Care of the Dying: Clinical and Financial Lessons from the Oregon Experience
Authors: Susan W. Tolle
Journal: Annals of Internal Medicine (1998)

Editorials1 April 1998Care of the Dying: Clinical and Financial Lessons from the Oregon ExperienceSusan W. Tolle, MDSusan W. Tolle, MDOregon Health Sciences University; Portland, OR 97201-3098Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-7-199804010-00009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Is there a consensus about the right to compassionate care for all terminally ill Americans? Quill and colleagues, in this issue [1], highlight seven specific areas of converging opinion in this area. For example, the fierce debates about physician-assisted suicide have focused the attention of all of us, whatever our views on that contentious issue, on our inadequacies in practicing comfortable and respectful end-of-life care [2, 3].In Oregon, the public discussion leading up to the 1994 and 1997 votes to legalize physician-assisted suicide was intense and polarized. During both campaigns, media advertisements obscured the substantial common ground between the ...References1. Quill TE, Meier DE, Block SD, Billings JA. The debate over physician-assisted suicide: empirical data and convergent views. Ann Intern Med. 1998; 128:552-8. Google Scholar2. Field MF, Cassel CK. Approaching death: improving care at the end of life. Washington, DC: National Academy Pr; 1997. Google Scholar3. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995; 274:1591-8. Google Scholar4. Lee MA, Tolle SW. Oregon's assisted suicide vote: the silver lining [Editorial]. Ann Intern Med. 1996; 214:267-9. Google Scholar5. Sachs GA, Miles SH, Levin RA. Limiting resuscitation: emerging policy in the emergency medical system. Ann Intern Med. 1991; 114:151-4. Google Scholar6. Dunn PM, Nelson CA, Tolle SW, Tilden VP. Communicating preferences for life-sustaining treatment using a physician order form [Abstract]. J Gen intern Med. 1997; 12:102. Google Scholar7. Dunn PM, Schmidt TA, Carley MM, Donius M, Weinstein MA, Dull VT. A method to communicate patient preferences about medically indicated life-sustaining treatment in the out-of-hospital setting. J Am Geriatr Soc. 1996; 44:785-91. Google Scholar8. Weinberg JE, Cooper MM, eds. The Dartmouth Atlas of Health Care 1998. Chicago: American Hospital Publishing; 1998:81-106. Google Scholar9. Gallup Organization. Knowledge and Attitudes Related to Hospice Care. National Hospice Assoc; 1996. Google Scholar10. Center for Health Statistics. Mortality Profile, Vital Statistics, 1996. Portland, OR: Oregon Health Division; 1997. Google Scholar11. Office of Diversion Control. DADS Quarterly Reports, 1996. Arlington, VA: U.S. Department of Justice; 1996. Google Scholar12. Tolle SW, Dunn PM, Reagan B. Testimony before the Judiciary Committee, Oregon House of Representatives, 12 March 1997. Google Scholar13. Scott HD, Shapiro HB. Universal insurance for American health care: a proposal of the American College of Physicians. Ann Intern Med. 1992; 117:511-9. Google Scholar14. Burt RA. The Supreme Court speaks-not assisted suicide but a constitutional right to palliative care. N Engl J Med. 1997; 337:1234-6. Google Scholar15. Covinsky KE, Landefeld CS, Teno J, Connors AF Jr, Dawson N, Youngner S, et al. Is economic hardship on the families of the seriously ill associated with patients and surrogate care preferences? SUPPORT Investigators. Arch Intern Med. 1996; 156:1737-41. Google Scholar Author, Article, and Disclosure InformationAuthors: Susan W. Tolle, MDAffiliations: Oregon Health Sciences University; Portland, OR 97201-3098Corresponding Author: Susan W. Tolle, MD, Center for Ethics in Health Care, L101, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byA CRITICAL ANALYSIS OF CRITICISMS OF THE OREGON DEATH WITH DIGNITY ACTIncreased Family Reports of Pain or Distress in Dying Oregonians: 1996 to 2002Using population death rate to predict rate of admissions to the intensive care unitBOOK REVIEWSOregon Versus Ashcroft: Pain Relief, Physician-Assisted Suicide, and the Controlled Substances ActAn Overview of Palliative Nursing CareAn Overview of Palliative Nursing CareChanging End-of-Life Planning: The Oregon ExperienceAs Individual as Death Itself: A Focus Group Study of Terminal Care in Nursing HomesECONOMIC INFLUENCES ON END-OF-LIFE CARE: EMPIRICAL EVIDENCE AND ETHICAL SPECULATIONPhysician‐assisted suicide in Oregon: why so few occurrences?Physician-Assisted Suicide: A Clinician's PerspectiveHow Do the Mental Health Issues Differ in the Withholding/Withdrawing of Treatment versus Assisted Death?Palliative Care ConsultationsThe Role of Guidelines in the Practice of Physician-Assisted SuicideArthur L. Caplan, PhD, Lois Snyder, JD, and Kathy Faber-Langendoen, MD, for the University of Pennsylvania Center for Bioethics Assisted Suicide Consensus PanelResponding to Legal Requests for Physician-Assisted SuicideJames A. Tulsky, MD, Ralph Ciampa, STM, and Elliott J. Rosen, EdD, for the University of Pennsylvania Center for Bioethics Assisted Suicide Consensus PanelPhysicians' Experiences with the Oregon Death with Dignity ActLegalized Physician-Assisted Suicide in Oregon — The Second YearEthics perspectives on end-of-life careAssisted suicide and nursing: Possibly compatible?Oregon's Low In-Hospital Death Rates: What Determines Where People Die and Satisfaction with Decisions on Place of Death?Susan W. Tolle, MD, Anne G. Rosenfeld, PhD, RN, Virginia P. Tilden, DNSc, RN, and Yon Park, BALegalized Physician-Assisted Suicide in Oregon — The First Year's ExperienceLooking Beyond the "Form" to Complex Interventions Needed to Improve End-of-Life CareSurvival Rates and Cardiopulmonary ResuscitationEnd-of-life Decision-making in Community-Acquired Pneumonia 1 April 1998Volume 128, Issue 7Page: 567-568KeywordsDeath ratesHealth care qualityHealth insuranceMedical servicesMedicareMorphineNursing homesPalliative carePatient advocacySuicide ePublished: 15 August 2000 Issue Published: 1 April 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...