Physician Assisted Suicide: Racial Disparities in California, New Jersey, and Oregon in 2021

Background/significance

Physician Assisted Suicide (PAS) is a debated topic within medical ethics. PAS is the intentional taking of one’s own life through the self-administration of a lethal drug prescribed by a physician. PAS is currently legal in 11 jurisdictions in the United States. While much of the debate has focused on autonomy, little attention has been given to racial and economic disparities among patients dying by PAS. As PAS is legalized, it is important that C/L Psychiatrists be attentive to such disparities.

Methods

The 2020 U.S. Census Bureau reports from California, Washington, New Jersey, Oregon were reviewed for general population data. The California End of Life Option Act 2021 Data Report, New Jersey Medical Aid in Dying for the Terminally Ill Act 2021 Data Summary, Oregon Death with Dignity 2021 Data Summary were reviewed for PAS specific data.

Results

According to the 2020 US Census, California’s population is 35.2% White alone (non-Hispanic), 40.2% Hispanic, 6.5% Black alone, and 15.9% Asian alone. In California in 2021, 772 PAS prescriptions were written and 486 PAS deaths following ingestion were recorded. Of the 486 patients, 416 (85.6%) were White, 4 (0.8%) were Black, 34 (7%) were Asian, and 25 (5.1%) were Hispanic. 55.2% had obtained a bachelor’s degree or higher (vs. 35.3% of general population).

According to the 2020 US Census, Oregon’s population is 74.1% White alone (non-Hispanic), 14.0% Hispanic, 2.3% Black alone, and 5.0% Asian alone. For 2021, in Oregon 382 PAS prescriptions were written and 238 PAS deaths following ingestion were recorded. Of the 238, 226 (95%) were White, 0 were Black, 6 (2.5%) were Asian, and 6 (2.5%) were Hispanic. 45.5% had obtained a bachelor’s degree or higher (vs. 35.0% of general population).

According to the 2020 US Census, New Jersey’s population is 53.5% White alone (non-Hispanic), 21.5% Hispanic, 15.3% Black alone, and 10.3% Asian alone. For 2021, in Oregon 50 PAS prescriptions were written and 42 PAS deaths following ingestion were recorded. Among the 50 prescriptions recorded for patients, 47 (94%) were White, 0 were Black, 3 (6%) were Asian, and 0 were Hispanic. 66% had obtained a bachelor’s degree or higher. (vs. 41.5% of general population).

Discussion

Among jurisdictions studied, patients dying by PAS are less likely to be racial minorities. They were more likely to be White and more highly educated than the general population. C/L Psychiatrists may ask what potential ethical commitments among ethnic minorities are more likely to cause these differences. Could further pushes to legalize PAS exacerbate mistrust among the minorities toward the healthcare system in the US?

Conclusion/Implications

Compared to the general population, patients who reportedly request and die via PAS are more likely to be non-Hispanic White and more highly educated. Similarly, report PAS recipients are less likely to be Hispanic, African American, and Asian.

References (2-5)

United States Census Bureau 2020

California End of Life Option Act 2021 Data Report

New Jersey Medical Aid in Dying for the Terminally Ill Act 2021 Data Summary

Oregon Death with Dignity 2021 Data Summary