title: Implementing a Death with Dignity program at a comprehensive cancer center.
abstract: BACKGROUND
  The majority of Death with Dignity participants in Washington State and Oregon have received a diagnosis of terminal cancer. As more states consider legislation regarding physician-assisted death, the experience of a comprehensive cancer center may be informative.
  
  
  METHODS
  We describe the implementation of a Death with Dignity program at Seattle Cancer Care Alliance, the site of care for the Fred Hutchinson-University of Washington Cancer Consortium, a comprehensive cancer center in Seattle that serves the Pacific Northwest. Institution-level data were compared with publicly available statewide data from Oregon and Washington.
  
  
  RESULTS
  A total of 114 patients inquired about our Death with Dignity program between March 5, 2009, and December 31, 2011. Of these, 44 (38.6%) did not pursue the program, and 30 (26.3%) initiated the process but either elected not to continue or died before completion. Of the 40 participants who, after counseling and upon request, received a prescription for a lethal dose of secobarbital (35.1% of the 114 patients who inquired about the program), all died, 24 after medication ingestion (60% of those obtaining prescriptions). The participants at our center accounted for 15.7% of all participants in the Death with Dignity program in Washington (255 persons) and were typically white, male, and well educated. The most common reasons for participation were loss of autonomy (97.2%), inability to engage in enjoyable activities (88.9%), and loss of dignity (75.0%). Eleven participants lived for more than 6 months after prescription receipt. Qualitatively, patients and families were grateful to receive the lethal prescription, whether it was used or not.
  
  
  CONCLUSIONS
  Overall, our Death with Dignity program has been well accepted by patients and clinicians.
authors.affiliation: Fred Hutchinson Cancer Research Center, and the University of Washington, Seattle, USA. eloggers@seattlecca.org
authors.forename: Elizabeth Trice
authors.initials: ET
authors.lastname: Loggers
authors.forename: Helene
authors.initials: H
authors.lastname: Starks
authors.forename: Moreen
authors.initials: M
authors.lastname: Shannon-Dudley
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Back
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: F Marc
authors.initials: FM
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D002173:Cancer Care Facilities / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009922:Oregon; D016134:Organizational Policy; D026684:Personal Autonomy; D012297:Right to Die; D017236:Suicide, Assisted / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D014861:Washington; D055815:Young Adult