07:00 AM PDT on Friday, July 23, 2004

Associated Press

A new study by a team of Oregon Health & Science University researchers has found that dying patients in Oregon are twice as likely to experience pain during their last week of life than they did prior to the passage of landmark legislation in 1997.

(kgw.com graphic)

It's a conclusion which throws into doubt the widespread view that pain control has improved markedly in Oregon following the enactment of the 1997 Oregon Death With Dignity Act.

"End of life care has not been 'fixed,' and there is plenty of room for improvement, particularly in the final of week of life," the team of scientists wrote in an article, published recently in the Journal of Palliative Medicine.

The researchers said the contradiction may be explained in part by the rising expectations about pain control in the wake of the publicity following the Oregon law.

Stretched budgets for the care of Medicaid and Medicare patients may also be to blame, they said.

"What this study did for me was contrast our view of things versus what's actually happening," said Dr. Erik Fromme, who led the research.

The study asked family members to rate the dying patient's pain during the final week of his or her life. Researchers then compared 340 deaths from pre-1997 with 1,384 deaths from 2000 to 2002.

They found a startling difference -- 48 percent of the later patients were said to be in moderate or severe pain, compared to 31 percent in the earlier group.

After accounting for medical and demographic differences, the researchers concluded that dying patients in the later group were twice as likely to be described as having endured moderate or severe pain.

Oregon is the only state in which a doctor can legally prescribe a lethal dose of medication to terminally ill patients. The Oregon Death With Dignity Act took effect after two ballot measures, court challenges and a fierce debate in the public sphere.

Fromme says public debate over doctor-assisted suicide raised the profile of the pain endured by many at the end of life. "People all around the state have heard the publicity, but they haven't necessarily gotten better care. If people's expectations are higher, I'm glad," he said. "But in addition to expecting more, I hope they'll push health care providers to get them the care and pain relief they need."

The results, said Ann Jackson, executive director of the Oregon Hospice Association, show how important it is for family members "to be constantly vigilant when it comes to pain and end-of-life care.

"The system default is to do as little as possible," she said.