, including a rush of patients from out-of-state and those pressured by relatives to end their lives out of economic considerations.

None of that appears to have happened, however.

Instead, many more people here end their days at home or in hospice settings where they have emotional and spiritual support as well as palliative (pain-management) treatment. Among the 50 states, home death rates are highest in Oregon, and hospital death rates are lowest. Oregonians are also more likely to have "living wills" - documents in which they ask not to be kept alive by artificial means if recovery seems improbable - and medical directives on file, and they're more likely to decline medical treatments (including feeding and hydration tubes) that prolong life.

This is consistent with what most Americans say they want. The Gallup polling organization, for example, has found that 9 out of 10 Americans say they would want to die at home if faced with the end stages of a terminal illness. And most Americans, according to recent surveys, support the removal of life support in cases like Mrs. Schiavo's - for a spouse or child who appears to have no chance of recovery, or for themselves in the same predicament. (At time of writing, 12 days after her feeding tube was removed, Schiavo remained alive in hospice care.)

While Oregon is unique in some ways - it's the most "unchurched" state, with residents less likely to be members of or regularly attend churches, synagogues, or mosques - it also reflects the kind of leave-me-alone libertarianism that such legendary conservatives as the late Sen. Barry Goldwater (R) of Arizona espoused.

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