PALL-01. PHYSICIAN ASSISTED SUICIDE IN HIGH GRADE GLIOMAS: A UNIVERSITY-BASED PRACTICE PERSPECTIVE

Abstract

BACKGROUND: Death is inevitable for the overwhelming majority of patients with high-grade gliomas (HGG). Consequently, assisting patients and families with end of life is an integral aspect of neuro-oncology care. In Washington state, physician assisted suicide (PAS) was enacted as law in 2009, modeled and similar to that in Oregon state. METHODS: During the years 2009 to 2015, 300 patients with HGG were cared for in a university-based practice. 215 patients have died and 14 (6.5%; 10 glioblastoma, 4 anaplastic glioma) requested PAS. As mandated by law, all patients requesting PAS were Washington state residents, acting voluntarily, mentally competent, not depressed, aware of their diagnosis and prognosis and discussed their wish to end life with family in which there was agreement as to the patients' request. Additionally and as required by law, patients made 3 verbal requests (2 to the prescribing physician each separated by a 2-week interval and one to the consulting physician) and a single written request before life ending medication was prescribed (either secobarbital or the combination of morphine sulfate, phenobarbital and chloral hydrate). RESULTS: Ten prescriptions for secobarbital and 4 for the morphine sulfate combination were prescribed. Four patients (29%) elected to proceed with PAS and took the end of life prescribed medicine. Ten patients decided not to use the prescribed medicine. In the four patients taking end of life medication, death ensued on average in 6 minutes (range 4-8 minutes) and in all instances family was with the patient at time of death. Families described death as peaceful with rapid onset sleep, unresponsiveness and respiratory arrest. CONCLUSION: Notwithstanding the availability of a Washington state PAS program, relatively few terminal HGG patients make a request for PAS and if end of life medication is prescribed only a minority elected to proceed.