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

Objective: To examine Oregon's Death-with-Dignity-Act (DWDA) death and suicide patterns among women age 65 and older, relative to patterns among sameage 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.