Data Center

Data on Rectal Self-Administration of Aid-in-Dying Medications

Background

No state health department’s aid-in-dying report, medical journal peer-reviewed studies, schools of medicine or other research institutions, have collected or reported on data about the rectal self-administration of aid-in-dying medications.

The Academy’s data reporting system has received and analyzed data on 1,002 DDMAPh self-administrations (as of 8/15/23), of which 162 (16.2%) were by the rectal route. The data reflects practices in NJ, CO, NM, CA, WA. Anecdotal information from other aid-in-dying jurisdictions indicates that rectal self-administrations have become ubiquitous in all geographic regions where aid in dying is legal.

Data Results

Mean Time to Sleep

All DDMAPh self-administrations (1,002): 5.4 minutes
Rectal-route self-administrations (162): 5.8 minutes
Difference: 0.2 minutes = 7% increase comparing rectal to all other routes

Mean Time to Death

All DDMAPh self-administrations (1,002): 86 minutes
Rectal-route self-administrations (162): 122 minutes
Difference: 36 minutes = 42% increase comparing rectal to all other routes

Discussion

Comparing rectal-route self-administrations to all aid-in-dying self-administrations, longer times to sleep and times to death are of minimal clinical significance. Patients can be reassured that the rectal route is clinically comparable to other routes of self-administration of aid-in-dying medications.

Of note, these patient populations are not necessarily comparable. The N of 1,002 vs 162 is notable. As well, the reasons for using the rectal route are often that the patient has some significant gastrointestinal disease, putting them at higher risk of a longer time to death. Each patient should be evaluated individually, with all risk factors for a longer death taken into consideration, before advising a patient about if or how to proceed.

Conclusion

The rectal route of self-administration of aid-in-dying medications, now involving approximately 1 of every 6 aid-in-dying cases reported to the Academy, is effective. The somewhat longer times to death are of minimal clinical bedside significance.

Teaching and supporting best practices for the care of patients considering or completing medical aid in dying.

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