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A Comparison of Physician-Assisted/Death-With-Dignity-Act Death and Suicide Patterns in Older Adult Women and Men

      Highlights

      • What is the primary question addressed by this study?
        This study compares physician-assisted/Death-with-Dignity death and suicide patterns in women and men age 65 and older in Oregon, the first U.S. state to legalize physician-assisted death under the 1997 Death-with-Dignity-Act (DWDA)--as a way to assess the impact of the DWDA on older adult women, a group considered vulnerable to being pressured into a DWDA death.
      • What is the main finding of this study?
        Between 1998 and 2018 women age 65 and older represented 46% of DWDA deaths and 16.3% of suicides in their age group. DWDA deaths were the most common form (52.7%) of self-initiated death for older adult women, and firearm suicides (65.7%) for older adult men.
      • What is the meaning of the finding?
        This study's findings, consistent with those of studies conducted in Switzerland, raise questions about the role of medicalization and legalization in increasing women's interest in, and mortality by self-initiated death.

      ABSTRACT

      Objective

      To examine Oregon's Death-with-Dignity-Act (DWDA) death and suicide patterns among women age 65 and older, relative to patterns among same-age men, as a way to assess DWDA's impact on older adult women, a group considered vulnerable.

      Design

      Oregon's 1998–2018 DWDA- and suicide-mortality rates and confidence intervals were calculated.

      Results

      Between 1998 and 2018 women age 65 and older represented 46% of DWDA deaths and 16.3% of suicides in their age group. Among women age 65 and older DWDA and suicide mortality increased whereas among same-age men DWDA deaths increased and suicides declined. DWDA deaths were the most common form (52.7%) of self-initiated death for older adult women, and firearm suicides (65.7%) for older adult men.

      Conclusion

      Legalization has a substantial impact on older adult women's engagement in self-initiated death. In Switzerland and in Oregon, where assisted suicide/medical-aid-in-dying (MAID) is legal and where assisted-suicide/MAID and suicide comparative-studies have been conducted, older adult women avoid self-initiated death except when physician-approved. Older adult women's substantial representation among assisted-suicide/MAID decedents, relative to suicide, may be a clue of their empowerment to determine the time of their death, when hastened-death assistance is permitted; or of their vulnerability to seeking a medicalized self-initiated death, when in need of care.

      Key Words

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