"Ask DDNC" is a new column created to serve as a resource for you. Today, we'll focus on advance directives. We consulted Ann Jackson, MBA, for her advice. Ann Jackson is former director of the Oregon Hospice Association and now consults about end-of-life issues and options.

Every state has an official advance directive and is appropriate for all capable adults, regardless of health status at the time it's completed. Its purpose is to protect your right to refuse medical treatment you don't want, or request treatment you do want if or when you aren't able to make such decisions yourself.

Many people aren't aware that, without an advance directive, everything will be done to preserve life—even when it's not likely CPR or other life-sustaining treatments will be successful. In this column, I'll use Oregon's as an example. The Oregon advance directive is straightforward and relatively easy to complete. You can complete Part B, Part C, or both, depending on your advance-planning needs. You must complete Part D and your health care representative, if you appoint one, must complete Part E—Part D is for your signature and the signatures of your witnesses, and Part E is to be signed by your health care representative accepting the appointment.

Written into Death with Dignity laws is the requirement the state's Health Department must issue annual reports of information collected during the medication request process.

Oregon's Public Health Division recently issued their 15th annual report, and consistent with all previous years, the data continue to show the law works the way it's intended: rarely used, but providing comfort to countless individuals who know they have options at the end of their lives.

Some quick facts about the usage of Oregon's law in 2012:

• 77 people hastened their deaths under the Oregon law.
• This accounts for 0.2% of all deaths in Oregon.
• The top three concerns people expressed to their doctors when requesting the medication were centered around wanting control over their final days.
• Of the end-of-life concerns expressed, the least common was "financial implications of treatment."

The numbers also show people who request the medication under Oregon's law are receiving high quality end-of-life care:

Physician-assisted death happens every day in every state. This reality is often avoided by patients and the medical community in discussions about end-of-life care, and it's time we started talking about it. A new study published last week in The Lancet looked at this situation in the Netherlands.

The researchers analyzed the prevalence of assisted death before and after the Dutch law went into effect in 2002. The results of this study showed two important trends regarding assisted death:

• The practice was already happening before the law was in place: The same percentage of deaths were attributed to physician-assisted death before and after the law was in place.
• Presence of a law doesn't result in increased use: The law didn't lead to a common myth spouted by opponents that legally regulating assisted death will lead to people clamoring to access the law. Or as it was known in Oregon, "People would flock to our beaches to die."

Robb Miller has been the Executive Director of Compassion & Choices of Washington—an affiliate of Compassion & Choices—since 2000. He was also one of the leaders of the coalition that passed Initiative 1000, the Washington Death with Dignity Act, with nearly 60% of the vote in 2008.

When the Washington Department of Health issued its third annual report on the Washington State Death with Dignity Act in early May, there was little interest from the media and no good news for opponents of patient autonomy at the end-of-life.

The lack of interest from the media tells us there was nothing sensational and no controversies to report. On the other hand, less media coverage means less awareness about the law.

Only 16 more people received prescriptions for life-ending medication as compared to 2010, and only 10 more died after receiving prescriptions. Of the 94 individuals who died, 70 self-administered medication, and 19 didn't—32% of patients who acquired prescriptions in 2011 elected not to take the medication. This is bad news for opponents who claimed that people who use the law would be anxious to die and would take the medication prematurely. The report indicates just the opposite.

The Oregon Public Health Division released its statutorily-required annual report about the Oregon Death with Dignity Act and the terminally ill individuals who qualified under its provisions. The release reflects statistics from the 14th year of implementation, and encompasses data from January 7, 2011-February 29, 2012—roughly 13 months.

Consistent with information from prior years, the data show Death with Dignity is a rarely used option for a small number of terminally ill Oregonians. The report indicates the process was implemented, in every instance, under the strict guidelines written into Oregon law and the established medical standard of care that has evolved since implementation.